Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 3. Suicide prevention hotlines

Abstract

Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517

Interfaces between oncology and psychiatry

“…Suicide risk among cancer patients who have mood disorders or anxiety and somatoform disorders is higher than for those without mental disorders 30 . A unified framework for describing suicidal conduct must include thought, planning, and attempt 31 – 33 . This improves situational management.…”

“…Risk factors for suicide behavior must be categorized by the individual's condition, genetic predisposition, demographics, psychological variables, physical well-being, and health status, including chronic diseases. Also, the person's history of suicidal conduct, including non-suicidal self-harm, should be evaluated 31 – 33 . The examination of a mental disorder requires a safety plan that includes counseling, research, and monitoring to protect the individual.…”

“…Suicide-risk persons must be monitored. Hospitalization may be necessary to protect their health in high-risk scenarios such as repeated attempts or a set strategy 31 – 33 .…”

Puerperal psychosis: an update

“…It is important to begin by managing psychiatric emergencies such as psychomotor agitation, suicidal behavior, substance use disorder, and clinical emergencies. Specific protocols for agitation and suicidal behavior can be found in specific guidelines 9,[11][12][13][14][15][16] .…”

“…In most cases, a woman who has been diagnosed with postpartum psychosis will need inpatient psychiatric therapy to undergo diagnostic examination, safety evaluation, and treatment commencement. The woman's significant others are identified and involved in her therapy and rehabilitation so that they can be an ally to her 9,[11][12][13][14][15][16] .…”