JMIR Publications

ABSTRACT

Background:

Background:

Suicide is a leading cause of death in the United States; suicidal ideation (SI) is a significant precursor/risk factor for suicide.

Objective:

The objective of this study was to examine the impact of a telepsychiatric care platform on change in SI over time, and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission.

Methods:

Methods:

Participants included 8,581 U.S.-based adults (Treatment n = 8,366; Control n = 215) seeking treatment for depression and/or anxiety. The treatment group included patients who completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers received decision-support at treatment onset and received regular data on participants. Participants in the control group consisted of individuals who completed initial enrollment data and completed surveys at baseline and 12 weeks, but who did not receive care.

Results:

Results:

Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=.24-.37) with SI at baseline. Sleep issues and feeling tired/low energy, while significant, had lower correlations with SI (r = .13-.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r = -.16) and 12 weeks (r = -.10), but less improvement over time (r = -.12 and -.11, respectively). Though not different at baseline, at 12 weeks, 34% of the control group, and 12% of the treatment group expressed SI. While the treatment group got better over time regardless of various demographic variables, for the control group, after controlling for age and depression severity, those with less education got worse over time. A model incorporating treatment group, age, sex, and PHQ-8 scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely to have complete SI remission than those in the control group. Females and those with advanced education beyond high school were about 1.4 times more likely to remit than their counterparts.

Conclusions:

Conclusions:

Results highlight the efficacy of antidepressant intervention to reduce SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trial, is needed.