m-Health Approaches in Suicide Prevention at the Emergency Department: Some Theoretical and Practical Considerations
Emergency Departments (ED) are a critical link in the suicide prevention chain. Indeed, their role is crucial in identifying, admission and clinical management of suicidal patients, as they often serve as an urgent, primary or sole point of contact with the health care system; moreover, they are directly confronted with the high rate of Suicidal Behavior (SB) recidivism amongst suicidal individuals discharged from EDs. However, suicide prevention at EDs appears as underused and needs to be reinforced in its implementation. A particular care has to be addressed to prepare the post-discharge period, in order to limit risk of social isolation and provide support. In this direction, m-Health approaches may offer an integrative contribution to the prevention strategies well-established in literature: a) They may be considered part of the “caring contacts” strategies post-ED, and b) By a personalized programming, their applications may provide a support for “safety planning” interventions, designed to identify and manage vulnerabilities and resources of the individual during the suicidal crisis. They rely on a number of coherent theoretical references and could possibly make it feasible as an original perspective to study SB. Nevertheless, m-Health has to be perceived and utilized merely as a tool, which in any case can substitute clinical evaluation and human presence at the moment of the confrontation with suicidal individual’s distress.
Keywords: Suicide; Suicide behavior; Prevention; Emergency departments; m-Health
The role of the Emergency Departments (EDs) in identification, admission and clinical management of suicidal patients (presenting suicidal ideation, SI, and/or having committed a Suicidal Attempt, SA) is crucial, as EDs often serve as an urgent, primary or sole point of contact with the health care system (Larkin & Beautrais, 2010; Ting et al., 2012; US Department of Health and Human Services Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012; Betz et al., 2016). EDs represent also a critical link in the suicide prevention chain (Larkin & Beautrais, 2010; US Department of Health and Human Services Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012; Betz et al., 2016; Miller et al., 2017). They are indeed directly confronted with the Suicidal Behavior (SB) recidivism phenomenon amongst suicidal individuals discharged from EDs, who present a high near-term risk of further SI, SA, and suicide completion (Larkin & Beautrais, 2010; Arias et al., 2015).
Up to 25% of those who made a Medically Serious Suicide Attempt (MSSA) and have been seen in the EDs, make another attempt, and 5%-10% eventually die by suicide within 5 years (Beautrais, 2003; Beautrais, 2004). Within 10 years, 28.1% of those who had been admitted for a documented suicide attempt, both MSSA and Medically Not Serious Suicide Attempt (MNSSA) were readmitted for a further attempt, and 4.6% died by suicide (Gibb et al., 2005). The rates of readmission at the EDs of MSSA and MNSSA patients and their mortality risk from suicide are highest in the first two years after the first admission at the EDs, although deaths and readmissions occurred throughout the 10 years study period (Gibb et al., 2005). Amongst the patients admitted for SI, within 5 years 38% had represented at least once with either a SA or for further SI (Larkin et al., 2008). Most of the studies, that examined risk of suicidal relapses in patients dismissed from EDs tended to include also subjects who were admitted for self harms; indeed, self-harms without lethal intent occur frequently in the same patients and they can be a precursor of SB (Pompili et al., 2015). Two systematic reviews published in 2002 (Owens et al., 2002) and in 2014 (Carrol et al., 2014) converged to similar data, showing that one year following the self- harm an overall average of 16% repeated the self-harm behavior and approximately 2% died by suicide. Further, during the year before their deaths, 39% of suicide victims visited the EDs at least once and 39% of them were admitted for self-harm (Gairin et al., 2003). Additional evidence suggests that over a 15 years follow-up, in a large (N=11.583) sample of patients who were presented to the hospital after selfharm, the overall suicide risk in the first year was 66 times higher than the annual risk of suicide in the general population, and this risk progressively increased over the years (Hawton et al., 2003).
In spite of the data, suicide prevention at EDs appears as underused and needs strengthened in its implementation (Larkin & Beautrais, 2010; Knesper, 2010; Betz et al., 2016; Miller et al., 2017; Bridge et al., 2017). A particular care, in analogy with psychiatric hospitals aftercare strategies for suicidal patients, has to be addressed to the post-discharge period, in order to provide support and limit risk of social isolation (Pompili & Baldessarini, 2015).
“Caring Contact” and Multifaceted Interventions in Suicide Prevention at EDs
One of the most extensively studied intervention of prevention among suicidal patients who presented at EDs is maintaining an active contact with them after their discharge; the evidence for this type of intervention is strong enough to be a standard of care (Hogan, 2016). In a systematic meta-analysis on studies investigating the effect of interventions to prevent SB relapse in patients admitted to EDs for a SA or self-harm (Inagaki et al., 2015), the selected trials were classified into four categories based on the type of the intervention offered: 1) Active contact and follow-up group; 2) Psychotherapeutic interventions; 3) Pharmacological interventions; and, 4) Miscellaneous. Specifically, the category of “Active contact and follow-up” was subsequently divided into five subgroups: a) Intensive care plus outreach: intensive follow-up with scheduled visits (Allard et al., 1992), home visits by community nurse to improve compliance and assure continuity care (Van Heeringen et al., 1995), intensive interventions based on a problem-solving approach performed by a community psychiatric nurse during hospitalization and post-hospitalization period (Van der Sande et al., 1997), outreach consultations based on assertive intervention performed by a specialized nurse (Morthorst et al., 2012); b) Brief intervention with long-term follow-up (the SUPRE-MISS trial, undertaken by the World Health Organization) (Fleischmann et al., 2008, Bertolote et al., 2010); c) Letter/Postcard contact to suicide attempters discharged from EDs (Carter et al., 2005, Carter et al., 2007, Beautrais et al., 2010, Hassanian-Moghaddam et al., 2011; Carter et al., 2013); d) Telephone contact (Motto 1976; Motto & Bostrom 2001; Cedereke et al., 2002; Vaiva et al., 2006) and telephone contact in elderly people (De Leo et al., 1995; De Leo et al., 2002); e) Composite letter/postcard and telephone contact (Kapur et al., 2013). Although with a number of differences for each single study, overall only this category of “Active contact and follow-up” has been shown to reduce the risk of a repeat SA at 12 months (Inagaki et al., 2015). This result, consistent with a previous critical review performed in patients discharged from inpatient psychiatry departments and Eds (Luxton et al., 2013), highlight that caring contacts with suicidal patients following their EDs visit reduce the SB recidivism.
Experts clinical guidelines in prevention of suicide at the EDs recommend a complete panel of activities that include suicide risk screening and assessment, ED-based interventions, and post-ED resources (Capoccia & Labre, 2015; Suicide Prevention Resource Center, 2015; Betz & Boudreaux, 2016; Betz et al., 2016). Safety planning interventions, consisting in establishing personalized plans with warning signs, list of coping strategies and emergency contacts, are included (Stanley & Brown, 2012; Betz & Boudreaux, 2016; Betz et al., 2016). In the recent multicenter Emergency Department Safety Assessment and Follow-up Evaluation (EDSAFE) study among 1376 adults with SI or SA enrolled in 8 EDs in United States, a multifaceted intervention delivered during and after the ED visit (including suicide risk screening, brief interventions in ED and a series of telephone calls after ED discharge) resulted in a 5% absolute decrease in the proportion of patients subsequently attempting suicide with a relative risk reduction of 20% compared with treatment as usual and a 30% decrease in the total number of SA over a 52-week follow-up period (Boudreaux et al., 2013; Miller et al., 2017).
m-Health, according to the WHO’s definition, is the “use of mobile and wireless communication devices to support healthcare objectives” (Lal & Adair, 2014). Concerning SB prevention at EDs, m-Health-based interventions seem to represent an emergent and promising domain (Aguirre et al., 2013; Larsen, 2015; Larsen et al., 2016a; Kreuze et al., 2016; Siegel, 2016; Franco-Martin et al., 2018). On the one hand, they may be considered part of the “caring contacts” strategies post-ED, by maintaining and/ or reinforcing a patient supporting network both in the medical context and in the personal sphere. On the other hand, by a personalized programming, they may provide a support to store data issued from “safety planning” interventions: individualized step-by-step approaches to empower patients help-seeking during suicidal crises, tailored on its current needs and resources (Stanley & Brown, 2012; Kennard et al., 2015; Betz & Boudreaux, 2016; Pauwels et al., 2017; Andreasson et al., 2017).
Recent experiences (Bush et al., 2015; Larsen et al., 2016b; Berrouiguet et al., 2016; Jang et al., 2017) indicated that m-Health mobile applications may be installed across the various portable devices for the patients (who have presented to the EDs with SI or having committed a SA, and who have been clinically judged apt to be dismissed) at the moment of his discharge from the EDs. These applications may programmed to: a) establish some regular contacts between the patients and the EDs caregivers (via calls, SMS, WhatsApp), according to the specific requirements and preferences of the patient; b) create some personalized lists, characterized eventually by attractive and dynamic interfaces, including warning signs and mechanisms for coping; pre-selected contacts with relevant people of patient’s network (both personal and caregivers-related, including the access to the 24h/24h number of the EDs) may also be determined to be used in case of emergency. The multidisciplinary staff who characterizes the emergency services facilitates the practical feasibility. Good acceptability from the patients have also been described (O’Brien et al., 2016).
Other preliminary experiences more focused on research (Selby et al., 2013) suggested the possibility of determining a detailed assessment of the temporal dynamics risk of the patient through algorithms realized based on a self-evaluation logbook (by taking into account the type and the intensity of the SI, the contributory/triggering factors as well as the protective factors and the emotional status). The applications based on the elaboration and interpretation of these data, once perfected, may contribute to an individualized screening and assessment of the suicidal risk, in the context of the recommended multifaceted prevention interventions (Boudreaux et al., 2013; Miller et al., 2017).
