نشریه علمی پژوهشی طب انتظامی Journal of Police Medicine
Volume 10, Issue 4 (2021)
J Police Med 2021, 10(4) |
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Ethics code: IR.ARUMS.REC.1399.328
Clinical trials code: IR.ARUMS.REC.1399.328
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Mohammadi N, Sadri Damirchi E, Sheykholeslami A, Ghamari Givi H. The Effectiveness of the Online Crisis Intervention Program on the Suicidal Ideation of Patients with Covid-19. J Police Med 2021; 10 (4)
URL: http://jpmed.ir/article-1-1011-en.html
URL: http://jpmed.ir/article-1-1011-en.html
1- Department of Counseling, Faculty of Education & Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
2- Department of Counseling, Faculty of Education & Psychology, University of Mohaghegh Ardabili, Ardabil, Iran ,e.sadri@uma.ac.ir
2- Department of Counseling, Faculty of Education & Psychology, University of Mohaghegh Ardabili, Ardabil, Iran ,
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INTRODUCTION
… [1-3]. Due to the global status of corona virus disease which affects all countries in the world, the discussion about psychological effects of this viral disease on mental health is very important [4]. The results of study conducted in 2020 on 1060 ordinary volunteers in China showed that more than 70% of examinees suffered from some kind of psychological disorder caused by corona virus [2]. ... [5]. Zuromski et al. [6] have shown in their research that after each stressful event, the rate of suicidal ideation in individuals increases. In the France study, the findings show that people with PTSD report high suicide rates [7]. ... [8]. About 90% of suicides in the world occur in people with mental disorders such as depression [9]. Suicides due to fear of corona virus have been reported in countries such as Pakistan, Bangladesh and India [10]. Some studies have examined the relationship between suicide and the pandemic outbreak of corona [11]. ... [12]. Research has shown that many people saw a police officer three months before committing suicide [13]. ... [14-17]. Mobini, Dehkordi and Pirani [18] have concluded in a study that crisis intervention is one of the effective factors that can reduce psychological damage in crisis situations. Sultanpour, Mirzaei and Kadkhoda [19] have also highlighted the importance of the role of law enforcement in crises and have shown that the police can help increasing the sense of security during a corona Prevalence.
AIM(S)
The aim of this study was to evaluate the effectiveness of the online crisis intervention program on suicidal ideation in patients with Covid-19.
RESEARCH TYPE
The present study is applied in terms of purpose and quasi-experimental in terms of method with pre-test-post-test design with a control group.
RESEARCH SOCIETY, PLACE AND TIME
The statistical population of the study consisted of all people who contracted Covid-19 in 2020 in Rasht.
SAMPLING METHOD AND NUMBER
The approximate number of patients with Covid-19 in Rasht in the first half of 2020 was estimated to be 400 people, which according to the Krejcie and Morgan table and taking into account the percentage of falls, 196 people were considered as a sample. After removing incomplete questionnaires, 180 questionnaires were analyzed. By converting the data into standard scores, 16% of the samples (about 30 people) entered the study. Due to the fact that the sample size in the intervention studies is at least 10-12 people [20], in this study in each group, taking into account the probability of sample fall (loss), 15 samples were considered.
USED DEVICES & MATERIALS
BSSI questionnaire was used to collect data. The scale is 19-item self-examination tool designed to detect and measure the intensity of thoughts, behaviors, and planning for suicide over last week. On this scale, score of zero means that there are no suicidal thoughts at all, one to five, the presence of suicidal thoughts, a score of six to 19, a readiness for suicide, and a score of 20 to 38 indicates the intention to attempt suicide [21]. Beck reported the reliability coefficient among the evaluators of this questionnaire as 0.89 and 0.83, respectively [21]. In Iran, using Cronbach's alpha method, coefficients of 0.87 to 0.97 have been obtained [22]. Cronbach's alpha coefficient in the present study was 0.87. The implementation of this research was done in two stages; In the first stage, based on documents, sources, theoretical literature, research background and existing programs in this field [15, 23, 24], the crisis intervention program was developed in 10 sessions of 60 minutes in a virtual and online manner (Table 1). Then, in the second stage, the developed program was performed on the experimental group and the control group did not receive any intervention. Finally, after the sessions, post-test was performed in experimental and control groups. The content validity index of each session and the total mean was 0.97 (above 0.79) and the content validity of the developed package was confirmed.
ETHICAL PERMISSIONS
This research is taken from the author's PhD thesis with ethics ID of IR.ARUMS.REC.1399.328.
STATISTICAL ANALYSIS
To evaluate the effect of the treatment on patients' suicidal ideation and to control the effects of the pretest, univariate(prolog) analysis of covariance was used under SPSS 23 software.
