The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
Cheryl A King - One of the best experts on this subject based on the ideXlab platform.
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predicting suicidal behavior among lesbian gay bisexual and transgender youth receiving Psychiatric Emergency services
Journal of Psychiatric Research, 2020Co-Authors: Johnny Berona, Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:Lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). However, few studies have comprehensively examined SITBs and their longitudinal course in LGBT youth at high risk for suicide. The aims of the present study were to characterize histories of SITBs among high-risk LGBT youth and to examine prospective associations with suicidal behavior. Participants were 285 youth (41.8% LGBT) ages 13-25 years receiving Psychiatric Emergency department (ED) services. Post-discharge suicidal behavior was assessed via 4-month phone interviews and 12 month chart reviews. The sample was 42.1% male, 57.9% female, 2.5% gender minority, 41.8% sexual minority. LGBT participants were more likely to have prior Psychiatric ED visits and hospitalizations, more frequent past week suicide ideation, and more severe nonsuicidal self-injury (NSSI). We conducted stratified survival analyses to identify predictors of time to suicidal behavior post discharge. The final model for LGBT youth included past week suicide ideation and past month NSSI episodes. Among non-LGBT youth, the final model included number of lifetime NSSI methods and use of a highly lethal suicide attempt method. Within this sample of youth receiving Psychiatric Emergency services, LGBT youth were overrepresented and had more severe histories of SITBs. Results suggest the importance of assessing both lifetime and recent factors (i.e., past week and month), particularly for LGBT youth. Future research should replicate these findings in larger samples to explore whether there are unique risk factors that can aid in predicting and preventing suicide among LGBT youth.
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prospective associations of coping styles with depression and suicide risk among Psychiatric Emergency patients
Behavior Therapy, 2017Co-Authors: Adam G Horwitz, Johnny Berona, Ewa K Czyz, Cheryl A KingAbstract:Suicide is the second leading cause of death for those ages 13-25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult Psychiatric Emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.
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coping with suicidal urges among youth seen in a Psychiatric Emergency department
Psychiatry Research-neuroimaging, 2016Co-Authors: Ewa K Czyz, Johnny Berona, Adam G Horwitz, Alejandra Arango, Yasmin Colelewis, Cheryl A KingAbstract:This study of youth seeking Psychiatric Emergency department (ED) services examined (1) youth self-efficacy to use suicide-specific coping strategies, (2) whether these self-efficacy beliefs varied by demographic and clinical characteristics, (3) and associations of these beliefs with suicide attempts and ED visits 3-5 months later. Participants were 286 Psychiatric ED patients (59% Female), ages 13-25. Ratings of self-efficacy to engage in 10 suicide-specific coping behaviors were assessed at index visit. A total of 226 participants (79%) were assessed 3-5 months later. Youth endorsed low-to-moderate self-efficacy for different suicide-specific coping behaviors, with lowest ratings endorsed for limiting access to lethal means and accessing professional resources. More severe baseline psychopathology was associated with lower self-efficacy. Males endorsed higher self-efficacy for coping behaviors not requiring external support. Lower coping self-efficacy for some of the key strategies, and lower confidence that these strategies will be helpful, differentiated those with and without follow-up suicide attempts and ED visits. The generally low-to-moderate confidence in youths' ability to engage in coping behaviors to manage suicidal crises, and its association with follow-up suicidal crises, is concerning because many of these strategies are commonly included as part of discharge recommendations or safety planning. Implications of findings are discussed.
