Major Depressive Disorder, Suicides, and the Role of Dimensional Psychiatry for Triaging in Primary Care Settings: A Case Series Retroanalysis.

Autor:	Yarlagadda A; Dr. Yarlagadda is Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia., Johnson AR; LTC Johnson currently serves as the Deputy Installation Director of Behavioral Health for the Desmond Doss Health Clinic in Schofield Barracks, Hawaii., Bickerstaff CM; Ms. Bickerstaff is a Behavioral Health Specialist at McDonald Army Health Center in Fort Eustis, Virginia., Yancey JR; Dr. Yancey is Assistant Professor at Uniformed Services University of the Health Sciences in Bethesda, Maryland., Preston SL; Dr. Preston is Associate Professor, Department of Psychiatry at Uniformed Services University of the Health Sciences in Bethesda, Maryland, and is with the Office of the Army Surgeon General, Defense Health Headquarters in Falls Church, Virginia., Etheridge LL; Mr. Etheridge is with Garland School of Social Work, Baylor University in Waco, Texas., Maddalozzo M; Dr. Maddalozzo is with the Langley Air Force Base Mental Health Clinic in Hampton, Virginia., Ochinang S; Mr. Ochinang is Deputy Director for Psychological Health at McDonald Army Health Center in Fort Eustis, Virgnia., Jackson RA; Dr. Jackson is with Fort Eustis Behavioral Health Clinic in Fort Eustis, Virginia., Clayton AH; Dr. Clayton is with University of Virginia in Charlottesville, Virgnia.
Jazyk:	angličtina
Zdroj:	Innovations in clinical neuroscience [Innov Clin Neurosci] 2022 Oct-Dec; Vol. 19 (10-12), pp. 10-15.
Abstrakt:	Objective: The goal was to promote early diagnosis and referral of patients with depressive symptomology in the primary care setting using a biopsychosocial-informed risk stratification tool to prevent suicides. Methods: A qualitative analysis of military suicides stationed at Fort Eustis, Virginia, using demographics from Fatality Review Boards (FRBs) of 10 cases assessing shared biopsychosocial stressors was conducted. The case reviews were used to assess the failure modes and effects analyses (FMEA), prompting the development of a performance improvement (PI) plan via a risk stratification scale that recognizes opportunities for intervention in the primary care and supervisor/peer settings to improve patient outcomes. Results: FMEA revealed the presence and interplay of multiple biopsychosocial stressors specifically impacting relationships, occupational functioning, financial status, legal issues, and undiagnosed mental health conditions across the 10 suicides reviewed. Furthermore, the severity of each stressor was best examined from a dimensional perspective to gauge the impact on or impairment of the individual in the military setting. The dimensional use of biopsychosocial stressors is congruent with our hypothesis that an increase in duration and intensity of biopsychosocial stressors increases risk of suicide. Conclusion: This case series reveals a gap in suicide assessment and suggests the use of a dimensional approach to measure biopsychosocial stressors at the entry level, such as primary care settings, or in the case of the military, during routine counseling. Additionally, a risk stratification tool that crosses biopsychosocial domains could provide a more accurate assessment for self-harm, in turn enabling a timely referral to appropriate helping agencies, including nonclinical resources. Competing Interests: DISCLOSURES: Dr. Clayton has received grants from Daré Bioscience; Janssen; Relmada Therapeutics, Inc.; and Sage Therapeutics; advisory board fee/consultant fees from Fabre-Kramer; Janssen Research & Development, LLC; MindCure; Ovoca Bio PLC; PureTech Health; S1 Biopharma; Sage Therapeutics; Takeda/Lundbeck; Vella Bioscience, Inc.; and WCG MedAvante-ProPhase; royalties/copyright from Ballantine Books/Random House; Changes in Sexual Functioning Questionnaire; Guilford Publications; and shares/restricted stock units from Euthymics; Mediflix LLC; and S1 Biopharma. All other authors have no conflicts of interest relevant to the content of this article. (Copyright © 2022. Matrix Medical Communications. All rights reserved.)
Databáze:	MEDLINE
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