Search Results (9)

Suicide is a global and public health crisis that impacts people of all ages and backgrounds. The literature supports that individuals with serious mental illness are at a higher risk of suicide compared with those without a serious mental illness. It is also well-documented that individuals are at particularly high risk of suicide immediately post-hospitalization for a psychiatric illness. Our narrative review synthesizes and analyzes the existing literature on this phenomenon, the rates of suicide post-hospitalization, the risk factors for suicide during that time, and the interventions and strategies developed to reduce the rates. Current risk assessments struggle to identify individual patients who are at the highest risk of suicide post-discharge. Research has shifted towards focusing on brief crisis interventions to target this high-risk period. Other interventions in the literature include those that attempt to increase engagement with mental health services and increase institutional resources. We also synthesize literature on the iatrogenic risk of hospitalization, the impact hospitalization itself can have on patients, and their risk of suicide once discharged. Future directions could include further exploration of the impact these interventions have on specific populations, such as those with comorbid psychiatric and substance use conditions. Full article

A suicide epidemic exists among young U.S. veterans, with risk especially elevated in the first year of transition for the 200,000 servicemembers exiting the military annually. The VA Veteran Sponsorship Initiative (VSI) is a public–private-partnership between federal and community partners that aims to decrease suicides by providing a VA-certified volunteer peer sponsor and connection to community services. Onward Ops is a key community-based national program that enrolls, matches and manages the relationship between servicemembers and sponsors. A prior randomized controlled trial showed that the effectiveness of community interventions can be enhanced when augmented by an Onward Ops sponsor. In preparation for national implementation, we conducted a quasi-experimental, matched-cohort pilot to evaluate the feasibility of an adapted VSI protocol and then assessed effectiveness. The adaptations were executed using the Framework for Reporting Adaptations and Modifications-Enhanced between April 2021 and April 2023. The formative results supported the feasibility of the adaptations to enable proactive enrollment on military installations and expand data infrastructure, partnerships, peer sponsors, and VA clinical services. We then assessed the effectiveness for outcomes not studied in the original VSI trial for active-duty soldiers who enrolled between April and December 2023. After nearest-neighbor matching, the sample included 551 VSI participants and 551 soldiers transitioning as usual. The point-probability contrast or risk differences from the conditional logistic regression model indicated that the VSI caused a statistically significant increase in VA primary care utilization of 0.198 and a statistically significant decrease in suicide attempts of −0.019, both assessed 10 months post-military discharge. The study demonstrated the utility of public–private-partnerships, peer-sponsorship programs and enhanced VA services to support servicemembers during transition. Full article

This narrative literature review explores the clinical use of Ketamine as part of an untested hypothetical model framework for bridge therapy for acute suicidality. Long-term suicide rates continue to increase in the United States and in many other countries, creating a pressing public health challenge with a variety of treatment considerations. Existing standard-of-care SSRI therapeutics have a delay between administration and symptom relief at 2–6 weeks, leaving a so-called danger zone of about 1–3 months of risk for suicidal follow-through behaviors. Ketamine, a potent NMDA (N-methyl-D-aspartate) receptor antagonist, has recently seen widespread interest in both regulatory and clinical settings for increasing neuroplasticity and alleviating depressive symptoms. Ketamine’s mechanism-of-action through mTORC1 is much faster than SSRI’s downstream transcriptional regulation, leading to quicker relief of suicidal symptoms and the removal of the danger zone lag period. The current literature suggests that a controlled, supervised subanesthetic dose of Ketamine in a clinical setting has low risks of addiction or abuse, distinguishing therapeutic uses of Ketamine from recreational uses. While the biological efficacy of Ketamine is established, this conceptual review focuses on a possible initial hypothetical framework of a “Bridge Protocol.” We searched PubMed, Google Scholar, The Cochrane Library, and PsycINFO (January 2000–December 2025) to synthesize evidence regarding SSRI latency, acute Ketamine protocols, and post-discharge safety. We conclude that while promising, the proposed Ketamine Bridge Therapy requires rigorous longitudinal validation and sustained clinical studies before it can be safely used and experience widespread adoption. Full article

Background/Objective: The transition from psychiatric inpatient care to community settings poses risks of relapse, rehospitalization, and poor well-being. This study examined changes in anxiety, depression, suicidal ideation, sleep issues, and well-being over six months post-discharge and assessed the effectiveness of supportive text messaging (Text4Support) alone and with peer support, compared to treatment as usual (TAU). Methods: A pragmatic stepped-wedge cluster-randomized trial included 1098 participants discharged from psychiatric units across Alberta, Canada. Participants were allocated to the TAU, Supportive Text Messaging (SMS), or SMS plus peer support (SMS+PS) group. Outcomes were measured using GAD-7, PHQ-9, and WHO-5 at baseline and at six weeks, three months, and six months post-discharge. ANCOVA compared outcomes across groups at each time point, controlling for baseline values. Results: Follow-up completion declined (20% at six weeks, 16% at three months, and 15% at six months). No group differences emerged for anxiety, depression, suicidal ideation, or sleep issues at six weeks or three months. Well-being was significantly higher in the SMS group at six weeks (η² = 0.10). At six months, between-group differences appeared for anxiety and depression, though post hoc tests showed no pairwise differences. Conclusions: Supportive text messaging may improve well-being shortly after discharge and holds promise as a low-intensity transitional care strategy, though findings are limited by low follow-up. Full article

