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1.
Background
Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.Objective
To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.Methods
A cross sectional study was conducted from March–December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.Results
The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2–138.8, p-value <0.01).Conclusion
Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt. 相似文献2.
Derek Paul De Beurs Anton LM de Vries Marieke H de Groot Jos de Keijser Ad JFM Kerkhof 《Journal of medical Internet research》2014,16(9)
Background
The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration.Objective
The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS).Methods
The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT.Results
The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average.Conclusions
This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper. 相似文献3.
Purpose
This study examined the association between early initiation of problem behaviors (alcohol drinking, cigarette smoking, and sexual intercourse) and suicidal behaviors (suicidal ideation and suicide attempts), and explored the effect of concurrent participation in these problem behaviors on suicidal behaviors among Korean adolescent males and females.Materials and Methods
Data were obtained from the 2006 Korean Youth Risk Behavior Survey, a nationally representative sample of middle and high school students (32,417 males and 31,467 females) in grades seven through twelve. Bivariate and multivariate logistic analyses were conducted. Several important covariates, such as age, family living structure, household economic status, academic performance, current alcohol drinking, current cigarette smoking, current butane gas or glue sniffing, perceived body weight, unhealthy weight control behaviors, subjective sleep evaluation, and depressed mood were included in the analyses.Results
Both male and female preteen initiators of each problem behavior were at greater risk for suicidal behaviors than non-initiators, even after controlling for covariates. More numerous concurrent problematic behaviors were correlated with greater likelihood of seriously considering or attempting suicide among both males and females. This pattern was more clearly observed in preteen than in teen initiators although the former and latter were engaged in the same frequency of problem behavior.Conclusion
Early initiation of alcohol drinking, cigarette smoking, and sexual intercourse, particularly among preteens, represented an important predictor of later suicidal ideation and suicide attempts in both genders. Thus, early preventive intervention programs should be developed and may reduce the potential risks for subsequent suicidal behaviors. 相似文献4.
5.
Ver?nica de Medeiros Alves Leilane Camila Ferreira de Lima Francisco Flaviane Maria Pereira Belo Valfrido Le?o de-Melo-Neto Vinicius Gomes Barros Antonio E Nardi 《Clinics (S?o Paulo, Brazil)》2016,71(3):135-139
OBJECTIVE:
To identify the socio-demographic profiles, suicidal ideation, the presence of mental disorders and the quality of life of patients using mental health services in Arapiraca, Alagoas, Brazil.METHOD:
Interviews were conducted in family health units and the Psychosocial Attention Center. The sample included 202 mental disorder patients with a risk of suicide attempts, 207 mental disorder patients without a risk of suicide attempts and 196 controls. This study used an identification questionnaire, the abbreviated World Health Organization Quality of Life questionnaire, Beck‘s Suicidal Ideation Scale and the Mini International Neuropsychiatric Interview.RESULTS:
Patients who had a mental disorder and a risk of suicide attempts tended to be single, had less education and lower family income, were not working and showed lower scores in quality of life domains; 73 of these patients had suicidal ideation in the previous week. Depressive disorders, manic episodes, hypomanic episodes, social phobias, obsessive compulsive disorder, post-traumatic stress disorder, psychotic syndromes and generalized anxiety disorder were more frequent and statistically significant for patients at risk for suicide attempts.CONCLUSION:
The management of patients with a risk of suicide attempts must focus on individual patients because this risk is directly linked to changes in quality of life and the improvement of these patients'' prognosis. 相似文献6.
eHealth Interventions for HIV Prevention in High-Risk Men Who Have Sex With Men: A Systematic Review
Rebecca Schnall Jasmine Travers Marlene Rojas Alex Carballo-Diéguez 《Journal of medical Internet research》2014,16(5)
Background
While the human immunodeficiency virus (HIV) incidence rate has remained steady in most groups, the overall incidence of HIV among men who have sex with men (MSM) has been steadily increasing in the United States. eHealth is a platform for health behavior change interventions and provides new opportunities for the delivery of HIV prevention messages.Objective
The purpose of this systematic review was to examine the use of eHealth interventions for HIV prevention in high-risk MSM.Methods
We systematically searched PubMed, OVID, ISI Web of Knowledge, Google Scholar, and Google for articles and grey literature reporting the original results of any studies related to HIV prevention in MSM and developed a standard data collection form to extract information on study characteristics and outcome data.Results
In total, 13 articles met the inclusion criteria, of which five articles targeted HIV testing behaviors and eight focused on decreasing HIV risk behaviors. Interventions included Web-based education modules, text messaging (SMS, short message service), chat rooms, and social networking. The methodological quality of articles ranged from 49.4-94.6%. Wide variation in the interventions meant synthesis of the results using meta-analysis would not be appropriate.Conclusions
This review shows evidence that eHealth for HIV prevention in high-risk MSM has the potential to be effective in the short term for reducing HIV risk behaviors and increasing testing rates. Given that many of these studies were short term and had other limitations, but showed strong preliminary evidence of improving outcomes, additional work needs to rigorously assess the use of eHealth strategies for HIV prevention in high-risk MSM. 相似文献7.
