PM.20.059 – Precision psychiatry in mental health care for patients with suicide risk

Route: Personalised medicine: the individual at the centre

Cluster question: 095 How can we personalise health care, for example by using biomarkers?

Psychotherapy and pharmacotherapy can effectively reduce thoughts about suicide, and prevent suicidal behaviour (i.e. attempts and completed suicides). Nevertheless, it is known from studies in the field of depression that psychotherapy has no effect or even a negative outcome in about 40% of patients and that antidepressants can have adverse effects. Such adverse effects would be especially risky among patients who consider suicide. Moreover, mental health care would be more efficient if it would be known who can be expected to be responsive to which treatment.

It is largely unknown which patient characteristics are associated with treatment effect. Existing randomised controlled trials (RCTs) have mainly examined treatment effects at a group-level instead of the individual level, primarily because individual RCTs do not have the statistical power to examine patient-related moderators or mediators (e.g. age, sex, cultural background, type of disorder, substance abuse etc.). This ‘power’ problem can be solved by combining data of multiple studies. A pooled dataset of 10%-30% of all studies that have been conducted in this field would have ample power to determine patient characteristics associated with treatment outcome.

When these patient characteristics are determined, we can develop a decision support algorithm that can help clinicians determine the most fitting psychotherapy and/or pharmacotherapy for an individual patient. This decision support algorithm will be evaluated by comparing algorithm results with clinician advice. This algorithm can be implemented in an online toolkit for clinicians that is currently being developed by 113 Zelfmoordpreventie and which will be implemented through an existing network of mental health care centres (http://www.supranetggz.nl/).

Keywords

mental health care, precision psychiatry, suicide prevention

Other organisations

Alii, Amsterdam UMC department of Psychiatry, GGZ inGeest, Stichting 113 Zelfmoordpreventie

Submitter

Organisation Vrije Universiteit Amsterdam (VU), section Clinical Psychology
Name Dr. W. (Wouter) van Ballegooijen
E-mail w.van.ballegooijen@vu.nl