RESUMEN
Across 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth meta-analysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiproblem treatment (0.15). ESs differed across control conditions, with "usual care" emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science. (PsycINFO Database Record
Asunto(s)
Práctica Profesional , Psicoterapia/métodos , Investigación , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Niño , Trastornos de la Conducta Infantil/psicología , Trastornos de la Conducta Infantil/terapia , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Humanos , Psicología InfantilRESUMEN
OBJECTIVE: Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI-S), and evaluates its use in an objective structured clinical examination (OSCE). METHOD: The authors developed the CAI-S on the basis of the literature on suicide risk-assessment and management, and consultation with faculty focus groups from three sites in a large academic psychiatry department. The CAI-S structures faculty ratings regarding interviewing and data collection, case formulation and presentation, treatment-planning, and documentation. To evaluate the CAI-S, 31 faculty members used it to rate the performance of 31 learners (26 psychiatric residents and 5 clinical psychology interns) who participated in an OSCE. After interviewing a standardized patient, learners presented their risk-assessment findings and treatment plans. Faculty used the CAI-S to structure feedback to the learners. In a subsidiary study of interrater reliability, six faculty members rated video-recorded suicide risk-assessments. RESULTS: The CAI-S showed good internal consistency, reliability, and interrater reliability. Concurrent validity was supported by the finding that CAI-S ratings were higher for senior learners than junior learners, and were higher for learners with more clinical experience with suicidal patients than learners with less clinical experience. Faculty and learners rated the method as helpful for structuring feedback and supervision. CONCLUSION: The findings support the usefulness of the CAI-S for evaluating competency in suicide risk-assessment and management.
Asunto(s)
Competencia Clínica , Internado y Residencia/normas , Psiquiatría/normas , Medición de Riesgo/métodos , Prevención del Suicidio , Manejo de la Enfermedad , Evaluación Educacional/métodos , Femenino , Humanos , Internado y Residencia/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: This study evaluated the impact of structured training in evidence-based risk assessment for suicide. METHODS: Forty-five psychiatry and psychology trainees participated in a workshop on evidence-based risk assessment. A comparison group of ten psychiatry trainees participated in a different workshop on the application of evidence-based medicine to psychiatry that was not focused specifically on risk assessment. Before and after each workshop, participants rated their skills in assessing patients' risk of suicide and wrote progress notes regarding clinical vignettes that included the assessment of and plan regarding suicide risk. Researchers systematically rated the progress notes. RESULTS: Participation in risk assessment training predicted improvement on specific indicators of documentation quality, ratings of the overall quality of documentation of suicide risk, and self-rated competence in suicide risk assessment. CONCLUSIONS: Structured clinical training in evidence-based risk assessment can improve documentation of assessment and management of patients' risk of suicide.
Asunto(s)
Psiquiatría/educación , Psicología/educación , Prevención del Suicidio , California , Educación , Medicina Basada en la Evidencia/educación , Humanos , Medición de RiesgoAsunto(s)
Trastornos Mentales/psicología , Psiquiatría/educación , Psicología Clínica/educación , Violencia/psicología , Actitud del Personal de Salud , Competencia Clínica , Documentación/métodos , Documentación/normas , Educación/métodos , Evaluación Educacional/métodos , Psiquiatría Forense/educación , Psiquiatría Forense/métodos , Humanos , Internado y Residencia/métodos , Masculino , Registros Médicos/estadística & datos numéricos , Trastornos Mentales/clasificación , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Medición de Riesgo/métodos , Factores de Riesgo , Gestión de Riesgos/métodos , Autoeficacia , Encuestas y Cuestionarios , Enseñanza , Violencia/prevención & control , Violencia/estadística & datos numéricosRESUMEN
Although depression is strongly associated with suicide attempts and suicide deaths, most depressed youth do not make an attempt, indicating the need to identify additional risk factors. We examined suicide attempts among 451 depressed primary care patients, 13 to 21 years of age. In bivariate analyses, youth classified as suicide attempters showed elevated levels of psychopathology, specifically depressive symptoms, externalizing behaviors, anxiety, substance use, mania, and posttraumatic stress disorder symptoms. Externalizing behaviors and depression severity uniquely contributed to the prediction of suicide attempts in multivariate analyses. High levels of environmental stress as well as a few key stressful events were associated with suicide attempts; a recent romantic breakup or being assaulted added to suicide attempt risk, beyond the effects of psychopathology. Implications of results for primary care preventive services and suicide attempt prevention are discussed.