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self rated expectations of suicidal behavior predict future suicide attempts among adolescent and young adult Psychiatric Emergency patients
Depression and Anxiety, 2016Co-Authors: Ewa K Czyz, G Adam M S Horwitz, Cheryl A KingAbstract:BACKGROUND: This study's purpose was to examine the predictive validity and clinical utility of a brief measure assessing youths' own expectations of their future risk of suicidal behavior, administered in a Psychiatric Emergency (PE) department; and determine if youths' ratings improve upon a clinician-administered assessment of suicidal ideation severity. The outcome was suicide attempts up to 18 months later. METHODS: In this medical record review study, 340 consecutively presenting youths (ages 13-24) seeking PE services over a 7-month period were included. Subsequent PE visits and suicide attempts were retrospectively tracked for up to 18 months. The 3-item scale assessing patients' perception of their own suicidal behavior risk and the clinician-administered ideation severity scale were used routinely at the study site. RESULTS: Cox regression results showed that youths' expectations of suicidal behavior were independently associated with increased risk of suicide attempts, even after adjusting for key covariates. RESULTS were not moderated by sex, suicide attempt history, or age. Receiver-operating characteristic (ROC) analyses indicated that self-assessed expectations of risk improved the predictive accuracy of the clinician-administered suicidal ideation measure. CONCLUSIONS: Youths' ratings indicative of lower confidence in maintaining safety uniquely predicted follow-up attempts and provided incremental validity over and above the clinician-administered assessment and improved its accuracy, suggesting their potential for augmenting suicide risk formulation. Assessing youths' own perceptions of suicide risk appears to be clinically useful, feasible to implement in PE settings, and, if replicated, promising for improving identification of youth at risk for suicidal behavior.© 2016 Wiley Periodicals, Inc. Language: en
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predicting future suicide attempts among adolescent and emerging adult Psychiatric Emergency patients
Journal of Clinical Child and Adolescent Psychology, 2015Co-Authors: Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15 to 24 years (M=19.4 years) who presented for Psychiatric Emergency services during a 9-month period. These patients' medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Socioeconomic status, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for male patients but not female). Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for male patients.
Ewa K Czyz - One of the best experts on this subject based on the ideXlab platform.
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predicting suicidal behavior among lesbian gay bisexual and transgender youth receiving Psychiatric Emergency services
Journal of Psychiatric Research, 2020Co-Authors: Johnny Berona, Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:Lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). However, few studies have comprehensively examined SITBs and their longitudinal course in LGBT youth at high risk for suicide. The aims of the present study were to characterize histories of SITBs among high-risk LGBT youth and to examine prospective associations with suicidal behavior. Participants were 285 youth (41.8% LGBT) ages 13-25 years receiving Psychiatric Emergency department (ED) services. Post-discharge suicidal behavior was assessed via 4-month phone interviews and 12 month chart reviews. The sample was 42.1% male, 57.9% female, 2.5% gender minority, 41.8% sexual minority. LGBT participants were more likely to have prior Psychiatric ED visits and hospitalizations, more frequent past week suicide ideation, and more severe nonsuicidal self-injury (NSSI). We conducted stratified survival analyses to identify predictors of time to suicidal behavior post discharge. The final model for LGBT youth included past week suicide ideation and past month NSSI episodes. Among non-LGBT youth, the final model included number of lifetime NSSI methods and use of a highly lethal suicide attempt method. Within this sample of youth receiving Psychiatric Emergency services, LGBT youth were overrepresented and had more severe histories of SITBs. Results suggest the importance of assessing both lifetime and recent factors (i.e., past week and month), particularly for LGBT youth. Future research should replicate these findings in larger samples to explore whether there are unique risk factors that can aid in predicting and preventing suicide among LGBT youth.
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prospective associations of coping styles with depression and suicide risk among Psychiatric Emergency patients
Behavior Therapy, 2017Co-Authors: Adam G Horwitz, Johnny Berona, Ewa K Czyz, Cheryl A KingAbstract:Suicide is the second leading cause of death for those ages 13-25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult Psychiatric Emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.
