Caring Contacts to Reduce Psychiatric Morbidity Following Hospitalization During the COVID-19 Pandemic: A Pilot Randomized Controlled Trial.

OBJECTIVES: Caring Contacts are an emerging intervention that aims to reduce distress and suicide risk after acute psychiatric care. This trial aimed to determine whether, during a pandemic, there was any evidence that the mental health benefits and reduction in suicidal ideation (SI) associated with delivering Caring Contacts to recently discharged psychiatric patients were greater than a control communication. The secondary objective was to identify whether the predicted benefits were greater among people living alone or those diagnosed with depression. METHOD: A single-site pilot randomized clinical trial (n = 100), with patients recruited from the adult Inpatient Psychiatry Unit at Sunnybrook Health Sciences Centre, Toronto, Canada between August 2020 and May 2021. Participants were randomized (1:1) to the Caring Contact or control group. Participants received three Caring Contact or control communications via email or mail (on days 4, 21, and 56 post-discharge). Mental health symptoms were assessed using the self-report Hopkins Symptom Checklist-25 (HSCL-25) scores at discharge (baseline) and when participants received each communication. Analysis of variance was used for the primary comparisons and exploratory analyses for subgroups. RESULTS: Both groups experienced a significant worsening of mental health symptoms at all time points post-discharge relative to baseline. There were no significant differences between groups at any time point, however, on day 4 there was a 24.2% and 72.6% attenuated worsening in the Caring Contact group compared to the control group for total symptom severity and SI, respectively. There was no significant interaction effect for the depression subgroup or those living alone. CONCLUSIONS: While this pilot study was not powered to identify significant differences between groups, results are indicative of feasibility and acceptability of the intervention and provide some indication that Caring Contacts may have benefited patients in the days following discharge, supporting the need for larger-scale trials. The study was registered with clinicaltrials.gov (study ID NCT04456062). Abrégé. OBJECTIFS: Les contacts attentionnés sont une nouvelle intervention qui vise à réduire le risque de détresse et de suicide après des soins intensifs psychiatriques. Le présent essai visait à déterminer si, durant une pandémie, des données probantes indiquaient que les avantages pour la santé mentale et la réduction de l'idéation suicidaire (IS) associés à la prestation de soins attentionnés à des patients psychiatriques récemment mis en congé étaient plus puissants que le contrôle des communications. L'objectif secondaire était d'identifier si les avantages escomptés étaient plus grands chez les personnes vivant seules ou chez celles où la dépression était diagnostiquée. MÉTHODE: Un essai clinique randomisé (n = 100) d'un seul site, dont les patients étaient recrutés à l'Unité de psychiatrie pour patients hospitalisés adultes du Centre des sciences de la santé Sunnybrook de Toronto, Canada, entre août 2020 et mai 2021. Les participants ont été randomisés (1:1) aux Contacts attentionnés ou au groupe témoin. Les participants ont reçu trois communications des Contacts attentionnés ou des témoins par courriel ou courrier (aux jours 4, 21, 56 après-congé). Les symptômes de santé mentale ont été évalués à l'aide des scores auto-déclarés à la liste de contrôle des symptômes de Hopkins-25 (HSCL-25) au congé (à la base) et quand les participants ont reçu chaque communication. ANOVA a été utilisée pour les comparaisons primaires, et les analyses exploratoires pour les sous-groupes. RÉSULTATS: Les deux groupes ont connu une aggravation significative des symptômes de santé mentale à différents moments après le congé relativement à la base. Il n'y avait pas de différences significatives entre les groupes à tout moment, cependant au jour 4 il y avait une aggravation atténuée de 24,2% et de 72,6% dans le groupe des Contacts attentionnés comparé au groupe témoin pour la gravité totale des symptômes et les IS respectivement. Il n'y avait pas d'effet d'interaction significatif pour le sous-groupe de la dépression ou de ceux vivant seuls. CONCLUSIONS: Bien que cette étude pilote n'ait pas été mandatée pour identifier les différences significatives entre les groupes, les résultats indiquent la faisabilité et l'acceptabilité de l'intervention et offrent certaines indications à l'effet que Contacts attentionnés puissent avoir été bénéfiques pour les patients dans les jours suivant le congé, appuyant ainsi le besoin d'essais à plus grande échelle. L'étude a été enregistrée à clinicaltrials.gov (ID de l'étude NCT04456062).

