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Williams AJ, Cleare S, Borschmann R, Tench CR, Gross J, Hollis C, Chapman-Nisar A, Naeche N, Townsend E, Slovak P. Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079801. [PMID: 38195171 PMCID: PMC10806609 DOI: 10.1136/bmjopen-2023-079801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Purrble, a socially assistive robot, was codesigned with children to support in situ emotion regulation. Preliminary evidence has found that LGBTQ+ youth are receptive to Purrble and find it to be an acceptable intervention to assist with emotion dysregulation and their experiences of self-harm. The present study is designed to evaluate the impact of access to Purrble among LGBTQ+ youth who have self-harmful thoughts, when compared with waitlist controls. METHODS AND ANALYSIS The study is a single-blind, randomised control trial comparing access to the Purrble robot with waitlist control. A total of 168 LGBTQ+ youth aged 16-25 years with current self-harmful ideation will be recruited, all based within the UK. The primary outcome is emotion dysregulation (Difficulties with Emotion Regulation Scale-8) measured weekly across a 13-week period, including three pre-deployment timepoints. Secondary outcomes include self-harm (Self-Harm Questionnaire), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire-9). We will conduct analyses using linear mixed models to assess primary and secondary hypotheses. Intervention participants will have unlimited access to Purrble over the deployment period, which can be used as much or as little as they like. After all assessments, control participants will receive their Purrble, with all participants keeping the robot after the end of the study. After the study has ended, a subset of participants will be invited to participate in semistructured interviews to explore engagement and appropriation of Purrble, considering the young people's own views of Purrble as an intervention device. ETHICS AND DISSEMINATION Ethical approval was received from King's College London (RESCM-22/23-34570). Findings will be disseminated in peer review open access journals and at academic conferences. TRIAL REGISTRATION NUMBER NCT06025942.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Seonaid Cleare
- Department of Informatics, King's College London, London, UK
- University of Glasgow, Glasgow, UK
| | - Rohan Borschmann
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Oxford, Oxford, UK
| | | | - James Gross
- Stanford University, Stanford, California, USA
| | - Chris Hollis
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | | | | | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Petr Slovak
- Department of Informatics, King's College London, London, UK
- University of Oxford, Oxford, UK
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Cantrell A, Sworn K, Chambers D, Booth A, Taylor Buck E, Weich S. Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-107. [PMID: 38314750 DOI: 10.3310/vkty5822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Katie Sworn
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | | | - Scott Weich
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
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Bahamón MJ, Javela JJ, Bonilla-Cruz NJ, Rivera D, Vinaccia S, Forgiony-Santos J. Psychometric properties of the Alexian Brother Urge to Self-Injure (ABUSI) Spanish version for adolescents. Heliyon 2023; 9:e16167. [PMID: 37484386 PMCID: PMC10360585 DOI: 10.1016/j.heliyon.2023.e16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/22/2023] [Accepted: 05/08/2023] [Indexed: 07/25/2023] Open
Abstract
Objective This study aimed to evaluate the psychometric properties of the Alexian Brother Urge to Self-Injure (ABUSI) in its Spanish version for Colombian adolescents. This instrument was created to measure cognitive and emotional aspects of the urge to self-injure by assessing the frequency, the urge, thoughts associated with time and place, the capacity for resistance, and thoughts associated with the urge to self-injure. Method A total of 752 preadolescents and adolescents between 10 and 18 years of age, with a mean of 15.3 years (SD = 1.97), participated. The instruments used were The Alexian Brother Urge to Self-Injure ABUSI, ERS Suicide Risk Scale, Plutchik Suicide Risk Scale, and the Zimet The MSPSS Perceived Social Support Scale. Confirmatory factor analysis, inter-test correlations, to estimate cut-off point discriminant validity Receiver Operating Characteristics (ROC) and to determine convergent validity, a Pearson's coincidence analysis was performed between the ABUSI total score and the ERS Suicide Risk Scale, the Plutchik's Suicide Risk Scale and Zimet's Perceived Social Support Scale assessments. Results The presence of a unidimensional model of the instrument is confirmed with adequate fit, reliability, and concurrent validity indices. The high score classification was determined from six (6) points for the total of the scale. These results show that ABUSI is a valid and reliable tool for the clinical assessment of self-injurious behavior in adolescents and preadolescents.
