Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Protective Factors. Show all posts
Showing posts with label Protective Factors. Show all posts

Friday, May 6, 2022

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)
The Lancet, Vol 44, 101266

Summary

Background

People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.

Findings

Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).
 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.

Wednesday, August 12, 2020

Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action

June Gruber et al.
American Psychologist. 
Advance online publication.
http://dx.doi.org/10.1037/amp0000707

Abstract

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.

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Concluding Comments

Clinical psychological science is needed more than ever in response to both the acute and enduring psychological effects of COVID-19 (Adhanom Ghebreyesus, 2020). This article is intended to inspire dialogue surrounding the challenges the field faces and how it must adapt to meet the mental health demands of a rapidly evolving psychological landscape. Of course, sustained change will require strong advocacy to ensure that mental health research funding is available to understand and address mental health challenges following COVID-19. To secure a leadership role, clinical psychological scientists must be prepared to raise their voices not only within scientific outlets, but also in public discussions on the airwaves (radio, cable news), alongside colleagues in other scientific fields. Sustained effort, collaboration with other disciplines, and unity within psychology will be necessary to address the multifaceted impacts of COVID-19 on humanity.

Wednesday, September 18, 2019

California Requires Suicide Prevention Phone Number On Student IDs

Mark Kreider
Kaiser Health News
Originally posted August 30, 2019

Here is an excerpt:

A California law that has greeted students returning to school statewide over the past few weeks bears a striking resemblance to that Palo Alto policy from four years ago. Beginning with the 2019-20 school year, all IDs for California students in grades seven through 12, and in college, must bear the telephone number of the National Suicide Prevention Lifeline. That number is 800-273-TALK (8255).

“I am extremely proud that this strategy has gone statewide,” said Herrmann, who is now superintendent of the Roseville Joint Union High School District near Sacramento.

The new student ID law marks a statewide response to what educators, administrators and students themselves know is a growing need.

The numbers support that idea — and they are as jarring as they are clarifying.

Suicide was the second-leading cause of death in the United States among people ages 10 to 24 in 2017, according to the U.S. Centers for Disease Control and Prevention.  The suicide rate among teenagers has risen dramatically over the past two decades, according to data from the CDC.

The info is here.

Monday, July 8, 2019

Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation

Bradley Belsher, Derek Smolenski, Larry Pruitt, and others
JAMA Psychiatry. 2019;76(6):642-651.
doi:10.1001/jamapsychiatry.2019.0174

Abstract
Importance  Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente.

Objectives
To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates.

Evidence Review
A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies.

Findings
From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics.

Conclusions and Relevance
To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

Friday, April 5, 2019

A Prominent Economist’s Death Prompts Talk of Mental Health in the Professoriate

Emma Pettit
The Chronicle of Higher Education
Originally posted March 19, 2019

Reaching Out

For Bruce Macintosh, Krueger’s death was a reminder of how isolating academe can be. Macintosh is a professor of physics at Stanford University who was employed at a national laboratory, not a university, until about five years ago. That culture was totally different, he said. At other workplaces, Macintosh said, you interact regularly with peers and supervisors, who are paying close attention to you and your work.

“There’s nothing like that in an academic environment,” he said. “You can shut down completely for a year, and no one will notice,” as long as the grades get turned in.

It seems, Macintosh said, as if there should be multiple layers of support within a university department to help faculty members who experience depression or other forms of mental illness. But certain barriers still exist between professors and the resources they need.

A 2017 survey of 267 faculty members with mental-health histories or mental illnesses found that most respondents had little to no familiarity with accommodations at their institution. Even fewer reported using them.

The info is here.

Note: Career success, wealth, and prestige are not protective factors for suicide attempts or completions.  Interpersonal connections to family and friends, access to quality mental health care, problem-solving skills, meaning in life, and purposefulness are.

Thursday, December 7, 2017

Social media threat: People learned to survive disease, we can handle Twitter

Glenn Harlan Reynolds
USA Today
Originally posted November 20, 2017

Here is an excerpt:

Hunters and gatherers were at far less risk for infectious disease because they didn’t encounter very many new people very often. Their exposure was low, and contact among such bands was sporadic enough that diseases couldn’t spread very fast.

It wasn’t until you crowded thousands, or tens of thousands of them, along with their animals, into small dense areas with poor sanitation that disease outbreaks took off.  Instead of meeting dozens of new people per year, an urban dweller probably encountered hundreds per day. Diseases that would have affected only a few people at a time as they spread slowly across a continent (or just burned out for lack of new carriers) would now leap from person to person in a flash.

