Tagsuicide

Reading of the Week: Suicide Prevention in the Acute Care Setting (JAMA Psychiatry); Also, Gottlieb on Racism (Wash Post)

From the Editor

In the year before they suicide, more than 90% of people have had contact with some type of acute care – an ED visit, a trip to the family doctor, or an appointment at an outpatient specialty clinic. So how can we help people better? Given the contact, what can we do to reduce suicides?

This week, we have two selections; the first focuses on this question. In a new JAMA Psychiatry paper, Dr. Stephanie K. Doupnik (of the University of Pennsylvania) and her co-authors do a systematic review and meta-analysis of 14 studies that used brief suicide prevention interventions in acute care settings (think brief contact interventions like a phone call after an ED visit). They find an encouraging result: “In this meta-analysis, brief suicide prevention interventions were associated with reduced subsequent suicide attempts.” We consider the big paper, and the editorial that accompanies it.

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In the other selection, therapist Lori Gottlieb discusses race and therapy in a Washington Post essay. She examines her own biases, and the way they play out in her therapy session. “Here’s what we didn’t talk about [in school]: the racism that might take place inside the supposedly ‘safe space’ of our therapy rooms – our patients’ racism and our own.”

Please note that there will be no Reading next week. Happy Canada Day.

DG

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Reading of the Week: What do Google Searches Tell Us about Suicide & COVID? (CJP) Also, Bullock on Suicide (NEJM)

From the Editor

How will the pandemic impact mental health? Will we see more people with depression and PTSD? What about suicides?

In a recent JAMA Psychiatry paper, Mark A. Reger (of the University of Washington) and his co-authors argued that we may see a “perfect storm” with COVID-19, increasing the risk of suicide. A BMJ blog speculated that we could have a “pandemic after the pandemic,” as mental health problems grow even as the virus fades.

This week, we have two selections; the first focuses on suicide and the pandemic. Using an innovative approach – that is, considering Google searches for suicide and related terms, as a proxy for completions – the authors draw on American and international data. In a new Canadian Journal of Psychiatry paper, Dr. Mark Sinyor (of the University of Toronto) and his co-authors find surprisingly “that the initial stages of the pandemic were accompanied by a substantial reduction in searches related to suicide, anxiety, and hopelessness with no change in searches for depression.”

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In the second selection, Dr. Justin L. Bullock (of the University of California, San Francisco) discusses suicide in The New England Journal of Medicine. The young doctor is very personal, describing his own struggles with mental illness. “‘I’m starting to get depressed,’ I told my sister emotionlessly. She began to cry, probably flashing back to the last time I was severely depressed, attempted suicide, and ended up in the ICU. I told her I was sad that my 2-year-old niece wouldn’t remember me. ‘Do you think I would ever let her forget you?’ she responded. We both cried.”

DG

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Reading of the Week: COVID & Suicide (JAMA Psych); also, Digital Mental Health (JMIR) and Solomon on COVID & Depression (NYT)

From the Editor

Will suicide rates rise with COVID? How will mental health care delivery change? Are we overlooking the most vulnerable?

This week’s Reading will focus on the latest in the literature on the COVID and mental health care, with three selections.

In the first, we consider a paper on COVID and suicide. In a JAMA Psychiatry paper, Mark A. Reger (of University of Washington) and his co-authors consider the impact of the global emergency on suicide. They are practical, and explain that there are clear opportunities for suicide prevention. In responding to COVID, they call for a “comprehensive approach that considers multiple US public health priorities, including suicide prevention.”

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What is the role of digital mental health during and after this pandemic? In the second selection, we consider a new JMIR Mental Health paper. Dr. John Torous (of Harvard University) and his co-authors note the greater use of telemental health, apps, and other forms of e-mental health care. They write: “The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown.”

Finally, in the third selection, we look at an essay by Andrew Solomon. The Pulitzer Prize-finalist author discusses pandemic and mental health, worrying that those in need may be overlooked. “When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased.”

DG

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Reading of the Week: Cuijpers on Depression Treatment (WP); Also, Suicide (NEJM), and Sinyor on DeRozan & Depression (Star)

From the Editor

How to treat depression? How do we approach suicide? Who is the greatest Raptor of all time?

This week, we consider three pieces.

In the first selection, Pim Cuijpers (Vrije Universiteit Amsterdam) and his co-authors do a network meta-analysis of depression treatment, weighing psychotherapy, pharmacotherapy, and the combination of the two. They find: “combined treatment is more effective than psychotherapy or pharmacotherapy alone in the short‐term treatment of moderate depression, and there are no significant differences between psychotherapy and pharmacotherapy.”

In a short New England Journal of Medicine paper, Drs. Seena Fazel (Oxford University) and Bo Runeson (Karolinska Institutet) review a topic of relevance to all clinicians: suicide. “Management of suicidality calls for a comprehensive approach to assessment and treatment.”

TORONTO, ON - SEPTEMBER, 25 DeMar DeRozen poses for photos. It was media day for the Toronto Raptors at their training facility, the BioSteel Centre. Coaches and players met with media, answered questions and had a variety of photographs taken. (Richard Lautens/Toronto Star via Getty Images)Yes, we talk about basketball this week

Finally, in the third selection, the University of Toronto’s Dr. Mark Sinyor writes about basketball and his favourite Raptor – and, yes, stigma.

