Digital interventions may help reach more suicidal people

Decades of investigating the phenomenon of suicide within the framework of medical research have not reduced suicide rates in the world. I believe that understanding suicide as a medical illness is a misconception. The concept of the normal course of the disorder as we know it from somatic pathology, allowing the diagnosis of the disorder does not apply to Suicidal Thinking. Even comprehensive suicide models cannot predict suicide, nor do they translate into effective prevention and treatment. Mental health disorders are a risk factor for suicide, not a cause of suicide. Furthermore, the medical model assumes that people with mental health problems typically seek help. The fact is that thousands of people at risk of suicide do so no Ask for help. The principles of medical thinking do not match the personal experience of suicide. In short: He is the person who turns on himself during an emotional crisis, not the depression.

“We needed someone to listen to us without trying to talk us out of it.”

This is how a group of individuals who had attempted suicide answered my question what could help prevent them from harming themselves. Here are the conclusions I draw from the above statement:

1. Suicidal thoughts and plans are psychological in nature. In difficult life situations for which a person does not see a solution, thoughts of suicide as a possible option are common and often fleeting. Suicide is not viewed as a goal as a form of disease. This is supported by findings that three-quarters of individuals who reported episodes of suicidal ideation in the past year said they did not feel they needed treatment (1).
2. Suicidal cognitions are usually characterized by ambivalence. This means that there is room for connection to a person’s life directions Objectives– If we can find the right time, the right medium, the right language, and the right message to reach people who wouldn’t normally seek professional help. Pathologizing suicide does not help reach people at risk.

In my practice 50 years of Psychotherapy I learned how to connect with people and build an early working alliance. Here are the basic elements necessary:

• The working relationship respects the patient’s need for autonomy, especially when there is a discrepancy.
• Patients seeking help have their own implicit or explicit goals.
• Therapeutic interventions must validate the person’s own experience. Listening to the patient’s narrative is the royal road to establishing a working relationship (see my article). mail).
• The one-size-fits-all approach (characteristic of the medical approach) does not work. What is important in communicating with suicidal people is to realize that each person and their inner experience is unique.

In recent years, new interest has emerged in the relationship between psychological interventions and suicidal behavior as an outcome. Research into the relationship between the therapeutic alliance and suicidal behavior has shown that an alliance with a therapist, care coordinator, or mental health team has a significant impact on patients’ suicide risk (2). Fiction genre cooperation Effectively reduces suicidal thoughts, early alliance is associated with decreased suicidal thinking and behaviors (3, 4).

Promising new developments in the field of suicide prevention

In the past decades, digital interventions in mental health have made increasing gains attention As new and cost-effective alternatives to traditional mental health projects. Digital interventions allow communication at any time, with anonymous access, avoiding related barriers He is afraid to Stigma, shameand prejudice Against negative experiences with health care providers. Online search histories reveal a high level of inconsistency regarding suicide-related content. A US study reported that 77 percent of individuals hospitalized for suicidal thoughts and behaviors conducted online searches related to seeking help, including how to find inpatient and outpatient behavioral health care, as well as information about suicide methods (5). The paradox of suicidal cognition is an opportunity to reach at-risk people and support life-oriented goals.

Digital interventions include smartphone apps, websites, chatbots, or Teletherapy communication. They can be complementary or stand-alone interventions to address suicidal behaviors, providing broad and affordable resources for people contemplating suicide. The challenge is how to get people’s attention within the “noise” of useful, unhelpful and dangerous information on the Internet about suicide, and to keep callers connected. Young people in particular often avoid contact with traditional mental health services, but their interest in digital technology to support mental health offers huge potential for smartphone interventions to connect with this group.

A meta-analysis of six randomized controlled trials (RCTs) using the Internet Cognitive behavioral A treatment intervention involving 1,567 participants found that the interventions were associated with significant reductions in suicidal ideation compared to control conditions (6). Another meta-analysis of 16 studies with a total of 4,398 participants found that self-directed digital interventions that directly target suicidal ideation were effective in reducing suicidal ideation, with direct interventions producing more positive effects than indirect interventions (7). Several meta-analyses of digital health interventions report effect sizes similar to effect sizes of traditional face-to-face interventions.

For example, a study using a self-guided smartphone app on suicidal ideation in youth based on elements of behavioral buffer therapy found that the app showed greater reductions in suicidal ideation immediately and three months after the intervention compared to those who received the control app (8).

A recent randomized controlled trial of a digital intervention providing email correspondence delivered by volunteer youth participants (“peers”) included 420 participants with a control group of young people who self-reported the online service but had not signed up for advice (Under 25). A main effect of symptom improvement was observed in both groups for suicidal ideation and psychiatric symptoms, without a significant effect for group (9).

Conclusions

Digital technology-based interventions have great potential to reach people who would not normally contact mental health services. It provides easy, widespread and affordable help to people contemplating suicide, as an addition to traditional methods of suicide prevention. Effectiveness studies are promising but reveal that self-directed digital interventions face significant limitations due to participant heterogeneity and anonymity. It is necessary to create more digital projects to deepen our understanding of how such interventions can be designed to reach specific population groups, including people in low- and middle-income countries, different cultures, etc. One important aspect is the models of suicide used in digital interventions. Health authorities are advised to support the implementation and evaluation of digital interventions.

If you or someone you love is thinking about suicide, get help right away. For help 24/7, call 988 for the Suicide and Crisis Lifeline 988, or reach out to the Crisis Text Line by texting 741741. To find a therapist near you, visit Therapy guide in Psychology Today.