Archive
Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma
Source: Agency for Healthcare Research and Quality
OBJECTIVES:
To assess efficacy, comparative effectiveness, and harms of psychological, pharmacological, and emerging interventions to prevent posttraumatic stress disorder (PTSD) in adults.
DATA SOURCES:
PubMed®, the Cochrane Library, CINAHL, Embase, PILOTS, International Pharmaceutical Abstracts, PsycINFO®, Web of Science, reference lists of published literature (from January 1, 1980, to July 30, 2012). In addition, we searched various sources for grey literature.
REVIEW METHODS:
Two investigators independently selected, extracted data from, and rated risk of bias of relevant studies. If data were sufficient, we conducted quantitative analyses using random-effects models to estimate pooled effects. We graded strength of evidence (SOE) based on established guidance.
RESULTS:
We included 19 trials with a range of populations exposed to a variety of psychological traumas. Participants suffered from symptoms of PTSD but did not meet diagnostic criteria for PTSD. For most interventions studied, we did not find reliable evidence to support efficacy for the prevention of PTSD or for the reduction of PTSD-related symptom severity. Evidence was sufficient to justify conclusions about three treatments. First, debriefing does not reduce either the incidence or the severity of PTSD or related psychological symptoms in civilian victims of crime, assault, or accident trauma (low SOE). Second, our meta-analyses of three trials showed that, in subjects with acute stress disorder, brief trauma-focused cognitive behavioral therapy (CBT) was more effective than supportive counseling (SC) in reducing the severity of PTSD (moderate SOE). Pooled results did not reach statistical significance for incidence of PTSD, depression symptom severity (both low SOE), and anxiety symptom severity (moderate SOE), but numerically favored CBT over SC. Finally, collaborative care for a traumatic injury requiring hospitalization produces a greater decrease in PTSD symptom severity at 6, 9, and 12 months after injury than does usual care (low SOE). The efficacy of psychological interventions to prevent PTSD did not differ between men and women (low SOE). Evidence was insufficient to determine whether previous depression or a history of child abuse or baseline PTSD symptoms influence the effectiveness of interventions. Evidence was insufficient to determine the effect of timing, intensity, or dosing on the effectiveness or risk of harms of interventions or to justify conclusions about the comparative risk of harms. For emerging interventions such as yoga, dietary supplements, and complementary or alternative interventions, no studies met our eligibility criteria. Evidence was insufficient to determine whether any treatment approaches were more effective for victims of particular trauma types.
CONCLUSIONS:
Evidence supporting the effectiveness of most interventions used to prevent PTSD is lacking. If available in a given setting, brief trauma-focused CBT might be the preferable choice for reducing PTSD symptom severity in persons with acute stress disorder and collaborative care might be preferred for trauma patients requiring surgical hospitalization; by contrast, debriefing appears to be an ineffective intervention to reduce symptoms and prevent PTSD.
Safety of antidepressants in adults aged under 65: protocol for a cohort study using a large primary care database.
Source: BMC Psychiatry
Background
Antidepressants are among the most commonly prescribed drugs in primary care in England and their use is increasing. This is largely due to longer durations of treatment of depression. Observational studies have shown some differences in adverse outcomes associated with different antidepressant drugs but relatively little is known about their relative safety particularly with long term use. The primary aim of this study is to determine the relative and absolute risks of pre-defined adverse events comparing different classes of antidepressant drugs in adults aged under 65 years and diagnosed with depression.
Methods/design
The study will identify a cohort of patients with a first recorded diagnosis of depression between 1/1/2000 and 31/07/2011, and made between the ages of 20 to 64 years using a large primary care database (QResearch). Patients will be followed up until 1/08/2012. Details of all prescriptions for antidepressants in patients in the cohort will be extracted, including the date of each prescription, the type of antidepressant drug, the dose and total quantity prescribed. Prospectively recorded data will be used to ascertain information on adverse outcomes that occurred during follow-up and after entry into the cohort. These are: all-cause mortality, suicide, attempted suicide/self-harm, sudden death, antidepressant overdose/poisoning, myocardial infarction, stroke/transient ischaemic attack, cardiac arrhythmia, epilepsy/seizures, upper gastrointestinal bleeding, falls, fractures, adverse drug reactions and motor vehicle crashes. Cox proportional hazard models will be used to estimate the association of the outcomes with class of antidepressant drug adjusting for potential confounding variables. The analyses will also examine associations by duration and dose and with the most frequently prescribed individual antidepressant drugs. Self-controlled case series analyses will be used to estimate the relative incidence of the outcomes of interest for defined time periods of antidepressant use.