FINDING BY TEXT
The mean age of 30 participants in this study was 40.06 ±5.37 years in the experimental group and 38.00±8.73 years in the control group. The mean scores of suicidal ideation in the experimental group in the post-test stage (3.26 ± 2.71) were lower than the control group (7.93±3.43), which was statistically significant in contrast to the pre-test stage (Table 2; p<0.01). Before performing univariate analysis of covariance, its assumptions were tested. In examining the normality of the distribution of scores, the results of Kolmogorov-Smirnov test showed that the distribution of scores of suicidal ideation in the pre-test (0.135) and post-test (0.117) stages was statistically insignificant and therefore normal (p >0.05). Also, Levin test was used to evaluate the homogeneity of variances, the value of which (0.491) indicated its insignificance and as a result, homogeneity of variances (p >0.05). According to Table 3, considering the values of F for the post-suicidal ideation test (32.08) and their significance level (p <0.01), it was observed that the developed program was effective and was able to reduce suicidal ideation.
MAIN COMPARISON TO THE SIMILAR STUDIES
The findings showed that the crisis intervention program significantly reduced the suicidal ideation of patients with Covid-19. The present study in this field is consistent with previous findings [16-18]. In the present explanation, it can be said that a crisis intervention program helps a person to have a correct understanding of the crisis, to express their feelings and thoughts, and to develop their interpersonal communications before finding a way to solve the crisis. It also helps the individual to use effective problem-solving strategies as well as more adaptive mechanisms so that they can reduce the severity of stress and trauma-related disorders in them and increase their resilience and adaptability, and improve their quality of life [23]. ... [24].
SUGGESTIONS
It is suggested that this study be retested in larger groups to meet the reliability of this treatment with greater confidence. It is also suggested that psychology and counseling units in health care organizations use this treatment in individual and group counseling sessions to increase the adaptation of people with suicidal ideation.
LIMITATIONS
One of the limitations of this study was the statistical population of the study, which consisted of patients with Covid-19 in Rasht. Therefore, the possibility of generalizing the results is limited; other limitations of the study were the use of available samples and the lack of a follow-up session. Therefore, to evaluate the long-term effect of the intervention, it is necessary to perform follow-up tests at regular intervals.
CONCLUSIONS
Due to the fact that patients with covid-19 are exposed to negative emotions, in such cases, suicidal ideation may come to their minds. Therefore, instructing these people in crisis management can increase their control over stressful situation and reduce suicidal ideation in them. Therefore, according to the attained results, it is recommended that psychologists use this therapeutic approach to reduce the psychological problems of people with suicidal ideation.
CLINICAL & PRACTICAL TIPS IN POLICE MEDICINE
Crisis intervention programs have a positive impact on different communities, thus it enables the police to establish appropriate communications with people in crisis in difficult situations and to prevent further injuries. Police work is also such that there is a need to pay more attention to the mental health of employees, so these interventions can also be effective for police officers to provide them with more mental health.
ACKNOWLEDGMENTS
The research group considers it necessary to express its gratitude and appreciation to all the participants who sincerely helped the research group with conducting this research.
CONFLICT OF INTEREST
The authors hereby state that there is no conflict of interest in the present study.
FUNDING SOURCES
This study had no financial support.
TABLES AND CHARTS
Table 2) Suicidal ideation scores in the control and experimental groups
Table 3) Evaluation of the effect of treatment on suicidal ideation post-test
… [1-3]. Due to the global status of corona virus disease which affects all countries in the world, the discussion about psychological effects of this viral disease on mental health is very important [4]. The results of study conducted in 2020 on 1060 ordinary volunteers in China showed that more than 70% of examinees suffered from some kind of psychological disorder caused by corona virus [2]. ... [5]. Zuromski et al. [6] have shown in their research that after each stressful event, the rate of suicidal ideation in individuals increases. In the France study, the findings show that people with PTSD report high suicide rates [7]. ... [8]. About 90% of suicides in the world occur in people with mental disorders such as depression [9]. Suicides due to fear of corona virus have been reported in countries such as Pakistan, Bangladesh and India [10]. Some studies have examined the relationship between suicide and the pandemic outbreak of corona [11]. ... [12]. Research has shown that many people saw a police officer three months before committing suicide [13]. ... [14-17]. Mobini, Dehkordi and Pirani [18] have concluded in a study that crisis intervention is one of the effective factors that can reduce psychological damage in crisis situations. Sultanpour, Mirzaei and Kadkhoda [19] have also highlighted the importance of the role of law enforcement in crises and have shown that the police can help increasing the sense of security during a corona Prevalence.
AIM(S)
The aim of this study was to evaluate the effectiveness of the online crisis intervention program on suicidal ideation in patients with Covid-19.