Camille Pouchieu Caroline Méjean Valentina A Andreeva Emmanuelle Kesse-Guyot Philippine Fassier Pilar Galan Serge Hercberg Mathilde Touvier 《Journal of medical Internet research》2015,17(2)
Background
In spite of the growing literature in the field of e-epidemiology, clear evidence about computer literacy or attitudes toward respondent burden among e-cohort participants is largely lacking.Objective
We assessed the computer and Internet skills of participants in the NutriNet-Santé Web-based cohort. We then explored attitudes toward the study demands/respondent burden according to levels of computer literacy and sociodemographic status.Methods
Self-reported data from 43,028 e-cohort participants were collected in 2013 via a Web-based questionnaire. We employed unconditional logistic and linear regression analyses.Results
Approximately one-quarter of participants (23.79%, 10,235/43,028) reported being inexperienced in terms of computer use. Regarding attitudes toward participant burden, women tended to be more favorable (eg, “The overall website use is easy”) than were men (OR 0.65, 95% CI 0.59-0.71, P<.001), whereas better educated participants (>12 years of schooling) were less likely to accept the demands associated with participation (eg, “I receive questionnaires too often”) compared to their less educated counterparts (OR 1.62, 95% CI 1.48-1.76, P<.001).Conclusions
A substantial proportion of participants had low computer/Internet skills, suggesting that this does not represent a barrier to participation in Web-based cohorts. Our study also suggests that several subgroups of participants with lower computer skills (eg, women or those with lower educational level) might more readily accept the demands associated with participation in the Web cohort. These findings can help guide future Web-based research strategies. 相似文献8.
Weon Young Lee Young-Ho Khang Manegseok Noh Jae-In Ryu Mia Son Yeon-Pyo Hong 《Yonsei medical journal》2009,50(4):482-492
Purpose
This study aims to examine how inequalities in suicide by education changed during and after macroeconomic restructuring following the economic crisis of 1997 in South Korea.Materials and Methods
Using Korea''s 1995, 2000, and 2005 census data aggregately linked to mortality data (1993 - 2006), relative and absolute differentials in suicide mortality by education were calculated by gender and age among Korean population aged 35 and over.Results
Average annual suicide mortality rates have steadily increased from 1993 - 1997 to 2003 - 2006 in almost all sociodemographic groups stratified by gender, age, and education. Based on the relative index of inequality (RII) and slope index of inequality (SII), educational differentials in suicide mortality generally increased over time in men and women aged 45 years +. Although RII did not increase with year among men and women aged 35 - 44 years, SII showed a significantly increasing trend in this age group.Conclusion
These worsening absolute inequalities in suicide mortality indicate that the governmental suicide prevention policy should be directed toward socially disadvantaged groups of the Korean population. 相似文献9.
Ursula Whiteside Anita Lungu Julie Richards Gregory E Simon Sarah Clingan Jaeden Siler Lorilei Snyder Evette Ludman 《Journal of medical Internet research》2014,16(2)
Background
Computerized, Internet-delivered interventions can be efficacious; however, uptake and maintaining sustained client engagement are still big challenges. We see the development of effective engagement strategies as the next frontier in online health interventions, an area where much creative research has begun. We also argue that for engagement strategies to accomplish their purpose with novel targeted populations, they need to be tailored to such populations (ie, content is designed with the target population in mind). User-centered design frameworks provide a theoretical foundation for increasing user engagement and uptake by including users in development. However, deciding how to implement this approach to enage users in mental health intervention development is challenging.Objective
The aim of this study was to get user input and feedback on acceptability of messaging content intended to engage suicidal individuals.Methods
In March 2013, clinic intake staff distributed flyers announcing the study, “Your Feedback Counts” to potential participants (individuals waiting to be seen for a mental health appointment) together with the Patient Health Questionnaire. The flyer explained that a score of two or three (“more than half the days” or “nearly every day” respectively) on the suicide ideation question made them eligible to provide feedback on components of a suicide prevention intervention under development. The patient could access an anonymous online survey by following a link. After providing consent online, participants completed the anonymous survey.Results
Thirty-four individuals provided data on past demographic information. Participants reported that they would be most drawn to an intervention where they knew that they were cared about, that was personalized, that others like them had found it helpful, and that included examples with real people. Participants preferred email invitations with subject lines expressing concern and availability of extra resources. Participants also provided feedback about a media prototype including a brand design and advertisement video for introducing the intervention.Conclusions
This paper provides one model (including development of an engagement survey, audience for an engagement survey, methods for presenting results of an engagement survey) for including target users in the development of uptake strategies for online mental health interventions. 相似文献10.
