Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior;and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p <.001) and NSSI (past 6 months, 64% vs. 39%, p <.001);less depression, anxiety, posttraumatic stress, and substance use;and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p <.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.Copyright © 2023 Society of Clinical Child and Adolescent Psychology.

Introduction to part IV: Special topics for health promotion

This section presents diverse themes related to health promotion in online, hybrid, or face-to-face experiences. Mental health, care sensitive to indigenous cultures, integrative and complementary practices, suicide prevention, and interprofessional education are relevant issues. The authors provide a critical discussion related to teaching, research, and community relations. Thus, they emphasize the relevant role of universities, research institutions, and partnerships with local communities to ensure an educational process committed to developing skills that promote the health and well-being of individuals, specific groups, and the population. The authors consider the challenges, potentials, and limits of these actions in the context of the coronavirus disease 2019 (COVID-19) pandemic. The six chapters offer a variety of innovative, creative, and collaborative strategies to strengthen the incorporation of knowledge, values, attitudes, and practices associated with the fields, concepts, and principles of health promotion. The writings shared in the chapters of Part 4: Topics of Health Promotion may broaden horizons on possible paths and choices to build educational processes based on active, participatory, critical, and reflective models coherent with health promotion. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Suicide and Telehealth Treatments: A PRISMA Scoping Review.

BACKGROUND: This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). AIM: The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). METHOD: To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. RESULTS: Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. LIMITATIONS: Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. CONCLUSION: Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond.

Interprofessional Suicide Prevention Education.

The COVID-19 pandemic has raised concerns regarding possible spikes in suicidal behavior in light of heightened risk factors such as social isolation and financial strain; thus, comprehensive suicide prevention training for emerging health service providers is increasingly vital. This article summarizes an interprofessional education (IPE) suicide prevention course delivered in-person in Spring 2020. Pilot data demonstrate that despite the impact of COVID-19 on higher education, this course had long-term impacts on trainee suicide prevention efficacy, IPE attitudes, and use of course content in practice. Discussion serves to address enhancements for interprofessional and suicide prevention education during and after the pandemic. Emphasis is placed on adaptable training strategies, considerations in the delivery format, guidelines for intensive virtual meetings with trainee teams, and future directions in IPE suicide prevention training research.

Developing and Implementing a Depression Screening and Referral Protocol Among College Students

Depression is prevalent among college students but remains underrecognized and undertreated. Evidence supports universal depression screening among college students combined with follow-up systems to ensure appropriate diagnosis and management. Screening tools may include versions of the Patient Health Questionnaire, and follow-up systems may include following up with the current provider or referring the student to a mental health specialist. The purpose of this quality improvement project was to promote the identification of college students with depression and subsequent appropriate referrals.

Reducing Secondary Trauma and Promoting Self-Compassion Through a Graduate Medical Education (GME) Wellness Elective (Sch456)

Outcomes: 1. Explore the ways that palliative and mental health providers can collaborate to offer a novel, interdisciplinary wellness curriculum. 2. Evaluate impacts of a wellness course on secondary trauma, self-compassion, and burnout. Background(s): Palliative care and mental health providers possess skill sets that, when combined, can uniquely foster the well-being of colleagues within and beyond our specialties. The need for such peer support has become more urgent during the COVID pandemic. Self-care, compassion satisfaction, and trauma-informed training have been positively associated with an ability to cope with stressors in healthcare. We designed a 2-week GME elective intended to increase self-compassion and connection and reduce secondary trauma and burnout. Description: The course has been offered annually since 2019 to cohorts of 12-15 trainees across 14 specialties. Trainees participated in-person (2019, 2021) and virtually (2020). Coursework includes psychological safety, burnout/suicide prevention, self-compassion, occupational trauma and recovery, expressive art, medical error, cultural humility/upstanding, narrative medicine, conflict resolution, mindfulness, and others. We sought to evaluate the impact of the elective on burnout, self-compassion, and secondary trauma using the Professional Quality of Life (PROQOL) survey in the 2021 cohort. We evaluated trainee satisfaction with the course in all three cohorts (2019-2021). Result(s): 1 month after the elective, trainees reported a reduction in secondary trauma (p<0.0001) and an increase in self-compassion (p<0.005). The effect on burnout was not significant (p=0.57). Over 3 years, 100% of trainees (n=43) strongly agreed that the course was worth their time. Participants reported the course gave them "skills to better tolerate distress about things I cannot change" as well as self-agency through connection: "My peers helped me find new power that I didn't know I had." Conclusion(s): We generated a curriculum that impacted self-compassion and secondary trauma. We did not see an effect on burnout, which could be related to returning to an unchanged stressful environment following the course. Expanding access to this curriculum would afford opportunities to assess impact on a larger scale.Copyright © 2023

A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers.