The association of social, economic, and health-related variables with suicidal and/or self-harm thoughts in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic: An exploratory study.

Individuals with pre-existing psychiatric diagnoses appear to be vulnerable to worsening mental health symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Furthermore, psychiatric hospitalizations during the pandemic may be complicated by increased risk of SARS-Cov-2 infection and limited social engagement due to changes in hospital policies. The objective of our exploratory study was to determine whether social, economic, and health-related variables were associated with thoughts of suicide and/or self-harm since March 2020 in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic. Chi-square tests revealed four variables were significantly associated with thoughts of suicide and/or self-harm: 1) difficulty with cancellation of important events, 2) some form of loneliness, 3) decreased time spent in green spaces, and 4) increased time spent using devices with screens. The logistic regression model showed a significant association between suicidal and/or self-harm thoughts and cancellation of important events. Further investigation of the loneliness variable components revealed a significant association between suicidal and/or self-harm thoughts and feeling a lack of companionship, feeling isolated, and feeling alone. These results suggest that social challenges experienced during the pandemic were associated with negative mental health symptoms of individuals admitted to a psychiatric inpatient unit.

Cross-sectional survey of the Mental health and Addictions effects, Service impacts and Care needs of children, youth and families during the COVID-19 pandemic: the COVID-19 MASC study protocol.

INTRODUCTION: The COVID-19 pandemic has had a tremendous negative effect on the mental health and well-being of Canadians. These mental health challenges are especially acute among vulnerable Canadian populations. People living in Canada's most populous province, Ontario, have spent prolonged time in lockdown and under public health measures and there is a gap in our understanding of how this has impacted the mental health system. This protocol describes the Mental health and Addictions Service and Care Study that will use a repeated cross-sectional design to examine the effects, impacts, and needs of Ontario adults during the COVID-19 pandemic. METHODS AND ANALYSIS: A cross-sectional survey of Ontario adults 18 years or older, representative of the provincial population based on age, gender and location was conducted using Delvinia's AskingCanadians panel from January to March 2022. Study sample was 2500 in phases 1 and 2, and 5000 in phase 3. The Alcohol, Smoking and Substance Involvement Screening Test and Diagnostic Statistical Manual-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult were used to assess for substance and mental health concerns. Participants were asked about mental health and addiction service-seeking and/or accessing prior to and during the pandemic. Analyses to be conducted include: predictors of service access (ie, sociodemographics, mental illness and/or addiction, and social supports) before and during the pandemic, and χ2 tests and logistic regressions to analyse for significant associations between variables and within subgroups. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Sunnybrook Research Ethics Board. Dissemination plans include scientific publications and conferences, and online products for stakeholders and the general public.

The BEACON study: an update to the protocol for a cohort study as part of an evaluation of the effectiveness of smartphone-assisted problem-solving therapy in men who present with intentional self-harm to emergency departments in Ontario.

BACKGROUND: Men who present to the emergency department (ED) with self-harm are at high risk of dying by suicide, with 2.7% of men dying in the year following their presentation, more than double the rate for women (1.2%). Despite this, care received after an ED visit is highly variable and many are not assessed for psychological needs. Furthermore, the limited psychological care that is available is often not covered by provincial health insurance. Even when referrals for follow-up care are made, engagement rates are low. Previous recommendations to improve engagement include written discharge plans, caring contacts, and focused interventions targeting middle-aged men at elevated risk of dying by suicide. Blended care, the incorporation of technology into traditional care, has also been proposed as a method to increase engagement in and clinical benefits from psychotherapy. This project aims to determine whether the delivery of an evidence based treatment (problem-solving therapy (PST)) is enhanced by the addition of a custom smartphone application (BEACON) compared to usual care. Due to the impact of the COVID-19 pandemic on site participation and the planned implementation, we have made several changes to the study design, primary outcome, and implementation. METHOD: We originally proposed a cohort study nested within a larger cluster randomized trial wherein intervention sites would deliver the blended care, and control sites, whose personnel were not aware of their participation, would continue delivering usual care. The cohort study evaluated participant level outcomes as previously described by Hatcher et al. (2020). Due to pandemic-related constraints, our number of participating sites dropped to five potential sites which left the cohort study underpowered. As such, we changed the study design to a multi-site, individual randomized controlled trial (RCT) among the five remaining sites. Participants will be randomized to six sessions of therapy (PST) alone, or to the therapy plus BEACON, and followed up for 6 months. Our primary outcome was changed to evaluate feasibility and acceptability with the aim of designing a definitive RCT. Study implementation was reimagined to allow for completely virtual/online conduct to comply with local COVID-19 and institutional restrictions on in-person activities. CONCLUSION: This updated protocol will provide strong results for the planning of a definitive RCT of the blended care intervention in the future, addressing areas of difficulty and concern prior to its implementation. We will evaluate the feasibility of the study intervention, assess recruitment and retention of participants, and address challenges with implementing the protocol. Lastly, we will evaluate the appropriateness of our primary outcome measure and accurately determine a sample size for a definitive RCT. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03473535 . Registered on March 22, 2018.

