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Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.
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Ideación Suicida , Intento de Suicidio , Humanos , Intento de Suicidio/estadística & datos numéricos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios de Seguimiento , Asunción de Riesgos , Adulto Joven , Alta del Paciente/estadística & datos numéricosRESUMEN
Suicide is the tenth leading cause of death in the United States. Caring Contacts (CC) is a suicide prevention intervention involving care teams sending brief messages expressing unconditional care to patients at risk of suicide. Despite solid evidence for its effectiveness, CC has not been broadly adopted by healthcare organizations. Technology has the potential to facilitate CC if barriers to adoption were better understood. This qualitative study assessed the needs of organizational stakeholders for a CC informatics tool through interviews that investigated barriers to adoption, workflow challenges, and participant-suggested design opportunities. We identified contextual barriers related to environment, intervention parameters, and technology use. Workflow challenges included time-consuming simple tasks, risk assessment and management, the cognitive demands of authoring follow-up messages, accessing and aggregating information across systems, and team communication. To address these needs, we propose design considerations that focus on automation, cognitive support, and data and workflow integration. Future work will incorporate these findings to design informatics tools supporting broader adoption of Caring Contacts.
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Suicidio , Humanos , Estados Unidos , Prevención del Suicidio , Informática , Comunicación , Investigación CualitativaRESUMEN
BACKGROUND: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. OBJECTIVE: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. METHODS: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. RESULTS: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=-3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=-3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). CONCLUSIONS: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons.
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Following publication of the original article [1] the authors reported an important acknowledgement was mistakenly omitted from the 'Acknowledgements' section. The full acknowledgement is included in this Correction article.
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OBJECTIVE: Suicide is a major public health concern among military servicemembers and previous research has demonstrated an association between bullying and suicide. This study evaluated the association between workplace bullying and suicidal ideation via perceived burdensomeness and thwarted belongingness which were hypothesized to mediate this association. METHOD: Four hundred and seventy-one suicidal Army Soldiers and U.S. Marines completed self-report measures of suicidal ideation, thwarted belongingness, perceived burdensomeness, and bullying. A series of regressions were used to test the hypothesized mediation model using the baseline data from a larger clinical trial. RESULTS: Perceived burdensomeness was a significant mediator of the association between bullying and the level of suicidal ideation, but thwarted belongingness was not a significant mediator. CONCLUSIONS: Perceived burdensomeness may represent a malleable target for intervention to prevent suicide among military service members, and should be evaluated further as an intervening variable with regard to suicidality in the setting of bullying victimization.
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Acoso Escolar/psicología , Costo de Enfermedad , Personal Militar/psicología , Ideación Suicida , Suicidio/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Autoinforme , Integración Social , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Encuestas y Cuestionarios , Lugar de Trabajo , Adulto Joven , Prevención del SuicidioRESUMEN
Social isolation, exposure to suicide, and overweight increase suicidal ideation in adolescents, but no study to date has examined their relative significance in American Indian and Alaska Native (AI/AN) youth. Generalized estimating equations and path analyses were used to measure the significance and mediation of these variables in the suicidal ideation of 721 AI/ANs and 12,107 White adolescents. Social isolation, exposure to suicide, and overweight were risk factors for suicidal ideation in both races, and the associations among the variables of interest and suicidal ideation varied by race. Interventionists need to consider race in the prevention of suicidal ideation in AI/AN and White youth.
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/etnología , Indígenas Norteamericanos/etnología , Sobrepeso/etnología , Aislamiento Social , Suicidio/etnología , Población Blanca/etnología , Adolescente , Femenino , Humanos , Masculino , Ideación SuicidaRESUMEN
BACKGROUND: With the current funding climate and need for advancements in implementation science, there is a growing demand for grantsmanship workshops to increase the quality and rigor of proposals. A group-based implementation science-focused grantsmanship workshop, the Implementation Development Workshop (IDW), is one methodology to address this need. This manuscript provides an overview of the IDW structure, format, and findings regarding its utility. RESULTS: The IDW methodology allows researchers to vet projects in the proposal stage in a structured format with a facilitator and two types of expert participants: presenters and attendees. The presenter uses a one-page handout and verbal presentation to present their proposal and questions. The facilitator elicits feedback from attendees using a format designed to maximize the number of unique points made. After each IDW, participants completed an anonymous survey assessing perceptions of the IDW. Presenters completed a funding survey measuring grant submission and funding success. Qualitative interviews were conducted with a subset of participants who participated in both delivery formats. Mixed method analyses were performed to evaluate the effectiveness and acceptability of the IDW and compare the delivery formats. Of those who participated in an IDW (N = 72), 40 participated in face-to-face only, 16 in virtual only, and 16 in both formats. Thirty-eight (face-to-face n = 12, 35 % response rate; virtual n = 26, 66.7 % response rate) responded to the surveys and seven (15.3 % response rate), who had attended both formats, completed an interview. Of 36 total presenters, 17 (face-to-face n = 12, 42.9 % response rate; virtual n = 5, 62.9 % response rate) responded to the funding survey. Mixed method analyses indicated that the IDW was effective for collaboration and growth, effective for enhancing success in obtaining grants, and acceptable. A third (35.3 %) of presenters ultimately received funding for their proposal, and more than 80 % of those who presented indicated they would present again in the future. The IDW structure and facilitation process were found to be acceptable, with both formats rated as equally strong. CONCLUSIONS: The IDW presents an acceptable and successful methodology for increasing competitiveness of implementation science grant proposals.
