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      Comprehensive Online Self-Monitoring to Support Clinicians Manage Risk of Suicide in Youth Depression : A Pilot Study

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          Abstract

          Abstract. Background: Routine monitoring of depression symptoms and suicide risk is essential for appropriate treatment planning and risk management, but not well implemented by clinicians. We developed a brief online monitoring tool to address this issue. Aims: To investigate whether the online tool can feasibly improve monitoring; whether it is acceptable and useful for young people and their clinicians; and to determine whether a shorter tool could be implemented. Method: In a naturalistic longitudinal cohort study, 101 young people with depression completed the online tool on a tablet, prior to their consultation. Their results were immediately available to their clinician. Clients and clinicians answered questionnaires about acceptability and usefulness. Results: The tool was feasible to implement. Young people and clinicians found the tool acceptable and useful for understanding symptoms and risk. A brief three-item suicidal ideation screening measure correlated well with a validated measure of suicidal ideation. Conclusion: The online tool facilitates the quick exchange of key information about suicide risk, allowing clinicians to immediately address this. This level of responsiveness is likely to improve treatment outcomes. The brief version allows full integration into clinical practice to support clinicians managing those at risk of suicide.

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          Most cited references41

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          Global burden of disease in young people aged 10-24 years: a systematic analysis.

          Young people aged 10-24 years represent 27% of the world's population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden. We used data from WHO's 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups. The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%). The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention. None. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            The Use of Confidence or Fiducial Limits Illustrated in the Case of the Binomial

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              Suicidality in pediatric patients treated with antidepressant drugs.

              There has been concern that widely used antidepressant agents might be associated with an increased risk of suicidal ideation and behavior (suicidality) in pediatric patients. To investigate the relationship between antidepressant drugs and suicidality in pediatric patients participating in randomized, placebo-controlled trials. Data were derived from 23 trials conducted in 9 drug company-supported programs evaluating the effectiveness of antidepressants in pediatric patients and 1 multicenter trial (the Treatment for Adolescents With Depression Study) that evaluated fluoxetine hydrochloride. All placebo-controlled trials submitted to the Food and Drug Administration were eligible for inclusion. Evaluable data were derived from 4582 patients in 24 trials. Sixteen trials studied patients with major depressive disorder, and the remaining 8 studied obsessive-compulsive disorder (n = 4), generalized anxiety disorder (n = 2), attention-deficit/hyperactivity disorder (n = 1), and social anxiety disorder (n = 1). Only 20 trials were included in the risk ratio analysis of suicidality because 4 trials had no events in the drug or placebo groups. Individual patient data were available for all the trials. A meta-analysis was conducted to obtain overall suicidality risk estimates for each drug individually, for selective serotonin reuptake inhibitors in depression trials as a group, and for all evaluable trials combined. There were no completed suicides in any of these trials. The multicenter trial was the only individual trial to show a statistically significant risk ratio (4.62; 95% confidence interval [CI], 1.02-20.92). The overall risk ratio for selective serotonin reuptake inhibitors in depression trials was 1.66 (95% CI, 1.02-2.68) and for all drugs across all indications was 1.95 (95% CI, 1.28-2.98). The overall risk difference for all drugs across all indications was 0.02 (95% CI, 0.01-0.03). Use of antidepressant drugs in pediatric patients is associated with a modestly increased risk of suicidality.
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                Author and article information

                Contributors
                Journal
                cri
                Crisis
                The Journal of Crisis Intervention and Suicide Prevention
                Hogrefe Publishing
                0227-5910
                2151-2396
                September 23, 2016
                2017
                : 38
                : 3
                : 147-157
                Affiliations
                [ 1 ]Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
                [ 2 ]Orygen Youth Health, Melbourne, VIC, Australia
                [ 3 ]headspace, Glenroy, Melbourne, VIC, Australia
                [ 4 ]Faculty of Health, University of Canberra, ACT, Australia
                [ 5 ]headspace National Youth Mental Health Foundation, VIC, Australia
                [ 6 ]Department of General Practice University of Melbourne, VIC, Australia
                [ 7 ]Young and Well Cooperative Research Centre, Abbotsford, VIC, Australia
                Author notes
                Sarah Hetrick Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia, shetrick@ 123456unimelb.edu.au
                Article
                cri_38_3_147
                10.1027/0227-5910/a000422
                27659516
                ea77105b-f963-4470-8aa3-75acbb6da372
                Copyright @ 2016
                History
                : January 13, 2016
                : April 21, 2016
                : April 30, 2016
                Categories
                Research Trends

                Emergency medicine & Trauma,Psychology,Health & Social care,Clinical Psychology & Psychiatry,Public health
                technology,young people,suicide prevention,depression

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