Discussion
The results of this study will help to establish the relative safety and balance of risks for different antidepressant drugs in people aged under 65.
Typology of persons with severe mental disorders
Typology of persons with severe mental disorders
Source: BMC Psychiatry
Background
Persons with severe mental disorders (PSMD) form a highly heterogeneous group. Identifying subgroups sharing similar PSMD profiles may help to develop treatment plans and appropriate services for their needs. This study seeks to establish a PSMD typology by looking at individual characteristics and the amount and adequacy of help received.
Methods
The study recruited a sample of 352 persons located in south-western Montreal (Quebec, Canada). Cluster analysis was used to create a PSMD typology.
Results
Analysis yielded five clusters: 1. highly functional older women with mood disorders, receiving little help from services; 2. middle-aged men with diverse mental disorders and alcohol abuse, receiving insufficient and inadequate help; 3. middle-aged women with serious needs, mood and personality disorders and suicidal tendencies, living in autonomous apartments, and receiving ample but inadequate help; 4. highly educated younger men with schizophrenia, living in autonomous apartments, and receiving adequate help; and 5. older poorly educated men with schizophrenia, living in supervised apartments, with ample help perceived as adequate. Marked differences were found between men and women, between users diagnosed with schizophrenia and others, and between persons living in supervised or autonomous apartments.
Conclusion
Our study highlights the existence of parallel subgroups among PSMD related to their socio-demographic status, clinical needs and service-use profiles, which could be used to focus more appropriate interventions. For mental health service planning, it demonstrates the relevance of focusing on individuals showing critical needs who are affected by multiple mental disorders (especially when associated with alcohol abuse), and often find help received as less adequate.
Screening for and Treatment of Suicide Risk Relevant to Primary Care: A Systematic Review for the U.S. Preventive Services Task Force
Source: Annals of Internet Medicine
Background:
In 2009, suicide accounted for 36 897 deaths in the United States.
Purpose:
To review the accuracy of screening instruments and the efficacy and safety of screening for and treatment of suicide risk in populations and settings relevant to primary care.
Data Sources:
Citations from MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL (2002 to 17 July 2012); gray literature; and a surveillance search of MEDLINE for additional screening trials (July to December 2012).
Study Selection:
Fair- or good-quality English-language studies that assessed the accuracy of screening instruments in primary care or similar populations and trials of suicide prevention interventions in primary or mental health care settings.
Data Extraction:
One investigator abstracted data; a second checked the abstraction. Two investigators rated study quality.
Data Synthesis:
Evidence was insufficient to determine the benefits of screening in primary care populations; very limited evidence identified no serious harms. Minimal evidence suggested that screening tools can identify some adults at increased risk for suicide in primary care, but accuracy was lower in studies of older adults. Minimal evidence limited to high-risk populations suggested poor performance of screening instruments in adolescents. Trial evidence showed that psychotherapy reduced suicide attempts in high-risk adults but not adolescents. Most trials were insufficiently powered to detect effects on deaths.
Limitation:
Treatment evidence was derived from high-risk rather than screen-detected populations. Evidence relevant to adolescents, older adults, and racial or ethnic minorities was limited.
Conclusion:
Primary care–feasible screening tools might help to identify some adults at increased risk for suicide but have limited ability to detect suicide risk in adolescents. Psychotherapy may reduce suicide attempts in some high-risk adults, but effective interventions for high-risk adolescents are not yet proven.
Primary Funding Source:
Agency for Healthcare Research and Quality
NTSB — Safety Report on Eliminating Impaired Driving
Safety Report on Eliminating Impaired Driving
Source: National Transportation Safety Board
On May 14, 2013, the 25th anniversary of our nation’s deadliest drunk-driving crash, which killed 24 children and three adults in Carrollton, Ky., the NTSB’s five-member board voted unanimously to issue bold recommendations to help the United States reach zero and eliminate alcohol-impaired driving.
Bold steps are needed: On average, every hour, one person dies in a crash involving a drunk driver and 20 more people are injured, including three with debilitating injuries. That adds up quickly to yearly totals of nearly 10,000 deaths, 27,000 lives forever altered and another 146,000 injured.
The safety report and recommendations culminate a year-long effort by the NTSB to thoroughly examine this problem and develop a set of targeted interventions. The recommendations include:
- Reduce state BAC limits from 0.08 to 0.05 or lower
- Increase use of high-visibility enforcement
- Develop and deploy in-vehicle detection technology
- Require ignition interlocks for all offenders
- Improve use of administrative license actions
- Target and address repeat offenders
- Reinforce use and effectiveness of DWI courts
Intimate Partner Violence and Incident Depressive Symptoms and Suicide Attempts: A Systematic Review of Longitudinal Studies
Source: PLoS Medicine
Background
Depression and suicide are responsible for a substantial burden of disease globally. Evidence suggests that intimate partner violence (IPV) experience is associated with increased risk of depression, but also that people with mental disorders are at increased risk of violence. We aimed to investigate the extent to which IPV experience is associated with incident depression and suicide attempts, and vice versa, in both women and men.
Methods and Findings
We conducted a systematic review and meta-analysis of longitudinal studies published before February 1, 2013. More than 22,000 records from 20 databases were searched for studies examining physical and/or sexual intimate partner or dating violence and symptoms of depression, diagnosed major depressive disorder, dysthymia, mild depression, or suicide attempts. Random effects meta-analyses were used to generate pooled odds ratios (ORs). Sixteen studies with 36,163 participants met our inclusion criteria. All studies included female participants; four studies also included male participants. Few controlled for key potential confounders other than demographics. All but one depression study measured only depressive symptoms. For women, there was clear evidence of an association between IPV and incident depressive symptoms, with 12 of 13 studies showing a positive direction of association and 11 reaching statistical significance; pooled OR from six studies = 1.97 (95% CI 1.56–2.48, I2 = 50.4%, pheterogeneity = 0.073). There was also evidence of an association in the reverse direction between depressive symptoms and incident IPV (pooled OR from four studies = 1.93, 95% CI 1.51–2.48, I2 = 0%, p = 0.481). IPV was also associated with incident suicide attempts. For men, evidence suggested that IPV was associated with incident depressive symptoms, but there was no clear evidence of an association between IPV and suicide attempts or depression and incident IPV.
Conclusions
In women, IPV was associated with incident depressive symptoms, and depressive symptoms with incident IPV. IPV was associated with incident suicide attempts. In men, few studies were conducted, but evidence suggested IPV was associated with incident depressive symptoms. There was no clear evidence of association with suicide attempts.
Predictors of psychiatric disorders in combat Veterans
Predictors of psychiatric disorders in combat Veterans
Source: BMC Psychiatry
Background
Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan.
Methods
The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders.
Results
In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified.
Conclusions
Overall, the study’s most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.
The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature
The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature
Source: Archives of Suicide Research
In this review, we explore social contagion as an understudied risk factor for non-suicidal self-injury (NSSI) among adolescents and young adults, populations with a high prevalence of NSSI. We review empirical studies reporting data on prevalence and risk factors that, through social contagion, may influence the transmission of NSSI. Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics. Preliminary research suggests iatrogenic effects of social contagion of NSSI through primary prevention are not likely. Thus, social contagion factors may warrant considerable empirical attention. Intervention efforts may be enhanced, and social contagion reduced, by implementation of psychoeducation and awareness about NSSI in schools, colleges, and treatment programs.
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Smoking, Income and Subjective Well-Being: Evidence from Smoking Bans
Smoking, Income and Subjective Well-Being: Evidence from Smoking Bans
Source: Institute for the Study of Labor
This paper investigates the effects of local smoking bans on different out-comes using county and time variation over the last 20 years in the US. First, I find no evidence that local smoking bans in bars, restaurants and workplaces decrease the prevalence of smoking. The estimates are very small and not statistically significant. Well-being is also affected by these policies: public smoking bans make smokers who do not quit more satisfied with their life. I verify the robustness of this result throughout, and validate my findings with two distinct data sources. I discuss and test the mechanisms behind this seemingly paradoxical relationship. The evidence suggests that smokers adapt to this policy since the impact on satisfaction is negative just before the implementation and positive afterward. Last, I find evidence that smokers do not favor the implementation of smoking bans. Yet, once they are exposed to a public smoking ban, they are less-opposed to those policies. Together the evidence suggests that current smokers are time-inconsistent and benefit from smoking policies.
Suicide Among Adults Aged 35–64 Years — United States, 1999–2010
Suicide Among Adults Aged 35–64 Years — United States, 1999–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Suicide is an increasing public health concern. In 2009, the number of deaths from suicide surpassed the number of deaths from motor vehicle crashes in the United States (1). Traditionally, suicide prevention efforts have been focused mostly on youths and older adults, but recent evidence suggests that there have been substantial increases in suicide rates among middle-aged adults in the United States (2). To investigate trends in suicide rates among adults aged 35–64 years over the last decade, CDC analyzed National Vital Statistics System (NVSS) mortality data from 1999–2010. Trends in suicide rates were examined by sex, age group, race/ethnicity, state and region of residence, and mechanism of suicide. The results of this analysis indicated that the annual, age-adjusted suicide rate among persons aged 35–64 years increased 28.4%, from 13.7 per 100,000 population in 1999 to 17.6 in 2010. Among racial/ethnic populations, the greatest increases were observed among American Indian/Alaska Natives (AI/ANs) (65.2%, from 11.2 to 18.5) and whites (40.4%, from 15.9 to 22.3). By mechanism, the greatest increase was observed for use of suffocation (81.3%, from 2.3 to 4.1), followed by poisoning (24.4%, from 3.0 to 3.8) and firearms (14.4%, from 7.2 to 8.3). The findings underscore the need for suicide preventive measures directed toward middle-aged populations.
What Do We Mean by “Behavioral Health Integrated with Primary Care”?
What Do We Mean by "Behavioral Health Integrated with Primary Care"?
Source: Agency for Healthcare Research and Quality
In this emerging field, like others, it is important to develop shared language that enables communication and collaboration across sites, disciplines, and time. The Academy’s Lexicon is a set of concepts and definitions developed by expert consensus for what we mean by behavioral health and primary care integration—a functional definition —what things look like in practice. This consensus Lexicon enables effective communication and concerted action among clinicians, care systems, health plans, payers, researchers, policymakers, business modelers, and patients working for effective, widespread implementation on a meaningful scale.
The original version of the Academy’s Lexicon was developed through an Agency for Health Research and Quality (AHRQ) small conference grant in 2009 to develop a National Research Agenda for Collaborative Care. Through the planning process for that meeting, it was clear that the experts used the same words to refer to different concepts or practices and struggled to communicate effectively. After the meeting’s pilot work to develop a shared understanding, participants agreed that the Lexicon was an important, even critical, advancement for the field but that it needed further refinement. To that end, AHRQ funded an R-13 grant that enabled C.J. Peek and the University of Minnesota to collaborate with the Academy’s National Integration Advisory Council (NIAC) to provide expert consensus and further refine the Lexicon. The current lexicon is the culmination of that effort.
The Lexicon starts with an executive summary that gives the reader an overview of what is to follow. The pages that follow expand and clarify the content. Appendices include a Glossary of common terms.
2013 National Drug Control Strategy
2013 National Drug Control Strategy
Source: White House
The Obama Administration’s inaugural National Drug Control Strategy, published in 2010, charted a new course in our efforts to reduce illicit drug use and its consequences in the United States—an approach that rejects the false choice between an enforcement-centric “war on drugs” and drug legalization. Science has shown that drug addiction is not a moral failing but rather a disease of the brain that can be prevented and treated. Informed by this basic understanding, the 2010, 2011 and 2012 Strategies established and promoted a balance of evidence-based public health and safety initiatives focusing on key areas such as substance abuse prevention, treatment, and recovery.
The 2013 National Drug Control Strategy, released on April 24, builds on the foundation laid down by the Administration’s previous three Strategies and serves as the Nation’s blueprint for reducing drug use and its consequences. Continuing our collaborative, balanced, and science-based approach, the new Strategy provides a review of the progress we have made over the past four years. It also looks ahead to our continuing efforts to reform, rebalance, and renew our national drug control policy to address the public health and safety challenges of the 21st century.