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Organización de la Financiación/métodos , Implementación de Plan de Salud/métodos , Comunicación por Videoconferencia , Educación , Implementación de Plan de Salud/economía , Humanos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Identification of psychometrically strong instruments for the field of implementation science is a high priority underscored in a recent National Institutes of Health working meeting (October 2013). Existing instrument reviews are limited in scope, methods, and findings. The Society for Implementation Research Collaboration Instrument Review Project's objectives address these limitations by identifying and applying a unique methodology to conduct a systematic and comprehensive review of quantitative instruments assessing constructs delineated in two of the field's most widely used frameworks, adopt a systematic search process (using standard search strings), and engage an international team of experts to assess the full range of psychometric criteria (reliability, construct and criterion validity). Although this work focuses on implementation of psychosocial interventions in mental health and health-care settings, the methodology and results will likely be useful across a broad spectrum of settings. This effort has culminated in a centralized online open-access repository of instruments depicting graphical head-to-head comparisons of their psychometric properties. This article describes the methodology and preliminary outcomes. METHODS: The seven stages of the review, synthesis, and evaluation methodology include (1) setting the scope for the review, (2) identifying frameworks to organize and complete the review, (3) generating a search protocol for the literature review of constructs, (4) literature review of specific instruments, (5) development of an evidence-based assessment rating criteria, (6) data extraction and rating instrument quality by a task force of implementation experts to inform knowledge synthesis, and (7) the creation of a website repository. RESULTS: To date, this multi-faceted and collaborative search and synthesis methodology has identified over 420 instruments related to 34 constructs (total 48 including subconstructs) that are relevant to implementation science. Despite numerous constructs having greater than 20 available instruments, which implies saturation, preliminary results suggest that few instruments stem from gold standard development procedures. We anticipate identifying few high-quality, psychometrically sound instruments once our evidence-based assessment rating criteria have been applied. CONCLUSIONS: The results of this methodology may enhance the rigor of implementation science evaluations by systematically facilitating access to psychometrically validated instruments and identifying where further instrument development is needed.
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Conducta Cooperativa , Evaluación de Programas y Proyectos de Salud/métodos , Investigación Biomédica Traslacional/métodos , Medicina Basada en la Evidencia/métodos , Humanos , Psicometría , Proyectos de Investigación/normas , Investigación Biomédica Traslacional/normasRESUMEN
OBJECTIVE: The present study explored the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. METHOD: Women meeting DSM-IV criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community treatment by experts. The Structural Analysis of Social Behavior (Benjamin, 1974) was used to measure both the therapeutic relationship and introject. RESULTS: Relative to community treatment by experts, DBT participants reported the development of a more positive introject, including significantly greater self-affirmation, self-love, self-protection, and less self-attack, during the course of treatment and 1-year follow-up. The therapeutic relationship did not have an independent effect on intrapsychic or symptomatic outcome but did interact with treatment. DBT participants who perceived their therapist as affirming and protecting reported less frequent occurrences of nonsuicidal self-injury. CONCLUSIONS: The study showed positive intrapsychic change during DBT and emphasized the importance of affirmation and control in the therapeutic relationship. Results are discussed in the context of understanding the mechanisms of change in DBT.
