E-health

iCare: Psychoeducation for parents of children with suicide attempt

Each year, there are approximately 11,000 suicide attempts in Denmark, mainly among young people under the age of 25. Clinicians who provide support to young people after suicide attempt are often consulted by the young person’s parents who are keen to support their child. To provide better information to parents, DRISP has developed a website for this target group and in collaboration with parents with lived experiences. This website is now testing to determine whether parents find it useful. In connection with the project, several qualitative studies have been conducted, which are described here below.

Study 1: Existing evidence regarding the experiences of relatives caring for people with suicide attempts was reviewed. A total of 12 studies on the subject were included and a meta-ethnographic synthesis was conducted. The results showed that relatives of people with suicide attempts often pass through four unique phases, which each represent different perspectives and emotions. It was also found that interaction with other relatives who experienced comparable challenges made it easier for relatives to pass through these phases and helped them to find themselves in new and challenging situations.

The study can be found here:
https://www.sciencedirect.com/science/article/pii/S0020748920302790

Study 2: Interviews were conducted with 21 Danish parents of children with suicidal behavior. The results of the study showed that parents’ perceived that their identity was affected by their children’s suicidal acts. The perceived identity of the parents passed through up to three interrelated phases. Each phase reflected a different perspective of their identity and was developed in social interaction with other people. It was also found that not all parents were able to re-establish their parenting agency.

This study can be found here: https://www.sciencedirect.com/science/article/pii/S002074892030279

DRISP: Jette Louise Skovgaard Larsen, Anette Juel Kynde, Britt Morthorst, Annette Erlangsen

Partners

Elene Fleischer, PhD Netværk for selvmordsramte (www.nefos.dk)
Niels Buus, Mental Health Nursing, Sydney Nursing School, University of Sydney
Jan-Henrik Winsløw, Enhed for Selvmordsforebyggelse, Region Nordjylland
Prof Keith Hawton, Centre for Suicide Research, University of Oxford

App for people with self-harm – MYPLAN Zero Self-Harm

Some people intentionally harm themselves to relieve mental pain. It may be difficult to stop this behavior once it has been initiated. There are, unfortunately, few treatment options for people with self-harm. One recommended approach is to develop strategies in the form of a safety plan, which can be activated if the urge for self-harm arises.

The Zero Self-Harm app was developed as an extension of the MYPLAN app. People with lived experiences, in the form of current and past self-harm, were included in the development process through focus group interviews. The app helps the user to identify warning signs and to develop strategies to cope with future crises.

Zero Self-Harm is currently being tested in a research project, which consists of: 1) a randomized study to investigate whether the Zero Self-Harm app may reduce self-harming behavior, and 2) a qualitative evaluation of barriers and facilitators for using the app. The RCT is expected to be initiated in the autumn of 2020 and to be completed in 2023.

The project is supported by the TRYG Foundation.

Drisp: Lene Qvist Larsen, Annette Erlangsen, Jette Louise Skovgaard Larsen; Kate Andreasson Aamund, Merete Nordentoft, Eybjørg A Heygum Egilsdóttir; Evelyn Guerrero

Self-help Online against Suicidal Thoughts

In the project Self-Help Online against Suicidal Thoughts (SOS), it was investigated whether internet-based self-help therapy could help people with suicidal thoughts. The study was led by psychologist Charlotte Mühlmann from DRISP in collaboration with colleagues and conducted as a randomized study.

Together with the Danish telephone helpline for suicide prevention (“Livslinien”), 402 adults with suicide thoughts were recruited during 2016-2018. The average age of the participants was 34 years. One third of the participants had previously had a suicide attempt, while 55% were in therapeutic or psychiatric treatment at the time they joined the study.

Half of the 402 participants were randomized to test the online program, while the other half served as a control group, i.e. did not receive the program. The findings showed that after 6 weeks, there was a significant difference; those who had received the self-help program had experienced a reduction of suicidal thoughts, feelings of hopelessness and worries when compared to the control group.