Implementing the STEADY Wellness Program to Support Healthcare Workers throughout the COVID-19 Pandemic.

The COVID-19 pandemic has posed an ongoing threat to the mental wellbeing of countless individuals worldwide, with healthcare workers at particularly high risk. We developed the STEADY staff wellness program prior to the pandemic based on the available literature and input from stakeholders, guided by the Knowledge-to-Action (KTA) Implementation Science Framework. We quickly adapted the STEADY program for implementation in selected high-need units within Canada's largest trauma hospital during the pandemic's first wave. This brief report describes implementation of the STEADY program, retroactively applying the structure of the Knowledge-to-Action Implementation Science Framework to the practical steps taken. We identified the importance of more frequent, shorter contact with HCWs that occurred in-person, with an emphasis on peer support. A flexible approach with strong support from hospital leadership were key facilitators. Our findings suggest that a flexible approach to practical program implementation, theoretically underpinned in best-practices, can result in an acceptable program that promotes increased HCW wellbeing during a pandemic.

SARS-CoV-2 Infection and the Risk of Suicidal and Self-Harm Thoughts and Behaviour: A Systematic Review.

OBJECTIVE: The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly. METHOD: As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded. RESULTS: We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour. CONCLUSIONS: This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.

Systematic review of the impact of the COVID-19 pandemic on suicidal behaviour amongst health and social care workers across the world.

BACKGROUND: The COVID-19 pandemic has had an impact on the mental health of healthcare and social care workers, and its potential effect on suicidal thoughts and behaviour is of particular concern. METHODS: This systematic review identified and appraised the published literature that has reported on the impact of COVID-19 on suicidal thoughts and behaviour and self-harm amongst healthcare and social care workers worldwide up to May 31, 2021. RESULTS: Out of 37 potentially relevant papers identified, ten met our eligibility criteria. Our review has highlighted that the impact of COVID-19 has varied as a function of setting, working relationships, occupational roles, and psychiatric comorbidities. LIMITATIONS: There have been no completed cohort studies comparing pre- and post-pandemic suicidal thoughts and behaviours. It is possible some papers may have been missed in the search. CONCLUSIONS: The current quality of evidence pertaining to suicidal behaviour in healthcare workers is poor, and evidence is entirely absent for those working in social care. The clinical relevance of this work is to bring attention to what evidence exists, and to encourage, in practice, proactive approaches to interventions for improving healthcare and social care worker mental health.

Suicide and resilience-related Google searches during the first 12 months of the COVID-19 pandemic.

Online searches related to suicide may sometimes be an early proxy indicator for behavioural outcomes. We used interrupted time series regression analyses to examine changes in suicide and resilience-related Google searches worldwide and in the United States during the first 12 months of the COVID-19 pandemic. Searches for the word "suicide" were unchanged worldwide (-1%; 95%CI, -12%-11%) and in the US (-7%; 95%CI, -15%-2%) with decreased searches for "suicide methods" and increased searches for "how to kill yourself" and for resilience-related terms. This study provides potential evidence that suicides may not increase worldwide during the first year of the pandemic.

Innovations in suicide assessment and prevention during pandemics.

