Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential multiple assignment randomized trial / E. K. CZYZ in Journal of Child Psychology and Psychiatry, 62-8 (August 2021)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 62-8 (August 2021) . - p.1019-1031 Titre : Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential multiple assignment randomized trial Type de document : Texte imprimé et/ou numérique Auteurs : E. K. CZYZ, Auteur ; C. A. KING, Auteur ; D. PROUTY, Auteur ; V. J. MICOL, Auteur ; M. WALTON, Auteur ; I. NAHUM-SHANI, Auteur Article en page(s) : p.1019-1031 Langues : Anglais (eng) Mots-clés : Adolescent  Adolescent Behavior  Aftercare  Female  Hospitalization  Humans  Male  Patient Discharge  Suicidal Ideation  Suicide, Attempted  Adolescents  adaptive intervention  safety planning  sequential multiple assignment randomized trial  suicide attempt Index. décimale : PER Périodiques Résumé : BACKGROUND: The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI targeting suicide risk after hospitalization. METHODS: Adolescent inpatients (N = 80; ages 13-17; 67.5% female) were randomized in Phase 1 to a Motivational Interview-Enhanced Safety Plan (MI-SP), delivered during hospitalization, alone or in combination with postdischarge text-based support (Texts). Two weeks after discharge, participants were re-randomized in Phase 2 to added telephone booster calls or to no calls. Mechanisms of change were assessed with daily diaries for four weeks and over a 1- and 3-month follow-up. This trial is registered with clinicaltrials.gov (identifier: NCT03838198). RESULTS: Procedures were feasible and acceptable. Mixed effects models indicate that adolescents randomized to MI-SP + Texts (Phase 1) and those randomized to booster calls (Phase 2) experienced significant improvement in daily-level mechanisms, including safety plan use, self-efficacy to refrain from suicidal action, and coping by support seeking. Those randomized to MI-SP + Texts also reported significantly higher coping self-efficacy at 1 and 3 months. Although exploratory, results were in the expected direction for MI-SP + Texts, versus MI-SP alone, in terms of lower risk of suicide attempts (Hazard ratio = 0.30; 95% CI = 0.06, 1.48) and suicidal behavior (Hazard ratio = 0.36; 95% CI = 0.10, 1.37) three months after discharge. Moreover, augmentation with booster calls did not have an overall meaningful impact on suicide attempts (Hazard ratio = 0.65; 95% CI = 0.17, 3.05) or suicidal behavior (Hazard ratio = 0.78; 95% CI = 0.23, 2.67); however, boosters benefited most those initially assigned to MI-SP + Texts. CONCLUSIONS: The current SMART was feasible and acceptable for the purpose of informing an AI for suicidal adolescents, warranting additional study. Findings also indicate that postdischarge text-based support offers a promising augmentation to safety planning delivered during hospitalization. En ligne : http://dx.doi.org/10.1111/jcpp.13383 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456 [article] Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential multiple assignment randomized trial [Texte imprimé et/ou numérique] / E. K. CZYZ, Auteur ; C. A. KING, Auteur ; D. PROUTY, Auteur ; V. J. MICOL, Auteur ; M. WALTON, Auteur ; I. NAHUM-SHANI, Auteur . - p.1019-1031. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 62-8 (August 2021) . - p.1019-1031 Mots-clés : Adolescent  Adolescent Behavior  Aftercare  Female  Hospitalization  Humans  Male  Patient Discharge  Suicidal Ideation  Suicide, Attempted  Adolescents  adaptive intervention  safety planning  sequential multiple assignment randomized trial  suicide attempt Index. décimale : PER Périodiques Résumé : BACKGROUND: The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI targeting suicide risk after hospitalization. METHODS: Adolescent inpatients (N = 80; ages 13-17; 67.5% female) were randomized in Phase 1 to a Motivational Interview-Enhanced Safety Plan (MI-SP), delivered during hospitalization, alone or in combination with postdischarge text-based support (Texts). Two weeks after discharge, participants were re-randomized in Phase 2 to added telephone booster calls or to no calls. Mechanisms of change were assessed with daily diaries for four weeks and over a 1- and 3-month follow-up. This trial is registered with clinicaltrials.gov (identifier: NCT03838198). RESULTS: Procedures were feasible and acceptable. Mixed effects models indicate that adolescents randomized to MI-SP + Texts (Phase 1) and those randomized to booster calls (Phase 2) experienced significant improvement in daily-level mechanisms, including safety plan use, self-efficacy to refrain from suicidal action, and coping by support seeking. Those randomized to MI-SP + Texts also reported significantly higher coping self-efficacy at 1 and 3 months. Although exploratory, results were in the expected direction for MI-SP + Texts, versus MI-SP alone, in terms of lower risk of suicide attempts (Hazard ratio = 0.30; 95% CI = 0.06, 1.48) and suicidal behavior (Hazard ratio = 0.36; 95% CI = 0.10, 1.37) three months after discharge. Moreover, augmentation with booster calls did not have an overall meaningful impact on suicide attempts (Hazard ratio = 0.65; 95% CI = 0.17, 3.05) or suicidal behavior (Hazard ratio = 0.78; 95% CI = 0.23, 2.67); however, boosters benefited most those initially assigned to MI-SP + Texts. CONCLUSIONS: The current SMART was feasible and acceptable for the purpose of informing an AI for suicidal adolescents, warranting additional study. Findings also indicate that postdischarge text-based support offers a promising augmentation to safety planning delivered during hospitalization. En ligne : http://dx.doi.org/10.1111/jcpp.13383 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456

Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients / C. A. KING in Journal of Child Psychology and Psychiatry, 60-10 (October 2019)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 60-10 (October 2019) . - p.1055-1064 Titre : Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients Type de document : Texte imprimé et/ou numérique Auteurs : C. A. KING, Auteur ; J. GRUPP-PHELAN, Auteur ; David A. BRENT, Auteur ; J. M. DEAN, Auteur ; M. WEBB, Auteur ; Jeffrey A. BRIDGE, Auteur ; A. SPIRITO, Auteur ; L. S. CHERNICK, Auteur ; E. M. MAHABEE-GITTENS, Auteur ; R. D. MISTRY, Auteur ; M. REA, Auteur ; A. KELLER, Auteur ; A. ROGERS, Auteur ; R. SHENOI, Auteur ; M. CWIK, Auteur ; D. R. BUSBY, Auteur ; T. C. CASPER, Auteur Article en page(s) : p.1055-1064 Langues : Anglais (eng) Mots-clés : Suicide risk  adolescence  emergency department  social connectedness  suicide attempt Index. décimale : PER Périodiques Résumé : BACKGROUND: The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short-term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3-months of an emergency department (ED) visit. METHODS: Adolescents, ages 12-17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3-month telephone follow-up, and 2,104 participants completed this follow-up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3-month follow-up. RESULTS: One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3-month follow-up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past-year nonsuicidal self-injury (NSSI) incidents, and social connectedness. CONCLUSIONS: Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts. En ligne : http://dx.doi.org/10.1111/jcpp.13087 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=406 [article] Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients [Texte imprimé et/ou numérique] / C. A. KING, Auteur ; J. GRUPP-PHELAN, Auteur ; David A. BRENT, Auteur ; J. M. DEAN, Auteur ; M. WEBB, Auteur ; Jeffrey A. BRIDGE, Auteur ; A. SPIRITO, Auteur ; L. S. CHERNICK, Auteur ; E. M. MAHABEE-GITTENS, Auteur ; R. D. MISTRY, Auteur ; M. REA, Auteur ; A. KELLER, Auteur ; A. ROGERS, Auteur ; R. SHENOI, Auteur ; M. CWIK, Auteur ; D. R. BUSBY, Auteur ; T. C. CASPER, Auteur . - p.1055-1064. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 60-10 (October 2019) . - p.1055-1064 Mots-clés : Suicide risk  adolescence  emergency department  social connectedness  suicide attempt Index. décimale : PER Périodiques Résumé : BACKGROUND: The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short-term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3-months of an emergency department (ED) visit. METHODS: Adolescents, ages 12-17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3-month telephone follow-up, and 2,104 participants completed this follow-up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3-month follow-up. RESULTS: One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3-month follow-up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past-year nonsuicidal self-injury (NSSI) incidents, and social connectedness. CONCLUSIONS: Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts. En ligne : http://dx.doi.org/10.1111/jcpp.13087 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=406

Short-term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization / E. K. CZYZ in Journal of Child Psychology and Psychiatry, 60-7 (July 2019)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 60-7 (July 2019) . - p.732-741 Titre : Short-term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization Type de document : Texte imprimé et/ou numérique Auteurs : E. K. CZYZ, Auteur ; A. G. HORWITZ, Auteur ; A. ARANGO, Auteur ; C. A. KING, Auteur Article en page(s) : p.732-741 Langues : Anglais (eng) Mots-clés : Ecological momentary assessment  adolescents  hopelessness  interpersonal-psychological theory  suicidal ideation Index. décimale : PER Périodiques Résumé : BACKGROUND: Our understanding of suicidal ideation (SI) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near-term SI. METHODS: Thirty-four adolescents hospitalized due to last-month suicide attempt and/or last-week SI (76% female; ages 13-17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge (n = 652 observations). RESULTS: There was notable variability in day-to-day SI, with half of ideation ratings changing at least one within-person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same-day), but not short-term prospective (next-day), associations between SI (frequency, duration, urge) and well-established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same- and next-day suicidal ideation. CONCLUSIONS: This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high-risk adolescents' sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short-term risk and meaningful intervention targets in high-risk teens. En ligne : http://dx.doi.org/10.1111/jcpp.12974 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=401 [article] Short-term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization [Texte imprimé et/ou numérique] / E. K. CZYZ, Auteur ; A. G. HORWITZ, Auteur ; A. ARANGO, Auteur ; C. A. KING, Auteur . - p.732-741. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 60-7 (July 2019) . - p.732-741 Mots-clés : Ecological momentary assessment  adolescents  hopelessness  interpersonal-psychological theory  suicidal ideation Index. décimale : PER Périodiques Résumé : BACKGROUND: Our understanding of suicidal ideation (SI) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near-term SI. METHODS: Thirty-four adolescents hospitalized due to last-month suicide attempt and/or last-week SI (76% female; ages 13-17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge (n = 652 observations). RESULTS: There was notable variability in day-to-day SI, with half of ideation ratings changing at least one within-person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same-day), but not short-term prospective (next-day), associations between SI (frequency, duration, urge) and well-established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same- and next-day suicidal ideation. CONCLUSIONS: This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high-risk adolescents' sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short-term risk and meaningful intervention targets in high-risk teens. En ligne : http://dx.doi.org/10.1111/jcpp.12974 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=401

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