Family-Based Crisis Intervention With Suicidal Adolescents

Wharff, Elizabeth A.; Ginnis, Katherine; Ross, Abigail M.; White, Erina; White, Matthew T.; Forbes, Peter

doi:10.1097/pec.0000000000001076

Cited by 41 publications

(101 citation statements)

References 23 publications

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“…Communication is considered a key element of a family environment that promotes recovery for the young person (Wharff et al, ), and our results indicate that following the SFAI there was a large improvement in the confidence of the family to be able to communicate. The large positive change for the dimension ‘how the adult is managing currently,’ suggests that participants felt the adult became more confident in helping the young person and more able to manage following the SFAI.…”

Section: Discussionsupporting

confidence: 54%

“…Despite the complexities and controversies regarding how we define family environment, it is clear from the literature that activating family support, improving confidence in communication between family members (Wharff et al., ), and promoting a positive connection amongst family members are very important in reducing the risk of self‐harm and level of distress for young people (Cottrell et al., ).…”

Section: Discussionmentioning

confidence: 99%

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A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

Young

Conrad²,

Mah³

2019

ANZ J of Family Therapy

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The family environment is considered an important influence on a young person's well‐being. The ‘Safety First Assessment Intervention’ is a model of care that considers and incorporates the importance of family environment when assessing and managing distressed young people. This pilot study explores the influence of the ‘Safety First Assessment Intervention’ on the family environment of young people referred to Child and Adolescent Mental Health Services. A pre‐ and post‐design was used, with families completing the Family Survey before and after their assessment/intervention. The Family Survey was correlated with a validated measure of family function, the APGAR, and pre‐intervention. Significant changes in multiple dimensions of family environment, including reduced level of distress for the adult, increased level of distress for the young person, improved sense of how the family felt the adult was managing currently, and improved confidence in family communication were found. There was no significant change in how the adult understood their role in helping the young person manage their distress. A thematic analysis showed trends in the current concerns for young people and adults as well as the difficulty young people in distress have in identifying their strengths. This pilot study demonstrates that the ‘Safety First Assessment Intervention’ can influence the family environment in a positive way and highlights the importance of using a family‐based approach for distressed young people.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

Young

Conrad²,

Mah³

2019

ANZ J of Family Therapy

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“…Forty studies were further excluded because of identical or overlapping patient samples. A total of 115 studies reporting 167 samples were included in the meta‐analysis (SM 2, Table of Included Studies, and SM 3 Data used in meta‐analysis). The samples included 46 samples of females, 46 samples of males and 75 samples of both sexes.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Wang

Swaraj

Chung

et al. 2019

Acta Psychiatr Scand

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analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours.Objective: To quantify the suicide rate among people discharged from nonpsychiatric settings after presentations with suicidal thoughts or behaviours. Method: Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. Results: A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I 2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). Conclusions: People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades. Summations• The pooled suicide rate among patients with suicidal thoughts or behaviours following discharge from a non-psychiatric setting was 483 per 100 000 person-years (95% CI 445-520).• Suicide rates were lower among samples of younger people (<25 years of age) and among more recently published studies, but were higher in the first year after discharge, among older people (>55 years of age), and men.• All patients presenting to emergency departments and general hospitals with suicidal thoughts or behaviours warrant a careful assessment and individualized treatment planning. Considerations• High between-study heterogeneity limits the extent to which the results can be regarded as generalizable.• The meta-analysis could not examine a range of clinical factors that might contribute to variation in suicide rates.• Few studies from low-and middle-income countries could be included.

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“…Four additional articles were identified through the reference lists and from the sharing of other researchers. The remaining articles were screened for abstract and 27 articles were examined for full-text (Cotgrove et al, 1995; Harrington et al, 1998; Wood et al, 2001; Spirito et al, 2002; Huey et al, 2004; Donaldson et al, 2005; King et al, 2006, 2009; Chanen et al, 2008; Hazell et al, 2009; Schuppert et al, 2009, 2012; Diamond et al, 2010; Asarnow et al, 2011, 2017; Esposito-Smythers et al, 2011; Green et al, 2011; Ougrin et al, 2011, 2013; Rossouw and Fonagy, 2012; Alavi et al, 2013; Hughes and Asarnow, 2013; Pineda and Dadds, 2013; Mehlum et al, 2014, 2016; Goodyer et al, 2017; Wharff et al, 2017). A summary of the process is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 16 articles met full inclusion criteria as randomized controlled trials of adolescents with self-harm of suicidality as primary presenting problem (Harrington et al, 1998; Wood et al, 2001; Spirito et al, 2002; Donaldson et al, 2005; Chanen et al, 2008; Hazell et al, 2009; Schuppert et al, 2009, 2012; Diamond et al, 2010; Asarnow et al, 2011; Esposito-Smythers et al, 2011; Green et al, 2011; Ougrin et al, 2011; Rossouw and Fonagy, 2012; Mehlum et al, 2014; Wharff et al, 2017). Four of the studies did not report the data in the format required and hence were not included in the meta-analysis (Schuppert et al, 2009, 2012; Rossouw and Fonagy, 2012; Wharff et al, 2017). The characteristics of the included 12 studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Treatment Engagement in Specific Psychological Treatment vs. Treatment as Usual for Adolescents With Self-Harm: Systematic Review and Meta-Analysis

2019

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Background: Self-harm is a major public health problem. It is one of the best predictors of suicide in adolescents. Despite recent advances in the understanding of self-harm, poor treatment engagement remains a significant clinical obstacle.Objectives: The purpose of this meta-analysis is to update and extend previous research investigating treatment engagement with specific psychological treatments (SPT) vs. treatment as usual (TAU) in adolescents who self-harm.Methods: Data sources were identified by searching the Medline, PsychINFO, EMBASE, and PubMed databases as of October 2017. Randomized Controlled Trials (RCTs) comparing SPT and TAU in adolescents (through age 18 years) with self-harm were included.Results: The results show that 12 RCTs investigating 1,255 young people were included in the meta-analysis. The proportion of adolescents not completing four or more sessions in SPT was significantly lower (28.4%, 179/630) than TAU (45.9%, 287/625), RR = 0.64 (95% CI:0.51 −0.79), p < 0.0001. There were significantly more adolescents engaged with SPT than TAU.Conclusions: Specific psychological treatments should be offered to adolescents with self-harm to maximize treatment engagement. Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment goals.

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Family-Based Crisis Intervention With Suicidal Adolescents

Abstract: Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.

Cited by 41 publications

References 23 publications

A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Treatment Engagement in Specific Psychological Treatment vs. Treatment as Usual for Adolescents With Self-Harm: Systematic Review and Meta-Analysis

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