Prevenció del suïcidi per a persones amb diagnòstic d'esquizofrènia : un nou enfocament basat en estratègies telemàtiques

Una revisió de la literatura científica troba resultats que suggereixen que les intervencions de prevenció del suïcidi mitjançant contacte telefònic semblen ser viables i eficaces per a reduir la ideació suïcida en pacients amb esquizofrènia i símptomes psicòtics.Una revisión de la literatura científica halla resultados que sugieren que las intervenciones de prevención del suicidio mediante contacto telefónico parecen ser viables y eficaces para reducir la ideación suicida en pacientes con esquizofrenia y síntomas psicóticosA review of the scientific literature finds results suggesting that suicide prevention interventions using telephone contact appear to be feasible and effective in reducing suicidal ideation in patients with schizophrenia and psychotic symptoms

Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt : controlled study in a Spanish population /

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2017-2018L'Organització Mundial de la Salut (OMS) determina que la conducta suïcida és un problema de salut pública de primera magnitud. S'estima que cada any un milió de persones moren per suïcidi al món i que les temptatives autolítiques podrien ser 40 vegades més freqüents que aquells que cometen suïcidi. A Catalunya, 500 persones moren per suïcidi anualment. Aquestes xifres són de vital importància ja que una de les poblacions amb major risc reconegut de suïcidi i accessible als programes preventius d'intervenció està constituïda pels pacients supervivents a temptatives de suïcidi que són atesos en els serveis hospitalaris d'urgències. En aquest sentit, les mesures que han demostrat una major efectivitat son aquelles que han millorat l'accesibilitat als serveis de salut de les persones en risc i el seguiment acurat durant el periode critic posterior a la tentativa autolitica. La realitat actual és que practicament no disposem d'estudis de qualitat que demostrin eficacia en programes de prevenció de la conducta suïcida. L'objectiu d'estudi d'aquesta tesis és avaluar l'eficàcia d'un programa d'intervenció telefònica en la prevenció de la conducta suïcida i l'efecte de la intervenció als 5 anys de seguiment. La intervenció telefònica es va dur a terme en els pacients que havien estat atesos i donats d'alta en el servei d'Urgències del Parc Taulí Sabadell Hospital Universitari. La intervenció consistia en un seguiment telefònic durant un any i la priorització d'una visita de seguiment al Centre de Salut Mental a la setmana següent de ser donats d'alta. La intervenció telefònica es realitza a la setmana i als 1, 3, 6, 9 i 12 mesos posteriors al intent de suïcidi. El grup control va ser la població atesa a urgències de l'Hospital Consorci de Terrassa per tentativa autolitica, la qual no va rebre el programa d'intervenció de gestió telefònica. Es va observar que el programa d'intervenció telefònica per als pacients que acudeixen a Urgències per temptativa autolítica és ser més eficaç que el tractament habitual ja que redueix les complicacions i potencialment evita el suïcidi. Els resultats van mostrar que la intervenció aconseguia retardar el temps que els pacients tardaven en fer la temptativa autolítica, i per tant evitava que el pacient realitzés una temptativa autolítica en el període de màxim risc, i, per altra banda, reduïa la freqüència de temptatives durant el primer any d'intervenció. Aquest segon resultat positiu del programa és dins d'una tendència general cap a una reducció de la taxa de reintent suïcidi en les dues comunitats. El follow-up de 5 anys que hem realitzat un cop finalitzada la intervenció, ha demostrat que els efectes beneficiosos de la intervenció no es mantenen a llarg termini. La gestió telefònica realitzada en un entorn de pràctica clínica real podria ser una estratègia útil i poc costosa d'implementar en altres centres de salut mental Esperem que això, amb l'ajuda de més estudis, donarà lloc a una millor comprensió dels factors que hi intervenen i a una millora de la eficàcia de les intervencionsThe World Health Organization (WHO) states that suicidal behavior is a first magnitude public health problem. It is estimated that every year one million people die by suicide in the world. Suicide attempts could be 40 times more frequent than those who commit suicide. In Catalonia, 500 people die by suicide each year. These data are vital because one of the populations at risk of suicide known and accessible preventive intervention programs is made up of surviving patients in suicide attempts are treated at hospital emergency services. In this regard, the measures that have proven more effective are those that have improved accessibility to mental health services for people at risk and also careful monitoring intervention during the critical period after the suicide attempt. The current situation is that we still do not have enough quality studies that demonstrate efficacy in prevention programs for suicidal behavior. The aim of this thesis study is to evaluate the effectiveness of a telephone management program in the prevention of suicidal behavior and the effect of the intervention at 5 years of follow up. The intervention was conducted in patients who had been treated for suicide attempt and discharged from the Emergency Room of Parc Tauli Sabadell Hospital Universitari. The intervention consisted of a telephone follow-up intervention for one year and a first week post-discharge visit at the Mental Health Centre. The telephone follow-up start at 1 week and 1, 3 , 6, 9 and 12 months after the suicide attempt . The control group was given a population Emergency Hospital Consortium of Terrassa tentative autolitica , which did not receive the intervention program management Telephone A telephone management programme for patients with suicide attempts admitted to emergency departments, including an early post-discharge visit by a psychiatrist proves to be more efficient than usual treatment as it reduces complications and potentially prevents suicide completion. Our results show that such an intervention is effective in delaying further suicide attempts and in reducing the rate of reattempts during the year of intervention. This second positive finding of the programme is within a general trend towards a reduction in the suicide reattempt rate in both communities. Over the long term, the beneficial effects were not mantained. The telephone management of cases in a real clinical-practice setting could be a useful strategy and inexpensive programme to implement in other mental health centres. We hope that this, with the help of further studies, will lead to a better understanding of the factors involved in this type of intervention and a consequent improvement in its effectiveness