m-Health use in mental healthcare is an expanding area conceived for monitoring symptoms and improving outcomes in several psychiatric disorders, involving mood disorders, anxiety disorders, schizophrenia, eating disorders, and personality disorders (Lal & Adair, 2014; Anthes 2016). These approaches are particularly diffused in the substance use disorders domain across various substances, populations and settings; scientific validations are nevertheless available in a minority of cases (McClure et al., 2013, Kiluk & Carroll, 2013, Marsch et al., 2014; Anthes 2016). A rigorous test in a large cohort of young people of a publicly available evidence-based application (Digital- Alcohol Risk Alertness Notifying Network for Adolescent and Young Adults [D-ARIANNA]), estimating an overall risk score of binge drinking, showed a population-level benefit at 2 weeks (Carrà et al., 2016); the possibility of an high personalized risk communication for informed decision-making and an easily disseminating of this application are of particular interest (Carrà et al., 2016). A very recent systematic review and meta-analysis found a moderate but significant benefit on effectiveness of web/ text-based interventions for smoking cessation as compared with routinely used approaches (Crocamo et al., 2018); according with the literature, communication media characteristics may facilitate these approaches for large-scale public health interventions (Crocamo et al., 2018).
m-Health approaches in people with addiction are paradigmatic in exemplifying a number of advantages that may be generalized to other mental health problematics, included SB, both in the assessment and in the intervention processes. At the clinician’s level, communication with the patient may be improved and clinical decision refined, by the possibility of collecting a great quantity of specific data and the individualization of the intervention (Wood et al., 2014). At the individual’s level, they may be largely accessible, offer information in an engaging manner, ensure a greater sense of privacy, and reduce stigmatization or embarrassment (Wood et al., 2014). Finally, these approaches are conceived to increase the patient reflexivity on their own, support its empowerment and improve its involvement, which represents in themselves possible therapeutic goals (Marzano et al., 2015). In this direction, the assessment and the intervention potential of m-Health approaches may enable them to integrate, also in SB prevention domain, the development of a proactive “P4 medicine”: predictive, preventive, personalized and participative (Hood & Flores, 2012).
From the “Interpersonal-Psychological Theory of Suicide” to the Connectedness
From a theoretical point of view, m-Health approaches in SB prevention refer to the “Interpersonal-Psychological Theory” of Suicide (IPTS), the “impossible situation”, and the connectedness conceptualizations. In these models it is described, with a particular reference to the suicidal individual, the essential intrapsychic place occupied by both perceiving himself as a part of something meaningful outside oneself and being able to communicate and interact with it. The consequent resource of having the possibility of relying on the existence of a network caring and maintaining positive feelings is also at the base of the “caring contacts” strategies.
The “Interpersonal-Psychological Theory of Suicide” (IPTS) (Joiner, 2005; Van Orden et al., 2010) postulates that the most dangerous kind of desire for suicide is nurtured from the simultaneous presence of two interpersonal constructs: the “thwarted belongingness” (feelings of not belonging to one’s social group) and the “perceived burdensomeness” (perception of being a burden for significant figures of the entourage). The “thwarted belongingness”, in particular, is comprised of two facets, which are loneliness (“I feel disconnected from others”) and the absence of reciprocally-caring relationships (“I have no one to turn to”, “I don’t support others”). A necessary component to act on this desire for suicide is represented by the “acquired capability for suicide” that stems from repeated exposition to painful/fearful events, the most significant of which is a prior SA (Joiner, 2005; Van Orden et al., 2010). The IPTS has been increasingly studied over the last years and its theoretical dimensions received empirical support in various populations, including a community-dwelling population visiting a psychiatric ED for SI or SA (Baertschi et al., 2017).
The “impossible situation” is conceptually close to the IPTS. It postulates that individuals who committed suicide or a MSSA differ from individuals who committed a MNSSA not only because of higher level of suicide intent and higher lethality level, but also for loneliness, problems in self-disclosure, less help-seeking behaviours, and communication difficulties (Levi et al., 2008; Horesh et al., 2012; Levi-Belz et al., 2103; Levi-Belz e al., 2014; Gvion et al., 2014; Levi-Belz & Beautrais, 2016); communicational difficulties are also associated with higher lethality in the case of average/high mental pain (Levi-Belz et al., 2103). Therefore, the proposed model of serious SB posits that a situation becomes “impossible” when the person with high level of mental pain is unable to communicate his/her distress (Levi et al., 2008; Levi- Belz et al., 2103; Gvion et al., 2014). From this perspective, serious SB can be considered as an extreme and dramatic way of communication and interaction, in line with some previous works (Stengel, 1964; William, 2001).
The IPTS and the “impossible situation” evoke the more general notion of connectedness. Lack of connectedness to others has been variously defined in literature, but it commonly refers to poor integration into a social network, lack of social support (and/or perceived social support), and perceptions of social isolation (and/or one’s subjective sense of connection to others) (Kaminski et al., 2010; Daniel &Goldston, 2012). The role of the absence of connectedness as a relevant risk factor for SB across the lifespan and thus as a possibly useful target in prevention strategy interventions, has been largely described over the last years: widely among teenagers (King & Merchant 2008; Kaminski et al., 2010; Czyz et al., 2012; Carroll et al., 2014; Whitlock et al., 2014; Arias et al., 2015; Ghassemi et al., 2015; Opperman et al., 2015, Arango et al., 2016), but also amongst adults and elderly people (Purcell et al., 2012; Lourey et al., 2013; Van Orden et al., 2013; Conwell, 2014), sexual minorities (Duong & Bradshaw, 2014) and ethnical minorities (Hill, 2009).
