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1.
Adm Policy Ment Health ; 51(1): 47-59, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37861855

ABSTRACT

Suicide prevention training programs have spread rapidly within child and public-serving organizations, due to the alarming increase in youth suicide rates. Yet, within these organizations, roles and responsibilities can shape attitudes and intentions related to suicide prevention, thereby influencing the uptake of prevention efforts. As such, various organizational and individual factors can predict uptake, adoption, and maintenance of prevention efforts (Fixsen et al., 2005). To date, few studies have examined the service delivery context in understanding training effectiveness, especially as it relates to QPR (Question Persuade and Refer), one of the most widely disseminated suicide prevention gatekeeper programs. The purpose of this longitudinal study was to evaluate whether individual and organizational characteristics influenced the effectiveness and sustainability of training outcomes, and whether such differences existed among diverse child and public-serving delivery sectors. Several training outcomes that align with the Theory of Planned Behavior (Ajzen, 1991) were examined, including confidence, attitudes, social norms, and suicide prevention behaviors. Measures were assessed prior to and 90 days after the QPR program among a sample of 858 professionals. Community support personnel uniquely showed improvements on social norms while juvenile justice and child welfare workers engaged in more suicide prevention behaviors post training. While trainees across sectors had improved suicide prevention attitudes, law enforcement personnel were the exception. Organizational climate predicted change in suicide prevention attitudes, confidence, and social norms. Trainees who were older, Latinx, and Black had the most improvement on several training outcome variables, but these findings also varied within service sectors.


Subject(s)
Suicide Prevention , Suicide , Adolescent , Child , Humans , Longitudinal Studies , Program Evaluation , Inservice Training
2.
J Psychiatr Pract ; 28(3): 184-192, 2022 05 01.
Article in English | MEDLINE | ID: mdl-35511094

ABSTRACT

INTRODUCTION: The loss of a patient to suicide has an enormous impact on clinicians, but few studies have examined its effects. METHOD: In this retrospective study, we compared clinicians who have and have not experienced a patient suicide using a survey of 2157 outpatient clinicians from 169 New York clinics to determine differences in their suicide prevention knowledge, practices, training, and self-efficacy. RESULTS: Approximately 25% of the clinician respondents lost patients to suicide; psychiatrists, nurses/nurse practitioners, and those with more years of experience were disproportionately affected. After controlling for these demographic/professional differences, clinicians who had experienced patient suicide reported feeling that they had insufficient training, despite actually having more suicide prevention training, greater knowledge of suicide prevention practices, and feeling more comfortable working with suicidal patients than clinicians who had not lost a patient to suicide. There were no differences in self-efficacy or utilization of evidence-based clinical practices. CONCLUSIONS: Controlling for demographic/professional differences, clinicians who experienced a patient suicide had more training, knowledge, and felt more comfortable working with suicidal patients. It is critical that sufficient training be available to clinicians, not only to reduce patient deaths, but also to help clinicians increase their comfort, knowledge, skill, and ability to support those bereaved by suicide loss.


Subject(s)
Mental Health , Suicide Prevention , Suicide , Humans , Professional Practice , Retrospective Studies , Suicidal Ideation , Suicide/psychology
3.
School Ment Health ; 14(1): 125-135, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35273652

ABSTRACT

Suicidal thoughts and behaviors are highly prevalent among adolescents, and peers are often the first, and sometimes only, people to know about youth suicidality. Since many adolescents do not directly disclose suicidal thoughts, school-based suicide prevention programs aim to train youth to recognize warning signs of suicide in their peers that serve as "cues" to refer at-risk peers to an appropriate adult. However, peer-presented cues vary widely in presentation, and adolescents are more likely to recognize overt (i.e., obvious or explicit) as opposed to covert (i.e., hidden or implied) cues. The type of cue exhibited may, in turn, affect whether adolescents make a referral to an adult. The current study examined whether training suicide prevention influences referral intentions for overt and covert suicide cues. Participants included 244 high school students (54% female; M age = 16.21) in the Southeastern United States who received suicide prevention training (SOS; Signs of Suicide) as part of their health curriculum. Prior to training, students endorsed higher referral intentions for peers exhibiting overt compared to covert cues. Training was associated with increased intentions to refer peers across cue type, but referral intentions for covert cues improved significantly from pre to post-training while those for overt cues remained high and stable. Findings suggest that suicide prevention training might differentially improve students' ability to detect and respond appropriately to less obvious indicators of suicide risk. These findings may inform the adaptation and development of future, more nuanced school-based suicide prevention programming.