DG

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Reading of the Week: More Sleep, Fewer Suicidal Thoughts? New AJP Paper; Also, Is Depression like Cancer (NYT)? Admissions & Ethnic Minorities (EPS)

From the Editor

Can a sleep intervention reduce suicidal thoughts in those with depression and insomnia?

When seeing people with depression, we often tend to focus on the Big Problem: that is, the major depressive disorder itself. But should we also consider trying to provide early symptomatic relief, with, say, a sleep medication?

In the first selection, we look at a new paper from The American Journal of Psychiatry. Dr. William V. McCall of the Medical College of Georgia at Augusta University and his co-authors write about the REST-IT study, a randomized controlled trial of zolpidem-CR for those with MDD and insomnia. “The results do not support the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia…”

sleeping-babySleeping Like a Baby: Fewer Suicidal Thoughts?

In the second selection, the University of Western Ontario’s Rebecca Rodrigues and her co-authors consider involuntary psychiatric admissions and ethnic minority groups in the context of early psychosis. Spoiler alert: “African and Caribbean groups were the most likely to experience an involuntary admission…”

And in the third selection, phyisician Jill Halper wonders: is depression like cancer? “My rabbi said that my husband, like a dying cancer patient, had been in hospice care. We just didn’t realize it.”

DG

 

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Reading of the Week: Your Patient’s Suicide – the New BJP Bulletin Paper; Also, Langford on Suicide and His Journey

From the Editor

It’s the phone call that we all dread – the call from the family or the coroner, explaining that your patient has died, likely by suicide.

At some point, we all receive that call.

Obviously, we think about the impact of suicide on families. But what impact does suicide have on us clinicians? In this week’s Reading, we consider the new BJP Bulletin paper on suicide and psychiatrists. Dr. Rachel Gibbons, an English psychiatrist, and her co-authors try to answer this question with a survey. Among their findings: a quarter of psychiatrist has considered a career change after a patient’s suicide.

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In this week’s other selection, in a Lancet Psychiatry paper, Dr. Alex Langford, also an English psychiatrist, talks about the impact that suicide has had on his life.

DG

 

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Reading of the Week: Can Social Connectedness Prevent Suicides? The New JAMA Psychiatry Paper on Caring Contacts in the Military

From the Editor

Social disconnectedness contributes to suicide. Past studies have tried to connect with people at risk, using simple tools like postcards.

This week, we look at a JAMA Psychiatry paper. The University of Washington’s Katherine Anne Comtois and her co-authors use a text message-based intervention (Caring Contacts) to try to reduce suicidal thoughts and behaviours in active military personal. They find: “Although the primary hypotheses were not supported, Caring Contacts was found to be a simple, scalable intervention that may be effective in reducing the occurrence of suicide ideation and attempts.”

Military man texts using smart phone in the city Suicide prevention by text: clever? Too clever?

We consider the paper and two editorials. We also consider a New York Times essay that asks: “If suicide is preventable, why are so many people dying from it?”

DG

 

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Reading of the Week: Cancer and Suicide – the New JAMA Psychiatry Paper

From the Editor

When I worked closely with cancer patients, we would often speak of that moment – the moment they were diagnosed, when they officially became cancer patients. Many recalled their first emotions: the disbelief, the shock, the anger. A few could even tell me sparkling details, like the way the doctor looked at them or what she was wearing. And, for all, that moment had been life altering.

That moment is followed by challenges, and for some, depression and even suicide.

What is the risk of suicide after the cancer diagnosis? In this week’s Reading, we look at a new JAMA Psychiatry paper. Drawing on English data, and involving 4.7 million people, Public Health England’s Katherine Henson and her co-authors look at cancer and suicide. They find: “Despite low absolute numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths.”

popepaintingBig diagnosis, big risk?

In this Reading, we consider the paper on this important topic, as well as an editorial.

DG

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Reading of the Week: “It was scary and sad, but it was also a terrible sort of relief” – Dr. Danziger on Her Father’s Suicide

From the Editor

“By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief.”

So begins a short and honest essay by Dr. Phoebe Danziger. Our American colleague’s JAMA paper doesn’t require much of an introduction. She speaks about her father, his mental illness, and his death. She also touches on her own depression. And she speaks candidly of a childhood coloured by her father’s illness.

36yts2xd_400x400Phoebe Danziger

In this Reading, we consider Dr. Danziger’s essay.

DG

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Reading of the Week: How to Cope With a Patient’s Suicide? What to do When Nudges Don’t Work? Can Technology Bring Physicians Together?

From the Editor

“We talk about the toll suicide takes on families… We talk about the tragedy for the people who’ve died… What we don’t openly talk about is suicide’s toll on the doctors who have treated these patients.”

So writes Dr. Dinah Miller, a psychiatrist affiliated with Johns Hopkins Medicine. She discusses the death of a patient and the impact on her life.

Dr. Miller’s essay is one of three selections in this week’s Reading.

The papers are different and look at different issues. The one common thread: they were all published in The New England Journal of Medicine.

And they all ask important, thought-provoking questions:

How to cope with a patient’s suicide?

What to do when nudges don’t work?

Can technology bring physicians together?

p17Dr. Dinah Miller

Enjoy.

DG

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