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coping with suicidal urges among youth seen in a Psychiatric Emergency department
Psychiatry Research-neuroimaging, 2016Co-Authors: Ewa K Czyz, Johnny Berona, Adam G Horwitz, Alejandra Arango, Yasmin Colelewis, Cheryl A KingAbstract:This study of youth seeking Psychiatric Emergency department (ED) services examined (1) youth self-efficacy to use suicide-specific coping strategies, (2) whether these self-efficacy beliefs varied by demographic and clinical characteristics, (3) and associations of these beliefs with suicide attempts and ED visits 3-5 months later. Participants were 286 Psychiatric ED patients (59% Female), ages 13-25. Ratings of self-efficacy to engage in 10 suicide-specific coping behaviors were assessed at index visit. A total of 226 participants (79%) were assessed 3-5 months later. Youth endorsed low-to-moderate self-efficacy for different suicide-specific coping behaviors, with lowest ratings endorsed for limiting access to lethal means and accessing professional resources. More severe baseline psychopathology was associated with lower self-efficacy. Males endorsed higher self-efficacy for coping behaviors not requiring external support. Lower coping self-efficacy for some of the key strategies, and lower confidence that these strategies will be helpful, differentiated those with and without follow-up suicide attempts and ED visits. The generally low-to-moderate confidence in youths' ability to engage in coping behaviors to manage suicidal crises, and its association with follow-up suicidal crises, is concerning because many of these strategies are commonly included as part of discharge recommendations or safety planning. Implications of findings are discussed.
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self rated expectations of suicidal behavior predict future suicide attempts among adolescent and young adult Psychiatric Emergency patients
Depression and Anxiety, 2016Co-Authors: Ewa K Czyz, G Adam M S Horwitz, Cheryl A KingAbstract:BACKGROUND: This study's purpose was to examine the predictive validity and clinical utility of a brief measure assessing youths' own expectations of their future risk of suicidal behavior, administered in a Psychiatric Emergency (PE) department; and determine if youths' ratings improve upon a clinician-administered assessment of suicidal ideation severity. The outcome was suicide attempts up to 18 months later. METHODS: In this medical record review study, 340 consecutively presenting youths (ages 13-24) seeking PE services over a 7-month period were included. Subsequent PE visits and suicide attempts were retrospectively tracked for up to 18 months. The 3-item scale assessing patients' perception of their own suicidal behavior risk and the clinician-administered ideation severity scale were used routinely at the study site. RESULTS: Cox regression results showed that youths' expectations of suicidal behavior were independently associated with increased risk of suicide attempts, even after adjusting for key covariates. RESULTS were not moderated by sex, suicide attempt history, or age. Receiver-operating characteristic (ROC) analyses indicated that self-assessed expectations of risk improved the predictive accuracy of the clinician-administered suicidal ideation measure. CONCLUSIONS: Youths' ratings indicative of lower confidence in maintaining safety uniquely predicted follow-up attempts and provided incremental validity over and above the clinician-administered assessment and improved its accuracy, suggesting their potential for augmenting suicide risk formulation. Assessing youths' own perceptions of suicide risk appears to be clinically useful, feasible to implement in PE settings, and, if replicated, promising for improving identification of youth at risk for suicidal behavior.© 2016 Wiley Periodicals, Inc. Language: en
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predicting future suicide attempts among adolescent and emerging adult Psychiatric Emergency patients
Journal of Clinical Child and Adolescent Psychology, 2015Co-Authors: Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15 to 24 years (M=19.4 years) who presented for Psychiatric Emergency services during a 9-month period. These patients' medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Socioeconomic status, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for male patients but not female). Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for male patients.
Robert Dicker - One of the best experts on this subject based on the ideXlab platform.