RESEARCH TYPE
The present study is applied in terms of purpose and quasi-experimental in terms of method with pre-test-post-test design with a control group.
RESEARCH SOCIETY, PLACE AND TIME
The statistical population of the study consisted of all people who contracted Covid-19 in 2020 in Rasht.
SAMPLING METHOD AND NUMBER
The approximate number of patients with Covid-19 in Rasht in the first half of 2020 was estimated to be 400 people, which according to the Krejcie and Morgan table and taking into account the percentage of falls, 196 people were considered as a sample. After removing incomplete questionnaires, 180 questionnaires were analyzed. By converting the data into standard scores, 16% of the samples (about 30 people) entered the study. Due to the fact that the sample size in the intervention studies is at least 10-12 people [20], in this study in each group, taking into account the probability of sample fall (loss), 15 samples were considered.
USED DEVICES & MATERIALS
BSSI questionnaire was used to collect data. The scale is 19-item self-examination tool designed to detect and measure the intensity of thoughts, behaviors, and planning for suicide over last week. On this scale, score of zero means that there are no suicidal thoughts at all, one to five, the presence of suicidal thoughts, a score of six to 19, a readiness for suicide, and a score of 20 to 38 indicates the intention to attempt suicide [21]. Beck reported the reliability coefficient among the evaluators of this questionnaire as 0.89 and 0.83, respectively [21]. In Iran, using Cronbach's alpha method, coefficients of 0.87 to 0.97 have been obtained [22]. Cronbach's alpha coefficient in the present study was 0.87. The implementation of this research was done in two stages; In the first stage, based on documents, sources, theoretical literature, research background and existing programs in this field [15, 23, 24], the crisis intervention program was developed in 10 sessions of 60 minutes in a virtual and online manner (Table 1). Then, in the second stage, the developed program was performed on the experimental group and the control group did not receive any intervention. Finally, after the sessions, post-test was performed in experimental and control groups. The content validity index of each session and the total mean was 0.97 (above 0.79) and the content validity of the developed package was confirmed.
ETHICAL PERMISSIONS
This research is taken from the author's PhD thesis with ethics ID of IR.ARUMS.REC.1399.328.
STATISTICAL ANALYSIS
To evaluate the effect of the treatment on patients' suicidal ideation and to control the effects of the pretest, univariate(prolog) analysis of covariance was used under SPSS 23 software.
FINDING BY TEXT
The mean age of 30 participants in this study was 40.06 ±5.37 years in the experimental group and 38.00±8.73 years in the control group. The mean scores of suicidal ideation in the experimental group in the post-test stage (3.26 ± 2.71) were lower than the control group (7.93±3.43), which was statistically significant in contrast to the pre-test stage (Table 2; p<0.01). Before performing univariate analysis of covariance, its assumptions were tested. In examining the normality of the distribution of scores, the results of Kolmogorov-Smirnov test showed that the distribution of scores of suicidal ideation in the pre-test (0.135) and post-test (0.117) stages was statistically insignificant and therefore normal (p >0.05). Also, Levin test was used to evaluate the homogeneity of variances, the value of which (0.491) indicated its insignificance and as a result, homogeneity of variances (p >0.05). According to Table 3, considering the values of F for the post-suicidal ideation test (32.08) and their significance level (p <0.01), it was observed that the developed program was effective and was able to reduce suicidal ideation.
MAIN COMPARISON TO THE SIMILAR STUDIES
The findings showed that the crisis intervention program significantly reduced the suicidal ideation of patients with Covid-19. The present study in this field is consistent with previous findings [16-18]. In the present explanation, it can be said that a crisis intervention program helps a person to have a correct understanding of the crisis, to express their feelings and thoughts, and to develop their interpersonal communications before finding a way to solve the crisis. It also helps the individual to use effective problem-solving strategies as well as more adaptive mechanisms so that they can reduce the severity of stress and trauma-related disorders in them and increase their resilience and adaptability, and improve their quality of life [23]. ... [24].
SUGGESTIONS
It is suggested that this study be retested in larger groups to meet the reliability of this treatment with greater confidence. It is also suggested that psychology and counseling units in health care organizations use this treatment in individual and group counseling sessions to increase the adaptation of people with suicidal ideation.
LIMITATIONS
One of the limitations of this study was the statistical population of the study, which consisted of patients with Covid-19 in Rasht. Therefore, the possibility of generalizing the results is limited; other limitations of the study were the use of available samples and the lack of a follow-up session. Therefore, to evaluate the long-term effect of the intervention, it is necessary to perform follow-up tests at regular intervals.
CONCLUSIONS
Due to the fact that patients with covid-19 are exposed to negative emotions, in such cases, suicidal ideation may come to their minds. Therefore, instructing these people in crisis management can increase their control over stressful situation and reduce suicidal ideation in them. Therefore, according to the attained results, it is recommended that psychologists use this therapeutic approach to reduce the psychological problems of people with suicidal ideation.
