Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns a randomized clinical trial

Abstract

IMPORTANCE In the United States, approximately 1 physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing more than 4-fold during the first 3 months of internship year. Despite this increase, to our knowledge, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. OBJECTIVE To assess the effectiveness of a web-based cognitive behavioral therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. DESIGN, SETTING. AND PARTICIPANTS A Randomized Clin. Trial Conducted at 2 Univ. Hospitals with 199 Interns from Multiple Specialties during Acad. Years 2009-2010 or 2011-2012. the Current Stud. Was Conducted from May 2009 to June 2010 and May 2011 to June 2012, and Data Were Analyzed Using Intent-to-treat Principles, Including Last Observ. Carried Forward. INTERVENTIONS Interns Were Randomly Assigned to 2 Stud. Groups , and Completed Stud. Activities Lasting 30 Minutes Each Week for 4 Weeks Prior to Starting Internship Yr.. Participants Assigned to WCBT Completed Online CBT Modules and Those Assigned to ACG Received Emails with Gen. Info. about Depression, Suicidal Thinking, and Loc. Mental Hlth. Professionals. MAin OUTCOMES and MEASURES the Patient Hlth. Questionnaire-9was Used to Assess Suicidal Ideation Prior to the Start of Intern Yr. and at 3-month Intervals Throughout the Yr.. RESULTS A Total of 62.2%of Interns Agreed to Take Part in the Stud.; 100 Were Assigned to the WCBT Grp. and 99 to the ACG. during at Least 1 Point over the Course of Internship Yr., 12%of Interns Assigned to WCBT Endorsed Suicidal Ideation Compared with 21.2%of Interns Assigned to ACG. after Adjusting for Covariates Identified A Priori That Have Previously Shown to Increase the Risk for Suicidal Ideation, Interns Assigned to WCBT Were Less Likely to Endorse Suicidal Ideation during Internship Yr. Compared with Those Assigned to ACG. CONCLUSIONS and RELEVANCE This Stud. Demonstrates That A Free, Easily Accessible, Brief WCBT Prog. is Assoc. with Reduced Likelihood of Suicidal Ideation among Med. Interns. Prev. Programs with These Characteristics Could Be Easily Disseminated to Med. Train. Programs Across the Country.