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Affiliation(s)
- Marly Johana Bahamón
- Faculty of Health Sciences and Investigation Group I-Flor, University of Sinú, Monteria, Colombia
- Red Iberoamericana de Suicidología REDISUI, Colombia
| | - José Julián Javela
- Faculty of Health Sciences and Investigation Group I-Flor, University of Sinú, Monteria, Colombia
- Red Iberoamericana de Suicidología REDISUI, Colombia
| | | | - Diego Rivera
- Department of Health Science, Public University of Navarre, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Stefano Vinaccia
- Faculty of Health Sciences and Investigation Group I-Flor, University of Sinú, Monteria, Colombia
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Bjureberg J, Kuja-Halkola R, Ohlis A, Lichtenstein P, D'Onofrio BM, Hellner C, Cederlöf M. Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study. J Child Psychol Psychiatry 2022; 63:921-928. [PMID: 34856636 DOI: 10.1111/jcpp.13544] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND More knowledge about risks of clinical outcomes associated with nonsuicidal self-injury (NSSI) and suicide attempts (SAs) is needed to inform risk assessment and intervention. METHODS Longitudinal cohort study based on 1,855 youths was clinically assessed for NSSI and SA, and followed up (from December, 2011 to December 2013) for the outcomes; diagnosed self-injury, alcohol/substance use disorder, and psychiatric inpatient care data derived from Swedish registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the outcomes were estimated with Cox regressions, and additionally adjusted for the potential effect of sex and the number of clinical assessments. NSSI and SA were treated as time-varying covariates. RESULTS Youths with NSSI had elevated risks of all outcomes, compared with youths without NSSI or SA; the HR was 2.3, 95% confidence interval [1.6, 3.4] for self-injury, 1.4 [0.9, 2.1] for alcohol/substance use disorder, and 1.3 [1.0, 1.7] for psychiatric inpatient care. Youths with SA displayed higher risks for the outcomes than the NSSI group; the HR was 5.5 [2.4, 12.6] for self-injury, 2.0 [0.9, 4.4] for alcohol/substance use disorder, and 2.6 [1.5, 4.5] for psychiatric inpatient care. Youths with both NSSI and SA showed similar risks as youths with SA; HR 4.1 [2.0, 8.3] for self-injury, 2.0 [1.1, 4.1] for alcohol/substance use disorder, but a higher risk of psychiatric inpatient care; HR 5.0 [3.1, 7.9]. All results remained virtually unchanged in the adjusted analyses. CONCLUSIONS Youths with NSSI and/or SA had higher risks for subsequent adverse clinical outcomes. These excess risks were more pronounced among youths with SA and youths with both NSSI and SA, and the risk for psychiatric inpatient care was particularly high in youths with both NSSI and SA. Our findings suggest that early interventions for youths with NSSI or SA should not exclusively focus on suicide prevention, but also consider the risk of subsequent alcohol/substance use disorder.
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Affiliation(s)
- Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, CA, USA
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ohlis
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Martin Cederlöf
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Eylem O, van Straten A, de Wit L, Rathod S, Bhui K, Kerkhof AJFM. Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: the feasibility of a randomised controlled trial of a guided online intervention. Pilot Feasibility Stud 2021; 7:30. [PMID: 33494831 PMCID: PMC7830826 DOI: 10.1186/s40814-021-00772-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual. METHODS Turkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis. RESULTS Eighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups. CONCLUSION Although intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not. TRIAL REGISTRATION Netherlands Trial Register, NTR5028 . Registered on 1 March 2015.
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Affiliation(s)
- Ozlem Eylem
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands.
- Amsterdam Institute of Public Health, Amsterdam, Netherlands.
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Annemieke van Straten
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
| | - Leonore de Wit
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
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Faura-Garcia J, Orue I, Calvete E. Clinical assessment of non-suicidal self-injury: A systematic review of instruments. Clin Psychol Psychother 2021; 28:739-765. [PMID: 33283952 DOI: 10.1002/cpp.2537] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
There has been an increase in the number of assessment instruments for non-suicidal self-injury (NSSI). However, previous reviews are inconsistent and do not provide a comprehensive psychometric assessment of the instruments. This study aimed to systematically assess and compare the psychometric properties of clinically relevant instruments to measure NSSI in any population. Through a systematic review guided by COSMIN and PRISMA, two searches were conducted in English and Spanish in February 2020 in 13 databases including grey literature. Of the 7,813 initial records, 152 validations were extracted. From these, 83 instruments (22 versions or adaptations) were excluded for not measuring NSSI, having no potential clinical utility or not including psychometric properties. Finally, 26 (22 versions, 35 adaptations and 19 creations) instruments measuring NSSI were included. Predominantly, the studies were North American self-reports in English for community adolescents, adaptations or versions emanating from a small number of instruments. Twenty-six indicators were categorized to assess NSSI. The most frequent instruments are structured interviews, and their indicators were related to NSSI function and topography. Evidence of validity and reliability was positive but limited. Despite the high number of instruments and diversity of evaluations, we found no instrument with sufficient evidence for clinical assessment. Findings broadly overview NSSI assessment instruments' current use and future improvement in clinical and research settings.
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Affiliation(s)
- Juan Faura-Garcia
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Izaskun Orue
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
| | - Esther Calvete
- Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
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Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, Slater V, Reavey P, Byford S, Ivens J, Crommelin M, Hayes D, Middleton K, Young P, Taylor E. Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry 2021; 30:1427-1436. [PMID: 32885344 PMCID: PMC8440265 DOI: 10.1007/s00787-020-01617-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 10/24/2022]
Abstract
Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12-18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05-0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2-208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.
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Affiliation(s)
- Dennis Ougrin
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Stahl
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Jason Poole
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Toby Zundel
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Mandy Wait
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Victoria Slater
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Paula Reavey
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Sarah Byford
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - John Ivens
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Hayes
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Kerry Middleton
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Eric Taylor
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
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Norman H, Oskis A, Marzano L, Coulson M. The relationship between self‐harm and alexithymia: A systematic review and meta‐analysis. Scand J Psychol 2020; 61:855-876. [DOI: 10.1111/sjop.12668] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Hilary Norman
- Faculty of Science and Technology Middlesex University London UK
| | - Andrea Oskis
- Faculty of Science and Technology Middlesex University London UK
| | - Lisa Marzano
- Faculty of Science and Technology Middlesex University London UK
| | - Mark Coulson
- School of Psychology University of East Anglia Norwich UK
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Werner-Seidler A, Huckvale K, Larsen ME, Calear AL, Maston K, Johnston L, Torok M, O’Dea B, Batterham PJ, Schweizer S, Skinner SR, Steinbeck K, Ratcliffe J, Oei JL, Patton G, Wong I, Beames J, Wong QJJ, Lingam R, Boydell K, Salmon AM, Cockayne N, Mackinnon A, Christensen H. A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study. Trials 2020; 21:2. [PMID: 31898512 PMCID: PMC6941300 DOI: 10.1186/s13063-019-3901-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression. METHODS A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models. DISCUSSION This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.
