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Estudio primario

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Autores Harris KM , Goh MT
Revista International journal of mental health nursing
Año 2017
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There is considerable debate on whether suicide assessment carries an iatrogenic risk for participants/patients. A double-blind randomized controlled trial (registration: R000022314) tested the emotional impact of suicide assessment on participants ( n = 259) randomly assigned to experimental ( n = 122) or control conditions ( n = 137). The experimental condition included the Suicidal Affect-Behavior-Cognition Scale and intensive death-related questions, the control condition a quality of life scale. Both included measures of depression, social support and loneliness. Affective states were assessed immediately before and after testing, and research biases minimized. Post-test debriefing interviews collected qualitative reactions. Experimental participants ranged from nonsuicidal to highly suicidal. Between-groups ANCOVAs and repeated measures ANOVAs showed no differences by study condition, and no pre-post-test affect changes for either condition or suicidal participants ( P > 0 .10), supporting the null hypothesis of no iatrogenic effects. However, depressive participants in both conditions showed significant decreases in positive affect ( P < 0 .05). Smallest real difference (SRD) scores approximated clinically meaningful differences and showed 20% of participants had a significant positive survey reaction, 24% a negative reaction, with the rest neutral. Linear regressions revealed depressive symptoms and perceived family support, but not suicidality or other factors, predicted negative affect changes, which was supported by qualitative findings. Social desirability bias was also found in qualitative survey responses. No evidence of iatrogenic effects of suicide assessment were found. Recommendations are made to counter possible negative assessment effects on depressive participants/patients, and nurses and other caregivers are encouraged to talk to patients about suicidal symptoms.

Estudio primario

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Revista Journal of consulting and clinical psychology
Año 2015
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OBJECTIVE: This pilot randomized controlled trial examined the effect of an online intervention for college students at risk for suicide, Electronic Bridge to Mental Health Services (eBridge), which included personalized feedback and optional online counseling delivered in accordance with motivational interviewing principles. Primary outcomes were readiness to seek information or talk with family and friends about mental health treatment, readiness to seek mental health treatment, and actual treatment linkage. METHOD: Participants were 76 college students (45 women, 31 men; mean age = 22.9 years, SD = 5.0 years) at a large public university who screened positive for suicide risk, defined by at least 2 of the following: suicidal thoughts, history of suicide attempt, depression, and alcohol abuse. Racial/ethnic self-identifications were primarily Caucasian (n = 54) and Asian (n = 21). Students were randomized to eBridge or the control condition (personalized feedback only, offered in plain report format). Outcomes were measured at 2-month follow-up. RESULTS: Despite relatively modest engagement in online counseling (29% of students posted ≥1 message), students assigned to eBridge reported significantly higher readiness for help-seeking scores, especially readiness to talk to family, talk to friends, and see a mental health professional. Students assigned to eBridge also reported lower stigma levels and were more likely to link to mental health treatment. CONCLUSIONS: Findings suggest that offering students personalized feedback and the option of online counseling, using motivational interviewing principles, has a positive impact on students' readiness to consider and engage in mental health treatment. Further research is warranted to determine the robustness of this effect, the mechanism by which improved readiness and treatment linkage occurs, and the longer term impact on student mental health outcomes.

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Revista Prevention science : the official journal of the Society for Prevention Research
Año 2015
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The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest-posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for non-random selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in two Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed.

Estudio primario

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Revista Suicide and Life-Threatening Behavior
Año 2015
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Estudio primario

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Revista Journal of general internal medicine
Año 2014
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BACKGROUND: Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low. OBJECTIVE: To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control. DESIGN: Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO). PARTICIPANTS: Eight-hundred sixty-seven participants, with mean age 51.7; 43.9% women, 43.4% from a racial/ethnic minority group. INTERVENTION: The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video. MAIN MEASURES: Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]). KEY RESULTS: Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95% confidence interval = 1.5, 5.10, p = 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9. CONCLUSIONS: Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.

Estudio primario

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Revista Suicide & life-threatening behavior
Año 2014
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Although the Signs of Suicide (SOS) suicide prevention program has been implemented at both the middle and high school levels, its efficacy has been demonstrated previously only among high school students. The current study evaluated SOS implemented in high military impact middle schools. Compared to controls, SOS participants demonstrated improved knowledge about suicide and suicide prevention, and participants with pretest ideation reported fewer suicidal behaviors at posttest than controls with pretest ideation. These results provide preliminary evidence for SOS's efficacy as a suicide prevention program for middle school students.