Likewise, in recent years we’ve gone from an era when ideas spread comparatively slowly, to one in which social media in particular allow them to spread like wildfire. Sometimes that’s good, when they’re good ideas. But most ideas are probably bad; certainly 90% of ideas aren’t in the top 10%. Maybe we don’t know the mental disease vectors that we’re inadvertently unleashing.

It took three things to help control the spread of disease in cities: sanitation, acclimation and better nutrition. In early cities, after all, people had no idea how diseases spread, something we didn’t fully understand until the late 19th century. But rule-of-thumb sanitation made things a lot better over time. Also, populations eventually adapted:  Diseases became endemic, not epidemic, and usually less severe as people developed immunity. And finally, as Scott notes, surviving disease was always a function of nutrition, with better-nourished populations doing much better than malnourished ones.

The article is here.

Wednesday, August 13, 2014

Doing their duty: An empirical analysis of the unintended effect of Tarasoff

By Griffin Sims Edwards
Journal of Law and Economics, Vol. 57, 2014
Emory Law and Economics Research Paper No. 10-61

Abstract

The seminal ruling of Tarasoff v. Regents enacted a duty that required mental health providers to warn potential victims of any real threat to life made by a patient. Many have theorized that this required breach of confidentiality may have adverse effects on effective psychological treatment - but the question remains unanswered empirically. Due to the presence of duty to warn laws, patients might forego mental health treatment that leads them to violence. Using a fixed effects model and exploiting the variation in the timing and style of duty to warn laws across states, I find that mandatory duty to warn laws cause an increase in homicides of 5%. These results are robust to model specifications, falsification tests, and help to clarify the true effect of state duty to warn laws.

The entire article is here.

Sunday, September 18, 2011

DOD, Services Work to Prevent Suicides


By Karen Parrish
American Forces Press Service
WASHINGTON, Sept. 9, 2011 – Officials know the facts about suicide in the military services, but the causes and best means of prevention are more elusive, a senior Defense Department official said today.
In testimony before the House Armed Services committee, Dr. Jonathan Woodson, the assistant secretary of defense for health affairs and director of the TRICARE Management Activity, said DOD has invested “tremendous resources” to better understand how to identify those at risk of suicide, treat at-risk people, and prevent suicide.
“We continue to seek the best minds from both within our ranks, from academia, other federal health partners, and the private sector to further our understanding of this complex set of issues,” Woodson said.
The overall rate of suicide among service members has risen steadily for a decade, he said, and DOD and the services are taking a multidisciplinary approach in their efforts to save lives.
The Defense and Veterans Affairs Departments are developing shared clinical practice guidelines that health care providers in both agencies will use to assess suicide risk and help prevent suicide attempts, Woodson said.
DOD also is working with the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration to offer critical mental health services to National Guard and Reserve members, who often don’t live close to military medical facilities, he added.
Woodson acknowledged much work remains.
“We have identified risk factors for suicide, and factors that appear to protect an individual from suicide,” he said. “As you well understand, the interplay of these factors is very complex. Our efforts are focused on addressing solutions in a comprehensive and holistic manner.”

Defense suicide prevention research includes Army ‘STARS,’ a study to assess risk and resilience in service members, Woodson said.
“This is the largest single epidemiologic research effort ever undertaken by the Army, and is designed to examine mental health, psychological resilience, suicide risk, suicide-related behaviors and suicide deaths,” the assistant secretary said.
The study, he said, involves experts from the Uniform Services University of the Health Sciences, University of California, University of Michigan, Harvard University, and the National Institute of Mental Health.
STARS is examining past data on about 90,000 active-duty soldiers, evaluating soldiers' characteristics and experiences as they relate to subsequent psychological health issues, suicidal behavior and other relevant outcomes, he said.
DOD has added more than 200 mental health professionals from the Public Health Service to medical facilities’ staffs, and is expanding access to services in civilian communities, Woodson said.
“Within the department, we have amended medical doctrine and embedded our mental health professionals far forward … to provide care in theaters of operation,” he added.
The department also has worked to collect, analyze and share data more effectively “so that the entire care team understands the diagnosis and treatment plan,” he said.
“As important as any step, we have also made great attempts to remove stigma from seeking mental health services, a stigma that is common throughout society, and not just in the military,” Woodson continued. “This is a long-term effort, but both senior officers and enlisted leaders are speaking out with a common message.”
Defense leaders are encouraged that service members increasingly now seek professional help when it is recommended, he said.
The entire article can be found here.