Crisis Intervention And Prevention 14
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Background: Suicidal behaviour and deliberate self-harm are common among adults. Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services can reduce reattempt risk. Feasibility trials demonstrated that intervention through text message was also effective in preventing suicide repetition amongst suicide attempters. The aim of the current study is to investigate the effect of text message intervention versus traditional treatment on reducing the risk of suicide attempt repetition among adults after self-harm.
Methods/design: The study will be a 2-year multicentric randomized controlled trial conducted by the Brest University Hospital, France. Participants will be adults discharged after self-harm, from emergency services or after a short hospitalization. Participants will be recruited over a 12-month period. The intervention is comprised of an SMS that will be sent at h48, D7, D15 and monthly. The text message enquires about the patients' well-being and includes information regarding individual sources of help and evidence-based self help strategies. Participants will be assessed at the baseline, month 6 and 13. As primary endpoint, we will assess the number of patients who reattempt suicide in each group at 6 months. As secondary endpoints, we will assess the number of patients who reattempt suicide at 13 month, the number of suicide attempts in the intervention and control groups at 6 and 13 month, the number of death by suicide in the intervention and control groups at month 6 and 13. In both groups, suicidal ideations, will be assessed at the baseline, month 6 and 13. Medical costs and satisfaction will be assessed at month 13.
Discussion: This paper describes the design and deployment of a trial SIAM; an easily reproducible intervention that aims to reduce suicide risk in adults after self-harm. It utilizes several characteristics of interventions that have shown a significant reduction in the number of suicide reattempts. We propose to assess its efficacy in reducing suicide reattempt in the suicide attempter (SA) population.
The aim of this study was to evaluate the short-term impact of a group crisis intervention for children aged 9-15 years from five refugee camps in the Gaza Strip during ongoing war conflict. Children were selected if they reported moderate to severe posttraumatic stress reactions, and were allocated to group intervention (N=47) encouraging expression of experiences and emotions through storytelling, drawing, free play and role-play; education about symptoms (N=22); or no intervention (N=42). Children completed the CPTSD-RI and the CDI pre- and post-intervention. No significant impact of the group intervention was established on children's posttraumatic or depressive symptoms. Possible explanations of the findings are discussed, including the continuing exposure to trauma and the non-active nature of the intervention.
Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence.
Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.
Prevention and early intervention are recognized key elements for minimizing the impact of any potentially serious health condition. However, while representing a field of remarkable achievement, that of early intervention in youth health is a target not completely accomplished yet [7]. This is particularly true for youth mental health. In fact, mental healthcare has been traditionally oriented to provide health benefits to adult populations during crisis events and major emergencies [8]. In this framework, mental health presentations to emergency settings in pediatric populations are somewhat frequent events [9]. Deinstitutionalization policies have only partially addressed this issue, also in light of the large variability worldwide in the implementation of community mental health services [10], especially for children and young adults [11].
Based on evidence summarized above, there is a pressing need to develop, or improve where present, youth mental healthcare models which can implement prevention and early intervention strategies. While progress has been made for psychotic disorders, also due to the successful application of an at-risk mental state concept [22], this is still largely unexplored in the context of common mental disorders, such as depression, anxiety, substance abuse, and eating disorders [23]. In order to meet the need for early intervention into childhood and young adulthood mental health difficulties, it is imperative to parallel redesign prevention and early intervention services for young populations, by promoting multidisciplinary collaborations between different specialized professionals in an enhanced and integrated service of extended primary care [5].
The aim of this narrative review is threefold: (i) to update on the current debate on the at-risk mental state concept and the possibility of widening the clinical area of intervention beyond psychotic disorders; (ii) to review the role of psychosocial difficulties early in life as potentially stable risk factors for poor mental health, and the extent to which they have been targets for early intervention; and (iii) to report on the progress made so far in implementing collaborative and integrated services for youth mental health within the healthcare system.
The current literature review is intended to bring together research evidence on early life risk factors detection, youth mental health service provision, and application of a clinical staging model by using a trans-diagnostic approach. In particular, the present work aims to emphasize the relationship between these early intervention components and offer new directions for clinical research into the full development of a youth-based model of mental healthcare focused on prevention.
A literature search was performed using electronic databases (MEDLINE, Web of Science, and Scopus), using a combination of search terms describing risk factors, clinical staging, and multidisciplinary prevention and early interventions in youth mental health. Special attention was given to available research of the past 25 years as a major transition in the clinical characterization of the prodromal phase of major psychiatric disorders in youth has occurred during the past 2 to 3 decades [21]. In addition, some research evidence gathered outside this search was reported, if considered appropriate by all authors.
Mental health promotion focuses on enhancing the strengths, capacity and resources of individuals and communities to enable them to increase control over their mental health and its determinants. Prevention, on the other hand, aims to reduce the incidence, prevalence and severity of targeted mental health conditions [42]. In order to fill the treatment gap for mental, neurological, and substance use disorders worldwide, evidence-based guidelines developed by the WHO recommend that population level health interventions had an overall promotion focus. This is in line with the well-established continuum of care between interventions promoting positive mental health, interventions striving to prevent the onset of mental health disorders (primary prevention), and interventions aiming at early identification, case detection, early treatment, and rehabilitation (secondary and tertiary prevention) [43].
Primary prevention strategies may be universal, selective, or indicated, depending on whether they target the general population, a sub-group of the population, or specific individuals, respectively [42]. Rather than being separate, they should be seen as an integrated set of preventive interventions that continue throughout the neurodevelopmental stages of life as well as the intensification of risk [52].
Selective interventions aim at preventing the manifestation of psychiatric symptoms, thus altering the developmental pathway to full-threshold disorders in the premorbid state. Recipients of these interventions are individuals whose risk of developing a mental disorder is significantly higher than the rest of the population, while still being asymptomatic [42]. A number of risk factors have been identified, including parental mental illness [70], paternal age [71], maternal and obstetric complications of pregnancy [72, 73], season of birth [74], ethnic minority [75], immigration status [76], urban environment [77], infections [78], childhood adversities [28], vitamin D deficiency and malnutrition [79], low premorbid intelligence quotient [80], traumatic brain injury [81], and heavy tobacco [82] and cannabis use [83, 84].
It is worth reporting that most risk factors are shared across multiple mental disorders, suggesting the poor validity of boundaries between diagnostic categories, at least at this stage [85]. Also, while some risk factors are easily correctible (e.g. vitamin D deficiency) or technically preventable (e.g. cannabis use, infections), other require restructuring the role of the youth mental health professional as well employing a cadre of paraprofessionals to work more intensively with a large population of at-risk young individuals (e.g. childhood adversities), and for still others it is difficult to envisage programs ethically or practically sustainable (season of birth, urban environment) [86]. A few studies evaluated the effectiveness of prenatal and early infancy preventive programs for infants and children who may be socially disadvantaged or potentially at risk [87, 88]. Results supported long-term positive effects of nursing home visits to expectant mothers and their families in difficult social circumstances [87] as well as school educational interventions and home teaching to support low-income families and their preschool children [88] in reducing child abuse, neglect, and criminal behavior as well as improving the use of welfare and family socioeconomic status [87, 88]. 2b1af7f3a8