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suicidality and hospitalization as cause and outcome of pediatric Psychiatric Emergency room visits
European Child & Adolescent Psychiatry, 2015Co-Authors: Eugene Grudnikoff, Erin Callahan Soto, Robert Dicker, Anne Frederickson, Michael L Birnbaum, Ema SaitoAbstract:The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric Psychiatric Emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged <18 years consecutively assessed by a PPERS 01.01.2002–12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0 %) presented with suicidal ideation (16.2 %) or attempt/preparation (8.8 %). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p < 0.0001). Suicidal attempt/preparation was associated with female sex, depression, lower GAF score, past suicide attempt, precipitant of peer conflict, and no stimulant treatment (p < 0.0001). Compared to suicidal attempt/preparation, suicidal ideation was associated with school referral, and higher GAF score (p < 0.0001). Of the 265 patients with suicidality, 58.5 % were discharged home (ideation = 72.1 % vs. attempt/preparation = 33.7 %, p < 0.0001). In patients with suicidal ideation, outpatient disposition was associated with higher GAF score, school referral, and adjustment disorder (p < 0.0001). In patients with suicidal attempt/preparation, outpatient disposition was associated with higher GAF score, lower acuity rating, and school referral (p < 0.0001). Suicidality is common among PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve identification of non-emergent suicidal presentations and encourage more appropriate outpatient referrals.
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frequency and correlates of inappropriate pediatric Psychiatric Emergency room visits
The Journal of Clinical Psychiatry, 2009Co-Authors: Erin Callahan Soto, Anne M Frederickson, Harsh Trivedi, Marie C Eugene, Monica Shekher, Marc Weiskopf, Kelsey Allendicker, Robert Dicker, Victor Fornari, Christoph U CorrellAbstract:Background Despite increasing pediatric Psychiatric Emergency room service (PPERS) visits, data are lacking regarding visit characteristics and appropriateness. Method This retrospective cohort study consecutively assessed youngsters aged Results Of 1,062 PPERS patient visits (mean +/- SD age: 13.5 +/- 3.1 years, 51.1% male, and 51.2% white), 305 (28.7%) led to hospitalization. Although most patients (68.7%) were in outpatient care, only 21.9% sought and 11.5% completed an outpatient evaluation prior to reaching the Emergency room. As many as 34.4% of PPERS visits were somewhat/very inappropriate (optimal care: outpatient evaluation/treatment, even if delayed), 26.6% were somewhat appropriate/neutral (best served by outpatient evaluation/treatment, but timely appointment unavailable), and only 39.0% were fully appropriate. Main reasons for inappropriate PPERS visits were direct Emergency room referral from school (P = .0056) or mental health provider (P = .0438) without prior psychiatrist evaluation, or unavailable appointment (P = .0304). Multivariate predictors of inappropriate PPERS visits (r(2) = .296, P 48 (P Conclusions Over one third of PPERS visits were inappropriate, characterized by better functioning, low harm potential or severity of presenting complaint, and absent suicidality or psychosis. Development of and improved access to urgent child and adolescent Psychiatric outpatient care services in the community and referral agent educational programs may minimize inappropriate PPERS visits.
Adam G Horwitz - One of the best experts on this subject based on the ideXlab platform.
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predicting suicidal behavior among lesbian gay bisexual and transgender youth receiving Psychiatric Emergency services
Journal of Psychiatric Research, 2020Co-Authors: Johnny Berona, Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:Lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). However, few studies have comprehensively examined SITBs and their longitudinal course in LGBT youth at high risk for suicide. The aims of the present study were to characterize histories of SITBs among high-risk LGBT youth and to examine prospective associations with suicidal behavior. Participants were 285 youth (41.8% LGBT) ages 13-25 years receiving Psychiatric Emergency department (ED) services. Post-discharge suicidal behavior was assessed via 4-month phone interviews and 12 month chart reviews. The sample was 42.1% male, 57.9% female, 2.5% gender minority, 41.8% sexual minority. LGBT participants were more likely to have prior Psychiatric ED visits and hospitalizations, more frequent past week suicide ideation, and more severe nonsuicidal self-injury (NSSI). We conducted stratified survival analyses to identify predictors of time to suicidal behavior post discharge. The final model for LGBT youth included past week suicide ideation and past month NSSI episodes. Among non-LGBT youth, the final model included number of lifetime NSSI methods and use of a highly lethal suicide attempt method. Within this sample of youth receiving Psychiatric Emergency services, LGBT youth were overrepresented and had more severe histories of SITBs. Results suggest the importance of assessing both lifetime and recent factors (i.e., past week and month), particularly for LGBT youth. Future research should replicate these findings in larger samples to explore whether there are unique risk factors that can aid in predicting and preventing suicide among LGBT youth.
