Evidence Based Nursing

I. Clinical Question:
Does standardized screening for suicide risk in primary care can detect adolescents with suicidal
ideation?

II. Citation:
Department of Psychiatry and Human Behavior, Thomas Jefferson University/Jefferson Medical
College, Philadelphia, PA 19107, USA. matthew.wintersteen@jefferson.edu

III. Study Characteristics:

1. Patients included:
- Adolescents aged 12.0 to 17.9 years.

2. Interventions involved:
- The main study outcome was the relationship between overweight or
obesity and the effectiveness of hormonal contraception, which was
measured by pregnancy rates. Researchers also examined the effect of
body type on adverse events from hormonal contraceptives.
- The included research included studies of combined oral contraceptives
along with transdermal, vaginal, implant, and injectable contraceptives.
3. Does the study focus on a significant problem in clinical practice?
- Yes, because of the fact that contraceptives were often prescribed to
prevent conception so that patients can be able to project their goals
into their real purpose and for other reasons as well. With that, we can
say that it poses a significant problem because results of this study can
lead nurses to advise women who are taking contraceptives to reduce
(if ever proven) their weight so that the projected efficacy of the
contraceptives can be achieved.

IV. Methodology
- Physicians in 3 primary care practices received brief training in suicide risk, and 2
standardized questions were inserted into their existing electronic medical chart
psychosocial interview. The questions automatically populated for all adolescents aged
12.0 to 17.9 years. Deidentified data were extracted during both intervention trials and for
the same dates of the previous year. Referral rates were extracted from social work
records.
- Two primary care clinics (clinic A and clinic B) were selected as intervention
clinics, and a third clinic (clinic C) asked about participating in the study and was
offered the intervention. At these 3 clinics, physicians underwent brief training in
detecting suicide risk, and 2 standardized questions for adolescents aged 12.0 to
17.9 years were added to their existing electronic medical chart psychosocial
interview.
- The intervention was associated with doubling of the rates of inquiry about
suicide risk,
- All providers at the 3 sites were invited to a 90-minute training on youth suicide,
which detailed the screening procedures.
- The screening tool began with 2 questions regarding lifetime thoughts about
morbid ideation (ie, "Have you ever felt that life is not worth living?") and suicidal
ideation (ie, "Have you ever felt like you wanted to kill yourself?").
- A positive response to either of these 2 questions prompted 4 more questions
focused on lifetime suicide planning and experiences with suicidal ideation and
planning in the past week.

Mal-adaptive Disorder
 - The suicide questions were presented to patients by their providers as part of the
normal flow of psychosocial questions, all of which were prompted by an
electronic medical record.
V. Study Population

- 3 urban primary care clinics in the United States participated in the study. More
than half of the patients these clinics serve are female sex, and more three
quarters are black.

VI. Design

- This study incorporates an experimental research design by

which the researches are adept into conducting experiments by
the sample population to gather the results that they wish to
obtain. In this study, two primary care clinics (clinic A and clinic
B) were selected as intervention clinics, and a third clinic (clinic
C) asked about participating in the study and was offered the
intervention. At these 3 clinics, physicians underwent brief
training in detecting suicide risk, and 2 standardized questions
were added to their existing electronic medical chart
psychosocial interview

VII. Data Sources

- 3 urban primary care clinics in the United States participated in

the study. More than half of the patients these clinics serve are
female sex, and more three quarters are black. It primarily
includes adolescents aged 12.0 to 17.9 years. Data without
identifiers were extracted during intervention trials and for the
same dates of the preceding year, and referral rates were
determined from social work records.

VIII. Subject selection

- Inclusion and Exclusion

The article was not able to highlight the inclusion and the exclusion criteria
of the study population. It only pinpointed the fact that the obese women
and overweight women must be identified by the analysis cut off using
their BMI’s.

IX. Is the study replicated?

- The article was not able to highlight if the study was replicated. But as
seen through the cyberspace, there were studies conducted before that
obesity is associated with the efficacy of using contraceptives. With that,
perhaps, this study has a previous background by other researchers with
the same ideology that obesity is related to the efficacy of contraceptives.

X. Risks and Benefits

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 a. Risks

- The prevalence of suicide among adolescents climbed in 2005.

Approximately 20% of adolescents contemplate suicide each year, and
5% to 8% attempt suicide. A past suicide attempt is the best predictor
of attempting suicide, although many adolescents who commit suicide
do not have a past psychiatric diagnosis. Suicidal ideation usually
precedes suicide attempts in adolescents. The current study examines
the regular use of a screening tool for suicidal ideation among
teenagers attending primary care clinics.

b. Benefits

- Standardized screening for suicide risk in primary care can detect

youth with suicidal ideation and prompt a referral to a behavioral
health care center before a fatal or serious suicide attempt is made.

XI. Results

- There were 7 reports identified of 11 trials enrolling a total of 39,531

women. Pregnancy risk for overweight or obese women was higher in 1 of
3 studies using BMI. Compared with women with a BMI of less than 25
kg/m2, women with a BMI of 25 kg/m2 or more had higher risk for
pregnancy in this trial of 2 combination oral contraceptives (OR, 1.91; 95%
CI, 1.01 - 3.61).
- Body weight, but not BMI, was associated with pregnancy among women
using the skin patch (reported P < .001). Women weighing 70 kg or more
had higher pregnancy rates than those weighing less than 70 kg in studies
of a never-marketed vaginal ring (P < .0013) and a 6-rod implant (P < .05).
In contrast, there was no trend by body weight in 2 implant studies, and no
pregnancies occurred in trials of an injectable contraceptive.
- Body weight addresses overall body size, while BMI generally reflects the
amount of fat. Only one of three studies using BMI found a higher
pregnancy risk for overweight women. The efficacy of implants and
injectable contraceptives may be unaffected by body mass.

XII. Recommendations

- With the review that I have read in the article, it is most likely
recommended that the study be replicated and be conducted another
research with the employment of randomization, thorough follow up and
completeness of data. It is found in the article that the study still lacked
data despite of a massive study population. Hence, the results of this
study are still significant. It is somehow concluded that overweight or
obese women may find the hormonal contraceptives that they are taking
in less efficacious to them in comparison to women taking in hormonal
contraceptives who have a normal BMI.

XIII. Applicability

1. Was the study able to provide you a direct enough answer to your clinical
question?

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 - Yes. The study provided a sufficient answer to the clinical question in this
paper despite the lack of information regarding the study population and
to how the study population was limited to a number of 39,531 women

2. Is it feasible to carry out the nursing interventions in the real world?

- Yes. The feasibility of the intervention in this study only involves the
criteria to be set to women in taking in hormonal contraceptives. With that,
thorough counseling prior to the use of hormonal contraceptives is the
intervention involved in this study.

XIV. Reviewer’s conclusion

- Suicides among young people continue to be a serious problem. Each year in the U.S.,
thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-
to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. Teenagers
experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial
uncertainty, and other fears while growing up. For some teens, suicide may appear to be a
solution to their problems and stress. Depression and suicidal feelings are treatable
mental disorders. The child or adolescent needs to have his or her illness recognized and
diagnosed, and appropriate treatment plans developed. When parents are in doubt
whether their child has a serious problem, a psychiatric examination can be very helpful.
Standardized screening for suicide risk in primary care showed promising results that can
detect youth with suicidal ideation and prompt a referral to a behavioral health care center
before a fatal or serious suicide attempt is made.

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