Two leading theories within the field of suicide prevention are the interpersonal psychological theory of suicidal behaviour (IPT) and the integrated motivational-volitional (IMV) model. The IPT posits that suicidal thoughts emerge from high levels of perceived burdensomeness and thwarted belongingness. The IMV model is a multivariate framework that conceptualizes defeat and entrapment as key drivers of suicide ideation. We applied network analysis to cross-sectional data collected as part of the Scottish Wellbeing Study, in which a nationally representative sample of 3508 young adults (18-34 years) completed a battery of psychological measures. Network analysis can help us to understand how the different theoretical components interact and how they relate to suicide ideation. Within a network that included only the core factors from both models, internal entrapment and perceived burdensomeness were most strongly related to suicide ideation. The core constructs defeat, external entrapment and thwarted belonginess were mainly related to other factors than suicide ideation. Within the network of all available psychological factors, 12 of the 20 factors were uniquely related to suicide ideation, with perceived burdensomeness, internal entrapment, depressive symptoms and history of suicide ideation explaining the most variance. None of the factors was isolated, and we identified four larger clusters: mental wellbeing, interpersonal needs, personality, and suicide-related factors. Overall, the results suggest that relationships between suicide ideation and psychological risk factors are complex, with some factors contributing direct risk, and others having indirect impact.

Background Although many web-based mental health interventions are being released, the actual uptake by end-users is limited. The marginal level of engagement of end-users when developing these interventions is recognized as an important cause for uptake problems. In this paper we offer our perceptive on how to improve user engagement. By doing so we aim to stimulate a discourse on user involvement within the field of online mental health interventions. Methods We shortly describe three different methods (the expert driven method, intervention mapping, and scrum) that were currently used to develop web-based health interventions. We will focus to what extent the end-user was involved in the developmental phase, and what the additional challenges were. In the final paragraph, lessons learned are summarized, and recommendations provided. Results Every method seems to have its trade-off: if end-users are highly involved, availability of end-users and means become problematic. If end users are less actively involved, the product may be less appropriate for the end-user. Other challenges to consider are the funding of the more active role of technological companies, and the time it takes to process the results of shorter development cycles. Conclusions Thinking about user-centred design and carefully planning the involvement of end-users should become standard in the field of web-based (mental) health. When deciding on the level of user-involvement, one should balance the need for input from users with the availability of resources such as time and funding.

Evidence suggests that suicidal behaviour arises from one's attempt to escape from unbearable situations or unbearable thoughts and feelings. These feelings of entrapment are usually assessed via the 16-item Entrapment Scale, but this is too long for routine use in clinical practice. The aim of this study was to develop a brief version of the full scale that reliably assesses entrapment. We used data collected from a clinical sample (n = 497) of patients following hospital-treated self-harm and a population-based sample (n = 3457) of young adults. Four items were selected that had both the highest factor loading and discriminatory parameters and that covered the theoretical constructs of internal and external entrapment. Correlations between the 4-item short-form and the 16-item full scale were nearly perfect (0.94 for the clinical sample, 0.97 for the population-based sample). When comparing the correlations between the short-form and the full scale with other clinical and psychological scales, the correlations were nearly identical. The 4-item Entrapment Scale Short-Form (E-SF) will provide very comparable information about entrapment for each respondent as the full scale will do. However, its brevity will increase the likelihood that the assessment of entrapment will be implemented into everyday clinical practice.

Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. Netherlands Trial Register (NTR3092 www.trialregister.nl).

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The implementation of eMental health interventions (eMH) in routine healthcare constitutes a major challenge, and reliable instruments to assess implementation processes are lacking. The Normalisation MeAsure Development project (NoMAD) developed a 20-item self-report questionnaire to overcome this gap. Based on the Normalisation Process Theory, this instrument focuses on four generative mechanisms involved in implementation processes: Coherence, Cognitive Participation, Collective Action, and Reflexive MONITORING. A psychometric assessment of the original English version of NoMAD indicates that the theoretical model represented the data acceptably. Objective: We translated the NoMAD questionnaire to Dutch and studied the factor structure in Dutch mental healthcare settings. Methods: Dutch healthcare professionals involved in eMH implementation were invited to complete the NoMAD questionnaire. Confirmatory Factor Analysis (CFA) was conducted to verify interpretability of scale scores for three models: (1) the theoretical four-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were identified exploratively, and correlated scale scores with three control questions were used to assess convergent validity. Results: 313 healthcare professionals from mental healthcare settings completed the questionnaire (female: 77%; age: M = 46 ± 11). The internal consistency of the 20-item questionnaire was acceptable (.64 ≤ α ≤ .87). The theorised four-factor model and the hierarchical model fitted the data reasonably well in the CFA. The theorised four-factor model performed slightly better (CFI = .92, TLI = .90, RMSEA = .09, SRMR = .11, χ2diff = 25.21, p ≤ .05). Notwithstanding the significance, the difference is small and possibly not outweighing the practical relevance of a total score and sub-scale scores combined in one measurement model. One item was identified as weak (λCA.2 = .18). A moderate to strong convergent validity was found for two of the four sub-scales (.37 ≤ r ≤ .56, p ≤ .05). Conclusions: NoMAD’s theoretical factor structure was confirmed among mental healthcare professionals as meeting acceptable standards. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire. The data suggests that NoMAD holds across service settings including Dutch mental healthcare. Future research should assess the questionnaire’s relative predictive value and responsiveness over time, and clarify the conceptual interpretability of the scale scores in implementation practices.

In mental health care, both clinical and scientific decisions are based on within-subject comparisons of test scores on the same self-report questionnaire at different points in time. To establish the validity of test score comparisons over time, longitudinal measurement invariance should be established. The current study tested whether the 19 item Beck Scale for Suicide Ideation (BSS) is measurement invariant (MI) over time. As the first five items of the scale are often used to screen for the presence of suicidal thoughts, we also tested a model consisting of only the first five items. Psychiatric in- and out-patients (n=475) completed the questionnaire upon admission and after 3 months. By means of confirmatory factor analysis (CFA) we tested whether the parameters of a single factor model were equal over time. All fit indices indicated that both the 19-item questionnaire and the five-item screener were measurement invariant over time. This means that changes in test-scores over time can be attributed to true changes in the construct of interest. These findings legitimate the use of the 19 item scale and the five-item screener in longitudinal assessments.