In an “Ideation-to-Action” Framework
m-Health approaches in SB prevention are in line with some recommendations stated in the 2014 Lancet Psychiatry issue focused on SB (Hawton 2014; O’Connor & Nock, 2014), focused on the necessity of looking at the underlying core factors of suicidal potential in a different way and to develop new prevention strategies. Evidence-based interventions in suicide prevention, under their different population, institutional and individual aspects (Mann et al., 2005; WHO, 2012), are, indeed, primarily based on the state-of-the-art knowledge about risk factors (Schwartz- Lifshitz et al., 2012; Aleman & Denis, 2014; Hogan, 2016). SB emerges as the by-product of a multifactorial process that integrates at various level of complexity, several neurobiological, psychological, socio-economic and cultural factors, which have been framed in some comprehensive models having the heuristic interest of generalising and testing hypotheses in the pathogenesis of SB to detect high vulnerable subjects (Hawton & van Heeringen, 2009; van Heeringen & Mann, 2014; Turecki & Brent, 2015). In the “stress-diathesis model” the risk for the expression of SB is not merely determined by a unique stressor, consisting in the onset or acute worsening of a psychiatric disorder or of a psychosocial crisis, but also by a combination of specific vulnerability factors constituting the appropriate terrain (Mann et al., 1999; Mann 2003; Mann & Currier 2010; van Heeringen & Mann 2014). A sequencing of these vulnerability factors into distal and proximal ones, with several socio-demographic variables playing a role of moderators between them, has been conceptualised in the “neurodevelopmental model”, which emphasizes the concept of an individual vulnerability life-trajectory, interacting and managing environmental influences at any moment (Turecki et al., 2012; Turecki & Brent, 2015). Nevertheless, identifying the risk factors alone is not sufficient to improve prevention (Schwartz-Lifshitz et al., 2012; Glenn & Nock, 2014). The 2014 Lancet Psychiatry issue focused on SB (Hawton, 2014; O’Connor & Nock, 2014) strongly required to: 1) Inspire to psychological models to understand the processes involved both in the development of SI and in translating these ideas into suicidal acts; and, 2) Develop pragmatic interventions. By both their reference to the IPTS and the “impossible situation”, two models taking into account the psychological components in an “ideation-to-action” framework, and their proposal of practical strategies, m-Health approaches in this domain seem to be coherent with official requirements.
m-Health Research Perspectives
It has been postulated that m-Health research could provide new ways of exploring human behaviours, included SB (Marzano et al., 2015; Vahabzadeh et al., 2016). The complexity of the SB and its dynamic nature makes it difficult to test pathogenetic hypotheses and assess the outcomes of prevention actions. m-Research could allow the creation of detailed data collections, included information about their dynamic relationships (Tourus et al., 2015). In analogy with algorithms dedicated to the temporal dynamics risk assessment (Selby et al., 2013), similar algorithms may be created specifically for the variable or the psychological construct that have to be studied. By this way, it could enable to make stronger assumptions on causal inferences between the different variables as compared to those resulting from transversal or longitudinal studies (Ben-zeev et al., 2012).
m-Health approaches in suicide prevention at EDs may offer an integrative contribution to the well-established prevention strategies. This is particularly relevant for the “caring contacts” interventions, defined as “efforts to bridge the gap between ED visit and outpatient care” (Betz et al., 2016), and the “safety planning” interventions, designed to identify and manage personal vulnerabilities and resources of the individual during the suicidal crisis. The modern-day connectivity via a technological platform initiated and monitored through the EDs may help in providing both a sense of connectedness and the means to respond in a personalized manner to the immediate needs of the individual to help him better manage the existential condition as regards to the possibility of SB in order to prevent it. These approaches rely on a number of coherent theoretical references, evoking Durkheim’s theorization stated in 1897, and could possibly make it feasible in an original perspective to study SB. The current and future focus of m-Health care on suicide prevention will be to enhance selfesteem, empowerment of the individual, psycho-education, and facilitate access to care. Finally, we hypothesize that m-Health approaches will also help in maintaining the individual in their respective environments and prevent institutionalization of suicidal people.
However, m-Health interventions on suicidal behavior raise some delicate considerations and have to be used with a critical view. The connected devices will be omnipresent and integrated in the individual’s daily activities: on the one hand, they should play more and more the role of a mediator of the various daily activities and, on the other hand, they could also be assimilated to a permanent intrusive monitoring. It will be important to have an attentive approach to the psychosocial changes that such interventions could generate as well an ethical approach as regards to the security and confidentiality of the individual, because of the possibility of recording and stocking an immense quantity of personal data. They also intrinsically bear a paradox: these devices, which can be seen in some ways as conveying a progressive distancing of communication and the “real” interaction with other individuals, are offered here with the aim of facilitating precisely this interaction. For this reason, they must be seen by patients and caregivers as nothing else but tools, which will in no case replace clinical assessment and human interaction in the therapeutic relationship.
Aguirre, R.T.P., McCoy, M.K., & Roan, M. (2013). Development guidelines from a study of suicide prevention mobile applications (Apps). J Technol Hum Serv, 31(3): 269-293.
Aleman, A., & Denys, D. (2014). A road map for suicide research and prevention. Nature, 509 (7501): 421-423.
Allard, R., Marshall, M., & Plante, M. (1992). Intensive follow-up does not decrease the risk of repeat suicide attempts. Suicide Life Threat Behav, 22(3): 303-314.
Andreasson, K., Krogh, J., Bech, P., Frandsen, H., Buus, N., Stanley, B., et al. (2017). MYPLAN-mobile phone application to manage crisis of persons at risk of suicide: study protocol for a randomized controlled trial. Trials, 18(1): 171.
Anthes, E. (2016). Pocket psychiatry: Mobile mental-Health apps have exploded onto the market, but few have been thoroughly tested. Nature, 532(7): 20-23.
Arango, A., Opperman, K. J., Gipson, P. Y., & King, C. A. (2016). Suicidal ideation and suicide attempts among youth who report bully victimization, bully perpetration and/or low social connectedness. J Adolesc, 51: 19-29.
Arias, S.A., Miller, I., Camargo Jr, C.A., Sullivan, A.F., Goldstein, A.B., et al. (2015). Factors associated with suicide outcomes 12 months after screening positive for suicide risk in the emergency department. Psychiatr Serv, 67(2): 206-213.
Baertschi, M., Costanza, A., Richard-Lepouriel, H., Pompili, M., Sarasin, F., Weber, K., et al. (2017). The application of the interpersonal-psychological theory of suicide to a sample of Swiss patients attending a psychiatric emergency department for a non-lethal event. J Affect Disord, 210: 323-331.
Beautrais, A.L. (2003). Subsequent mortality in medically serious suicide attempts: A 5 year follow-up. Aust NZJ Psychiatry, 37(5): 595-599.
Beautrais, A. L. (2004). Further suicidal behavior among medically serious suicide attempters. Suicide Life Threat Behav 34(1), 1-11.
Beautrais, A.L., Gibb, S.J., Faulkner, A., Fergusson, D.M., & Mulder, R.T. (2010). Postcard intervention for repeat self-harm: Randomised controlled trial. Br J Psychiatry, 197(1): 55-60.
Ben-zeev, D., Young, M.A., & Depp, C.A. (2012). Real-time predictors of suicidal ideation : Mobile assessment of hospitalized depressed patients. Psychiatry Res, 197(1-2): 55-59.
Berrouiguet, S., Baca-García, E., Brandt, S., Walter, M., & Courtet, P. (2016). Fundamentals for future mobile-health (mHealth): A systematic review of mobile phone and web-based text messaging in mental health. J Med Internet Res, 18(6): e135.
Bertolote, J.M., Fleischmann, A., De Leo, D., Phillips, M.R., Botega, N.J., Vijayakumar, L., et al. (2010). Repetition of suicide attempts: Data from five culturally different low-and middle-income country emergency care settings participating in the WHO. Crisis, 31(4): 194-201.
Betz, M.E., Wintersteen, M., Boudreaux, E.D., Brown, G., Capoccia, L., Currier, G., et al. (2016). Reducing suicide risk: Challenges and opportunities in the Emergency Department. Ann Emerg Med, 68: 758-765.
Betz, M.E., & Boudreaux, E.D. (2016). Managing suicidal patients in the emergency department. Ann Emerg Med, 67: 276-282.
Boudreaux, E.D., Miller, I., Goldstein, A.B., Sullivan, A.F., Allen, M.H., Manton, A.P., et al. (2013). The emergency department safety assessment and follow-up evaluation (ED-SAFE): Method and design considerations. Contemp Clin Trials, 36(1): 14-24.
Bridge, J.A., Horowitz, L.M., & Campo, J.V. (2017). ED-SAFE-Can suicide risk screening and brief intervention initiated in the emergency department save lives? JAMA Psychiatry, 74(6): 555-556.
Bush, N.E., Dobscha, S.K., Crumpton, R., Denneson, L.M., Hoffman, J.E., Crain, A., et al. (2015). A virtual hope box smartphone app as an accessory to therapy: Proof-of-concept in a clinical sample of veterans. Suicide Life Threat Behav, 45(1): 1-9.
Capoccia, L., & Labre, M. (2015). Caring for adult patients with suicide risk: A consensus-based guide for emergency departments. Waltham, MA: Education Development Center, Inc, Suicide Prevention Resource Center.
Carrà, G., Crocamo, C., Bartoli, F., Carretta, D., Schivalocchi, A., Bebbington, P.E., et al. (2016). Impact of a mobile e-health intervention on binge drinking in young people: The digital-alcohol risk alertness notifying network for adolescents and young adults ptoject. J Adolesc Health, 58(5): 520-526.
Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic review and meta-analysis. PLoS ONE, 9(2).
Carter, G., Clover, K., Whyte, I., Dawson, A., & D’Este, C. (2005). Postcards from the EDge project: Randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ, 331(7520): 805.
Carter, G., Clover, K., Whyte, I., & Dawson, A. (2007). Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated. Br J Psychiatry, 191(6): 548-553.
Carter, G.L., Clover, K., Whyte, I.M., Dawson, A.H., & D’Este, C. (2013). Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning. Br J Psychiatry, 202(5): 372-380.
Cedereke, M., Monti, K., & Ojehagen, A. (2002). Telephone contact with patients in the year after a suicide attempt: Does it affect treatment attendance and outcome? A randomised controlled study. European Psychiatry, 17(2): 82-91.
Crocamo, C., Carretta, D., Ferri, M., Dias, S., Bartoli, F., & Carrà, G. (2018). Web- and text-based interventions for smoking cessation: Meta-analysis and meta-regression. Drug-Educ Prev and Polic, 25(3): 207-216.
Conwell, Y. (2014). Suicide later in life: Challenges and priorities for prevention. Am J Prev Med, 47(3): S244-S250.
Czyz, E.K., Liu, Z., & King, C. A. (2012). Social connectedness and one-year trajectories among suicidal adolescents following psychiatric hospitalization. J Clin Child Adolesc Psychol, 41(2): 214-226.
Daniel, S.S., & Goldston, D.B. (2012). Hopelessness and lack of connectedness to others as risk factors for suicidal behavior across the lifespan: Implications for cognitive-behavioral treatment. Cogn Behav Pract, 19(2): 288-300.
De Leo, D., Carollo, G., & Dello Buono, M. (1995). Lower suicide rates associated with a Tele-Help/Tele-Check service for the elderly at home. Am J Psychiatry, 152(4): 632.
De Leo, D., De, Dello Buono, M., & Dwyer, J. (2002). Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. Br J Psychiatry, 181(3): 226-229.
Duong, J., & Bradshaw, C. (2014). Associations between bullying and engaging in aggressive and suicidal behaviors among sexual minority youth: The moderating role of connectedness. J Sch Health, 84(10): 636-645.
Fleischmann, A., Bertolote, J.M., Wasserman, D., De Leo, D., Bolhari, J., Botega, N.J., et al. (2008). Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries. Bull World Health Organ, 86(9): 703-709.
Franco-Martín, M.A., Muñoz-Sánchez, J.L., Sainz-de-Abajo, B., Castillo-Sánchez, G., Hamrioui, S., & de la Torre-Díez, I. (2018). A systematic literature review of technologies for suicidal behavior prevention. J Med Syst, 42(4): 71.
Gairin, I., House, A., & Owens, D. (2003). Attendance at the accident and emergency department in the year before suicide: Retrospective study. Br J Psychiatry, 183(1): 28-33.
Ghassemi, M., Celi, L.A., & Stone, D.J. (2015). State of the art review : The data revolution in critical care. Crit Care, 19(1): 118.
Gibb, S.J., Beautrais, A.L., & Fergusson, D.M. (2005). Mortality and further suicidal behaviour after an index suicide attempt: A 10-year study. Aust NZJ Psychiatry, 39(1-2): 95-100.
Glenn, C.R., & Nock, M.K. (2014). Improving the short-term prediction of suicidal behavior. Am J Prev Med, 47(3): S176-S180.
Gvion, Y., Horresh, N., Levi-Belz, Y., Fischel, T., Treves, I., Weiser, M., et al. (2014). Aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters. Compr Psychiatry, 55(1): 40-50.
Hassanian-Moghaddam, H., Sarjami, S., Kolahi, A.A., & Carter, G.L. (2011). Postcards in persia: Randomised controlled trial to reduce suicidal behaviours 12 months after hospital-treated self-poisoning. Br J Psychiatry, 198(4): 309-316.
Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. Br J Psychiatry, 182(6): 537-542.
Hawton, K., & van Heeringen, K. (2009). Suicide. Lancet, 373: 1372-1.
Hawton, K. (2014). Suicide prevention: A complex global challenge. Lancet Psychiatry, 1(1): 2-3.
Hill, D.L. (2009). Relationship between sense of belonging as connectedness and suicide in American Indians. Arch Psychiatr Nurs, 23(1): 65-74.
Hogan, M. (2016). Better suicide screening and prevention are possible. JAMA Psychiatry, 73(11): 1111-1112.
Hood, L., & Flores, M. (2012). A personal view on systems medicine and the emergence of proactive P4 medicine: Predictive, preventive, personalized and participatory. N Biotechnol 29(6): 613-624.
Horesh, N., Levi, Y., & Apter, A. (2012). Medically serious versus non-serious suicide attempts: Relationships of lethality and intent to clinical and interpersonal characteristics. J Affect Disord, 136(3): 286-293.
Inagaki, M., Kawashima, Y., Kawanishi, C., Yonemoto, N., Sugimoto, T., Furuno, T., et al. (2015). Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: A meta-analysis. J Affect Disord, 175: 66-78.
Jang, S.H., Woo, Y.S., Hong, J.W., Yoon, B.H., Hwang, T.Y., Lee, S.Y., et al. (2017). Use of a smartphone application to screen for depression and suicide in South Korea. Gen Hosp Psychiatry, 46: 62-67.
Joiner, T. (2005). Why people die by suicide. Harvard University Press.
Kaminski, J.W., Puddy, R.W., Hall, D.M., Cashman, S.Y., Crosby, A.E., & Ortega, L.A.G. (2010). The relative influence of different domains of social connectedness on self-directed violence in adolescence. J Youth Adolesc, 39(5): 460-473.
Kapur, N., Gunnell, D., Hawton, K., Nadeem, S., Khalil S, Longson, D., et al. (2013). Messages from Manchester: Pilot randomised controlled trial following self-harm. Br J Psychiatry, 203: 73-74.