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Affiliation(s)
| | - Kit Huckvale
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Mark E. Larsen
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Alison L. Calear
- Centre for Mental Health Research, The Australian National University, Canberra, ACT Australia
| | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Lara Johnston
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Bridianne O’Dea
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, ACT Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, NSW Australia
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - S. Rachel Skinner
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Ju-Lee Oei
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW Australia
| | - George Patton
- Murdoch Children’s Research Institute and University of Melbourne, Melbourne, VIC Australia
| | - Iana Wong
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Joanne Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Quincy J. J. Wong
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Allison M. Salmon
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Nicole Cockayne
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
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Harris IM, Beese S, Moore D. Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools. BMJ Open 2019; 9:e029311. [PMID: 31494608 PMCID: PMC6731844 DOI: 10.1136/bmjopen-2019-029311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cohort studies, case-control studies and randomised controlled trials of adolescents aged 10-25 who had undergone risk assessment in a clinical setting following an episode of self-harm were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were grouped by tool and narrative synthesis undertaken, with studies appraised using a checklist combining the QUIPS (Quality In Prognosis Studies) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tools. RESULTS Of the 17 137 articles initially identified, 11 studies evaluating 10 separate tools were included. The studies varied in setting, population and outcome measure. The majority of the studies were rated as having an unclear risk of bias, and meta-analysis was not possible due to high variability between studies.The ability of the tools to correctly identify those adolescents going on to make a self-harm/suicide attempt ranged from 27% (95% CI 10.7% to 50.2%) to 95.8% (95% CI 78.9% to 99.9%). A variety of metrics were provided for 1-10 points increases in various tools, for example, odds and HRs. CONCLUSIONS This systematic review is the first to explore the use of assessment tools in adolescents. The predictive ability of these tools varies greatly. No single tool is suitable for predicting a higher risk of suicide or self-harm in adolescent populations. PROSPERO REGISTRATION NUMBER CRD42017058686.
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Affiliation(s)
| | - Sophie Beese
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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11
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Carson NJ, Mullin B, Sanchez MJ, Lu F, Yang K, Menezes M, Cook BL. Identification of suicidal behavior among psychiatrically hospitalized adolescents using natural language processing and machine learning of electronic health records. PLoS One 2019; 14:e0211116. [PMID: 30779800 PMCID: PMC6380543 DOI: 10.1371/journal.pone.0211116] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/09/2019] [Indexed: 01/01/2023] Open
Abstract
Objective The rapid proliferation of machine learning research using electronic health records to classify healthcare outcomes offers an opportunity to address the pressing public health problem of adolescent suicidal behavior. We describe the development and evaluation of a machine learning algorithm using natural language processing of electronic health records to identify suicidal behavior among psychiatrically hospitalized adolescents. Methods Adolescents hospitalized on a psychiatric inpatient unit in a community health system in the northeastern United States were surveyed for history of suicide attempt in the past 12 months. A total of 73 respondents had electronic health records available prior to the index psychiatric admission. Unstructured clinical notes were downloaded from the year preceding the index inpatient admission. Natural language processing identified phrases from the notes associated with the suicide attempt outcome. We enriched this group of phrases with a clinically focused list of terms representing known risk and protective factors for suicide attempt in adolescents. We then applied the random forest machine learning algorithm to develop a classification model. The model performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results The final model had a sensitivity of 0.83, specificity of 0.22, AUC of 0.68, a PPV of 0.42, NPV of 0.67, and an accuracy of 0.47. The terms mostly highly associated with suicide attempt clustered around terms related to suicide, family members, psychiatric disorders, and psychotropic medications. Conclusion This analysis demonstrates modest success of a natural language processing and machine learning approach to identifying suicide attempt among a small sample of hospitalized adolescents in a psychiatric setting.