Postel MG de Haan HA ter Huurne ED van der Palen J Becker ES de Jong CA 《Journal of medical Internet research》2011,13(4):e117-Dec;13(4):e117
Background
Web-based interventions for problem drinking are effective but characterized by high rates of attrition. There is a need to better understand attrition rates in order to improve the completion rates and the success of Web-based treatment programs.Objective
The objectives of our study were to (1) examine attrition prevalence and pretreatment predictors of attrition in a sample of open-access users of a Web-based program for problem drinkers, and (2) to further explore attrition data from our randomized controlled trial (RCT) of the Web-based program.Methods
Attrition data from two groups of Dutch-speaking problem drinkers were collected: (1) open-access participants enrolled in the program in 2009 (n = 885), and (2) RCT participants (n = 156). Participants were classified as noncompleters if they did not complete all 12 treatment sessions (9 assignments and 3 assessments). In both samples we assessed prevalence of attrition and pretreatment predictors of treatment completion. Logistic regression analysis was used to explore predictors of treatment completion. In the RCT sample, we additionally measured reasons for noncompletion and participants’ suggestions to enhance treatment adherence. The qualitative data were analyzed using thematic analysis.Results
The open-access and RCT group differed significantly in the percentage of treatment completers (273/780, 35.0% vs 65/144, 45%, χ2 1 = 5.4, P = .02). Logistic regression analysis revealed a significant contribution of treatment readiness, gender, education level, age, baseline alcohol consumption, and readiness to change to predict treatment completion. The key reasons for noncompletion were personal reasons, dissatisfaction with the intervention, and satisfaction with their own improvement. The main suggestions for boosting strategies involved email notification and more flexibility in the intervention.Conclusions
The challenge of Web-based alcohol treatment programs no longer seems to be their effectiveness but keeping participants involved until the end of the treatment program. Further research should investigate whether the suggested strategies to improve adherence decrease attrition rates in Web-based interventions. If we can succeed in improving attrition rates, the success of Web-based alcohol interventions will also improve and, as a consequence, their public health impact will increase.Trial
International Standard Randomized Controlled Trial Number (ISRCTN): 39104853; http://www.controlled-trials.com/ISRCTN39104853 (Archived by WebCite at http://www.webcitation.org/63IKDul1T) 相似文献11.
12.
Swarnaseetha Adusumalli HueyTyng Lee Qiangze Hoi Si-Lin Koo Iain Beehuat Tan Pauline Crystal Ng 《Journal of medical Internet research》2015,17(8)
Background
Some health websites provide a public forum for consumers to post ratings and reviews on drugs. Drug reviews are easily accessible and comprehensible, unlike clinical trials and published literature. Because the public increasingly uses the Internet as a source of medical information, it is important to know whether such information is reliable.Objective
We aim to examine whether Web-based consumer drug ratings and reviews can be used as a resource to compare drug performance.Methods
We analyzed 103,411 consumer-generated reviews on 615 drugs used to treat 249 disease conditions from the health website WebMD. Statistical analysis identified 427 drug pairs from 24 conditions for which two drugs treating the same condition had significantly and substantially different satisfaction ratings (with at least a half-point difference between Web-based ratings and P<.01). PubMed and Google Scholar were searched for publications that were assessed for concordance with findings online.Results
Scientific literature was found for 77 out of the 427 drug pairs and compared to findings online. Nearly two-thirds (48/77, 62%) of the online drug trends with at least a half-point difference in online ratings were supported by published literature (P=.02). For a 1-point online rating difference, the concordance rate increased to 68% (15/22) (P=.07). The discrepancies between scientific literature and findings online were further examined to obtain more insights into the usability of Web-based consumer-generated reviews. We discovered that (1) drugs with FDA black box warnings or used off-label were rated poorly in Web-based reviews, (2) drugs with addictive properties were rated higher than their counterparts in Web-based reviews, and (3) second-line or alternative drugs were rated higher. In addition, Web-based ratings indicated drug delivery problems. If FDA black box warning labels are used to resolve disagreements between publications and online trends, the concordance rate increases to 71% (55/77) (P<.001) for a half-point rating difference and 82% (18/22) for a 1-point rating difference (P=.002). Our results suggest that Web-based reviews can be used to inform patients’ drug choices, with certain caveats.Conclusions
Web-based reviews can be viewed as an orthogonal source of information for consumers, physicians, and drug manufacturers to assess the performance of a drug. However, one should be cautious to rely solely on consumer reviews as ratings can be strongly influenced by the consumer experience. 相似文献13.
