ABSTRACT
Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517
ABSTRACT
Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness.
Subject(s)
Hotlines , Suicide Prevention , Humans , Suicidal Ideation , Brazil , Suicide, Attempted/prevention & controlABSTRACT
OBJECTIVE: To present the Brazilian Psychiatric Association's Consensus for the Management of Acute Intoxication. METHODS: A group of experts selected by the Brazilian Psychiatric Association searched for articles in the MEDLINE (by PubMed) and Cochrane Database, limited to human studies and acute intoxication. Groups reviewed these materials for appropriateness to the topic and the quality of the work. To perform a table of agreed recommendations at the end of the systematic review, a survey using the Delphi method was conducted. Three survey rounds were conducted to develop a consensus. RESULTS: Support for intoxication may start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For that, the group proposed these orders of assessment: A (airway), B (breathing), C (circulation), D.1. (disability), D.2. (differential diagnosis), D.3. (decontamination), D.4. (drug antidotes), E (enhanced elimination). Then, the group of experts presented specific interventions for the main drugs of abuse. CONCLUSIONS: The approach to intoxication with drugs of abuse is complex and requires systematic protocols. The group of experts suggested the adoption of the classic use in welcoming the patient of the A-B-C-D-E technique with constant investigation of this patient until reaching a specific conduct and with the support to remit the picture. The group of experts believes that this document, at this time, can help psychiatric, general, and emergency doctors deal with psychiatric emergency episodes due to acute intoxication.