Suicide rates among veterans are higher than those of the general US population. Although veterans compose only 7.6% of the US population, nearly 14% of American adult suicides are among veterans. The rate of suicide is 1.5 times higher among all veterans and 2.1 times higher among female veterans compared with the general population. Only 47% of all veterans are enrolled in the US Department of Veterans Affairs (VA) Healthcare System, leaving a large number either not receiving health care or receiving it outside the VA. Recent legislation has improved access to care for veterans outside the VA, highlighting the need for a broad public health approach to address veteran suicide and the need for all health care institutions and clinicians to be familiar with the unique health concerns in this population. The purpose of this narrative review was to summarize the risk factors contributing to veteran suicide and to provide guidance on how to assess and mitigate these risks. Suicide is preventable through recognition of risk and prompt intervention. Health care providers both inside and outside the VA system are uniquely situated at the intersection of the many contributing factors to veteran suicide and should have a structured, proactive approach to address the problem.

Innovating for mental health and wellbeing among foundation year doctors

Fern Raven, advanced nurse (clinical) practitioner, explains how her role and its associated innovations have helped to improve mental health and wellbeing among foundation year doctors at her trust.

Increasing suicide awareness in nurse anesthesiology

Purpose: This Doctor of Nursing Practice (DNP) project aims to increase suicide and gatekeeper awareness among the University of Arizona nurse anesthesiology program clinical site coordinators through an educational presentation. Community-based gatekeeper training is one of the most widely used suicide prevention strategies, educating laypersons on how to recognize, approach, and support a person at risk of suicide.Background: Anesthesia providers have a greater risk of suicide than any other healthcare specialty, with certified registered nurse anesthetists (CRNAs) and resident registered nurse anesthetists (RRNAs) being significantly impacted. For example, 41.7% of RRNAs have reported symptoms of depression, and 21.2% reported suicidal ideation during their anesthesia education.Methods: This educational intervention quality improvement (QI) project aims to increase suicide awareness among the nurse anesthesiology clinical coordinators of the University of Arizona. The volunteer participants will be sent a previously recorded educational session and an accompanying PowerPoint via email. After viewing the educational session, participants will access the link embedded in the email to direct them to an anonymous retrospective pretest assessment survey. Results: Nine clinical coordinators participated in this QI project. A statistically significant improvement was seen overall and across all three survey subscales based on the Gatekeeper Behavior Scale. Also, all participants had found the educational intervention to be useful.Conclusions: Nurse anesthesiology clinical coordinator gatekeeper training effectively provides knowledge about RRNA suicide risks and warning signs, increases suicide prevention skills, and improves self-efficacy. The relevance of this topic continues to emerge with the untoward effects of COVID-19 and the addition of the practice doctorate in nurse anesthesiology education. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Suicide prevention: Global trends

Even before Covid-19 in 2020, why has suicide increased into a global crisis, and what can be done to reduce this? This chapter offers a panoramic overview of suicide: global trends, a focus on four diverse regions (Armenia, Haiti, Palestine, Nigeria), one case study, and methods of effective suicide intervention and prevention. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Suicide and autism: A lifespan perspective

People who are diagnosed with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behaviour compared to the general population;recent population-based studies demonstrate a three- to sevenfold increased risk of premature death by suicide. This chapter provides an overview of: (a) the current literature regarding risk and prevalence of suicide behaviour in autism;(b) the role of intellectual disability/intellectual developmental disorder in suicide in autism;(c) correlates, risk and protective factors;(d) dimensional constructs of suicide, including autistic traits;(e) current approaches to suicide assessment, including potential modifications;and (f) suicide prevention and service access. We consider these topics by drawing on state-of-the-art research, the perspective of lived experience, and consideration of the potential impacts of major events such as the coronavirus (COVID-19) pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Who benefits most from suicide prevention workshops in schools?

