Annual AAS Conference 2011

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.