Estudio primario

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Revista Advanced biomedical research
Año 2014
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BACKGROUND: prevention of suicide is one of priority world health. Suicide is one of the preventable causes of death. The aim of this study is evaluation of telephone follow up on suicide reattempt. MATERIALS AND METHODS: This randomized controlled clinical trial is a prospective study which has been done in Noor Hospital of Isfahan-Iran, at 2010. 139 patients who have suicide attempt history divided in one of two groups, randomly, 70 patients in" treatment as usual (TAU)" and 69 patients in "brief interventional control (BIC). Seven telephone contact with BIC group patients have been done "during six months" and two questionnaires have been filled in each session. The data has been analyzed by descriptive and Chi-square test, under SPSS. RESULTS: No significant differences of suicide reattempt has been found between two groups (P = 0.18), but significant reduction in frequency of suicidal thoughts (P = 0.007) and increase in hope at life (P = 0.001) was shown in intervention group. CONCLUSION: Telephones follow up in patients with suicide history decrease suicidal thought frequency" and increase hope in life, significantly.

Estudio primario

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Revista
Año 2014
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Estudio primario

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Revista Journal of the American Academy of Child and Adolescent Psychiatry
Año 2014
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OBJETIVO: Hemos examinado si una forma abreviada de la terapia dialéctica conductual, la terapia dialéctica conductual para adolescentes (DBT-A) es más eficaz que mejora la atención habitual (EUC) para reducir la autolesión en adolescentes. MÉTODO: Se realizó un estudio aleatorizado de 77 adolescentes con la reciente y repetitiva autolesiones tratados en las consultas externas de psiquiatría para adolescentes que fueron asignados al azar a cualquiera de DBT-A o EUC infantil comunitaria y. Las evaluaciones de las autolesiones, pensamientos suicidas, depresión, desesperanza y síntomas del trastorno límite de la personalidad se realizaron al inicio del estudio y después de 9, 15 y 19 semanas (final del período de prueba), y la frecuencia de hospitalizaciones y visitas a urgencias durante el juicio se registraron período. RESULTADOS: la retención de tratamiento en general es bueno en ambas condiciones de tratamiento, y el uso de los servicios de emergencia fue baja. DBT-A fue superior a la EUC en la reducción de la autolesión, ideación suicida y síntomas depresivos. Los tamaños del efecto eran grandes para los resultados del tratamiento en los pacientes que recibieron DBT-A, mientras que los tamaños del efecto fueron pequeños para los resultados en los pacientes que recibieron EUC. Se encontró número total de contactos de tratamiento para ser un mediador parcial de la asociación entre el tratamiento y los cambios en la severidad de la ideación suicida, mientras que no se encontraron efectos de mediación en los otros resultados o por el tiempo total de tratamiento. CONCLUSIÓN: DBT-A puede ser una intervención eficaz para reducir la autolesión, ideación suicida y la depresión en adolescentes con conductas repetitivas auto-daño. registro de ensayos clínicos de información-El tratamiento para adolescentes con deliberada Daño a sí mismo; http://ClinicalTrials.gov/; NCT00675129.

Estudio primario

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Revista PloS one
Año 2014
BACKGROUND: Many people with suicidal thoughts do not receive treatment. The Internet can be used to reach more people in need of support. OBJECTIVE: To test the effectiveness of unguided online self-help to reduce suicidal thoughts. METHOD: 236 adults with mild to moderate suicidal thoughts were randomised to the intervention (n=116) or a waitlist control group (n=120). Assessments took place at baseline, and 2, 4 and 6 weeks later. Primary outcome was suicidal thoughts. Secondary outcomes were depressive symptoms, anxiety, hopelessness, worry, and health status. RESULTS: The intervention group showed a small significant effect in reducing suicidal thoughts (d=0.28). Effects were more pronounced for those with a history of repeated suicide attempts. There was also a significant reduction in worry (d=0.33). All other secondary outcomes showed small but non-significant improvements. CONCLUSIONS: Although effect sizes were small, the reach of the internet could enable this intervention to help many people reduce their suicidal thoughts. TRIAL REGISTRATION: Netherlands Trial Register NTR1689.