Tannaz Moin Kristyn Ertl Jessica Schneider Elena Vasti Fatima Makki Caroline Richardson Kathryn Havens Laura Damschroder 《Journal of medical Internet research》2015,17(5)
Background
Diabetes prevention is a national goal and particularly important in the Veterans Health Administration (VHA) where 1 in 4 veterans has diabetes. There is growing evidence to support the use of Web-based diabetes prevention program (DPP) interventions, shown to be as effective and often more feasible than in-person interventions.Objective
Our primary objective was to qualitatively explore women veterans’ early experiences with a Web-based DPP intervention. Our secondary objective was to estimate weight loss, participation, and engagement to provide context for our qualitative findings.Methods
We conducted and analyzed semistructured interviews and collected data on weight change, participation, and engagement. A total of 17 women veterans with prediabetes from a Midwest VA Women’s Health Clinic were eligible to participate; 15 completed interviews.Results
Participants perceived the DPP program as an appealing way of initiating lifestyle changes and made them feel accountable in achieving their daily goals. The online program was convenient because it could be accessed at any time, and many found that it integrated well into daily life. However, some did not like the logging aspect and some found it to be too impersonal. Participants logged in a mean 76 times, posted a mean 46 group messages, and sent a mean 20.5 private messages to the health coach over 16 weeks. Participants lost 5.24% of baseline weight, and 82% (14/17) of participants completed at least 9 of 16 core modules.Conclusions
Women veterans’ early experiences with a Web-based DPP intervention were generally positive. Accountability and convenience were key enabling factors for participation and engagement. A Web-based DPP intervention appears to be a promising means of translating the DPP for women veterans with prediabetes. 相似文献14.
Tae Min Song Juyoung Song Ji-Young An Laura L. Hayman Jong-Min Woo 《Yonsei medical journal》2014,55(1):254-263
Purpose
The average mortality rate for death by suicide among OECD countries is 12.8 per 100000, and 33.5 for Korea. The present study analyzed big data extracted from Google to identify factors related to searches on suicide in Korea.Materials and Methods
Google search trends for the search words of suicide, stress, exercise, and drinking were obtained for 2004-2010. Analyzing data by month, the relationship between the actual number of suicides and search words per year was examined using multi-level models.Results
Both suicide rates and Google searches on suicide in Korea increased since 2007. An unconditional slope model indicated stress and suicide-related searches were positively related. A conditional model showed that factors associated with suicide by year directly affected suicide-related searches. The interaction between stress-related searches and the actual number of suicides was significant.Conclusion
A positive relationship between stress- and suicide-related searches further confirmed that stress affects suicide. Taken together and viewed in context of the big data analysis, our results point to the need for a tailored prevention program. Real-time big data can be of use in indicating increases in suicidality when search words such as stress and suicide generate greater numbers of hits on portals and social network sites. 相似文献15.
Jean Robson 《The British journal of general practice》2009,59(559):104-109
Background
Published clinical guidelines need to be combined with effective educational interventions to produce change in practice. Problem-based learning (PBL) groups are effective; however, research studies have not looked at change in practice following PBL that is independent of group interaction.Aim
To determine whether clinical guidelines combined with modified PBL e-learning modules, in which dialogue between learners is replaced by interaction with a computer, could increase knowledge, result in changes in practice, and be acceptable to participants as a mode of modifying practice.Design of study
Quantitative and qualitative methods.Setting
Web-based application.Results
Online PBL modules were studied by 45 primary care clinicians. Replacement of group functions by interaction with the computer was found to be an acceptable form of learning, and resulted in reported changes in practice among GPs choosing this method of study. This study shows that changes were independent of demonstrable knowledge gains.Conclusion
Online PBL modules could complement other arms of guideline-implementation strategies. More work is needed to determine which groups would benefit most. 相似文献16.