4.
J Affect Disord ; 299: 698-706, 2022 02 15.
Article in English | MEDLINE | ID: mdl-34813869

ABSTRACT

BACKGROUND: Behavioral health outpatients are at risk for self-harm. Identifying individuals or combination of risk factors could discriminate those at elevated risk for self-harm. METHODS: The study population (N = 248,491) included New York State Medicaid-enrolled individuals aged 10 to 64 with mental health clinic services between November 1, 2015 to November 1, 2016. Self-harm episodes were defined using ICD-10 codes from emergency department and inpatient visits. Multi-predictor logistic regression models were fit on a subsample of the data and compared to a testing sample based on discrimination performance (Area Under the Curve or AUC). RESULTS: Of N = 248,491 patients, 4,224 (1.70%) had an episode of intentional self-harm. Factors associated with increased self-harm risk were age 17-25, being female and having recent diagnoses of depression (AOR=4.3, 95%CI: 3.6-5.0), personality disorder (AOR=4.2, 95%CI: 2.9-6.1), or substance use disorder (AOR=3.4, 95%CI: 2.7-4.3) within the last month. A multi-predictor logistic regression model including demographics and new psychiatric diagnoses within 90 days prior to index date had good discrimination and outperformed competitor models on a testing sample (AUC=0.86, 95%CI:0.85-0.87). LIMITATIONS: New York State Medicaid data may not be generalizable to the entire U.S population. ICD-10 codes do not allow distinction between self-harm with and without intent to die. CONCLUSIONS: Our results highlight the usefulness of recency of new psychiatric diagnoses, in predicting the magnitude and timing of intentional self-harm risk. An algorithm based on this finding could enhance clinical assessments support screening, intervention and outreach programs that are at the heart of a Zero Suicide prevention model.


Subject(s)
Self-Injurious Behavior , Suicide , Adolescent , Adult , Female , Humans , Medicaid , Mental Health , New York/epidemiology , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/epidemiology , Young Adult
5.
Suicide Life Threat Behav ; 51(2): 325-333, 2021 04.
Article in English | MEDLINE | ID: mdl-33876486

ABSTRACT

OBJECTIVE: Many public health approaches to suicide prevention emphasize connecting at-risk individuals to professional treatment. However, it is unclear to what degree the outpatient mental health workforce has the requisite knowledge and skills to provide the evidence-based care needed to help those at risk. In this project, prior to the implementation of a statewide suicide prevention initiative, we assessed the baseline suicide prevention training and clinical practices of the New York State outpatient mental health workforce, a group likely representative of the broader U.S. clinical workforce. METHOD: A workforce survey of suicide prevention training and clinical practices was administered to 2,257 outpatient clinicians, representing 169 clinics serving approximately 90,000 clients. Clinicians were asked to complete the survey online, and all responses were confidential. RESULTS: Clinicians reported substantial gaps in their suicide prevention knowledge and training. The vast majority reported moderate self-efficacy working with suicidal clients and endorsed using evidence-based assessment procedures, but varied in utilization of recommended intervention practices. CONCLUSIONS: This study highlights gaps in clinicians' training and clinical practices that need to be overcome to provide evidence-based suicide care. Promisingly, positive associations were found between training and clinician knowledge, self-efficacy, and use of evidence-based practices.


