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1.
Mo Med ; 118(1): 7-12, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33551470

RESUMEN

Medical students, residents, and practicing physicians experience high burnout, depression, and suicide rates, and the COVID-19 pandemic has exacerbated stress for many.1-6 While laudable, current well-being efforts appear insufficient to meet the challenges that so many are facing. This essay explores approaches that individuals and organizations can take to promote mental health and well-being from medical school to practice.


Asunto(s)
/psicología , Salud Mental/normas , Médicos/psicología , Estudiantes de Medicina/psicología , Adaptación Psicológica/fisiología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/terapia , /epidemiología , Terapia Cognitivo-Conductual/métodos , Depresión/epidemiología , Depresión/terapia , Humanos , Sistema Límbico/fisiopatología , Salud Mental/estadística & datos numéricos , Atención Plena/métodos , Facultades de Medicina/organización & administración , Facultades de Medicina/normas , Estrés Psicológico/complicaciones , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Suicidio/prevención & control , Suicidio/psicología , Suicidio/estadística & datos numéricos
8.
Healthc Q ; 23(4): 9-11, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33475485

RESUMEN

As the population ages, more Canadians need home care to help manage their health conditions and live safely at home. For Canadians of all ages, timely access to mental health and addictions services is an area of growing concern. The impact of the COVID-19 pandemic and its strain on health system resources have further highlighted the need to improve services in these areas. The Canadian Institute for Health Information (CIHI) is working with governments across Canada to bridge data gaps, develop indicators and publicly report results as part of a collective effort to improve access in these two sectors. Results for three new indicators were released by CIHI in 2020.


Asunto(s)
Servicios de Salud Comunitaria/provisión & distribución , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/provisión & distribución , Servicios de Salud Mental/provisión & distribución , Trastornos Relacionados con Sustancias/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Cuidadores/psicología , Niño , Servicios Comunitarios de Salud Mental/provisión & distribución , Femenino , Humanos , Masculino , Persona de Mediana Edad , Centros de Tratamiento de Abuso de Sustancias/provisión & distribución , Suicidio/prevención & control , Adulto Joven
9.
J Psychiatr Res ; 133: 113-118, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33338733

RESUMEN

Firearm sales have surged during COVID-19, raising concerns about a coming wave of suicide deaths. Little is known, however, about the individuals considering acquiring firearms during the pandemic. Recent research has highlighted that individuals considering acquiring firearms may be motivated by exaggerated threat expectancies. In a sample of 3,500 Americans matched to 2010 United States Census data, we compared individuals intending to buy firearms in the coming 12 months (assessed in late June and early July 2020) to those undecided or not planning to acquire firearms on a range of demographic, anxiety, and firearm ownership variables. Our results indicated that those intending to acquire a firearm in the next twelve months are less tolerant of uncertainty, endorse exaggerated threat expectancies, and are experiencing more severe COVID-19 specific fears. Individuals intending to purchase firearms were also more likely to have experienced suicidal ideation in the past year, to have worked in law enforcement, and to have been considered essential workers during COVID-19. Furthermore, such individuals were more likely to already own firearms and to have purchased firearms during the opening months of the COVID-19 pandemic. Those intending to purchase firearms did not endorse lower perceived neighborhood safety, however, indicating that their intent to purchase firearms is unlikely to be driven by tangible threats in their immediate environment. These findings highlight that exaggerated fears may be motivating individuals to purchase firearms to diminish anxiety and that this trend may be particularly common among individuals who already own firearms.


Asunto(s)
/psicología , Cultura , Miedo , Armas de Fuego , Intención , Propiedad , Pandemias , Percepción Social/psicología , Problemas Sociales , Suicidio/prevención & control , Suicidio/psicología , Ansiedad/psicología , Toma de Decisiones , Humanos , Características de la Residencia , Seguridad
10.
Nurs Res ; 70(1): 72-79, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32956255

RESUMEN

BACKGROUND: Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. OBJECTIVES: The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. METHODS: The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study-from hospital enrollment to home-based visits. RESULTS: Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. DISCUSSION: Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. CONCLUSION: The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.