The Roles of Combat Exposure, Personal Vulnerability, and Involvement in Harm to Civilians or Prisoners in Vietn am War–Related Posttraumatic Stress Disorder
Source: Clinical Psychological Science
The diagnosis posttraumatic stress disorder was introduced in 1980 amid debate about the psychiatric toll of the Vietnam War. There is controversy, however, about its central assumption that potentially traumatic stressors are more important than personal vulnerability in causing the disorder. We tested this assumption with data from a rigorously diagnosed male subsample (n = 260) from the National Vietnam Veterans Readjustment Study. Combat exposure, prewar vulnerability, and involvement in harming civilians or prisoners were examined, with only combat exposure proving necessary for disorder onset. Although none of the three factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than prewar vulnerability in onset; prewar vulnerability was at least as important in long-term persistence. Implications for the primacy of the stressor assumption, further research, and policy are discussed.
See: Three Key Factors Interact to Increase PTSD Risk (Psychiatric News)
Screening for and Treatment of Suicide Risk Relevant to Primary Care: A Systematic Review for the U.S. Preventive Services Task Force
Source: Annals of Internal Medicine
Background:
In 2009, suicide accounted for 36 897 deaths in the United States.
Purpose:
To review the accuracy of screening instruments and the efficacy and safety of screening for and treatment of suicide risk in populations and settings relevant to primary care.
Data Sources:
Citations from MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL (2002 to 17 July 2012); gray literature; and a surveillance search of MEDLINE for additional screening trials (July to December 2012).
Study Selection:
Fair- or good-quality English-language studies that assessed the accuracy of screening instruments in primary care or similar populations and trials of suicide prevention interventions in primary or mental health care settings.
Data Extraction:
One investigator abstracted data; a second checked the abstraction. Two investigators rated study quality.
Data Synthesis:
Evidence was insufficient to determine the benefits of screening in primary care populations; very limited evidence identified no serious harms. Minimal evidence suggested that screening tools can identify some adults at increased risk for suicide in primary care, but accuracy was lower in studies of older adults. Minimal evidence limited to high-risk populations suggested poor performance of screening instruments in adolescents. Trial evidence showed that psychotherapy reduced suicide attempts in high-risk adults but not adolescents. Most trials were insufficiently powered to detect effects on deaths.
Limitation:
Treatment evidence was derived from high-risk rather than screen-detected populations. Evidence relevant to adolescents, older adults, and racial or ethnic minorities was limited.
Conclusion:
Primary care–feasible screening tools might help to identify some adults at increased risk for suicide but have limited ability to detect suicide risk in adolescents. Psychotherapy may reduce suicide attempts in some high-risk adults, but effective interventions for high-risk adolescents are not yet proven.
Primary Funding Source: Agency for Healthcare Research and Quality.
Cigarette Smoking Decreases among All Adults Except Those Aged 26 to 34
Cigarette Smoking Decreases among All Adults Except Those Aged 26 to 34 (PDF)
Source: Substance Abuse and Mental Health Services Administration
Smoking is a serious public health concern that continues to be the primary cause of preventable illness and death in the United States.
Policy efforts such as increased cigarette taxes and graphic warning labels have helped reduce smoking.
According to the 2011 National Survey on Drug Use and Health, 54.9 million adults smoked cigarettes in the past month. Smoking rates decreased between 2002 and 2011 for adults in all age groups except those aged 26 to 34 (Figure). Past month smoking among adults aged 26 to 34 showed no significant change between 2002 and 2011 (32.7 vs. 31.6 percent).
Research has shown that quitting by the age of 30 prevents almost all long-term health related effects of smoking. Although the number of adults smoking has declined, this report suggests a need for immediate targeting of cessation efforts toward smokers currently in their late 20s and early 30s.
Nonmedical Use of Prescription-Type Drugs, by County Type
Nonmedical Use of Prescription-Type Drugs, by County Type
Source: Substance Abuse and Mental Health Services Administration
- About 15.7 million persons aged 12 or older used prescription-type drugs nonmedically in the past year, and 6.7 million did so in the past month.
- Past year nonmedical use of prescription-type drugs was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties (5.4 vs. 6.4 and 6.6 percent); past month use was similar among all three types of counties.
- The rate of past year nonmedical use of pain relievers was lower in rural counties than in metropolitan and urbanized non-metropolitan counties (4.2 vs. 4.9 and 5.1 percent), as was the rate of nonmedical use of tranquilizers (1.8 vs. 2.1 and 2.3 percent); the rate of nonmedical use of stimulants and sedatives did not vary by type of county.
Young men’s attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services.
Source: BMC Psychiatry
Background
This mixed-methods study was designed to explore young Australian men’s attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.
Methods
National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).
Results
Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.
Conclusions
The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men’s views and everyday technology practices, and leverage the influence of peers.
Why the Rich Drink More but Smoke Less: The Impact of Wealth on Health Behaviors
Why the Rich Drink More but Smoke Less: The Impact of Wealth on Health Behaviors
Source: RAND Corporation
Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.
The Impact of Gatekeeper Training for Suicide Prevention on University Resident Assistants
The Impact of Gatekeeper Training for Suicide Prevention on University Resident Assistants
Source: Journal of College Counseling
Resident assistants (RAs) can serve as important suicide prevention gatekeepers. The purpose of the study was to determine if training improved RAs’ crisis communications skills and suicide-related knowledge and to determine if the knowledge elements predicted crisis communications skills. New RAs showed significant improvement in all areas from pretest to posttest, whereas returning RAs showed no significant increase in any of the areas. None of the knowledge areas predicted communications skills for either group.
Suicide is a significant problem in the college population (Kisch, Leino, & Silverman, 2005; Westefeld et al., 2006). It is the second leading cause of death among the U.S. college-age population (National Mental Health Association & the Jed Foundation, 2002), and it is estimated that there are 100 to 200 suicide attempts for every suicide completion (American Association of Suicidology, 2004). The National College Health Assessment conducted in Spring 2008 (N= 80,121) illustrated widespread suicide risk factors in the U.S. college population (American College Health Association [ACHA], 2009). Depression was the fourth ranked health problem during the past school year as self-reported by respondents. Furthermore, 36.7% reported feeling frequently overwhelmed, about 62% reported feeling hopeless, and 43% reported feeling so depressed at times that it was difficult to function (ACHA, 2009). It is clear that anxiety, depression, and other risk factors for suicide are present in current college students. More specific to suicide, 1.3% of participants reported that they had attempted suicide at least once during the past school year, and 9.0% of participants reported that they had seriously considered suicide (ACHA, 2009). Clearly, suicide prevention for college students is important.
Unfortunately, a service gap exists between the students who could benefit from counseling and those who seek it (Kadison & DiGeronimo, 2004; Kisch et al., 2005). On average, 10.4% of the students at campuses with counseling centers use the counseling center (Gallagher, 2009). According to Kisch et al. (2005), 80% to 90% of college students who die by suicide did not seek services at their college counseling center.
Gatekeeper training has been identified as a key strategy in suicide prevention in youth (Centers for Disease Control and Prevention, 1992; Chagnon, Houle, Marcoux, & Renaud, 2001; Gould & Kramer, 2001). The resident assistants (RAs) who live and work within the residence halls on college and university campuses are critical targets for gatekeeper training. However, little is known about best practices in training RAs (or other gatekeepers) to serve as a safety net for at-risk students. In the present study, we examined a brief suicide prevention curriculum provided to the RAs employed within a large university residential life system, to better understand their potential role as gatekeepers in campus suicide prevention.
Depression in Low-Income Mothers of Young Children: Are They Getting the Treatment They Need?
Depression in Low-Income Mothers of Young Children: Are They Getting the Treatment They Need?
Source: Urban Institute
Maternal depression can have severe and lasting consequences for both a mother and her child. This brief uses the National Survey of Drug Use and Health to estimate the prevalence, severity, and treatment of major depression among low-income mothers with young children (ages 0-5). We find that one out of eleven low-income mothers with young children had a major depressive episode in the past year, and nearly one-third did not report receiving any treatment. While uninsured low-income mothers had much lower treatment rates than insured low-income mothers, rates were comparable across treatment providers, suggesting that Medicaid fills an important gap.