Subject(s)
Self Efficacy , Suicide Prevention , Health Workforce , Humans , New York , Outpatients
6.
Psychiatr Serv ; 72(10): 1118-1125, 2021 10 01.
Article in English | MEDLINE | ID: mdl-33730886

ABSTRACT

OBJECTIVE: This study tested the hypothesis that fidelity of clinics to Zero Suicide (ZS) organizational practices is inversely related to suicidal behaviors of patients under clinical care. METHODS: Using cross-sectional analyses, the authors examined the fidelity of 110 outpatient mental health clinics to ZS organizational best practices and suicidal behaviors of clinic patients in the year before a large-scale Zero Suicide implementation. Fidelity to ZS organizational best practices was assessed over a 1-year period with an adapted version of the ZS Organizational Self-Study instrument (17 items self-rated on a Likert scale of 1-5). Suicidal behaviors of patients were identified by extracting information on suicide attempts and deaths from a mandated statewide incident-reporting system database. Clinics were dichotomized into any or no suicide incidents during the year of observation. Logistic regression analyses were used to adjust for clinic census and population type (majority child or adult). RESULTS: The clinics (N=110) served 30,257 patients per week. Clinics' total average fidelity score was 3.1±0.6 (range=1.41-4.12). For each point increase in fidelity, clinics had a significantly reduced likelihood of having a suicide incident (adjusted odds ratio=0.31, 95% confidence interval=0.14-0.69). Exploratory analysis identified significant differences for seven of 17 ZS organizational practices, with the largest effect sizes for suicide-specific quality improvement policies and activities (η2=0.097) and lethal means reduction (η2=0.073). CONCLUSIONS: These findings support an association between clinics' use of ZS organizational best practices and lower suicidal behaviors of patients under their care. Findings also support the validity of the ZS Organizational Self-Study instrument.


Subject(s)
Outpatients , Suicidal Ideation , Adult , Child , Cross-Sectional Studies , Humans , Mental Health , Suicide, Attempted
7.
Contemp Clin Trials ; 100: 106224, 2021 01.
Article in English | MEDLINE | ID: mdl-33220488

ABSTRACT

BACKGROUND: The treatment of suicidal patients often suffers owing to a lack of integrated care and standardized approaches for identifying and reducing risk. The National Strategy for Suicide Prevention endorsed the Zero Suicide (ZS) model, a multi-component, system-wide approach to identify, engage, and treat suicidal patients. The ZS model is a framework for suicide prevention in healthcare systems with the aspirational goal of eliminating suicide in healthcare. While the approach is widely endorsed, it has yet to be evaluated in a systematic manner. This trial evaluates two ZS implementation strategies statewide in specialty mental health clinics. METHODS/STUDY DESIGN: This trial is the first large-scale implementation of the ZS model in mental health clinics using the Assess, Intervene, and Monitor for Suicide Prevention (A-I-M) clinical model. Using a hybrid effectiveness-implementation type 1 design, we are testing the effectiveness of ZS implementation in 186 mental health clinics in 95 agencies in New York State. Agencies are randomly assigned to either: "Basic Implementation" (BI; a large group didactic learning collaboratives) or "Enhanced Implementation" (EI; participatory small group learning collaboratives; enhanced consultation for site champions). Primary outcomes include suicidal behaviors, hospitalizations and Emergency Department visits; implementation outcomes include protocol adoption, protocol fidelity and barriers/facilitators to implementation. DISCUSSION: This project has the potential to have a significant public health impact by determining the effectiveness of the ZS model in mental health clinics, a setting where suicide attempts and suicides occur at a higher rate than any other healthcare setting. It will also provide guidance on the implementation level required to achieve uptake and sustainability of ZS. TRIAL REGISTRATION: N/A.


Subject(s)
Outpatients , Psychiatry , Delivery of Health Care , Humans , Suicidal Ideation , Suicide, Attempted
8.
Suicide Life Threat Behav ; 50(1): 29-41, 2020 02.
Article in English | MEDLINE | ID: mdl-31112330