Asunto(s)
Cardiopatías/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Gestión de Riesgos/métodos , Gestión de Riesgos/normas , Estrés Psicológico/prevención & control , Suicidio/prevención & control , Suicidio/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Estados Unidos
12.
N Z Med J ; 133(1527): 26-38, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332326

RESUMEN

AIM: To describe the context surrounding the deaths of homeless people in New Zealand and to determine the proportion of deaths that could be considered amenable to healthcare. METHOD: We used coroners' findings related to 171 deaths of persons with "no fixed abode" at the time of death, from 2008 to 2019. Recent lists of amenable mortality from the New Zealand Ministry of Health and the Office of National Statistics in the UK were combined to determine the rate of amenable mortality. RESULTS: The life expectancy of homeless persons identified in this sample was 30 years shorter than in the housed population, with a mean age of death of 45.7 years. Deaths occurred mainly alone, in public spaces (56.1%) or in private vehicles (14%). Three-quarters (75.8%) of homeless persons died from conditions amenable to timely and effective healthcare interventions, mostly from natural causes (45.7%) and suicide (41.5%). CONCLUSION: Homeless people experience considerable challenges when accessing the healthcare system, as uncovered by the dramatic rate of amenable mortality. Our findings highlight the urgent need to implement specific models of care that are designed to meet the social and healthcare needs of homeless persons and address the significant health inequalities they experience.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Personas sin Hogar/estadística & datos numéricos , Esperanza de Vida , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Trastornos Relacionados con Alcohol/mortalidad , Trastornos Relacionados con Alcohol/prevención & control , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Niño , Etanol/envenenamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Nueva Zelanda/epidemiología , Neumonía/mortalidad , Neumonía/prevención & control , Suicidio/prevención & control , Suicidio/estadística & datos numéricos , Adulto Joven
15.
Lancet Digit Health ; 2(1): e25-e36, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-33328037

RESUMEN

BACKGROUND: Digital interventions that deliver psychological self-help provide the opportunity to reach individuals at risk of suicide who do not access traditional health services. Our primary objective was to test whether direct (targeting suicidality) and indirect (targeting depression) digital interventions are effective in reducing suicidal ideation and behaviours, and our secondary analyses assessed whether direct interventions were more effective than indirect interventions. METHODS: In this systematic review and meta-analysis, we searched online databases MEDLINE, PubMed, PsycINFO, and Cochrane CENTRAL for randomised controlled trials published between database inception to May 21, 2019. Superiority randomised controlled trials of self-guided digital interventions (app or web based, which delivered theory-based therapeutic content) were included if they reported suicidal ideation, suicidal plans, or suicide attempts as an outcome. Non-inferiority randomised controlled trials were excluded to ensure comparability of the effect. Data were extracted from published reports, and intention-to-treat data were used if available. The primary outcome was the difference in mean scores of validated suicidal ideation measures (Hedges'g) with the associated 95% CI for the analysis of digital intervention effectiveness on suicidal ideation. We also present funnel plots of the primary outcome measure (suicidal ideation) for direct and indirect interventions to assess for publication bias. We calculated I2 (with I2 CI) values to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO, CRD42018102084. FINDINGS: The literature search yielded 739 articles (including manual searching) for suicidality and 8842 articles for depression. After screening, 14 papers reporting on 16 studies were included in the narrative review and meta-analysis. The 16 studies (ten on direct interventions and six on indirect interventions) provided baseline data for 4398 participants. The primary outcome of overall post-intervention effect for suicidal ideation was small but significant immediately following the active intervention phase (Hedges'g -0·18, 95% CI -0·27 to -0·10, p<0·0001; I2=0%, I2 CI 0·0-47·9). The secondary objective, comparing direct and indirect interventions, showed that direct interventions (targeting suicidality) significantly reduced suicidal ideation at post-intervention (g -0·23, 95% CI -0·35 to -0·11, p<0·0001; I2=17·6%, I2 CI 0·0-58·6), but indirect interventions (targeting depression) failed to reach significance (g -0·12, 95% CI -0·25 to 0·01, p=0·071; I2=0%, I2 CI 0·0-30·7). INTERPRETATION: Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant for reducing suicidal ideation. Our findings suggest that digital interventions should be promoted and disseminated widely, especially where there is a lack of, or minimal access to, health services. FUNDING: Australian National Health and Medical Research Council.


