IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0281711.html
   My bibliography  Save this article

Assessing suicidality during the SARS-CoV-2 pandemic: Lessons learned from adaptation and implementation of a telephone-based suicide risk assessment and response protocol in Malawi

Author

Listed:
  • Kelsey R Landrum
  • Christopher F Akiba
  • Brian W Pence
  • Harriet Akello
  • Hamis Chikalimba
  • Josée M Dussault
  • Mina C Hosseinipour
  • Kingsley Kanzoole
  • Kazione Kulisewa
  • Jullita Kenala Malava
  • Michael Udedi
  • Chifundo C Zimba
  • Bradley N Gaynes

Abstract

The SARS-CoV-2 pandemic led to the rapid transition of many research studies from in-person to telephone follow-up globally. For mental health research in low-income settings, tele-follow-up raises unique safety concerns due to the potential of identifying suicide risk in participants who cannot be immediately referred to in-person care. We developed and iteratively adapted a telephone-delivered protocol designed to follow a positive suicide risk assessment (SRA) screening. We describe the development and implementation of this SRA protocol during follow-up of a cohort of adults with depression in Malawi enrolled in the Sub-Saharan Africa Regional Partnership for Mental Health Capacity Building (SHARP) randomized control trial during the COVID-19 era. We assess protocol feasibility and performance, describe challenges and lessons learned during protocol development, and discuss how this protocol may function as a model for use in other settings. Transition from in-person to telephone SRAs was feasible and identified participants with suicidal ideation (SI). Follow-up protocol monitoring indicated a 100% resolution rate of SI in cases following the SRA during this period, indicating that this was an effective strategy for monitoring SI virtually. Over 2% of participants monitored by phone screened positive for SI in the first six months of protocol implementation. Most were passive risk (73%). There were no suicides or suicide attempts during the study period. Barriers to implementation included use of a contact person for participants without personal phones, intermittent network problems, and pre-paid phone plans delaying follow-up. Delays in follow-up due to challenges with reaching contact persons, intermittent network problems, and pre-paid phone plans should be considered in future adaptations. Future directions include validation studies for use of this protocol in its existing context. This protocol was successful at identifying suicide risk levels and providing research assistants and participants with structured follow-up and referral plans. The protocol can serve as a model for virtual SRA development and is currently being adapted for use in other contexts.

Suggested Citation

  • Kelsey R Landrum & Christopher F Akiba & Brian W Pence & Harriet Akello & Hamis Chikalimba & Josée M Dussault & Mina C Hosseinipour & Kingsley Kanzoole & Kazione Kulisewa & Jullita Kenala Malava & Mic, 2023. "Assessing suicidality during the SARS-CoV-2 pandemic: Lessons learned from adaptation and implementation of a telephone-based suicide risk assessment and response protocol in Malawi," PLOS ONE, Public Library of Science, vol. 18(3), pages 1-17, March.
  • Handle: RePEc:plo:pone00:0281711
    DOI: 10.1371/journal.pone.0281711
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281711
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281711&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0281711?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Bo Runeson & Jenny Odeberg & Agneta Pettersson & Tobias Edbom & Ingalill Jildevik Adamsson & Margda Waern, 2017. "Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-13, July.
    2. Matthew Large & Muthusamy Kaneson & Nicholas Myles & Hannah Myles & Pramudie Gunaratne & Christopher Ryan, 2016. "Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-17, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Emilijus Žilinskas & Giedrė Žulpaitė & Kristijonas Puteikis & Rima Viliūnienė, 2021. "Mental Health among Higher Education Students during the COVID-19 Pandemic: A Cross-Sectional Survey from Lithuania," IJERPH, MDPI, vol. 18(23), pages 1-14, December.
    2. Konrad Michel, 2021. "Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?," IJERPH, MDPI, vol. 18(10), pages 1-9, May.
    3. Karl Andriessen & Lennart Reifels & Karolina Krysinska & Jo Robinson & Georgia Dempster & Jane Pirkis, 2019. "Dealing with Ethical Concerns in Suicide Research: A Survey of Australian Researchers," IJERPH, MDPI, vol. 16(7), pages 1-12, March.
    4. Frank Iorfino & Nicholas Ho & Joanne S Carpenter & Shane P Cross & Tracey A Davenport & Daniel F Hermens & Hannah Yee & Alissa Nichles & Natalia Zmicerevska & Adam Guastella & Elizabeth Scott & Ian B , 2020. "Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-16, December.
    5. Seo-Eun Cho & Zong Woo Geem & Kyoung-Sae Na, 2021. "Development of a Suicide Prediction Model for the Elderly Using Health Screening Data," IJERPH, MDPI, vol. 18(19), pages 1-10, September.
    6. Carl B. Roth & Andreas Papassotiropoulos & Annette B. Brühl & Undine E. Lang & Christian G. Huber, 2021. "Psychiatry in the Digital Age: A Blessing or a Curse?," IJERPH, MDPI, vol. 18(16), pages 1-32, August.
    7. Tara Hunt & Coralie Wilson & Peter Caputi & Ian Wilson & Alan Woodward, 2018. "Patterns of Signs That Telephone Crisis Support Workers Associate with Suicide Risk in Telephone Crisis Line Callers," IJERPH, MDPI, vol. 15(2), pages 1-13, January.
    8. Sally Hultsjö & Rikard Wärdig & Patrik Rytterström, 2019. "The borderline between life and death: Mental healthcare professionals’ experience of why patients commit suicide during ongoing care," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1623-1632, May.
    9. Kathryn Turner & Anthony R. Pisani & Jerneja Sveticic & Nick O’Connor & Sabine Woerwag-Mehta & Kylie Burke & Nicolas J. C. Stapelberg, 2022. "The Paradox of Suicide Prevention," IJERPH, MDPI, vol. 19(22), pages 1-15, November.
    10. Rose-Marie Lindkvist & Sofie Westling & Sophia Eberhard & Björn Axel Johansson & Olof Rask & Kajsa Landgren, 2021. "‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study," IJERPH, MDPI, vol. 19(1), pages 1-15, December.
    11. Qi Chen & Yanli Zhang-James & Eric J Barnett & Paul Lichtenstein & Jussi Jokinen & Brian M D’Onofrio & Stephen V Faraone & Henrik Larsson & Seena Fazel, 2020. "Predicting suicide attempt or suicide death following a visit to psychiatric specialty care: A machine learning study using Swedish national registry data," PLOS Medicine, Public Library of Science, vol. 17(11), pages 1-19, November.
    12. India Bellairs-Walsh & Sadhbh J. Byrne & Sarah Bendall & Yael Perry & Karolina Krysinska & Ashleigh Lin & Maria Michail & Michelle Lamblin & Tina Yutong Li & Sarah Hetrick & Jo Robinson, 2021. "Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners’ Perspectives," IJERPH, MDPI, vol. 18(24), pages 1-19, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0281711. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.