Behavioral Activation for Perinatal Suicide Ideation
Notice bibliographique
Résumé
Importance: Suicide is a leading cause of maternal postpartum death. Evidence-based interventions are needed. Objective: To determine whether the likelihood of endorsing suicide ideation (SI) changed during a brief behavioral activation (BA) psychotherapy for perinatal depression irrespective of clinician or delivery types. Design, Setting, and Participants: This is a secondary analysis of a multisite, noninferiority, 4-arm randomized clinical trial called SUMMIT(Scaling Up Maternal Mental Health Care by Increasing Access to Treatment). SUMMIT compared clinicians (nonspecialist vs specialist) and modalities (telemedicine vs in person) in delivering BA. Participants were enrolled from January 2020 to October 2023. The study was conducted at university-affiliated networks in Chicago, Illinois; Chapel Hill, North Carolina; and Toronto, Canada. Pregnant (≤36 weeks) and postpartum (4-30 weeks) adults with depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] score ≥10) were enrolled. Secondary data analyses were conducted in November 2024. Intervention: A manualized 6- to 8-session perinatal BA intervention delivered weekly. Main Outcomes and Measures: The primary outcome was SI, as measured by the EPDS item 10, assessed weekly and at 3 months postrandomization. SI endorsements were followed by the Columbia Suicide Severity Rating Scale (C-SSRS) for further safety assessment. Results: A total of 1230 pregnant and postpartum adults were enrolled, among whom 1117 completed 1 or more treatment session and provided 1 or more week of EPDS data and thus were included in the current study. Of 1117 included participants, 264 (23.6%) endorsed SI during treatment, and mean (SD) age was 33.4 (4.9) years. Cumulative link mixed models indicated that the odds of endorsing SI decreased by 25% with each additional treatment session (odds ratio [OR], 0.75; 95% CI, 0.58-0.96; P = .03). The odds of endorsing SI decreased by 80% at 3 months postrandomization compared with any time during treatment (OR, 0.20; 95% CI, 0.14-0.27; P < .001). The odds of endorsing SI did not differ between clinician type (nonspecialist vs specialist) or modality (telemedicine vs in person). Goodness-of-fit χ2 tests further indicated that participants were significantly more likely to endorse suicide thoughts on the C-SSRS at treatment onset compared with any other time point. Conclusions and Relevance: In this secondary analysis of the SUMMIT noninferiority randomized clinical trial, the likelihood of endorsing SI decreased over the course of a brief BA psychotherapy for perinatal depression and most significantly at 3 months postrandomization, irrespective of clinician or delivery types. BA may be one evidence-based, scalable approach for perinatal suicide prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT04153864.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».