Mechanisms of brief contact interventions in clinical populations: a systematic review

Milner, Allison; Spittal, Matthew J; Kapur, Navneet; Witt, Katrina; Pirkis, Jane

doi:10.1186/s12888-016-0896-4

Cited by 43 publications

(41 citation statements)

References 48 publications

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“…Fewer studies reported data on other clinically relevant outcomes, such as hopelessness [ 40 ], and none reported information on problem-solving following the completion of the intervention. The National Institute for Health and Clinical Excellence (NICE) guidelines recommend that all interventions for self-harm should, at a minimum, investigate the effect of psychological interventions for self-harm on potential mechanisms of action, including depression, hopelessness, and problem-solving [ 69 ], echoing more recent calls to this effect in the international scholarship [ 70 , 71 ]. Online resources may normalize self-harm and may provide vulnerable individuals with access to self-harm content and imagery, including information on methods of self-harm [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis

et al. 2017

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BackgroundOnline and mobile telephone applications (‘apps’) have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm.MethodsSeven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review.ResultsFourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide.ConclusionsMost studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis

et al. 2017

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“…Table 4.6 depicts a worked example of this GRADE-style appraisal, which is an assessment of brief contact interventions for reducing self-harm. Further worked examples can be found in Appendix C. Milner et al (2016) …”

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confidence: 99%

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Parkkinen¹,

Wallmann²,

Wilde³

et al. 2018

Evaluating Evidence of Mechanisms in Medicine

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If theoretical developments in evidence assessment are to prove useful, guidance on implementation is essential, and this chapter fills that need. A variety of tools are offered, which can be used either in isolation, or in the various combinations suggested. The starting point is an Is your policy really evidence-based? tool which should be very widely usable to give a very quick overview. Then two tools are offered for guideline developers for medical practice; these offer improved assessment of evidence of mechanism in assessing clinical trials, and, if needed, in basic science papers. For politicians, journalists, academics, and so on, a critical appraisal tool is offered alongside GRADE-style tables for mechanism assessment. A final tool is designed specifically for public health and social care.In this chapter, we present a number of tools for evaluating evidence of mechanisms that have been tailored for different users. A flowchart that shows how these tools can be used together is presented below in Fig. 4.1. IntroductionHow to use these tools For most users, the Is your policy really .2) will be the best place to start, because it can give a quick indication of cases where a more detailed review of evidence might be valuable. If a policy is found to have possible weaknesses in its underlying evidence base, the user can then employ the other tools provided here to produce a more thorough account of the strengths and weaknesses of the policy's evidence base. While we encourage interested users to experiment with each of these tools to see which might best fit their purposes, we propose the following provisional plan:For those interested in guidelines for medical practice. We would encourage these users to move on to a more systematic review of evidence using the For those working on public health and social care guidelines. The Public Health and Social Care tool (in Sect. 4.7) would be the most natural place to begin, because it explicitly asks appraisers to evaluate evidence of mechanisms that pertains both to individuals and to groups. Because of the diversity of the underlying research in public health and social care policies, the Critical Appraisal Tool for Evidence of Mechanisms would be the most useful tool to apply (see Sect. 4.5). Limitations of these tools These tools are fallible, and their use is not a substitute for expert appraisal of a guideline or policy. Answering each of the steps requires user judgement, and the scores produced by each tool contribute to-rather than determine-the quality of recommendations. In other words, the tool alone will not provide a final and complete judgement of the quality of evidence, and their use is not a substitute for expert judgement.These tools are specifically designed to assist in the evaluation of causal relationships. Guidance that relies on the precautionary principle may therefore score poorly, just because the precautionary principle is used when evidence of causal relationships is limited. Those poor scores should not therefore be inter...

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“…Other studies have also reported partially successful results for self-harm or other suicide behaviors, while others have reported null results (see Luxton, June, Comtois, 2013). A recent meta-analysis of a variety of brief contact interventions including CL found a nonstatistically significant reduction in subsequent self-harm or suicide attempt compared with control (Milner et al, 2015). The number of repeated acts of self-injury per person was significantly reduced with brief contact interventions.…”

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confidence: 98%

“…The research evaluating caring contacts is mixed regarding its effectiveness (Luxton, June et al, 2013;Milner, Carter, Pirkis, Robinson, & Spittal, 2015). Only the aforementioned study by Motto and the SUPRE-MISS reported by Fleischmann et al (2008) have shown contact intervention to reduce mortality rates in a randomized controlled trial (RCT).…”

mentioning

confidence: 99%

Caring E‐mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial

Luxton

Smolenski

Reger

et al. 2019

Suicide & Life Threat Behav

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Objective The purpose of this multisite study was to conduct a randomized controlled trial of an e‐mail version of the caring letters (CL) suicide prevention intervention to determine whether the intervention is efficacious in preventing suicide behaviors among U.S. service members and veterans. Method Psychiatric inpatients (N = 1,318) were recruited from four military medical centers and two VA hospitals and randomized to receive either 13 caring e‐mails over two years or usual care. Results There were 10 deaths from any cause in the CL group (three suicides) and 14 in the usual care group (seven suicides) during the individual two‐year follow‐up intervals. There was no statistically significant difference in the rate of all‐cause hospital readmission between the study groups (RR = 1.13; 95% CI = 0.94, 1.36). There were no differences observed between groups on self‐reported psychiatric hospital readmissions, self‐reported suicide attempts, or other measures associated with risk for suicide. Conclusions No firm conclusions about the efficacy of the intervention can be made because the study was inadequately powered. There were no adverse events associated with the intervention, and implementation of the procedures was feasible in the military and veteran hospital settings. These results provide important methodological considerations for caring contact trials in military populations.

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Mechanisms of brief contact interventions in clinical populations: a systematic review

Cited by 43 publications

References 48 publications

Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis

Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis

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Caring E‐mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial

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