Suicide risk assessment in the emergency department:an investigation of current practice in Scotland

Background: Suicide is a global public health issue. Approximately one third of individuals who complete suicide have attended an emergency department in the year preceding their death. The aim of this study was to investigate current suicide risk assessment practices across emergency department clinicians in Scotland.Methods: A mixed‐methods design was employed. A total of 112 surveys for emergency department clinicians were posted to 23 emergency departments in Scotland between March and September 2016. Follow‐up semi‐structured interviews were also conducted exploring clinician's experiences of suicide risk assessment. Interviews were analysed using thematic analysis.Results: Fifty‐one emergency department clinicians across 17 emergency departments completed the survey. Thirty‐five (68.6%) participants were currently using a suicide risk assessment tool; with most using locally developed tools and proformas (n = 20, 62.5%) or the SAD PERSONS scale (n = 13, 40.6%). Remaining participants (n = 16, 31.4%) did not use suicide risk assessment tools during assessment. Variation in practice was found both across and within emergency departments. Six clinicians participated in follow‐up interviews, which identified four major themes: Clinician Experiences of Suicide Risk Assessment; Components of Suicide Risk Assessment; Clinical Decision‐Making; and Supporting Clinicians.Conclusions: There is substantial variation in current practice, with around two‐thirds of clinicians using a variety of empirically and locally developed tools, and a third using their judgement alone. Clinicians find suicide risk assessment a challenging part of their role and discuss the need for increased training, and appropriate and helpful guidelines to improve practice

Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study

Background: It remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes. Methods: The study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician. Conclusion: The results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour

Mediators of Interpersonal Psychotherapy for Depressed Adolescents On Outcomes in Latinos: The Role of Peer and Family Interpersonal Functioning

Peer and family interpersonal functioning were examined as mediators of the impact of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A; Mufson, Dorta, Moreau, & Weissman, 2004) on depression and suicidal ideation among Latino youth. Only youth self-identifying as Latino (n = 50) were included in the analyses. The majority were female (86%) with a mean age of 14.58 (SD = 1.91). The current sample was drawn from the intent to treat sample of a clinical trial examining the effectiveness of IPT-A as compared with treatment as usual (TAU; Mufson, Dorta, Wickramaratne et al., 2004). Youth were randomly assigned to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments, completed at baseline and at Weeks 4, 8, and 12 (or at early termination), included self-report measures of depression and interpersonal functioning as well as clinician-Administered measures of depression. Multilevel modeling indicated that IPT-A led to greater improvement in interpersonal functioning with family and peers. Improved family and peer interpersonal functioning emerged as significant partial mediators of the relationship between IPT-A and depression. Only improved family interpersonal functioning emerged as a significant partial mediator of the relationship between IPT-A and suicidal ideation. However, this indirect effect was small, suggesting that most of the benefit of IPT-A for suicidal ideation appears to proceed through a pathway other than family interpersonal functioning. These results suggest that the impact of IPT-A on depressive symptoms is partially mediated by family and peer interpersonal functioning and contributes to our understanding of the mechanisms of IPT-A

Artificial Intelligence for Suicide Assessment using Audiovisual Cues: A Review

Death by suicide is the seventh leading death cause worldwide. The recent advancement in Artificial Intelligence (AI), specifically AI applications in image and voice processing, has created a promising opportunity to revolutionize suicide risk assessment. Subsequently, we have witnessed fast-growing literature of research that applies AI to extract audiovisual non-verbal cues for mental illness assessment. However, the majority of the recent works focus on depression, despite the evident difference between depression symptoms and suicidal behavior and non-verbal cues. This paper reviews recent works that study suicide ideation and suicide behavior detection through audiovisual feature analysis, mainly suicidal voice/speech acoustic features analysis and suicidal visual cues. Automatic suicide assessment is a promising research direction that is still in the early stages. Accordingly, there is a lack of large datasets that can be used to train machine learning and deep learning models proven to be effective in other, similar tasks.Comment: Manuscript submitted to Arificial Intelligence Reviews (2022