Asunto(s)
Autocuidado/métodos , Suicidio/prevención & control , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
17.
Artículo en Inglés | MEDLINE | ID: mdl-33095519

RESUMEN

Objective: To expand knowledge during the coronavirus disease 2019 (COVID-19) pandemic with regard to suicide prevention among the elderly population by providing recommendations for interview strategies using 3 suicide theories. Methods: Two hypothetical geriatric suicide cases (1 low lethality and 1 high lethality) are presented and categorized according to 3 suicide theories: interpersonal theory of suicide, three-step theory of suicide, and hopelessness theory of depression. Results: In crisis intervention, the clinician's interview must match the intrinsic belief of the suicide attempter to enable engagement and rapport. Use of different aspects of the 3 suicide theories can be useful but are dependent on the emergent nature of the attempt. Conclusion: The need for identification and treatment of those with mental health issues, especially among the elderly population, and collaborative multidiscipline management teams is increasing during the current global pandemic. Specific interview strategies are needed when engaging with elderly suicidal patients. Suicide prevention in elderly patients is worthy of strong public attention.


Asunto(s)
Infecciones por Coronavirus/psicología , Pandemias , Neumonía Viral/psicología , Psiquiatría/métodos , Suicidio/prevención & control , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/complicaciones , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Masculino , Neumonía Viral/complicaciones , Ideación Suicida , Suicidio/psicología , Intento de Suicidio/psicología
18.
Medicine (Baltimore) ; 99(44): e22905, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126345

RESUMEN

Coupled with the lowest level of social connectedness, South Korea has the highest suicide rate among the Organization for Economic Co-operation and Development countries. A possible link between community and suicide is social capital imprinted in social connectedness. This study explores whether social capital is protective against suicide ideation in relation to the poverty level of communities, and whether the associations are specific to certain elements of social capital.A total of 908 participants were included to assess cross-sectional association of social capital at individual level with suicide ideation by comparing between poor (government-leased apartments) and non-poor communities (nongovernment-leased apartments). Logistic regression analyses were performed to examine various social capital dimensions in relation to suicide ideation.Suicide ideation was far higher among those living in the poor communities (poor communities 12%; non poor communities 6.3%) and the level of social capital was lower in the poor communities. Nevertheless, the protective effect of social capital, in particular, the cognitive dimension against suicide ideation was demonstrated only in the poor communities (eg, odds ratio = 0.27, 95% confidence interval: 0.12-0.58 for trust in the poor communities). Low income was significantly associated with suicide ideation only in the poor communities, but depression and resilience were associated with suicide ideation both in the poor and non-poor communities.To increase the reliability of the results, established measures based on relevant literature were utilized, but measures on bridging social capital and social network might have relatively low reliability.As to protection against suicide ideation, the extent of reliance on social capital was higher in poor communities than in non-poor communities, in particular, the cognitive dimension was likely to activate in this regard.


Asunto(s)
Relaciones Interpersonales , Pobreza/psicología , Capital Social , Condiciones Sociales , Ideación Suicida , Suicidio , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Factores Protectores , Sistemas de Apoyo Psicosocial , Salud Pública , República de Corea/epidemiología , Características de la Residencia , Resiliencia Psicológica , Condiciones Sociales/economía , Condiciones Sociales/estadística & datos numéricos , Suicidio/economía , Suicidio/prevención & control , Suicidio/psicología , Suicidio/estadística & datos numéricos
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