CLINICAL & PRACTICAL TIPS IN POLICE MEDICINE
Crisis intervention programs have a positive impact on different communities, thus it enables the police to establish appropriate communications with people in crisis in difficult situations and to prevent further injuries. Police work is also such that there is a need to pay more attention to the mental health of employees, so these interventions can also be effective for police officers to provide them with more mental health.
ACKNOWLEDGMENTS
The research group considers it necessary to express its gratitude and appreciation to all the participants who sincerely helped the research group with conducting this research.
CONFLICT OF INTEREST
The authors hereby state that there is no conflict of interest in the present study.
FUNDING SOURCES
This study had no financial support.
TABLES AND CHARTS
Table 1) Summary of crisis intervention sessions
| Meeting | Subject | Purpose and activity |
| 1 | Introduction, pre-test implementation and program introduction | Introduce, conduct pre-test and introduce crisis intervention program for people who have covid-19 disease and are recovering, and setting agreements and implementation instructions for timely attendance of people with crisis at meetings. |
| 2 | Psychological retelling, finding areas of self-vulnerability, teaching harm reduction techniques, normalization | Psychological retelling for about two hours, including retelling the memory of when symptoms of covid-19 disease manifested, feelings and thoughts that arose after the onset of the illness, along with normalizing response, modulating, and discharging emotions in a supported environment. Matching emotions in the group and explaining how to deal with the symptoms of the disorder |
| 3 | Reduce arousal | Defining stress, stressors and symptoms of post-traumatic stress disorder, teaching mental imagery techniques in relation to effective exposure to re-experiencing the disease |
| 4 | Teach compassion, find self-care solutions | Training to form and create more and more diverse feelings about people's issues to increase care, help and attention to health, including maintaining personal hygiene both at home and outside the home. |
| 5 | Guided relaxation and mental imagery training | Introducing the symptoms of fear and avoidance, teaching life train techniques to avoid avoidance in the face of realities and giving muscle relaxation |
| 6 | Social activation, resumption of social relations and return to the social system | In this session, people who had covid-19 disease and were recovering were taught how to attract support and social assistance. |
| 7 | Teach effective communication, dialogue with others | Emphasis on the family or social support system taught coping skills and the skills of resuming effective relationships and communication (illness is always lurking in people and personal hygiene must always be observed). |
| 8 | Thought control training | The use of visual methods, including the method of mentally replacing disturbing thoughts when confronted with thoughts and memories, as well as methods of shrinking and removing memories in order to deal with disturbing thoughts. The techniques of writing debilitating thoughts and accepting situations and the position of power to act and choose between the two available options were used. |
| 9 | Reorientation | At this stage, the life goals of the review clients, new goals were drawn and ways to achieve them were determined. At this stage, the goal of treatment is to mobilize the potential force of the crisis for the growth and dynamism of the client. This is the beginning of a new direction in life. The value of a crisis becomes apparent when one is ready to reach higher levels of self-actualization and balance. This preparation is made possible by the methods of hopefulness, cognition and belief in enduring suffering and belief and connection with the Creator and destiny, and finally finding a meaning for survival. The methods that can be used at this stage are known as renewal and growth methods. |
| 10 | Summarize and performance post-test | In this session, the contents of the previous sessions were summarized and the assignments performed with the participation of people in crisis (covid-19 patients) were reviewed. At the end, people with crisis were retested and thanked for participating in the sessions. |
Table 2) Suicidal ideation scores in the control and experimental groups
| Level | Group | t | df | p | |
| the experiment (M±SD) | control (M±SD( | ||||
| Pre-test | 8.13±3.81 | 9.33±4.18 | -.082 | 28 | 0.419 |
| Post-test | 3.26±2.71 | 7.93±3.43 | -4.13 | 28 | 0.001 |
Table 3) Evaluation of the effect of treatment on suicidal ideation post-test
| Source | Total squares | Degrees of freedom | Average squares | F | p | Eta squares |
| y-intercepts | 0.156 | 1 | 0.156 | 0.044 | 0.835 | 0.002 |
| Pre -exam | 173.09 | 1 | 173.09 | 49.31 | 0.001 | 0.646 |
| Group | 112.63 | 1 | 112.63 | 32.08 | 0.001 | 0.543 |
| Error | 94.77 | 27 | 3.51 | - | - | - |
| total | 1372 | 30 | - | - | - | - |
Article Type: Original Research |
Subject:
Crisis Medicine
Received: 2021/04/14 | Accepted: 2021/07/17 | Published: 2021/10/2
Received: 2021/04/14 | Accepted: 2021/07/17 | Published: 2021/10/2
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