Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. Method:The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF (n ¼ 1265) and TAU (n ¼ 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate ¼ -.57, SE ¼ .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate ¼ -.04, SE ¼ .06, P ¼ 0.51). Furthermore, there was no effect of treatment status (estimate ¼ -.10, SE ¼ .16, P ¼ 0.52) on prevalence of suicide attempts (HF ¼ 11.9%, TAU ¼ 10.5%) during the 2-year follow-up period. Conclusion:This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.
Background Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes. Methods A retrospective chart review of adult outpatients ( n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales. Results Clients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = − 0.52 [95%CI, − 0.74 to − 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = − 0.65 [95%CI, − 0.89 to − 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses. Conclusions This study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients’ interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.
Rationale, aims and objectives: Cognitive behavioural therapy (CBT) is effective in treating anxiety disorders. In publically funded systems, CBT is not easily accessible due to long wait times. In order to provide quicker access, a large group CBT intervention was implemented in a tertiary care clinic. This study describes the design, feasibility and acceptability of such an intervention as part of stepped care for anxiety disorders. Method: The intervention followed a 2-session curriculum, consisting of 90 minutes classes providing didactic instruction on key CBT topics and self-management strategies. Classes accommodated 30 patients and were led by staff psychiatrists formally trained in CBT. A retrospective analysis of patients referred to the clinic during the first year of class implementation was performed to determine class completion rate, patient satisfaction (using a usefulness Likert Scale and Session Rating Scale [SRS]) and symptom trajectory (using the GAD-7).Results: The implementation of large group CBT classes reduced waiting times from approximately one year to approximately 3 months. One hundred and thirty-one patients were screened by the clinic, 88 of whom (67%) completed the intervention. Sixty-eight percent of patients rated the classes as useful; however, SRS findings indicated that only 46% of patients were satisfied. GAD-7 scores decreased by 1.57 (95% CI 0.2 to 2.95; SMD=0.24).Conclusions: This analysis contributes preliminary evidence that large group CBT education classes may be an acceptable means to reduce waiting times for CBT for anxiety disorders. Further controlled research is required to elucidate the benefit and cost effectiveness of such classes.
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