The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups. Full article

Revolving Door (RD) is a frequent phenomenon afflicting children and adolescents with psychiatric diagnoses. Nevertheless, risk factors for RD are still a matter of debate. To better understand RD phenomenon, we conducted a retrospective study on 224 children and adolescents (165 females and 59 males, aged 6–16 years) with a psychiatric hospitalization, taking the multiple risk factors together. At this aim, 108 patients with multiple hospitalizations and 116 patients with only one hospitalization were compared on demographic characteristics, clinical conditions, psychiatric ward stay, and post-discharge management factors. More than half of psychiatric patients were readmitted within three months of discharge. RD patients presented greater severity of illness, needed longer stays, and were more frequently placed in residential facilities than non-RD patients. Non-suicidal self-injurious and adoption were the main predictors of RD. Clinical instruments that detected behavioural and emotional symptoms, suicidal ideation severity, and level of impairment of the person’s functioning were useful to identify patients at high risk for RD. In conclusion, our findings pointed out that several risk factors have to be considered to better understand and, in the future, prevent RD phenomenon. Full article

Individuals affected by Coronavirus Disease 2019 (COVID-19) may experience psychiatric symptoms, including depression and suicidal ideation, that could lead to chronic impairment and a reduction in quality of life. Specifically, depressive disorder shows high incidence and may lead to chronic impairment and a reduction in the quality of life. To date, no studies on the presence of suicidality and quantitative analysis of depressive symptoms and their risk factors have yet been published. In this study, we aim to assess the prevalence of depressive symptoms and related risk factors at 3 months after discharge to home care following hospitalization for COVID-19 infection. Methods: Participants were contacted three months after hospital discharge from one of the five COVID-19 hospitals in Rome, as part of a larger project on health outcomes in COVID-19 inpatients (Long Term Neuropsychiatric Disorder in COVID-19 Project), and the Patient Health Questionnaire-9 (PHQ-9) was administered by telephone interview. Results: Of 115 participants, 14.8% (N = 17) received a PHQ-9-based diagnosis of depression, and n = 7 of them scored 1 or more on the item on suicidality. A linear regression model showed the predictive role of female sex, pulmonary chronic condition and previous mental disorder in the development of depressive disorder; the latter was confirmed also by binary logistic regression. Severity indexes of disease (length of hospitalization and intensive care treatment) were found not to be associated with the development of depressive symptoms. Conclusions: A small but clinically meaningful number of participants in the current study reported that they experienced symptoms of depression and suicidal ideation 3 months post-discharge from their COVID-19 hospitalization. In particular, given the findings that a history of prior psychiatric disorders was predictive of the development of depression symptoms, clinicians should carefully monitor for the presence of all psychiatric symptoms at follow-up visits. Full article

INTRODUCTION: According to a survey carried out in 130 World Health Organization member countries, 93% of these countries revealed a disruption in their mental health care during the pandemic period. Our purpose was to study the impact of the SARS-CoV-2 pandemic on visits to the psychiatric emergency department of a hospital centre. METHODS：A retrospective study was designed to characterise the visits to the emergency department during a lockdown period of 2020 in comparison with the same period of 2019. Sociodemographic aspects, assessment orders, diagnosis, suicide attempts and post-discharge destination were assessed. RESULTS: There was a 54.7% reduction in the total number of visits to the psychiatric emergency department in 2020. No significant variation was found in the main municipalities of origin or in the age of the patients. The number of assessment orders was higher in 2020. The most common diagnostic classification was mood disorders (F30–F39, ICD-10 classification) in both years, with a decrease in cases by 70.5% in 2020. The rate of hospitalisations was maintained, with a trend to an increase of the compulsory hospitalisations. CONCLUSIONS: Although there was a decrease in the attendance at the psychiatric emergency department associated with the pandemic, the response to serious clinical situations was guaranteed. Despite the risks associated with infection by SARS-CoV-2, it is essential to maintain the provision of mental health care. Full article

Introduction: Public health organizations have recommended restricted access and safe storage practices as means to reduce firearm injuries and deaths. We aimed to assess the effect of four firearm restrictions on firearm deaths in Norway 1969–2009. Methods: All deaths due to firearm discharge were included (5,660 deaths, both sexes). The statistical analysis to assess impact of firearm legislations was restricted to males because of the sex disproportionality (94% were males). Results: A total of 89% of firearm deaths (both sexes) were classified as suicide, 8% as homicide, and 3% as unintentional (accident). During the past four decades, male accidental firearm death rates were reduced significantly by 90%. Male firearms suicide rates increased from 1969 to 1991 by 166%, and decreased by 62% from 1991 to 2009. Despite the great reduction in male accidental firearm deaths, we were unable to demonstrate effects of the laws. In contrast, we found that a 1990 regulation, requiring a police permit before acquiring a shotgun, had a beneficial impact on suicide in the total sample and in those aged 15–34 years. Male firearm homicides decreased post-2003 regulation regarding storing home guard weapons in private homes. Conclusions: Our findings suggest that two laws could have contributed to reduce male firearm mortality. It is, however, a challenge to measure the role of four firearm restrictions. The null findings are inconclusive, as they may reflect no true impact or study limitations. Full article