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prospective associations of coping styles with depression and suicide risk among Psychiatric Emergency patients
Behavior Therapy, 2017Co-Authors: Adam G Horwitz, Johnny Berona, Ewa K Czyz, Cheryl A KingAbstract:Suicide is the second leading cause of death for those ages 13-25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult Psychiatric Emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.
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coping with suicidal urges among youth seen in a Psychiatric Emergency department
Psychiatry Research-neuroimaging, 2016Co-Authors: Ewa K Czyz, Johnny Berona, Adam G Horwitz, Alejandra Arango, Yasmin Colelewis, Cheryl A KingAbstract:This study of youth seeking Psychiatric Emergency department (ED) services examined (1) youth self-efficacy to use suicide-specific coping strategies, (2) whether these self-efficacy beliefs varied by demographic and clinical characteristics, (3) and associations of these beliefs with suicide attempts and ED visits 3-5 months later. Participants were 286 Psychiatric ED patients (59% Female), ages 13-25. Ratings of self-efficacy to engage in 10 suicide-specific coping behaviors were assessed at index visit. A total of 226 participants (79%) were assessed 3-5 months later. Youth endorsed low-to-moderate self-efficacy for different suicide-specific coping behaviors, with lowest ratings endorsed for limiting access to lethal means and accessing professional resources. More severe baseline psychopathology was associated with lower self-efficacy. Males endorsed higher self-efficacy for coping behaviors not requiring external support. Lower coping self-efficacy for some of the key strategies, and lower confidence that these strategies will be helpful, differentiated those with and without follow-up suicide attempts and ED visits. The generally low-to-moderate confidence in youths' ability to engage in coping behaviors to manage suicidal crises, and its association with follow-up suicidal crises, is concerning because many of these strategies are commonly included as part of discharge recommendations or safety planning. Implications of findings are discussed.
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predicting future suicide attempts among adolescent and emerging adult Psychiatric Emergency patients
Journal of Clinical Child and Adolescent Psychology, 2015Co-Authors: Adam G Horwitz, Ewa K Czyz, Cheryl A KingAbstract:The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15 to 24 years (M=19.4 years) who presented for Psychiatric Emergency services during a 9-month period. These patients' medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Socioeconomic status, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for male patients but not female). Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for male patients.
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columbia suicide severity rating scale predictive validity with adolescent Psychiatric Emergency patients
Pediatric Emergency Care, 2014Co-Authors: Polly Y Gipson, Adam G Horwitz, Prachi Agarwala, Kiel J Opperman, Cheryl A KingAbstract:OBJECTIVE: Despite the high prevalence of Psychiatric Emergency (PE) visits for attempted suicide and nonsuicidal self-injury (NSSI) among adolescents, we have limited information about assessment tools that are helpful in predicting subsequent risk for suicide attempts among adolescents in PE settings. This study examined the predictive validity of a highly promising instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS). METHOD: Participants were 178 adolescents (44.4% male; ages 13-17 years) seeking PE services. The C-SSRS interview and selected medical chart data were collected for the index visit and subsequent visits during a 1-year follow-up. RESULTS: A suicide risk concern was the most common chief complaint (50.6%) in this sample, and nearly one third of the adolescents (30.4%) reported a lifetime history of suicide attempt at index visit. Sixty-two adolescents (34.8%) had at least one return PE visit during follow-up. Lifetime history of NSSI predicted both return PE visits and a suicide attempt at return visit. The C-SSRS intensity scale score was a significant predictor of a suicide attempt at return visit for both the full sample of adolescents and the subsample who reported suicidal ideation at their index visit. In this subsample, one specific item on the intensity scale, duration, was also a significant predictor of both a return PE visit and a suicide attempt at return visit. CONCLUSIONS: The C-SSRS intensity scale and NSSI had predictive validity for suicide attempts at return visit. RESULTS also suggest that duration of adolescents' suicidal thoughts may be particularly important to risk for suicidal behavior, warranting further study. Language: en
Michael H. Allen - One of the best experts on this subject based on the ideXlab platform.
