Suicidal Ideation
Conditions
Keywords
self-harm, suicidal ideation, Mobile intervention, cultural adaptation, Pakistan, LMIC, Problem-solving, CBT
Brief summary
Determine the feasibility, acceptability and efficacy of an adapted digitally delivered CMAP (CMAP-SI) intervention (CAMI) compared to treatment as usual (TAU) for patients presenting with suicidal ideation.
Detailed description
The reported suicide rates in South Asia are high compared to the global average. These figures are likely to be an underestimate since suicide data from many LMICs such as Pakistan is lacking and what is available is not reliable (Jordans et al., 2014). According to an estimate, 5,000 to 7,000 suicides take place each year in Pakistan (Hafeez, 2016) and at least 10 to 20 suicide attempts happen for every suicide. Mobile health is a novel and emerging field in psychiatric and psychological care and treatment of mental health difficulties, it involves the use of telecommunications to provide health care, support and intervention from a distance. The proposed study will be carried out in two phases; Stage 1) adaptation of an already existing culturally adapted manual assisted problem solving intervention (CMAP) for patients with suicidal ideation presenting to primary care in Pakistan and further adaptation into a digital intervention. Stage 2) feasibility Randomised Control trial.
Interventions
BEHAVIORALCAMI
Culturally Adapted manual-assisted problem solving training based Mobile Intervention (CAMI) for Suicidal Ideation. CMAP is a manual-assisted intervention which has been adapted from a self-help guide called Life After Self-Harm based on the principles of Cognitive behavioral therapy (CBT). This intervention is an evaluation of suicidal ideation, crisis skills, problem-solving and CBT techniques to manage emotions, negative thinking, interpersonal relationships and relapse prevention strategies.
Sponsors
Pakistan Institute of Living and Learning
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
Researcher conducting assessments will be masked to participant group allocation. This will be achieved by briefing participants and research staff in advance around maintaining masking.
Intervention model description
multicenter exploratory RCT
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
Yes
Inclusion criteria
Individuals (aged 18-64) screened and identified as having suicidal ideation * Able to give written informed consent * Living within the catchment areas of participating hospitals * Have a smart phone and able to operate it * Able to read and speak Urdu * Not requiring in-patient psychiatric treatment.
Exclusion criteria
* Presence of a diagnosed physical or intellectual disability as it can prevent individuals from engaging with the intervention. This will be assessed by the research team at screening stage. Any disabilities will be identified by a relevant clinician (e.g. Psychiatrist). * Temporary resident unlikely to be available for follow-up (b) participants with a diagnosis of DSM-IV mental disorder due to general medical condition or substance misuse, dementia, delirium, alcohol and drug dependence, schizophrenia, or bipolar disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Suicide Ideation . | Change in scores from baseline to 3 and 6-month post-randomization | The BSI is a 19-item self-report instrument for detecting and measuring the current intensity of the patient's attitudes, behaviors and specificity of a patient's thoughts to die by suicide during the past week. Higher scores indicate greater severity of suicidal ideation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depression | Change in scores from baseline to 3 and 6-month post-randomization | Beck Depression Inventory (BDI), which is a 21-item scale measuring symptoms of depression. Higher scores on the scale indicate greater severity of depression. |
| Hopelessness | Change in scores from baseline to 3 and 6-month post-randomization | Beck Hopelessness Scale (BHS) (Beck, A and Steer, R, 1988) is a self-report instrument designed to measure three aspects of hopelessness: feelings about the future, loss of motivation and expectations during the past week. Higher scores indicate greater severity of hopelessness. |
| Health-related quality of life | Change in scores from baseline to 3 and 6-month post-randomization | Quality of life-EuroQoL (EQ-5D) (Brooks, R. and Group, E., 1996): This is a standardised instrument to measure health-related quality of life. It consists of a self-report questionnaire covering five dimensions of health (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Higher scores indicate better quality of life. |
| Client Service Receipt Inventory | Change in scores from baseline to 3 and 6-month post-randomization | Detailed description of the use of health services will be collected using the Client Service Receipt Inventory (CSRI) |
| Client Satisfaction Questionnaire | level of satisfaction at end of intervention i.e., 3-month post-randomization | The Client Satisfaction Questionnaire (Attkisson, Zwick, & planning, 1982) is an 8 item measure of client satisfaction with services. Higher scores indicate greater satisfaction with the services received. |
Countries
Pakistan
Contacts
Primary ContactNasim Chaudhry, MRC Psych, FRC Psych, MD
Backup ContactTayyeba Kiran, PhD
Outcome results
None listed