van Bastelaar KM Pouwer F Cuijpers P Riper H Twisk JW Snoek FJ 《Journal of medical Internet research》2012,14(1):e2-Feb;14(1):e2
Background
Depression and diabetes are two highly prevalent and co-occurring health problems. Web-based, diabetes-specific cognitive behavioral therapy (CBT) depression treatment is effective in diabetes patients, and has the potential to be cost effective and to have large reach. A remaining question is whether the effectiveness differs between patients with seriously impaired mental health and patients with less severe mental health problems.Objective
To test whether the effectiveness of an eight-lesson Web-based, diabetes-specific CBT for depression, with minimal therapist support, differs in patients with or without diagnosed major depressive disorder (MDD), diagnosed anxiety disorder, or elevated diabetes-specific emotional distress (DM-distress).Methods
We used data of 255 patients with diabetes with elevated depression scores, who were recruited via an open access website for participation in a randomized controlled trial, conducted in 2008–2009, comparing a diabetes-specific, Web-based, therapist-supported CBT with a 12-week waiting-list control group. We performed secondary analyses on these data to study whether MDD or anxiety disorder (measured using a telephone-administered diagnostic interview) and elevated DM-distress (online self-reported) are effect modifiers in the treatment of depressive symptoms (online self-reported) with Web-based diabetes-specific CBT.Results
MDD, anxiety disorder, and elevated DM-distress were not significant effect modifiers in the treatment of self-assessed depressive symptoms with Web-based diabetes-specific CBT.Conclusions
This Web-based diabetes-specific CBT depression treatment is suitable for use in patients with severe mental health problems and those with a less severe clinical profile.ClinicalTrial
International Standard Randomized Controlled Trial Number (ISRCTN): 24874457; http://www.controlled-trials.com/ISRCTN24874457 (Archived by WebCite at http://www.webcitation.org/63hwdviYr) 相似文献17.
Jessy A. Terpstra Rosalie van der Vaart Saskia Spillekom-van Koulil Arno van Dam Judith G.M. Rosmalen Hans Knoop Henriët van Middendorp Andrea W.M. Evers 《Patient education and counseling》2018,101(9):1702-1707
Objective
Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.Methods
The training consists of 1.5?days and covers the implementation domains “knowledge”, “skills”, “motivation”, and “organization”, by focusing on the therapy’s rationale, iCBT skills, and implementation strategies. Using an evaluation questionnaire, implementation determinants (therapist characteristics, e-health attitude, and implementation domains) and iCBT acceptance were assessed among participants after training.Results
Twenty-two therapists participated, who generally showed positive e-health attitudes, positive implementation expectations, and high iCBT acceptance. Organizational aspects (e.g., policy regarding iCBT implementation) were rated neutrally.Conclusions
An iCBT therapist training was developed and initial evaluations among participants showed favorable implementation intentions.Practice implications
Therapists’ positive training evaluations are promising regarding the dissemination of iCBT in daily practice. Organizational support is vital and needs to be attended to when selecting organizations for iCBT implementation. 相似文献18.
19.
Motoko Kawashima Miki Uchino Takashi Kawazoe Masaaki Kamiyashiki Kokoro Sano Kazuo Tsubota 《Journal of medical Internet research》2013,15(9)
Background
A Web-based self-check system including a brief questionnaire would seem to be a suitable tool for rapid disease screening.Objective
The purpose of this preliminary study was to test a Web-based self-screening questionnaire for drawing attention to dry eye disease among general Internet users and identifying those with a higher risk of developing the condition.Methods
A survey website was launched and used to recruit participants from general Internet users. In the first phase, volunteers were asked to complete a Web-based self-screening questionnaire containing 12 questions on dry eye symptoms. The second phase focused on the respondents who reported five or more dry eye symptoms and expressed their intention to seek medical attention. These participants performed the Schirmer test, for evaluating tear production, and completed a paper-based lifestyle questionnaire to provide relevant background data.Results
Of the 1689 visitors to the website, 980 (58.0%) volunteers completed the Web-based self-screening questionnaire. Among these, 355 (36.2%) respondents reported five or more dry eye symptoms. Then, 99 (27.9%) of the symptomatic participants performed the Schirmer test and completed the paper-based lifestyle questionnaire. Out of these, 32 (32.2%) had abnormal tear production (≤5 mm).Conclusions
The proposed Web-based self-screening questionnaire seems to be a promising tool for raising awareness of dry eye disease among general Internet users and identifying those with a higher risk of developing the condition, although further research is needed to validate its effectiveness. 相似文献20.
Rochelle Smits Jamie Bryant Rob Sanson-Fisher Flora Tzelepis Frans Henskens Christine Paul William Stevenson 《Journal of medical Internet research》2014,16(3)