Kennard, B.D., Biernesser, C., Wolfe, K.L., Foxwell, A.A., Lee, S.J.C., Rial, K.V., et al. (2015). Developing a brief suicide prevention intervention and mobile phone application: A qualitative report. J Technol Hum Serv 33(4): 345-357.
Kiluk, B.D., & Carroll, K.M. (2013). New developments in behavioral treatments for substance use disorders. Curr Psychiatry Rep 15: 420.
King, C.A., & Merchant, C.R. (2008). Social and interpersonal factors relating to adolescent suicidality: A review of the literature. Arch Suicide Res, 12(3): 181-196.
Knesper, D.J. (2010). Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. American Association of Suicidology & Suicide Prevention Resource Center.
Kreuze, E., Jenkins, C., Gregoski, M., York, J., Mueller, M., Lamis, D.A., et al. (2017). Technology-enhanced suicide prevention interventions: A systematic review of the current state of the science. J Telemed Telecare, 23(6): 605-617.
Lal, S., & Adair, C.E. (2014). E-mental health: A rapid review of the literature. Psychiatr Serv, 65(1): 24-32.
Larkin, G.L., Beautrais, A.L., Gibb, S., & Laing, N. (2008). The epidemiology of presentations for suicidal ideation to the emergency department. Academ Emerg Med, 15(5): S208-S209.
Larkin, G.L., & Beautrais, A. L. (2010). Emergency departments are underutilized sites for suicide prevention. Crisis, 31(1): 1-6.
Larsen, M. (2015). The use of technology in Suicide Prevention. In EMBC, 37th Annual International Conference of the IEEE, pp. 7316-7319.
Larsen, M.E., Nicholas, J., & Christensen, H. (2016). A systematic assessment of smartphone tools for suicide prevention. PloS One, 11(4): e0152285.
Larsen, J., Frandsen, H., & Erlangsen, A. (2016). MYPLAN-A mobile phone application for supporting people at risk of suicide. Crisis, 37(3): 236-240.
Levi, Y., Horesh, N., Fischel, T., Treves, I., Or, E., & Apter, A. (2008). Mental pain and its communication in medically serious suicide attempts: an “impossible situation.” J Affect Disord, 111(2): 244-250.
Levi‐Belz, Y., Gvion, Y., Horesh, N., & Apter, A. (2013). Attachment patterns in medically serious suicide attempts: The mediating role of self‐disclosure and loneliness. Suicide Life Threat Behav, 43(5): 511-522.
Levi-Belz, Y., Gvion, Y., Horesh, N., Fischel, T., Treves, I., Or, E., etb al. (2014). Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Arch Suicide Res, 18(1): 74-87.
Levi-Belz, Y., & Beautrais, A. (2016). Serious Suicide Attempts. Crisis, 37(4): 299-309.
Lourey, C., Plumb, J., & Mills, A. (2013). A contributing life, the 2012 national report card on mental health and suicide prevention. Sydney: National Mental Health Commission.
Luxton, D., June, J., & Comtois, K. (2013). Can postdischarge follow-up contacts prevent suicide and suicidal behavior? Crisis, 34: 32-41.
Mann, J.J., Waternaux, C., Haas, G.L., & Malone, K.M. (1999). Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry, 156(2): 181-189.
Mann, J. (2003). Neurobiology of suicidal behaviour. Nat Rev Neurosci: 4: 819-28.
Mann, J.J., Haas, A., Mehlum, L., & Phillips, M. (2005). Suicide Prevention Strategies. JAMA, 294(16): 2064-2074.
Mann, J.J., & Currier, D.M. (2010). Stress, genetics and epigenetic effects on the neurobiology of suicidal behavior and depression. Eur Psychiatry, 25(5): 268-271.
Marsch, L.A., Carroll, K.M., & Kiluk, B.D. (2014). Technology-based interventions for the treatment and recovery management of substance use disorders: A JSAT special issue. J Subst Abuse Treat 46: 1-4.
Marzano, L., Bardill, A., Fields, B., Herd, K., Veale, D., Grey, N., et al. (2015). The application of “mHealth”to mental health: Opportunities and challenges. Lancet Psychiatry, 2(10): 942-948.
McClure, E.A., Acquavita, S.P., Harding, E., & Stitzer M.L. (2013). Utilization of communication technology by patients enrolled in substance abuse treatment. Drug Alcohol Depend 129: 145-50.
Miller, I.W., Camargo, C.A., Arias, S.A., Sullivan, A.F., Allen, M.H., Goldstein, A.B., et al. (2017). Suicide prevention in an emergency department population. JAMA Psychiatry, 02906(6): 563-570.
Morthorst, B., Krogh, J., Erlangsen, A., & Alberdi, F. (2012). Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: Randomised controlled trial. BMJ, 345: e4972.
Motto, J. (1976). Suicide prevention for high‐risk persons who refuse treatment. Suicide Life Threat Behav, 6(4): 223-230.
Motto, J.A., & Bostrom, A.G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv, 52(6): 828-833.
O’Brien, K., LeCloux, M., & Ross, A. (2016). A pilot study of the acceptability and usability of a smartphone application intervention for suicidal adolescents and their parents. Arch Suicide Res 2: 1-11.
O’Connor, R.C., & Nock, M.K. (2014). The psychology of suicidal behaviour. Lancet Psychiatry, 1(1): 73-85.