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current practices for mental health follow up after Psychiatric Emergency department Psychiatric Emergency service visits a national survey of academic Emergency departments
General Hospital Psychiatry, 2011Co-Authors: Edwin D. Boudreaux, Michael H. Allen, Kathryn M. Niro, Ashley F. Sullivan, Christopher D. Rosenbaum, Carlos A. CamargoAbstract:Abstract Objective The objective was to describe continuity of care approaches for Psychiatric emergencies in the Emergency department. Methods A national survey of all 138 academic Emergency departments in the United States was conducted. Results Most Emergency physicians (81%) had no systematic method for identifying Psychiatric Emergency patients with high recidivism. In order to promote outpatient care, sites commonly reported using intensive interventions, including scheduling outpatient appointments prior to discharge (72%) and in-house case management (64%). Conclusion While systematic identification of repeat Psychiatric Emergency patients was uncommon, Emergency departments reported using a variety of fairly intensive strategies to promote continuity of care with outpatient mental health services.
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Current practices for mental health follow-up after Psychiatric Emergency department/Psychiatric Emergency service visits: a national survey of academic Emergency departments
General hospital psychiatry, 2011Co-Authors: Edwin D. Boudreaux, Michael H. Allen, Kathryn M. Niro, Ashley F. Sullivan, Christopher D. Rosenbaum, Carlos A. CamargoAbstract:Abstract Objective The objective was to describe continuity of care approaches for Psychiatric emergencies in the Emergency department. Methods A national survey of all 138 academic Emergency departments in the United States was conducted. Results Most Emergency physicians (81%) had no systematic method for identifying Psychiatric Emergency patients with high recidivism. In order to promote outpatient care, sites commonly reported using intensive interventions, including scheduling outpatient appointments prior to discharge (72%) and in-house case management (64%). Conclusion While systematic identification of repeat Psychiatric Emergency patients was uncommon, Emergency departments reported using a variety of fairly intensive strategies to promote continuity of care with outpatient mental health services.
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the Psychiatric Emergency research collaboration 01 methods and results
General Hospital Psychiatry, 2009Co-Authors: Edwin D. Boudreaux, Michael H. Allen, Cynthia A Claassen, Glenn W Currier, Louise Bertman, Rachel Lipson Glick, Jennifer M Park, David Feifel, Carlos A. CamargoAbstract:OBJECTIVE: To describe the Psychiatric Emergency Research Collaboration (PERC), the methods used to create a structured chart review tool and the results of our multicenter study. METHOD: Members of the PERC Steering Committee created a structured chart review tool designed to provide a comprehensive picture of the assessment and management of Psychiatric Emergency patients. Ten primary indicators were chosen based on the Steering Committee's professional experience, the published literature and existing consensus panel guidelines. Eight Emergency departments completed data abstraction of 50 randomly selected Emergency Psychiatric patients, with seven providing data from two independent raters. Inter-rater reliability (Kappas) and descriptive statistics were computed. RESULTS: Four hundred patient charts were abstracted. Initial concordance between raters was variable, with some sites achieving high agreement and others not. Reconciliation of discordant ratings through re-review of the original source documentation was necessary for four of the sites. Two hundred eighty-five (71%) subjects had some form of laboratory test performed, including 212 (53%) who had urine toxicology screening and 163 (41%) who had blood alcohol levels drawn. Agitation was present in 220 (52%), with 98 (25%) receiving a medication to reduce agitation and 22 (6%) being physically restrained. Self-harm ideation was present in 226 (55%), while other-harm ideation was present in 82 (20%). One hundred seventy-nine (45%) were admitted to an inpatient or observation unit. CONCLUSION: Creating a common standard for documenting, abstracting and reporting on the nature and management of Psychiatric emergencies is feasible across a wide range of health care institutions. Language: en