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Trastorno de Personalidad Limítrofe/terapia , Psicoterapia/métodos , Autoimagen , Adolescente , Adulto , Terapia Conductista/métodos , Terapia Conductista/estadística & datos numéricos , Trastorno de Personalidad Limítrofe/psicología , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Relaciones Profesional-Paciente , Psicoterapia/estadística & datos numéricos , Conducta Autodestructiva/prevención & control , Resultado del Tratamiento , Adulto JovenRESUMEN
This study examined the efficacy of dialectical behavior therapy (DBT) in reducing behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self-injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and without PTSD were equally likely to eliminate the exclusionary behaviors during 1 year of DBT. By posttreatment, 50-68% of the BPD clients with PTSD would have been suitable candidates for PTSD treatment. Borderline personality disorder clients with PTSD who began treatment with a greater number of recent suicide attempts and more severe PTSD were significantly less likely to become eligible for PTSD treatment.
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Trastorno de Personalidad Limítrofe/terapia , Terapia Cognitivo-Conductual/métodos , Meditación/métodos , Conducta Autodestructiva/terapia , Trastornos por Estrés Postraumático/terapia , Intento de Suicidio/prevención & control , Adulto , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Comorbilidad , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Trastornos Disociativos/terapia , Femenino , Estudios de Seguimiento , Humanos , Meditación/psicología , Inventario de Personalidad , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Intento de Suicidio/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder.
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Terapia Conductista/métodos , Trastorno de Personalidad Limítrofe/terapia , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Competencia Profesional , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Comorbilidad , Femenino , Humanos , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to evaluate preexisting psychiatric risk factors for postpartum suicide attempts resulting in hospitalization. STUDY DESIGN: We performed a population-based case-control study using Washington State birth certificates linked to hospital discharge data to evaluate the association between hospitalization with a psychiatric diagnosis, substance use diagnosis, or dual diagnosis in the 5 years before delivery with risk of postpartum suicide attempt. We compared cases (n = 355) hospitalized postpartum for a suicide attempt with controls (n = 1420) by using multivariable logistic regression. RESULTS: Women with a psychiatric disorder were at a 27.4-fold (95% confidence interval 10.6-70.8) increased risk, and those with a substance use disorder were at a 6.2-fold (95% confidence interval 2.8-13.9) increased risk, and those with a dual diagnosis were at an 11.1-fold (95% confidence interval 5.1-24.2) increased risk of postpartum suicide attempt compared with controls. CONCLUSION: Prenatal screening for preexisting psychiatric or substance abuse diagnoses may help identify women at risk of postpartum suicide attempt.
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Trastornos Puerperales/epidemiología , Trastornos Puerperales/psicología , Intento de Suicidio/psicología , Adulto , Estudios de Casos y Controles , Depresión Posparto/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Factores de Riesgo , Washingtón/epidemiologíaRESUMEN
To evaluate the feasibility and efficacy of a program to manage Social Security disability benefits in a clinical sample of patients with severe mental illness and co-occurring substance dependence, 41 patients were randomly assigned to have their benefits either contingently or noncontingently managed through their mental health center. Contingent management involved adjustments to the type or frequency (not amount) of disability benefits and payments for study participation based on ratings of substance use, money management, and treatment follow-through. The patients with contingent management used significantly less alcohol and drugs and showed much better money management than those with noncontingent management. Patients and case managers who participated in the study reported that they found the management strategy to be acceptable and useful.
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Manejo de Caso/organización & administración , Seguro por Discapacidad/economía , Seguro por Discapacidad/normas , Trastornos Mentales/economía , Servicios de Salud Mental/economía , Seguridad Social/economía , Trastornos Relacionados con Sustancias/economía , Adulto , Diagnóstico Dual (Psiquiatría) , Evaluación de la Discapacidad , Estudios de Factibilidad , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/terapia , Estados UnidosRESUMEN
OBJECTIVE: The authors studied the psychometric properties and utility of the Problem Severity Summary (PSS), a 13-item instrument that assesses symptom severity and functioning among adults with severe and persistent mental illness. METHODS: Case managers rated the PSS among more than 1,000 adults with severe and persistent mental illness who were receiving services at either mainstream community mental health centers or specialty community mental health centers (serving various minority groups) in one county in Washington State. A subsample of clients was used to assess the concurrent validity of the PSS with the Psychiatric Symptom Assessment Scale. RESULTS: Interrater reliability was adequate for ten of the 13 PSS items. Four meaningful factors were derived, each with adequate internal consistency: community functioning, negative social behavior, affective distress, and psychotic disturbance. The PSS demonstrated adequate concurrent and predictive validity. Sensitivity of the PSS factors to change showed that scores on three of the four scales changed significantly over one year. Discriminant validity indicated that the PSS is generally unbiased in terms of demographic characteristics. CONCLUSIONS: The PSS is a brief, easily administered instrument that shows psychometric promise for use in clinical contexts, such as treatment planning, concurrent review of care, and guidance for level-of-care decisions, as well as for quality management purposes.