Emerging evidence, based on the synthesis of reports from past infectious disease-related public health emergencies, supports an association between previous pandemics and a heightened risk of suicide or suicide-related behaviours and outcomes. Anxiety associated with pandemic media reporting appears to be one critical contributing factor. Social isolation, loneliness, and the disconnect that can result from public health strategies during global pandemics also appear to increase suicide risk in vulnerable individuals. Innovative suicide risk assessment and prevention strategies are needed to recognise and adapt to the negative impacts of pandemics on population mental health.

Suicide Risk and Prevention During the COVID-19 Pandemic: One Year On.

Emerging data from high and upper-middle-income countries indicate that suicide rates generally did not increase during the initial months of the COVID-19 pandemic, yet the pandemic's impact on suicide is complex. We discuss the nuances of this relationship, how it may evolve over time, and describe the specific steps that governments and societies must take to mitigate harm and prevent suicides in the late stages and aftermath of the pandemic.

The Impact of a Harry Potter-Based Cognitive-Behavioral Therapy Skills Curriculum on Suicidality and Well-being in Middle Schoolers: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of a Harry Potter-based mental health literacy curriculum, imparting cognitive behavioral therapy (CBT) skills, on suicidality and well-being in middle-schoolers. METHODS: Students (aged 11-14; grades 7-8) who received a 3-month teacher-delivered intervention embedded in the language arts curriculum (N=200) were compared to a wait-list control group (N=230) in the largest urban school board in Canada. Suicidality defined as a composite measure of self-reported suicidal ideation and attempts [primary outcome], self-reported emotion dysregulation, interpersonal chaos, confusion about self, and impulsivity [Life Problems Inventory (LPI)] and self-reported depression and anxiety symptoms [Revised Child Anxiety and Depression Scale (RCADS)] were the outcomes of interest. Measurements occurred prior to and after curriculum delivery with independent t-tests used to compare mean change scores between groups clustered by class. RESULTS: Thirty-seven English teachers in 46 classes across 15 schools comprised the planned study cohort. Composite suicidality scores were significantly worse in the control than intervention group at endpoint (0.05±0.54 vs. 0.17±0.47, t= -2.60, df=428, p=0.01). There were also significant improvements in LPI and RCADS scores in the intervention group compared to controls (LPI:-3.74±7.98 vs. 1.16±10.77 t=5.28, df=428, p<.001; RCADS: (-3.08±5.49 vs. -1.51±6.53 t=2.96, df=429, p=0.01). Sub-analyses revealed that these improvements were largely driven by a significant difference in scores in girls. LIMITATIONS: Sample size constraints as study terminated prematurely during COVID pandemic. CONCLUSIONS: This study demonstrates significant improvement in suicidality, emotional regulation, self-concept, interpersonal difficulties, depression and anxiety in youth, particularly girls following this intervention. Replication studies in larger samples are needed to confirm these results.

The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts.

Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13-16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

Tracking online searches for emotional wellbeing concerns and coping strategies in the UK during the COVID-19 pandemic: a Google Trends analysis [version 1;peer review: awaiting peer review]

Background: The coronavirus disease 2019 (COVID-19) pandemic is the largest acute public health emergency of this century. Government intervention to contain the virus focuses on non-pharmacological approaches such as physical distancing/lockdown (stay-at-home orders). As the situation develops, the impact of these measures on mental health and coping strategies in individuals and the population is unknown. Methods: We used Google Trends data (01 Jan 2020 to 09 Jun 2020) to explore the changing pattern of public concern in the UK to government measures as indexed by changes in search frequency for topics related to mental distress as well as coping and resilience. We explored the changes of specific topics in relation to key dates during the pandemic. In addition, we examined terms whose search frequency increased most. Results: Following lockdown, public concerns - as indexed by relative search trends - were directly related to COVID-19 and practicalities such as ‘furlough’ (paid leave scheme for people in employment) in response to the pandemic. Over time, searches with the most substantial growth were no longer directly or indirectly related to COVID-19. In contrast to relatively stable rates of searches related to mental distress, the topics that demonstrated a sustained increase were those associated with coping and resilience such as exercise and learning new skills. Conclusions: Google Trends is an expansive dataset which enables the investigation of population-level search activity as a proxy for public concerns. It has potential to enable policy makers to respond in real time to promote adaptive behaviours and deliver appropriate support.