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factors associated with the use of physical restraints for agitated patients in Psychiatric Emergency rooms
General Hospital Psychiatry, 2008Co-Authors: Marcelo N Migon, Evandro Silva Freire Coutinho, Giselle Huf, Clive E Adams, Geraldo Marcelo Da Cunha, Michael H. AllenAbstract:Abstract Objective To examine factors associated with physical restraint in Psychiatric Emergency rooms. Method We extracted variables likely to predict use of physical restraints from a large randomised trial undertaken in three Psychiatric Emergency rooms in Rio de Janeiro. We fitted a Bayesian binary multivariate model using only variables clearly preceding the restraints. Results Of 301 agitated, aggressive people admitted to Emergency rooms, 73 (24%) were restrained during the first 2 h of admission. In Rio, younger people (OR=1.03 for each year younger), exhibiting intense (OR=2.53) or extreme agitation (OR=7.71), thought to result from substance misuse (OR=1.75) or diagnoses other than psychosis (OR=1.88), arriving in the morning (OR=1.64) were at greater risk of physical restraints than older, less severely aggressive or agitated people, arriving at the hospital during the afternoon or night. Hospital, gender, first admission to hospital and medication were not associated with risk of being restrained. Conclusion Restraint practices in Rio are predictable and based on a limited clinical assessment. Predictive factors for physical restraint may vary worldwide, but should be monitored and studied to assist training, and to establish programs to evaluate and refine this controversial practice.
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use of restraints and pharmacotherapy in academic Psychiatric Emergency services
General Hospital Psychiatry, 2004Co-Authors: Michael H. Allen, Glenn W CurrierAbstract:Psychiatric Emergency services (PES) are an increasingly important component of mental health services. To assess the type and scope of services delivered in the PES setting, the American Association for Emergency Psychiatry sponsored an Expert Consensus Panel Survey of these services in 1999. The questionnaire was mailed to medical directors of PES facilities with 91% (n = 51) responding. More than 90% of the respondents were teaching sites. Restraints were reportedly used in a mean of 8.5% of presentations for a mean of 3.3 h per episode. Restraint utilization correlated with the percentage of psychotic patients treated, but not with a wide variety of other patient and service variables. Involuntary medications were used in 16% of cases, though in oral form in 29% of those cases. A large majority (94%) endorsed mild sedation permitting further assessment as the appropriate endpoint and rejected sleep or heavy sedation as an endpoint (82%). Benzodiazepines received the strongest endorsements and 82% indicated it would be appropriate to administer a benzodiazepine alone for agitation first and initiate antipsychotic treatment subsequently if appropriate. When there is no history of prior antipsychotic exposure, 60% favored a benzodiazepine alone. However, given a history of previous antipsychotic treatment, only 8% endorsed this strategy. Most respondents (78%) preferred to use oral medication for treating behavioral emergencies, whenever possible but 70.3% reported regular use of an IM combination of a benzodiazepine and high-potency typical neuroleptic when necessary. In addition to managing emergencies, 82% of services initiated standing medications for patients being admitted to hospital settings and 70% initiated regular medication treatments for patients being released to the community. Of patients started on oral antipsychotics, 42% received an atypical antipsychotic. Reflecting medication characteristics of particular importance in Emergency settings, most respondents (92%) cited selective serotonin reuptake inhibitors as the preferred type of antidepressant, and divalproex or related compounds (90%) for treatment of bipolar disorder in the PES.