Opperman, K., Czyz, E.K., Gipson, P.Y., & King, C.A. (2015). Connectedness and perceived burdensomeness among adolescents at elevated suicide risk: An examination of the interpersonal theory of suicidal behavior. Arch Suicide Res, 19(3): 385-400.
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Br J Psychiatry, 181(3): 193-199.
Pauwels, K., Aerts, S., Muijzers, E., De Jaegere, E., van Heeringen, K., & Portzky, G. (2017). BackUp: Development and evaluation of a smart-phone application for coping with suicidal crises. PLoS one, 12(6): e0178144.
Pompili, M., Goracci, A., Giordano, G., Erbuto, D., Girardi, P., Klonsky, E. D., et al. (2015). Relationship of non-suicidal self-injury and suicide attempt: A psychopathological perspective. J Psychopathol, 21(4): 348-353.
Pompili, M., & Baldessarini, R.J. (2015). Risk of suicide and all-cause mortality after self-harm. Lancet Psychiatry 2(9): 769-770.
Purcell, B., Heisel, M.J., Speice, J., Franus, N., Conwell, Y., & Duberstein, P.R. (2012). Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older. Am J Geriatr Psychiatry, 20(8): 717-723.
Schwartz-Lifshitz, M., Zalsman, G., Giner, L., & Oquendo, M. (2012). Can we really prevent suicide? Curr Psychiatry Rep, 14(6): 624-633.
Selby, E., Yen, S., & Spirito, A. (2013). Time varying prediction of thoughts of death and suicidal ideation in adolescents: weekly ratings over 6-month follow-up. J Clin Child Adolesc Psychol, 42(4): 481-495.
Siegel, A.J. (2016). Suicide prevention by smartphone. Am J Med 129(8): e145.
Stanley B. & Brown, G.K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cogn Behav Pract, 19: 256-264.
Stengel, E. (1964). Suicide and attempted suicide.
Suicide Prevention Resource Center. (2015). Continuity of care for suicide prevention: The role of emergency departments.
Ting, S.A., Sullivan, A.F., Boudreaux, E.D., Miller, I., & Camargo, C.A. (2012). Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry, 34(5): 557-565.
Torous, J., Staples, P., & Onnela, J.P. (2015). Realizing the potential of mobile mental health: New methods for new data in psychiatry. Curr Psychiatry Rep, 17(8): 1-7.
Turecki, G., Ernst, C., Jollant, F., Labonté, B., & Mechawar, N. (2012). The neurodevelopmental origins of suicidal behavior. Trends Neurosci, 35(1): 14-23.
Turecki, G., & Brent, D. (2015). Suicide and suicidal behaviour. Lancet, 373: 1372-1381.
US Department of Health and Human Services Office of the Surgeon General & National Action Alliance for Suicide Prevention. (2012). National Strategy for Suicide Prevention: Goals and Objectives for Action.
Vahabzadeh, A., Sahin, N., & Kalali, A. (2016). Digital suicide prevention: Can technology become a game-changer? Innova Clin Neurosci, 13(5-6): 16.
Vaiva, G., Ducrocq, F., Meyer, P., Mathieu, D., Philippe, A., Libersa, C., et al. (2006). Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. Br Med J, 332: 1241-1245.
Van Heeringen, C., Jannes, S., Buylaert, W., Henderick, H., De Bacquer, D., & Van Remoortel, J. (1995). The management of non-compliance with referral to out-patient after-care among attempted suicide patients: A controlled intervention study. Psychol Med, 25(05): 963-970.
Van Heeringen, K., & Mann, J. J. (2014). Suicide 1: The neurobiology of suicide Neurobiology of suicide: Introduction. The Lancet Psychiatry, 0366(14): 1-10.
Van Orden, K.A., Witte, T.K., Cukrowicz, K.C., Braithwaite, S.R., Selby, E.A, & Joiner, T.E. (2010). The interpersonal theory of suicide. Psychol Rev, 117(2): 575-600.
Van Orden, K.A., Stone, D.M., Rowe, J., McIntosh, W.L., Podgorski, C., & Conwell, Y. (2013). The senior connection: Design and rationale of a randomized trial of peer companionship to reduce suicide risk in later life. Contemp Clin Trials, 35(1): 117-126.
Van der Sande, R., Van Rooijen, L., Buskens, E., Allart, E., Hawton, K., Van Der Graaf, Y., et al. (1997). Intensive in-patient and community intervention versus routine care after attempted suicide. A randomised controlled intervention study. Br J Psychiatry, 171(1): 35-41.
Whitlock, J., Wyman, P.A., & Moore, S.R. (2014). Connectedness and suicide prevention in adolescents: Pathways and implications. Suicide Life Threat Behav, 44(3): 246-272.
WHO. (2012). Public health action for the prevention of suicide. Geneva: World Health Organization.
Wood, S.K., Eckley, L., Hughes, K., Hardcastle, K.A., Bellis, M.A., Schrooten, J., et al. (2014). Computer-based programs for the prevention and management of illicit recreational drug use: A systematic review. Addict Behav, 39: 30-8.
William, A. (2001). Suicide and attempted suicide. (P. B. Eds, Ed.). London.
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