Validation of an Online Version of the Alcohol Use Disorders Identification Test (AUDIT) for Alcohol Screening in Spanish University Students

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.This research was funded by Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III FEDER (PI13/00343); Ministerio de Sanidad, Consumo y Bienestar Social, Plan Nacional Sobre Drogas PNSD (exp.2015I015); and from the DIUE of the Generalitat de Catalunya (2017SGR452). L. Ballester was supported by an FPU grant (FPU15/05728); M. J. Blasco was supported by a Rio Hortega grant (ISCIII, CM14/00125); P. Castellvi was supported by a Sara Borrell grant (ISCIII, CD12/00440), the European Regional Development Fund (ERDF), the European Commission, the University of Jaen, Spain (R08/06/2018) and the Instituto de Estudios Giennenses; and P. Mortier was supported by a Sara Borrell grant (ISCIII, CD18/00049)

Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies

Background: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). Method: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. Results: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). Conclusion: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults

Accuracy of online survey assessment of mental disorders and suicidal thoughts and behaviors in Spanish university students. Results of the WHO World Mental Health- International College Student initiative

Objective To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive Episode[MDE], Mania/Hypomania[M/H], Panic Disorder[PD], Generalized Anxiety Disorder[GAD]) and suicidal thoughts and behaviors[STB] used in the UNIVERSAL project. Methods Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18-24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales [CIDI-SC], the Self-Injurious Thoughts and Behaviors Interview [SITBI] and the Columbia-Suicide Severity Rating Scale [C-SSRS]. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview [MINI]. Measures of diagnostic accuracy and McNemar chi(2) test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity. Results A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1-55.1% and negative predictive values 90.2-99.0%; likelihood ratios positive were in the range of 2.1-14.6 and likelihood ratios negative 0.1-0.6. All outcomes showed adequate areas under the curve [AUCs] (AUC> 0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs> 0.8). Conclusion The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes

Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders : A Systematic Review

BACKGROUND: Suicide is a health problem among patients diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may offer opportunities to reach this at-risk group. However, to consider the implementation of telehealth systems in the prevention of suicidal behaviors in patients diagnosed with schizophrenia, a review of the evidence is required. The present aim was to explore the effectiveness of telephone-based suicide prevention programs among patients with schizophrenia and related disorders. METHODS: A bibliographic search was carried out in the PubMed, PsycInfo, Scopus and Web of Science electronic databases following PRISMA guidelines. Two reviewers performed the selection, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria. RESULTS: Globally, an adherence was observed ranging from 78 to 100%. Three studies reported a reduction in suicidal ideation and two studies showed a reduction in the risk of relapse observed in the intervention group compared to a control group. CONCLUSIONS: In accordance with the limited data available, the use of a telephone contact approach appears to be feasible and effective in schizophrenia patients with suicidal behaviors. The preliminary evidence also suggests that this system appears to reduce suicidal ideation. Further research is required to design evidence-based future interventions and to determine whether this approach can improve patient outcomes

Effects of Cardiopulmonary Rehabilitation on the Muscle Function of Children with Congenital Heart Disease : A Prospective Cohort Study

Critical medical and surgical advances have led to a shift in the care and management of children with congenital heart disease (CHD). These patients present with muscle deconditioning, which negatively influences their response to exercise, functional capacities, and quality of life. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on the function of peripheral musculature of children with CHD. A single-center prospective cohort study was designed. Fifteen CHD subjects, between 12 and 16 years of age, with reduced aerobic capacity on a cardiopulmonary exercise test, were included in a three-month, 24-session CPRP. Measurements of the subjects' handgrip strength, biceps brachii and quadriceps femoris strength, and triceps surae fatigue process were collected at the beginning of the program, after completion, and six months after the end of the intervention. A substantial and statistically significant improvement was observed in the subjects' handgrip strength (kg) (p < 0.001), biceps brachii and quadriceps femoris strength (N) (p < 0.001), as well as triceps surae fatigue process (repetitions) (p = 0.018), with a maintenance of the results six months after the intervention. These results suggest that a CPRP could potentially improve the peripheral muscle function of children with CHD. Additional research is needed to confirm and expand on this hypothesis

Effects of Cardiopulmonary Rehabilitation on the Muscle Function of Children with Congenital Heart Disease: A Prospective Cohort Study

Critical medical and surgical advances have led to a shift in the care and management of children with congenital heart disease (CHD). These patients present with muscle deconditioning, which negatively influences their response to exercise, functional capacities, and quality of life. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on the function of peripheral musculature of children with CHD. A single-center prospective cohort study was designed. Fifteen CHD subjects, between 12 and 16 years of age, with reduced aerobic capacity on a cardiopulmonary exercise test, were included in a three-month, 24-session CPRP. Measurements of the subjects’ handgrip strength, biceps brachii and quadriceps femoris strength, and triceps surae fatigue process were collected at the beginning of the program, after completion, and six months after the end of the intervention. A substantial and statistically significant improvement was observed in the subjects’ handgrip strength (kg) (p &lt; 0.001), biceps brachii and quadriceps femoris strength (N) (p &lt; 0.001), as well as triceps surae fatigue process (repetitions) (p = 0.018), with a maintenance of the results six months after the intervention. These results suggest that a CPRP could potentially improve the peripheral muscle function of children with CHD. Additional research is needed to confirm and expand on this hypothesis

Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies

OBJECTIVE: To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. METHOD: We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. RESULTS: Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). CONCLUSION: Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group

Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies

OBJECTIVES: To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults. METHODS: Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed. RESULTS: Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied. CONCLUSIONS: More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.Ministerio de Sanidad, Consumo y Bienestar Social, PSND (Exp. 2015I015), Instituto de Salud Carlos III-FEDER (PI13/00343), Fondo de Investigación Sanitaria-ISCIII (CD12/00440; CM14/00125), DIUE Generalitat de Catalunya (2017 SGR 452), and European Regional Development Fund (PSI2017-90650-REDT)