ABSTRACT

BACKGROUND: The role of crisis hotlines traditionally was limited to de-escalation and service linkage. However, hotlines are increasingly recruited to provide outreach and follow-up to suicidal individuals. Hotlines have the opportunity to not just defuse current crises but also provide brief interventions to mitigate future risk. The Safety Planning Intervention (SPI) is a brief intervention designed to help manage suicidal crises, but its feasibility and effectiveness on hotlines are not established. AIMS: This study examined feasibility and perceived effectiveness of SPI, as reported by 271 crisis counselors at five centers in the National Suicide Prevention Lifeline network. METHOD: Counselors were trained to use SPI. Self-report surveys were completed immediately after training (time 1) and at the end of the study, approximately 9 months later (time 2). RESULTS: Counselors reported that SPI was feasible and helpful, and was used on both incoming and follow-up calls. Utilization and perceived effectiveness at time 2 were predicted by self-efficacy, feasibility, and helpfulness at time 1. LIMITATIONS: Results are preliminary and limited to counselors' perceptions. Future RCTs should establish efficacy of SPI for crisis callers. CONCLUSION: The Safety Planning Intervention is a promising approach to reduce crisis callers' future suicide risk that hotline counselors report is both feasible and helpful.


Subject(s)
Counseling , Crisis Intervention/methods , Hotlines , Suicidal Ideation , Suicide Prevention , Feasibility Studies , Humans , Self Efficacy , Self Report , Surveys and Questionnaires
9.
J Youth Adolesc ; 48(9): 1784-1795, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31289976

ABSTRACT

Adolescent perceived behavioral control (self-efficacy) plays a key role in influencing decision-making processes within the context of suicide prevention programming. Guided by Theory of Planned Behavior, models tested attitudinal and social factors predicting adolescent intentions and actual engagement in suicide prevention behaviors. Participants included 233 racially and ethnically diverse high school students (54% female) in a southwestern U.S. school district. Measures included attitudes, norms, perceived behavioral control, intentions, and behavior over follow-up. Structural equation modeling indicated that perceived behavioral control, rather than intentions, was the direct predictor of behaviors. For adolescents, beliefs about effectively utilizing learned suicide prevention behavior may be more important than intentions. The design of suicide prevention efforts should account for this important influence on adolescent decision-making.


Subject(s)
Adolescent Behavior/psychology , Health Promotion/methods , Self Efficacy , Suicide Prevention , Suicide/psychology , Adolescent , Decision Making , Female , Humans , Male , Schools , Southwestern United States , Students/psychology
10.
Psychiatry Res ; 275: 61-70, 2019 05.
Article in English | MEDLINE | ID: mdl-30878858

ABSTRACT

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.


Subject(s)
Emotional Regulation , Emotions , Frustration , Latent Class Analysis , Self-Injurious Behavior/psychology , Suicide, Attempted/psychology , Adolescent , Emotional Regulation/physiology , Emotions/physiology , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/epidemiology , Feeding and Eating Disorders/psychology , Female , Humans , Impulsive Behavior/physiology , Male , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/epidemiology , Southeastern United States/epidemiology , Students/psychology , Surveys and Questionnaires
11.
Suicide Life Threat Behav ; 49(2): 353-370, 2019 04.
Article in English | MEDLINE | ID: mdl-29470846

ABSTRACT

Gatekeeper training is a common approach for aiding suicidal youth. This study utilizes comparative effectiveness "benchmarks" from established programs to evaluate the Question, Persuade, Refer (QPR) program. The QPR program was implemented with adults (N = 2,389) working in youth-serving community agencies. Questionnaires assessed suicide prevention knowledge, attitudes, subjective norms, perceived behavioral control, and behaviors. Consistent with benchmarked studies, participants in QPR demonstrated knowledge and suicide prevention behavior gains compared with control groups. Future research should utilize benchmarking methods as a measure of effectiveness, and more thoroughly assess mechanisms that promote behavior change.


Subject(s)
Benchmarking , Program Evaluation , Suicide Prevention , Adolescent , Adult , Female , Humans , Male , Persuasive Communication , Surveys and Questionnaires
12.
Adm Policy Ment Health ; 46(2): 209-219, 2019 03.
Article in English | MEDLINE | ID: mdl-30460591

ABSTRACT

This study examined the roles that youth involvement and youth trainee-trainer alliance play in school mental health prevention within the context of youth suicide gatekeeper training. Measures included youth involvement in programming, trainee-trainer alliance, and intentions to refer at-risk youth at pre- and post-training. A moderated-mediation design was used to examine associations among these factors. Results show alliance mediating pre- and post-training referral intentions, and involvement moderating the relationship between alliance and post-training intentions. On average, trainee intentions improved from pre- to post-training, but trainees reporting high alliance endorsed higher post-training referral intentions regardless of involvement level. Low alliance resulted in lower than average post-training referral intentions, even with active involvement in programming, and those with both low alliance and involvement showed the lowest post-training referral intentions. Given these findings, fostering the youth trainee-trainer relationship may be an avenue to optimize prevention program effectiveness.


