The Need for Innovation in Health Care Systems to Improve Suicide Prevention

Stanley, Bárbara; Mann, J. John

doi:10.1001/jamapsychiatry.2019.2769

Cited by 36 publications

(29 citation statements)

References 35 publications

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“…This health service strategy reflects international guidelines and approaches to reduce risk (e.g. zero suicide) [70,72,73]. For those above a low threshold (~0.20), a further assessment and low intensity interventions could be recommended [74,75].…”

Section: Plos Onementioning

confidence: 98%

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Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study

Iorfino

Carpenter

et al. 2020

PLoS ONE

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Background A priority for health services is to reduce self-harm in young people. Predicting self-harm is challenging due to their rarity and complexity, however this does not preclude the utility of prediction models to improve decision-making regarding a service response in terms of more detailed assessments and/or intervention. The aim of this study was to predict self-harm within six-months after initial presentation. Method The study included 1962 young people (12–30 years) presenting to youth mental health services in Australia. Six machine learning algorithms were trained and tested with ten repeats of ten-fold cross-validation. The net benefit of these models were evaluated using decision curve analysis. Results Out of 1962 young people, 320 (16%) engaged in self-harm in the six months after first assessment and 1642 (84%) did not. The top 25% of young people as ranked by mean predicted probability accounted for 51.6% - 56.2% of all who engaged in self-harm. By the top 50%, this increased to 82.1%-84.4%. Models demonstrated fair overall prediction (AUROCs; 0.744–0.755) and calibration which indicates that predicted probabilities were close to the true probabilities (brier scores; 0.185–0.196). The net benefit of these models were positive and superior to the ‘treat everyone’ strategy. The strongest predictors were (in ranked order); a history of self-harm, age, social and occupational functioning, sex, bipolar disorder, psychosis-like experiences, treatment with antipsychotics, and a history of suicide ideation. Conclusion Prediction models for self-harm may have utility to identify a large sub population who would benefit from further assessment and targeted (low intensity) interventions. Such models could enhance health service approaches to identify and reduce self-harm, a considerable source of distress, morbidity, ongoing health care utilisation and mortality.

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Section: Plos Onementioning

confidence: 98%

“…Together, this reiterates the challenges health services and clinicians face when trying to prevent self-harm. There is a need for innovative health service approaches that can improve the consistency, effectiveness and safety of clinical decision-making [70].…”

Section: Plos Onementioning

confidence: 99%

Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study

Iorfino

Carpenter

et al. 2020

PLoS ONE

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“…Psychoeducation about physician suicide became a critical component of this phase including the multiple pathways of causality, managing difficult and often unanswerable questions, as well as the range of emotional responses in those left behind. Colleagues with expertise in suicide provided guidance in delivering information and support to HCW as well as on how to mitigate the risk of contagion and future suicides [ 41 , 42 ]. Opt-out one-to-one sessions became critical confidential spaces for HCW to express a range of emotions, including grief, and for destigmatizing mental health treatment.…”

Section: Resultsmentioning

confidence: 99%

Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response

Mellins

Mayer

Glasofer

et al. 2020

General Hospital Psychiatry

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Objective COVID-19 is an international public health crisis, putting substantial burden on medical centers and increasing the psychological toll on health care workers (HCW). Methods This paper describes CopeColumbia, a peer support program developed by faculty in a large Urban Medical Center's Department of Psychiatry to support emotional well-being and enhance the professional resilience of HCW. Results Grounded in evidence-based clinical practice and research, peer support was offered in three formats: groups, individual sessions, and town halls. Also, psychoeducational resources were centralized on a website. A Facilitator's Guide informed group and individual work by including: (1) emotional themes likely to arise (e.g., stress, anxiety, trauma, grief, and anger) and (2) suggested facilitator responses and interventions, drawing upon evidence-based principles from peer support, stress and coping models, and problem-solving, cognitive behavioral, and acceptance and commitment therapies. Feedback from group sessions was overwhelmingly positive. Approximately 1/3 of individual sessions led to treatment referrals. Conclusions Lessons learned include: (1) there is likely an ongoing need for both well-being programs and linkages to mental health services for HCW, (2) the workforce with proper support, will emerge emotionally resilient, and (3) organizational support for programs like CopeColumbia is critical for sustainability.

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“…As previously postulated, the time span during and after psychiatric inpatient treatment represents an important risk factor in this regard. Patients receiving inpatient psychiatric care are more severely affected by mental health disorders, when compared to the population for which outpatient care is sufficient and thus exhibit an increased risk for suicide [2][3][4][5][6]. In particular, the first week following discharge from inpatient psychiatric care was significantly associated with increase of suicidal behavior in previous studies [3,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 93%

The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries—An ecological study

et al. 2020

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Background. Suicide risk in patients is markedly elevated during psychiatric inpatient care, as well as after discharge. However, it is unclear whether, and to what extent, this increased suicide risk varies between sex. Thus, the aim of this study was to analyze sex differences for suicides during and after psychiatric hospitalization in various countries. Methods. National suicide mortality rates and inpatient-related suicide rates (three intervals: during psychiatric inpatient treatment, 1 month, and 1 year after discharge) from 12 countries for 2000-2016 were analyzed, and a logistic model was used to quantify the effect of sex. Results. Persons admitted to or discharged from psychiatric inpatient care exhibited significantly increased rates of suicide compared to those in the general population. Furthermore, increase of suicide risk was significantly higher for females than for males for all investigated time intervals (inpatient suicide odds ratio [OR] 1.85; suicide within 1 month after discharge-OR 1.94; suicide within 1 year after discharge-OR 2.04). Conclusion. Analysis confirmed the time during and after psychiatric inpatient care to be significantly associated with an elevated risk for suicide. Further, a significant sex effect was observed, with females in this population being at a proportionally higher risk for suicide during psychiatric inpatient treatment as well as the year following discharge. Our study implicates that more effective suicide preventive measures during inpatient stay, focusing on female patients, are needed.

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The Need for Innovation in Health Care Systems to Improve Suicide Prevention

Cited by 36 publications

References 35 publications

Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study

Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study

Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response

The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries—An ecological study

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