Using Voice Biomarkers to Classify Suicide Risk in Adult Telehealth Callers: Retrospective Observational Study.

BACKGROUND: Artificial intelligence has the potential to innovate current practices used to detect the imminent risk of suicide and to address shortcomings in traditional assessment methods. OBJECTIVE: In this paper, we sought to automatically classify short segments (40 milliseconds) of speech according to low versus imminent risk of suicide in a large number (n=281) of telephone calls made to 2 telehealth counselling services in Australia. METHODS: A total of 281 help line telephone call recordings sourced from On The Line, Australia (n=266, 94.7%) and 000 Emergency services, Canberra (n=15, 5.3%) were included in this study. Imminent risk of suicide was coded for when callers affirmed intent, plan, and the availability of means; level of risk was assessed by the responding counsellor and reassessed by a team of clinical researchers using the Columbia Suicide Severity Rating Scale (=5/6). Low risk of suicide was coded for in an absence of intent, plan, and means and via Columbia suicide Severity Scale Ratings (=1/2). Preprocessing involved normalization and pre-emphasis of voice signals, while voice biometrics were extracted using the statistical language r. Candidate predictors were identified using Lasso regression. Each voice biomarker was assessed as a predictor of suicide risk using a generalized additive mixed effects model with splines to account for nonlinearity. Finally, a component-wise gradient boosting model was used to classify each call recording based on precoded suicide risk ratings. RESULTS: A total of 77 imminent-risk calls were compared with 204 low-risk calls. Moreover, 36 voice biomarkers were extracted from each speech frame. Caller sex was a significant moderating factor (ß=-.84, 95% CI -0.85, -0.84; t=6.59, P<.001). Candidate biomarkers were reduced to 11 primary markers, with distinct models developed for men and women. Using leave-one-out cross-validation, ensuring that the speech frames of no single caller featured in both training and test data sets simultaneously, an area under the precision or recall curve of 0.985 was achieved (95% CI 0.97, 1.0). The gamboost classification model correctly classified 469,332/470,032 (99.85%) speech frames. CONCLUSIONS: This study demonstrates an objective, efficient, and economical assessment of imminent suicide risk in an ecologically valid setting with potential applications to real-time assessment and response. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12622000486729; https://www.anzctr.org.au/ACTRN12622000486729.aspx.

National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff.

OBJECTIVES: This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff. METHODS: A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. RESULTS: On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. CONCLUSIONS: Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. CLINICAL IMPLICATIONS: This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

Phase-based approaches for treating complex trauma: a critical evaluation and case for implementation in the Australian context

Phase-based approaches are a recommended treatment option for individuals with complex trauma histories;however, this is based on a limited body of empirical evidence. Phase-based approaches often involve two stages of treatment, with one focusing on safety and stabilisation and phase two on trauma memory processing. Historically, the Australian Better Access Scheme offered a government rebate for up to 10 group and 10 individual psychological sessions annually. In response to the coronavirus pandemic, the number of rebated individual sessions has been increased to 20 through June 2022. Combining individual and group session rebates, phase-based approaches that include both treatment modalities represent a feasible and accessible treatment option for complex trauma. Delivering phase one in a group milieu and providing individual treatment during phase two may be cost effective and optimise outcomes by leveraging the benefits of group and individual treatment for complex trauma. This article aims to provide an overview of the psychological impact of complex trauma, to highlight barriers to seeking mental healthcare, and to critically evaluate phase-based approaches for treating complex trauma. We highlight gaps in the research, followed by a discussion regarding the benefits and limitations of using this approach in the Australian mental health care system. <bold>Key points</bold> <bold>What is already known about this topic:</bold> (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care. (2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment. (3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support. (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care.(2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment.(3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support. <bold>What this topic adds:</bold> (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach. (2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually. (3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care. (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach.(2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually.(3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care. [ABSTRACT FROM AUTHOR] Copyright of Australian Psychologist is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Videoconferencing psychotherapy for couples and families: A systematic review.

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.

Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems.

PURPOSE: The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD: Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS: Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS: Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS: Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.