To improve suicide prevention in schools, we implemented workshops for students in grades 8-10. The students (N=200) were randomly assigned to either a training or a control group and were surveyed regarding their help-seeking and help-giving behavior and their depressive symptoms both before and after the training as well as 3 months later. The results indicate that especially those students assessed to be at a higher risk for suicide benefitted most from the training. Their number of depressive symptoms decreased significantly and remained stable. Participants undergoing the training tended to be more likely to ask a teacher for help and to initiate more crisis counseling interactions with peers in need than did untrained controls;these differences, however, were not statistically significant. Though hampered by high dropout rates because of the Covid-19 pandemic and a restrictive prescreening process, these results indicate the positive effects of an extracurricular suicide prevention program on students' well-being and behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Um die Suizidpravention an Schulen zu verbessern, wurden psychoedukative Workshops fur Schuler_innen implementiert und angeboten. N=200 Schuler_innen der 8.-10. Jahrgangsstufe wurden zufallig einer Experimental- oder Kontrollgruppe zugewiesen. Vor und nach dem Training sowie nach drei Monaten wurden sie zu ihrem hilfesuchenden und hilfegebendem Verhalten sowie ihrer depressiven Symptomatik befragt. Die Ergebnisse weisen darauf hin, dass besonders die als starker suizidgefahrdet eingestuften Jugendlichen von dem Training durch eine Abnahme ihrer depressiven Symptomatik profitierten. Schuler_innen der Kontrollgruppe verbesserten sich demgegenuber nicht signifikant in ihrer depressiven Symptomatik. Fur das hilfesuchende ebenso wie das hilfegebende Verhalten zeigten sich positive Trends, die jedoch nicht statistisch signifikant wurden. Diese Ergebnisse zeigen - wenn auch mit Limitationen aufgrund von Ausfallen durch die Coronapandemie 2020 und durch ein restriktives Vor-Screening - die Wirksamkeit einer aufwandigen auserschulischen Suizidpravention auf Befinden und Verhalten. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Non Suicidal Self Injury and Suicidal Behaviour: Indian Perspective

The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr Anitha Gautam will be talking about hidden epidemiology of suicide in India during COVID -19 pandemic. In India, for the past 5 years the number of deaths due to suicide has increased from approximately 1.3 lakhs in 2017 to 1.65 in 2021 (Suicide rate increasing from 9.9 to 12 per 1,00,000 population). Hence, there is need for developing a cost effective module which can address individual specific psychological stressors which are prevailing in Indian context. These psychological aspects can be delivered by non-specialist trained person. Dr.Hemendra Singh will discuss about association of Non- Suicidal Self Injury (NSSI) and suicide attempts among psychiatric patients based on his research and also need of developing a brief suicide prevention module for suicide attempters. As history of past suicide attempt is an important risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide. Dr Manaswi Gutam discusses on various strategies for suicide prevention along with highlights on NSSI. Dr Swati C would be discussing her experience of delivering brief intervention module for suicide prevention at a tertiary care hospital. Key Words: Non -Suicidal Self Injury, Suicide attempts, Psychiatric patients, Suicide Prevention.

The public health approach to suicide prevention in Ireland.

This article provides an overview of the public health approach to suicide in Ireland. The authors provide detail on the current suicide prevention strategy in Ireland, Connecting for Life, which is a whole-of-government, systemic, multicomponent national strategy. As the strategy enters its final extended phase of implementation over the period 2020-2024, the public health elements of Connecting for Life are presented, including the population level and more targeted approaches. The findings of an interim review of the strategy are discussed, in addition to the local and national implementation structures which are in place to assist implementation and monitoring of the strategy.

The adaptation of a community-based suicide prevention intervention during the COVID19 pandemic: a mixed method study

To investigate the outcomes of men using a community-based suicide prevention service before and during COVID-19 and to understand experiences of therapists for the rapid adaptation and delivery of the service throughout the pandemic. A mixed-methods approach using quantitative and qualitative data to assess the delivery of the intervention before and during the COVID-19 pandemic. The CORE-34 and CORE-10 Clinical Outcome Measures (CORE-OM) were used pre and post intervention to measure clinical change in psychological distress for the men engaged with the service. Six therapist interviews were used to supplement this data for the purposes of understanding the delivery of the service remotely during the pandemic. Data was collected between 1 August 2018 and 1 November 2021 (n = 1115). Interview data were conducted between March and May 2021. Across the cohort, for men who received therapy before (n = 450) or during the pandemic (n = 665), there was a statistically significant reduction in mean psychological distress scores between assessment and end of treatment (p < 0.001). Therapists adapted to delivering the hybrid model and discussed the barriers and facilitators to working this way. This study highlighted the effectiveness of the James' Place suicide prevention model in saving lives and managing to adapt during a global pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Physician suicide during the COVID-19 pandemic in Iran

Suicide is a significant and global public mental health problem. The suicide rate in Iran is disturbingly high;it has been reported to be 5.3 per 100.000 individuals. A meta-analysis indicated that physicians were at risk, with a reported standardized mortality risk of 1.44%. The rate of suicide has also been reported to be increasing in residents, in addition to a higher rate in senior specialists. Several possible suicides among Iran's resident doctor population have occurred in a short period, underlining the vital need for suicide prevention initiatives. (PsycInfo Database Record (c) 2023 APA, all rights reserved)