SHS – Sunnybrook Medical Services Alternative Funding Plan Association
SHS-21-005 – Using Caring Contacts to Reduce Psychiatric Morbidity Following Hospitalization during the COVID-19 Pandemic
The risk of worsening mental health symptoms and suicide is higher in the time period post-discharge from a psychiatric hospitalization and could be exacerbated by the COVID-19 pandemic. Caring Contacts are brief communications of hope and support sent to patients post-hospitalization that have helped to reduce mental health symptoms after discharge. We implemented a Caring Contacts vs. control intervention randomized controlled trial (RCT) to determine whether during a pandemic, the mental health benefits of delivering Caring Contacts to recently discharged psychiatric patients was greater than a control communication. We successfully delivered the RCT to 100 participants from the Sunnybrook Inpatient Psychiatry Unit. Participants received 3 Caring Contact or control emails and symptom questionnaires at Day 4, Day 21, and Day 56 post-discharge between August 4, 2020 and July 16, 2021. Our sample included a diverse group with participants (age ranging from 18-77, sex 50% female, 47% male, 3% other, and race/ethnicity including 48% White, 19% Asian, 8% Black, 25% other). Primary psychiatric diagnoses included mood disorder (57%), psychotic disorder (24%), substance use disorder (7%), personality disorder (6%), anxiety disorder (3%), and stressor-related disorder (3%).
Preliminary data analysis of scores from the Hopkins Symptom Checklist-25 (HSCL-25), a self-report mood symptom questionnaire, revealed that both groups experienced a worsening of total mood symptom severity (p<0.01) and suicidal ideation at day 4 post-discharge compared to baseline (Caring Contact p=0.42, Control p=0.09). There is early evidence to suggest that the Caring Contact intervention attenuated the degree of expected worsening of mood symptoms and suicidal ideation immediately following discharge. The Caring Contact group had a mean baseline total mood symptom severity score of 45.3 which increased to 48.5 at day 4 (∆ + 3.20 points) and the Control group had a mean baseline total mood symptom severity score of 44.0 which increased to 48.20 at day 4 (∆ + 4.20). Similarly, the Caring Contact group had a mean baseline suicidal ideation score of 1.33 which increased to 1.37 at day 4 (∆ + 0.04) and the Control group had a mean baseline suicidal ideation score of 1.41 which increased to 1.55 at day 4 (∆ + 0.14). This translates into a non-significant but notable 25% and 71% attenuated (e.g. decrease in expected) worsening of total mood symptom severity and suicidal ideation, respectively, in the Caring Contact group. The Caring Contact group and the Control group had similar scores for Day 21 and Day 56 post-discharge, so this trend did not continue to the same degree as seen initially with the Day 4 post-discharge scores. This can be explained, in part, by a lower response rate from participants at these time points as our sample may not have been sufficiently powered.
Exploratory analysis revealed that individuals with a primary or secondary diagnosis of depression who received a Caring Contact had a 72%, 44.2% and 44.1% demonstrated attenuated worsening of suicidal ideation at Day 4, Day 21, and Day 56 respectively compared to individuals with depression who received the control communication. Although this was not statistically significant, it is a promising trend and suggests that individuals with depression may especially benefit from receiving Caring Contacts.
Our study demonstrated feasibility for this type of intervention to be implemented clinically on the Sunnybrook Inpatient Psychiatry Unit. In addition to the quantitative data collected, some participants completed follow-up questionnaires and phone interviews to provide qualitative feedback about their experience in the study. We will use this feedback to further refine the intervention with a plan to implement Caring Contacts as standard clinical practice on our inpatient psychiatry unit. Further research is needed to explore the feasibility and generalizability of implementing Caring Contacts in other inpatient psychiatric settings as well as non-psychiatric settings with high psychiatric morbidity such as emergency services.
Mental Health and Well-Being
Primary Project Lead for Contact
Dr. Rosalie Steinberg
Secondary Project Lead for Contact
Dr. Ayal Schaffer