Suicide during Transition of Care: a Review of Targeted Interventions

Chaudhary, Amna Mohyud Din; Memon, Raheel Imtiaz; Dar, Sabrina K; Bhullar, Darmant Kaur; Dar, Kamil Rehmani; Sattar, Naveed

doi:10.1007/s11126-020-09712-x

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…The early decline in the trajectory of increasing suicidal ideation may be due to feeling supported, response to treatment, a better understanding of their psychotic experience, etc. Similarly, the increase at the end of follow-up may be explained by various factors related to this period: changes in the therapeutic relationship, transition between services and lack of continuity in care, 27 continued disability, relapse, 28 etc. Further studies, including qualitative ones, are needed to understand this increase, and more generally, how factors, such as stigma, 29 perceived control and the understanding and meaning given to the psychotic experience, may influence both recovery 30 – 32 and suicide risk in FEP.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study

Sicotte

Iyer²,

Lacourse

et al. 2023

Can J Psychiatry

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Objectives Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. Method This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners’ reports in 382 FEP patients [mean age = 23.53 ( SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Results Three suicidal ideation trajectories were identified: low and decreasing ( n = 325, 85.08%); early decline, then increasing ( n = 30, 7.85%), and persistent suicidal ideation ( n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Conclusions Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group.

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Section: Discussionmentioning

confidence: 99%

Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study

Sicotte

Iyer²,

Lacourse

et al. 2023

Can J Psychiatry

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“…Notably, increasing suicidal ideation has been observed in a subgroup of FEP patients by all three trajectory studies (including ours), regardless of the duration of follow-up. Transitions and lack of continuity in care can be risk factors for suicide (16). Feeling dependent on and not ready to be discharged from EIS could lead to distress (17).…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in the course of suicidal ideation and its relation to suicide attempts in first-episode psychosis: a five-year prospective study

Sicotte

Iyer

Lacourse

et al. 2022

Preprint

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Introduction : Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation with suicide attempts. Therefore, we aimed to identify five-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. Methods This five-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners’ reports in 382 FEP patients [mean age = 23.53(SD = 3.61)] admitted to two five-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Results Three suicidal ideation trajectories were identified: low and decreasing (85.08%); early decline, then increasing (7.85%), and persistent suicidal ideation (7.07%). Suicidal ideation prior to admission (OR = 2.85,p < 0.05) and cocaine use disorder (OR = 6.78,p < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33,p < 0.05) and attempts (OR = 8.18,p < 0.001) and alcohol use disorder (OR = 3.63, p < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Conclusion Our study highlights heterogeneity in the course of suicidal ideation over five years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly during periods of transition to other services and for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increased or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions.

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“…We included studies that described treatment within EDs or psychiatric wards, including those that started in the ED and continued in inpatient settings. We excluded interventions that were commenced in the ED and continued in outpatient settings, e.g., brief courses of therapy because reviews of these already exist (Chaudhary et al, 2020; Johnston et al, 2019; McCabe et al, 2018; Ougrin et al, 2012; Wilson et al, 2020). We excluded bNPIs conducted on non-psychiatric (medical) wards; although these patients may well be in crisis, we expected that the interventions would be different due to the lack of mental health trained staff.…”

Section: Methodsmentioning

confidence: 99%

“…There are systematic reviews that evaluate brief pharmacological treatment for mental health crises in the ED showing, e.g., that ketamine, droperidol and midazolam are the safest options for managing severe agitation (deSouza et al, 2022). There are systematic reviews of longer-term NPIs started in the ED that are then continued in the outpatient setting, despite the very great differences between environments (Chaudhary et al, 2020; Johnston et al, 2019; McCabe et al, 2018; Ougrin et al, 2012; Wilson et al, 2020) which indicate that NPIs such as green or gold card clinics and postcards to people after self-harm attempts may show potential in reducing suicide and suicide attempts. Other reviews have evaluated environmental interventions in the ED (MohammadiGorji et al, 2021) showing that environment plays a central role in mitigating aggression, service-wide interventions (Baker et al, 2021) showing great need for better systems to manage restrictive practices, psychological therapies on adult inpatient units (Jacobsen et al, 2018) showing that inpatient research lacks rigour and organisation, and the evidence for environment, policy and practice changes addressed acute severe behavioural disturbance in the ED (Weiland et al, 2017) demonstrating a deficit in research surrounding acute severe behavioural disturbance.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of brief non-pharmacological interventions in emergency departments and psychiatric inpatient units for people in crisis: A systematic review and narrative synthesis

Huber,

Milton,

Brewer

et al. 2023

Aust N Z J Psychiatry

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Objective: Heterogeneous brief non-pharmacological interventions and guidelines exist to treat the burgeoning presentations to both emergency department and inpatient settings, for those in a crisis of mental ill-health. We systematically reviewed the literature to create a taxonomy of these brief non-pharmacological interventions, and review their evaluation methods and effectiveness. Method: We conducted a systematic review across Cochrane, CINAHL, DARE, Embase, MEDLINE, PsycINFO databases. Studies meeting quality criteria, using Joanna Briggs Institute tools, were eligible. Interventions were categorised, and outcomes synthesised. Results: Thirty-nine studies were included: 8 randomised controlled trials, 17 quasi-experimental, 11 qualitative studies, and 3 file audits. Taxonomy produced six coherent intervention types: Skills-focussed, Environment-focussed, Special Observation, Psychoeducation, Multicomponent Group and Multicomponent Individual. Despite this, a broad and inconsistent range of outcome measures reflected different outcome priorities and prevented systematic comparison of different types of intervention or meta-analysis. Few brief non-pharmacological interventions had consistent evidential support: sensory modulation rooms consistently improved distress in inpatient settings. Short admissions may reduce suicide attempts and readmission, if accompanied by psychotherapy. Suicide-specific interventions in emergency departments may improve depressive symptoms, but not suicide attempt rates. There was evidence that brief non-pharmacological interventions did not reduce incidence of self-harm on inpatient wards. We found no evidence for frequently used interventions such as no-suicide contracting, special observation or inpatient self-harm interventions. Conclusion: Categorising brief non-pharmacological interventions is feasible, but an evidence base for many is severely limited if not missing. Even when there is evidence, the inconsistency in outcomes often precludes clinicians from making inferences, although some interventions show promise.

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Suicide during Transition of Care: a Review of Targeted Interventions

Cited by 7 publications

References 43 publications

Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study

Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study

Heterogeneity in the course of suicidal ideation and its relation to suicide attempts in first-episode psychosis: a five-year prospective study

The effectiveness of brief non-pharmacological interventions in emergency departments and psychiatric inpatient units for people in crisis: A systematic review and narrative synthesis

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