Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students
Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. Data come from everal waves of a prospective cohort study...
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| Vydáno v: | Psychological medicine Ročník 54; číslo 5; s. 971 - 979 |
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| Hlavní autoři: | , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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England
Cambridge University Press
01.04.2024
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| ISSN: | 0033-2917, 1469-8978, 1469-8978 |
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| Abstract | Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.
Data come from
everal waves of a prospective cohort study (2016-2022) of college students (
= 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.
5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.
Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students. |
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| AbstractList | Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.BACKGROUNDSuicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.METHODSData come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.RESULTS5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.CONCLUSIONSPredictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students. BackgroundSuicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.MethodsData come from several waves of a prospective cohort study (2016–2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00–19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.Results5454 students ranging in age from 17–36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93–36.07]; Specificity = 97.46 [95% CI 96.21–98.38], PPV = 53.06 [95% CI 40.16–65.56]; AUC range: 0.895 [95% CIs 0.872–0.917] to 0.966 [95% CIs 0.939–0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.ConclusionsPredictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students. Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. Data come from everal waves of a prospective cohort study (2016-2022) of college students ( = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group. 5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort. Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students. |
| Author | Hendrie, Delia Nock, Matthew K. Hasking, Penelope A. Preece, David A. Kessler, Ronald C. Bruffaerts, Ronny Rees, Clare Melvin, Glenn Boyes, Mark E. Auerbach, Randy P. Robinson, Kealagh McEvoy, Peter |
| AuthorAffiliation | 6 Department of Psychiatry, Columbia University, United States of America 2 enAble Institute, Faculty of Health Sciences, Curtin University, Australia 5 University Psychiatric Center, KU Leuven, Belgium 9 Department of Health Care Policy, Harvard Medical School, United States of America 8 Department of Psychology, Harvard University, United States of America 4 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Australia 7 Division of Clinical Developmental Neuroscience, Sackler Institute, United States of America 1 School of Population Health, Faculty of Health Sciences, Curtin University, Australia 3 Centre for Clinical Interventions, Perth, Australia |
| AuthorAffiliation_xml | – name: 6 Department of Psychiatry, Columbia University, United States of America – name: 2 enAble Institute, Faculty of Health Sciences, Curtin University, Australia – name: 9 Department of Health Care Policy, Harvard Medical School, United States of America – name: 5 University Psychiatric Center, KU Leuven, Belgium – name: 1 School of Population Health, Faculty of Health Sciences, Curtin University, Australia – name: 8 Department of Psychology, Harvard University, United States of America – name: 3 Centre for Clinical Interventions, Perth, Australia – name: 4 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Australia – name: 7 Division of Clinical Developmental Neuroscience, Sackler Institute, United States of America |
| Author_xml | – sequence: 1 givenname: Penelope A. orcidid: 0000-0002-0172-9288 surname: Hasking fullname: Hasking, Penelope A. – sequence: 2 givenname: Kealagh orcidid: 0000-0002-9367-7445 surname: Robinson fullname: Robinson, Kealagh – sequence: 3 givenname: Peter orcidid: 0000-0003-2924-6760 surname: McEvoy fullname: McEvoy, Peter – sequence: 4 givenname: Glenn orcidid: 0000-0002-6958-3908 surname: Melvin fullname: Melvin, Glenn – sequence: 5 givenname: Ronny orcidid: 0000-0002-0330-3694 surname: Bruffaerts fullname: Bruffaerts, Ronny – sequence: 6 givenname: Mark E. orcidid: 0000-0001-5420-8606 surname: Boyes fullname: Boyes, Mark E. – sequence: 7 givenname: Randy P. orcidid: 0000-0003-2319-4744 surname: Auerbach fullname: Auerbach, Randy P. – sequence: 8 givenname: Delia orcidid: 0000-0001-5022-5281 surname: Hendrie fullname: Hendrie, Delia – sequence: 9 givenname: Matthew K. orcidid: 0000-0001-6508-1145 surname: Nock fullname: Nock, Matthew K. – sequence: 10 givenname: David A. orcidid: 0000-0003-1060-2024 surname: Preece fullname: Preece, David A. – sequence: 11 givenname: Clare orcidid: 0000-0002-4218-5053 surname: Rees fullname: Rees, Clare – sequence: 12 givenname: Ronald C. orcidid: 0000-0003-4831-2305 surname: Kessler fullname: Kessler, Ronald C. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37732419$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1371_journal_pone_0319473 crossref_primary_10_1080_07448481_2024_2362329 crossref_primary_10_1016_j_psychres_2025_116555 |
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| Snippet | Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify... BackgroundSuicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to... |
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| SubjectTerms | Algorithms At risk populations At risk students Behavior Cohort analysis College students Colleges & universities Female High risk Humans Intervention Male Medical technology Mental health Predictions Prevention programs Probability Prospective Studies Response rates Risk Risk Factors Risk groups Risk reduction Safety Self destructive behavior Sex crimes Students Suicidal behavior Suicidal Ideation Suicide Suicide prevention Suicides & suicide attempts Telecommunications Telemedicine Telephone surveys Universities Volunteers |
| Title | Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students |
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