Subject(s)
Health Education/organization & administration , Interpersonal Relations , School Health Services/organization & administration , Suicide Prevention , Adolescent , Female , Humans , Male , Program Evaluation , Socioeconomic Factors
13.
Suicidologi ; 23(1): 22-30, 2018.
Article in English | MEDLINE | ID: mdl-29970972

ABSTRACT

Suicide is a serious public health concern in the US, especially for those served in outpatient behavioral health. Over the past decade, there has been a dramatic increase in US suicide rates, and a significant proportion of those dying by or attempting suicide were treated in outpatient behavioral healthcare within the prior year. In response, the US Action Alliance released the National Strategy for Suicide Prevention in 2012, a key tenet of which is the "Zero Suicide" (ZS) model. ZS provides resources for administrators and providers to create a systematic approach to quality improvement for suicide prevention in healthcare systems via seven essential elements (Lead, Train, Identify, Engage, Treat, Transition, Improve). In this paper, we describe the ZS model, as well as our operationalization of the model in an NIMH-funded study in ~170 free-standing New York State outpatient behavioral health clinics, serving >80,000 patients. This study is the largest implementation and evaluation of the ZS approach ever conducted in outpatient behavioral health. Evaluation of ZS implementation in "real-world" clinical settings will provide crucial insight regarding broader dissemination and inform how to best adopt empirically-supported care for suicidal patients in outpatient behavioral health, thereby reducing tragic and preventable loss of life.

14.
J Sch Health ; 87(2): 114-120, 2017 02.
Article in English | MEDLINE | ID: mdl-28076922

ABSTRACT

BACKGROUND: Suicide is the second leading cause of death for adolescents. Whereas school-based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates. METHODS: Five active consent methods (in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates. RESULTS: Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In-person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates. CONCLUSIONS: Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In-person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment.


Subject(s)
Parental Consent , School Health Services , Suicide Prevention , Adolescent , Adolescent Health , Health Promotion , Humans , Research , Southwestern United States
15.
J Clin Child Adolesc Psychol ; 46(4): 600-610, 2017.
Article in English | MEDLINE | ID: mdl-26042461

ABSTRACT

Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth literature; however, past research frequently suffered measurement issues that obscured temporal relationships between alliance and symptomatology by measuring variables later in therapy, thereby precluding examination of important early changes. The current study aimed to explore the directions of effect between alliance and outcome early in therapy with adolescents by examining associations between first- and fourth-session therapeutic alliance and symptomatology. Thirty-four adolescents (∼63% female, 38% ethnic/racial minority) participated in a school-based cognitive-behavioral therapy for adolescents with depression. Participants completed the Beck Depression Inventory at baseline and Session 4, and therapeutic alliance was coded from audiotapes of Sessions 1 and 4 by objective coders using the Alliance Observation Coding System. Autoregressive path analyses determined that first-session therapeutic alliance was a strong significant predictor of Session 4 depression symptoms, but pretreatment depression scores were not significantly predictive of subsequent therapeutic alliance. Adding reciprocal effects between alliance and depression scores did not adversely affect model fit, suggesting that reciprocal effects may exist. Early therapeutic alliance with adolescents is critical to fostering early gains in depressive symptomatology. Knowing alliance's subsequent effect on youth outcomes, clinicians should increase effort to foster a strong relationship in early sessions and additional research should be conducted on the reciprocal effects of therapeutic alliance and treatment outcome in adolescence.