Among the participants who had access to the program, 63% experienced a clinically significant decrease in their suicidal thoughts; corresponding to 6 points on the Beck Scale for Suicidal Ideation, which was the questionnaire used for measuring suicide risk. The significant difference was also present after seven months. Among those surveyed, 78% of the participants rated the program as useful.

You can find the study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774853

The project was supported by the Danish TrygFonden.

DRISP: Charlotte Mühlmann, Trine Madsen, Annette Erlangsen, Merete Nordentoft

Partner:

Livslinien

Managing suicidality in research on internet- and mobile-based interventions: current practice and recommendations

Many studies on internet-based therapy exclude participants with suicide thoughts. The aim of two studies is to provide an overview of the current practice in the management of suicidality in RCTs of internet interventions for depression and suicide thoughts. Researchers in the field have been found through a literature review and been asked to answer a questionnaire and be interviewed regarding their practices. Based on this overview, best-practice recommendations regarding how to manage suicidality in research on internet interventions for depression was published in 2020.

For more information read https://www.sciencedirect.com/science/article/abs/pii/S0165032719323353.

DRISP: Charlotte Mühlmann

Partners:

Institute of Psychology, University of Freiburg
Orygen, the National Centre of Excellence in Youth Mental Health

MYPLAN – a self-help tool for management of crisis

People who have had a suicide attempt have a significantly higher risk of repeated suicidal behaviour. MYPLAN was created with the intention of being a self-help tool for management of suicidal crisis. This project consists of 1) a qualitative study of stakeholders on improvements to MYPLAN; 2) a randomized clinical trial to evaluate MYPLAN’s efficacy in reducing suicide intent among persons at risk of suicide, and 3) a person-centered evaluation of the MYPLAN to identify barriers and facilitators to its general implementation. The RCT was initiated in 2019 and is currently ongoing. Following studies have been published :
The project received support from the Danish TRYG Foundation.

Publications

https://trialsjournal.biomedcentral.com
https://www.tandfonline.com

DRISP: Charlotte Mühlmann Kate Andreassen Aamund, Jette Louise S. Larsen, Annette Erlangsen

Partners:

Hanne Frandsen, Mental Health Centre Copenhagen, Region H
Niels Buus, Mental Health Nursing, Sydney Nursing School, University of Sydney, Australia

TEENS trial

Non-suicidal self-injury (NSSI) is very prevalent among adolescents estimated to a lifetime prevalence in non-clinical samples of 17%; increasing in psychiatric populations. NSSI an important predictor of later suicidal behavior. Evidence for treatment is spares but internet-based interventions guided by a therapist have been suggested. We aim to investigate the effect of internet-based ERITA compared to weekly journaling as add-on to treatment as usual in 13-17-year-old patients with NSSI referred to child– and adolescent mental health services. This pilot feasibility study (n=25) is an RCT. The experimental interventions are add-on to treatment as usual. Primary outcome is the frequency of NSSI assessed after 12 weeks. Also, adherence to treatment will be assessed.

DRISP: Britt Morthorst

Partners:

Child and Adolescent Mental Health Services in the Capital Region of Denmark
Johan Bjureberg, PhD, Karolinska Instituttet, Stockholm, Sweden
Clara Hellner, MD, PhD, Karolinska Instituttet, Stockholm, Sweden

Joinpoint regression analysis of suicides in Denmark during 1980-2015

Is the suicide rate in Denmark increasing or decreasing? Effective suicide prevention requires vigilant monitoring of suicide trends. The aim of this study was to assess the change in the Danish suicide rate over time using joinpoint regression analysis. The suicide rate fell sharply between 1980 and 1999 in Denmark, but since then the decrease has been modest, especially since 2007. Further reduction in the suicide rate requires new and effective measures. The study is published in Danish Medical Bulletin

DRISP: Susanne Dyvesether, Annette Erlangsen & Merete Nordentoft

Partners:

Julie L Forman, Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark