To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive EpisodeMDE, Mania/HypomaniaM/H, Panic DisorderPD, Generalized Anxiety ...DisorderGAD) and suicidal thoughts and behaviorsSTB used in the UNIVERSAL project.
Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18-24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales CIDI-SC, the Self-Injurious Thoughts and Behaviors Interview SITBI and the Columbia-Suicide Severity Rating Scale C-SSRS. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview MINI. Measures of diagnostic accuracy and McNemar χ2 test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity.
A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1-55.1% and negative predictive values 90.2-99.0%; likelihood ratios positive were in the range of 2.1-14.6 and likelihood ratios negative 0.1-0.6. All outcomes showed adequate areas under the curve AUCs (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8).
The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.
IntroductionSuicide is among the leading causes of preventable death worldwide. The impact of suicide affects the personal, social and economic levels. Therefore, its prevention is a priority for ...public health systems. Previous studies seem to support the efficacy of providing active contact to people who have made a suicide attempt. The current systematic review and meta-analysis aims to investigate the efficacy of distance suicide prevention strategies implemented through synchronous technology-based interventions.Methods and analysisThis protocol is designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The bibliographical searches were conducted in the databases PubMed, PsycINFO, Scopus and Web of Science in April 2022, with no restrictions on the time of publication and limited to publications in English or Spanish. The search strategy was performed using free-text terms and Medical Subject Headings terms: suicide, follow-up, synchronous, remote, telehealth, telephone, hotline, video-conference and text message. Two reviewers will independently conduct study screening, selection process, data extraction and risk of bias assessment. The analysis and synthesis of the results will be both qualitative and quantitative. A narrative synthesis, presented in a comprehensive table, will be performed and meta-analysis will be conducted, as appropriate, if sufficient data are provided.Ethics and disseminationThe present review and meta-analysis will not require ethical approval, as it will use data collected from previously published primary studies. The findings of this review will be published in peer-reviewed journals and widely disseminated.PROSPERO registration numberCRD42021275044.
Suicide is a health problem among patients diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may offer opportunities to reach this at-risk group. However, ...to consider the implementation of telehealth systems in the prevention of suicidal behaviors in patients diagnosed with schizophrenia, a review of the evidence is required. The present aim was to explore the effectiveness of telephone-based suicide prevention programs among patients with schizophrenia and related disorders.
A bibliographic search was carried out in the PubMed, PsycInfo, Scopus and Web of Science electronic databases following PRISMA guidelines. Two reviewers performed the selection, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria.
Globally, an adherence was observed ranging from 78 to 100%. Three studies reported a reduction in suicidal ideation and two studies showed a reduction in the risk of relapse observed in the intervention group compared to a control group.
In accordance with the limited data available, the use of a telephone contact approach appears to be feasible and effective in schizophrenia patients with suicidal behaviors. The preliminary evidence also suggests that this system appears to reduce suicidal ideation. Further research is required to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.
Abstract Objective To determine the effectiveness over one year of a specific telephone management programme on patients discharged from an emergency department (ED) after a suicide attempt. We ...hypothesized that the programme will reduce the percentage of patients re-attempting suicide and delay the time between attempts. Design A multicentre, case-control, population-based study. The effect of the 1-year intervention on the main outcome measures was evaluated with respect to a 1-year baseline period and a control group. Setting Two hospitals with distinct catchment areas in Catalonia (Spain). Participants A total of 991 patients discharged from the ED of either hospital after a suicide attempt during the baseline year and the intervention year. Intervention The intervention was carried out on patients discharged from the ED for attempted suicide (Sabadell). It consisted of a systematic, one-year telephone follow-up programme: after 1 week, thereafter at 1, 3, 6, 9 and 12-month intervals, to assess the risk of suicide and increasing adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone management. Main outcome measures Time elapsed between initial suicide attempt and subsequent one, and changes in the annual rate of patients who reattempted suicide in the year of the intervention and the preceding one. Results The telephone management programme delayed suicide reattempts in the intervention group compared to the baseline year (mean time in days to first reattempt, year 2008=346.47, sd =4.65; mean time in days to first reattempt, year 2007=316.46, sd =7.18; P <0.0005; χ ²=12.1, df =1) and compared to the control population during the same period (mean time in days to first reattempt, treatment period=346.47, sd =4.65; mean time in days to first reattempt, pre-treatment period=300.36, sd =10.67; P <0.0005; χ ²=16.8, df =1). The intervention reduced the rate of patients who reattempted suicide in the experimental population compared to the previous year (Intervention 6% (16/296) v Baseline 14% (39/285) difference 8%, 95% confidence interval 2% to 12%) and to the control population (Intervention 6% (16/296) v Control 14% (31/218) difference 8%, −13% to −2%) Limitations One of the main obstacles was the difficulty to contact all patients within the established deadlines. Another limitation of our study was that patients under the age of 18 underwent an intensive intervention in the day hospital, although their number was very small (13/319 in 2008) and did not significantly influence the results. But the main limitation of our study was that it was performed within the EAAD project. This project includes a comprehensive multilevel intervention practically in the same experimental area and aimed at an early diagnosis and treatment of depression, which is the main psychiatric disorder associated with suicide. Moreover, longer-term studies should be encouraged to determine whether such interventions really reduce suicide Conclusion A telephone management programme for patients discharged from an ED after a suicide attempted would be a useful strategy in delaying further suicide attempts and in reducing the rate of reattempts, which is known as the highest risk factor for suicide completion.
Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among ...Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18–24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT’s Cronbach’s alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.
Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of ...first-onset and persistence of either of these conditions.
Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up.
A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline.
Self-report data were used; external validation of the multivariable prediction models is needed.
MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.
•13.3% students had first-onset of MDE and/or GAD at 12-month follow-up.•Among students with baseline MDE and/or GAD, 46.7% persisted at 12-month follow-up.•Strongest predictors were lifetime symptoms of MDE-GAD and prior suicidal ideation.•Multivariable models provided AUCs 0.76–0.81 to predict first-onset and persistence.•74.9% onset MDE-GAD cases occur in 30% students at highest predicted baseline risk.
Suicide is a leading cause of death among young people. While suicide prevention is considered a research and intervention priority, longitudinal data is needed to identify risk and protective ...factors associate with suicidal thoughts and behaviors. Here we describe the UNIVERSAL (University and Mental Health) project which aims are to: (1) test prevalence and 36-month incidence of suicidal thoughts and behaviors; and (2) identify relevant risk and protective factors associated with the incidence of suicidal thoughts and behaviors among university students in Spain.
An ongoing multicenter, observational, prospective cohort study of first year university students in 5 Spanish universities. Students will be assessed annually during a 36 month follow-up. The surveys will be administered through an online, secure web-based platform. A clinical reappraisal will be completed among a subsample of respondents. Suicidal thoughts and behaviors will be assess with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Risk and protective factors will include: mental disorders, measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic variables, self-perceived health status, health behaviors, well-being, substance use disorders, service use and treatment. The UNIVERSAL project is part of the International College Surveys initiative, which is a core project within the World Mental Health consortium. Lifetime and the 12-month prevalence will be calculated for suicide ideation, plans and attempts. Cumulative incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed by Cox proportional hazard models.
The study will provide valid, innovative and useful data for developing prevention programs for youth suicide and for improving early identification for high-risk students. The longitudinal design of this study will improve causal interpretation of analyzed associations, needed for generating and validating predictive models. It will represent the first results about suicidal thoughts and behaviors in the Spanish university population. The World Mental Health Survey collaboration will permit accurate cross-national comparisons.
•Mental disorders among first-year Spanish university students are common.•35.7% of students screened positive for 12-month mental disorder.•Depression and generalized anxiety disorder are the most ...frequent disorders.•29.2% of students with mental disorders report severe role impairment.•12.6% of students with mental disorder receive mental health treatment.
The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited.
To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use.
First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM–IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed.
Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8).
The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations.
One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment.
Activation of the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway is one the most frequent genetic events in human cancer. A cell-based imaging assay that monitored the translocation of the ...Akt effector protein, Forkhead box O (FOXO), from the cytoplasm to the nucleus was employed to screen a collection of 33,992 small molecules. The positive compounds were used to screen kinases known to be involved in FOXO translocation. Pyrazolopyrimidine derivatives were found to be potent FOXO relocators as well as biochemical inhibitors of PI3Kα. A combination of virtual screening and molecular modeling led to the development of a structure-activity relationship, which indicated the preferred substituents on the pyrazolopyrimidine scaffold. This leads to the synthesis of ETP-45658, which is a potent and selective inhibitor of phosphoinositide 3-kinases and demonstrates mechanism of action in tumor cell lines and in vivo in treated mice.
•The Catalonia Suicide Risk code is a secondary suicide prevention program that aims to provide follow-up care of patients at high risk of suicide.•For patients enrolled in the CSRC, immediate ...follow-up actions include a face-to-face appointment (within 10 days for adults and 72 h for minors) and a telephone contact at 30 days of enrolment.•Although follow-up actions were successful for most patients, greater adherence to the recommended CSRC care pathway is needed.
Suicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program.
Observational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care.
A total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning.
Adherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts.
Although the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.
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