Subject(s)
Cognitive Behavioral Therapy/methods , Depressive Disorder/psychology , Psychotherapy/methods , Adolescent , Female , Humans , Male , Treatment Outcome
16.
J Psychiatr Res ; 77: 35-41, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26978183

ABSTRACT

BACKGROUND: Dysfunction in frontostriatal circuits likely contributes to impaired regulatory control in Bulimia Nervosa (BN), resulting in binge-eating and purging behaviors that resemble maladaptive habits. Less is known about the implicit learning processes of these circuits, which may contribute to habit formation. METHODS: We compared 52 adolescent and adult females with BN to 55 healthy matched-controls during performance of a probabilistic classification learning task, one form of implicit learning. Groups were compared in accuracy and response times, using mixed-models with block, age, and diagnosis as predictors, corrected for multiple comparisons with confounds covaried. RESULTS: BN participants showed differences in performance on a probabilistic classification learning task that varied by age. Adolescents with BN initially performed as accurately as healthy adolescents, but showed poorer perseverance over time. Adults with BN initially performed less accurately than healthy adults, but improved to perform equivalently. Symptom severity was associated with poorer accuracy in both adults and adolescents with BN. CONCLUSIONS: Frontostriatal dysfunction may underlie abnormalities in regulatory control and probabilistic classification learning in BN, likely contributing to the dysregulation of implicitly learned, maladaptive binge-eating and purging behaviors. Such dysfunction in BN may progress with increasing age, first manifesting in poor regulatory control over behaviors and then expanding to implicit learning processes that may underlie habitual behaviors.


Subject(s)
Aging/psychology , Bulimia Nervosa/psychology , Probability Learning , Adolescent , Adult , Child , Female , Humans , Psychological Tests , Reaction Time , Severity of Illness Index , Young Adult
17.
Crisis ; 36(4): 274-80, 2015.
Article in English | MEDLINE | ID: mdl-26440624

ABSTRACT

BACKGROUND: Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. AIMS: To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. METHOD: Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. RESULTS: Unlike in studies using forced-choice assessment, students' baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. CONCLUSION: Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students' actual levels of knowledge after participation in gatekeeper training.


Subject(s)
Health Education , Health Knowledge, Attitudes, Practice , School Health Services , Students , Suicidal Ideation , Suicide Prevention , Adolescent , Female , Focus Groups , Gatekeeping , Humans , Male , Mental Recall , Peer Group , Universities
18.
Int J Environ Res Public Health ; 12(4): 3741-55, 2015 Apr 01.
Article in English | MEDLINE | ID: mdl-25837350

ABSTRACT

The majority of suicidal adolescents have no contact with mental health services, and reduced help-seeking in this population further lessens the likelihood of accessing treatment. A commonly-reported reason for not seeking help is youths' perception that they should solve problems on their own. In this study, we explore associations between extreme self-reliance behavior (i.e., solving problems on your own all of the time), help-seeking behavior, and mental health symptoms in a community sample of adolescents. Approximately 2150 adolescents, across six schools, participated in a school-based suicide prevention screening program, and a subset of at-risk youth completed a follow-up interview two years later. Extreme self-reliance was associated with reduced help-seeking, clinically-significant depressive symptoms, and serious suicidal ideation at the baseline screening. Furthermore, in a subset of youth identified as at-risk at the baseline screening, extreme self-reliance predicted level of suicidal ideation and depressive symptoms two years later even after controlling for baseline symptoms. Given these findings, attitudes that reinforce extreme self-reliance behavior may be an important target for youth suicide prevention programs. Reducing extreme self-reliance in youth with suicidality may increase their likelihood of appropriate help-seeking and concomitant reductions in symptoms.


Subject(s)
Depression/epidemiology , Mental Health Services/statistics & numerical data , Problem Solving , Suicidal Ideation , Adolescent , Depression/psychology , Female , Help-Seeking Behavior , Humans , Male , New York/epidemiology , Risk Factors
19.
J Pediatr Nurs ; 27(3): 225-32, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22525810

ABSTRACT

Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace.


Subject(s)
Nursing Assessment , Pediatric Nursing , Trichotillomania , Child , Humans , Trichotillomania/diagnosis , Trichotillomania/epidemiology , Trichotillomania/nursing
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