Practitioner review: Borderline personality disorder in adolescence: Recent conceptualization, intervention, and implications for clinical practice

The past decade has seen an unprecedented increase in research activity on personality disorders in adolescents. The increase in research activity, in addition to major nosological systems legitimizing the diagnosis of borderline personality disorder (BPD) in adolescents, highlights the need to communicate new research on adolescent personality problems to practitioners. In this review, we provide up-to-date information on the phenomenology, prevalence, associated clinical problems, etiology, and intervention for BPD in adolescents. Our aim is to provide a clinically useful practitioner review and to dispel long-held myths about the validity, diagnostic utility, and treatability of personality disorders in adolescents

Self-determination theory and the collaborative assessment and management of suicidality

Purpose The collaborative assessment and management of suicidality (CAMS) is a first-encounter suicide-specific brief intervention that motivates suicidal individuals for voluntary treatment engagement and choosing life. How the intervention works, however, has not been theoretically explained. The purpose of this paper is to explain the effectiveness using self-determination theory (SDT). Design/methodology/approach The paper focuses the theoretical examination on the philosophy of care and the clinical procedures of the CAMS suicide intervention. SDT is used as the theoretical lens of the examination. Findings The underlying philosophy of care and the clinical procedures of CAMS enhance the autonomy, relatedness and competence of the client in the first encounter. The paper proposes that fulfilling these basic human needs results in the intervention outcomes of treatment engagement and choosing life for the time being. Originality/value CAMS has not previously been theoretically explained. This paper explains the effectiveness of the intervention in engaging suicidal clients in further treatment through SDT.Peer reviewe

A randomized clinical trial comparing family-focused treatment and individual supportive therapy for depression in childhood and early adolescence

OBJECTIVE: Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders. METHOD: Children were randomized to 15 sessions of FFT-CD (n = 67) or IP (n = 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score ≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment. RESULTS: Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat = 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t = 1.97, p = .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes. CONCLUSION: Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.R01 MH082856 - NIMH NIH HHS; R01 MH082861 - NIMH NIH HH

Improving Nursing Attitudes Toward Suicide Prevention in the Emergency Department: the Implementation of an Adolescent Suicide Risk Screening Tool

The Center for Disease Control ranked suicide as the second leading cause of death for American adolescents (2015). This crisis of adolescent suicide warrants evaluation and improvement of current suicide prevention practices. The Emergency Department (ED) offers 24-hour services and may be the only organized healthcare for utilized by some individuals. Nurses are the front-line provider of care in the ED and this role offers opportunity to identify an adolescent with increased suicide risk. The purpose of this EBP project is to evaluate nursing attitudes toward suicide prevention by implementing the best practice screening tool for adolescent suicide risk assessment. ED nurses’ attitudes toward suicide prevention directly impacts the candor of responses from adolescents during the risk assessment. This project evaluated ED nurses’ attitudes toward suicide prevention utilizing the Attitudes to Suicide Prevention (ASP) scale which collects information specific to front-line health professionals. A mandatory class emphasized the current crisis of adolescent suicide and the best evidence recommendation for implementation of the Ask Suicide-Screening Questions (ASQ) risk assessment tool. The ASQ was implemented as a practice change to be completed by ED nurses for all adolescents seeking treatment in the ED. Evaluation of ASQ results followed one month of implementation and results were compared to previous practice data. Seven positive risk screens for adolescents seeking treatment for complaints unrelated to psychiatric or suicidal origin were identified with one month of ASQ implementation. This finding would have been unrecognized with prior practice standards. These results were relayed to staff. A post-intervention ASP survey was voluntarily completed by ED nurses to evaluate a change in nursing attitudes. With the implementation of an educational event and the successful implementation of a new screening tool, improved ED nursing attitudes toward suicide prevention were demonstrated. Results indicated a more positive staff attitude towards suicide prevention, but were not statistically significant (p \u3e .05). Data demonstrated an increase in the number of adolescents identified with an increased suicide risk. Based on these results, implementing the ASQ demonstrated an improvement in adolescent suicide risk assessment practice and nursing attitudes toward suicide prevention in the ED