Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder

Abstract

Objectives:There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation.Methods:In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15–25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data.Results:The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision.Conclusions:The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

“Some guidance and somewhere safe”: Caregiver and clinician perspectives on service provision for families of young people experiencing serious suicide ideation and attempt

“…Indeed, internet-based forums have been identified as helpful for those experiencing post-suicide bereavement (Bailey, Krysinska, O'Dea, & Robinson, 2017). Just as a multidisciplinary team-based approach can assist clinicians feel contained in working with this population (Rice et al, 2014), models of peer support can assist caregivers (Leggatt & Woodhead, 2016). Hence, there is a strong rationale to trial such online intervention with the present population, which would be especially helpful for caregivers who are unable to attend the clinical service in person.…”

Moderated online social therapy for depression relapse prevention in young people: pilot study of a ‘next generation’ online intervention

“…Given the substantial social and economic costs associated with depressive disorders, effective early intervention and maintenance of acute phase treatment effects are of critical importance . A recent Cochrane review of depression relapse prevention studies in young people, however, found little evidence to support any particular treatment approach in preventing relapse or recurrence of depressive episodes .…”

“…7 Given the substantial social and economic costs associated with depressive disorders, effective early intervention 8 and maintenance of acute phase treatment effects are of critical importance. 9,10 A recent Cochrane review of depression relapse prevention studies in young people, however, found little evidence to support any particular treatment approach in preventing relapse or recurrence of depressive episodes. 11 Randomized controlled trials in young people have shown that medication is only modestly effective in preventing relapse of depression and improving functioning in the longer term, [12][13][14] with meta-analyses casting doubt on the risk-benefit ratio of antidepressant use in those under 25 years in acute treatment.…”

Systematic Review and Quality Appraisal of Practice Guidelines for Self‐Harm in Children and Adolescents

“…Lastly, deciding which documents qualify as a “clinical practice guideline” is not a concrete process. Strict application of our inclusion and exclusion criteria by another group may result in a broader set of documents (e.g., Rice et al., ); however, our group has perused such documents and these would have likely been categorized as “poor quality.” Applying the AGREE II criteria to documents that were not developed with the intention of being a CPG was seen as unfair. Future researchers may wish to expand on the definition of a CPG to include the following: “a document that synthesizes results from primary studies and uses this synthesis to inform clinical and/or health services recommendations.”…”