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Affiliation(s)
- Nicholas J Carson
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America
| | - Maria Jose Sanchez
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America.,Prevention and Community Health Department, Milken School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Frederick Lu
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America
| | - Kelly Yang
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America.,Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Michelle Menezes
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America.,University of Virginia, Charlottesville, VA, United States of America
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States of America.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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12
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Yuan SNV, Kwok KHR, Ougrin D. Treatment Engagement in Specific Psychological Treatment vs. Treatment as Usual for Adolescents With Self-Harm: Systematic Review and Meta-Analysis. Front Psychol 2019; 10:104. [PMID: 30778310 PMCID: PMC6369209 DOI: 10.3389/fpsyg.2019.00104] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Self-harm is a major public health problem. It is one of the best predictors of suicide in adolescents. Despite recent advances in the understanding of self-harm, poor treatment engagement remains a significant clinical obstacle. Objectives: The purpose of this meta-analysis is to update and extend previous research investigating treatment engagement with specific psychological treatments (SPT) vs. treatment as usual (TAU) in adolescents who self-harm. Methods: Data sources were identified by searching the Medline, PsychINFO, EMBASE, and PubMed databases as of October 2017. Randomized Controlled Trials (RCTs) comparing SPT and TAU in adolescents (through age 18 years) with self-harm were included. Results: The results show that 12 RCTs investigating 1,255 young people were included in the meta-analysis. The proportion of adolescents not completing four or more sessions in SPT was significantly lower (28.4%, 179/630) than TAU (45.9%, 287/625), RR = 0.64 (95% CI:0.51 -0.79), p < 0.0001. There were significantly more adolescents engaged with SPT than TAU. Conclusions: Specific psychological treatments should be offered to adolescents with self-harm to maximize treatment engagement. Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment goals.
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13
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Brahmbhatt K, Grupp-Phelan J. Parent-Adolescent Agreement About Adolescent's Suicidal Thoughts: A Divergence. Pediatrics 2019; 143:peds.2018-3071. [PMID: 30642951 PMCID: PMC6361356 DOI: 10.1542/peds.2018-3071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Jacqueline Grupp-Phelan
- University of California, San Francisco Benioff Children's Hospitals, San Francisco, California
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14
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Iyengar U, Snowden N, Asarnow JR, Moran P, Tranah T, Ougrin D. A Further Look at Therapeutic Interventions for Suicide Attempts and Self-Harm in Adolescents: An Updated Systematic Review of Randomized Controlled Trials. Front Psychiatry 2018; 9:583. [PMID: 30532713 PMCID: PMC6266504 DOI: 10.3389/fpsyt.2018.00583] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/24/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Suicide attempts (SA) and other types of self-harm (SH) are strong predictors of death by suicide in adolescents, emphasizing the need to investigate therapeutic interventions in reduction of these and other symptoms. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting therapeutic interventions that were effective in reducing SH including SA, while additionally exploring reduction of suicidal ideation (SI) and depressive symptoms (DS). Method: A systematic literature search was conducted across OVID Medline, psycINFO, PubMed, EMBASE, and Cochrane Library from the first available article to October 22nd, 2017, with a primary focus on RCTs evaluating therapeutic interventions in the reduction of self-harm. Search terms included self-injurious behavior; self-mutilation; suicide, attempted; suicide; drug overdose. Results: Our search identified 1,348 articles, of which 743 eligible for review, yielding a total of 21 studies which met predetermined inclusion criteria. Eighteen unique therapeutic interventions were identified among all studies, stratified by individual-driven, socially driven, and mixed interventions, of which 5 studies found a significant effect for primary outcomes of self-harm and suicide attempts (31.3%), and 5 studies found a significant effect for secondary outcomes of suicidal ideation and depressive symptoms (29.4%) for therapeutic intervention vs. treatment as usual. Collapsing across different variations of Cognitive Behavior Therapy (CBT), and classifying Dialectical Behavior Therapy for Adolescents (DBT-A) as a type of CBT, CBT is the only intervention with replicated positive impact on reducing self-harm in adolescents. Conclusion: While the majority of studies were not able to determine efficacy of therapeutic interventions for both primary and secondary outcomes, our systematic review suggests that individual self-driven and socially-driven processes appeared to show the greatest promise for reducing suicide attempts, with benefits of combined self-driven and systems-driven approaches for reducing overall self-harm. Further RCTs of all intervention categories are needed to address the clinical and etiological heterogeneity of suicidal behavior in adolescents, specifically suicidal ideation and depressive symptoms.
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Affiliation(s)
- Udita Iyengar
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Natasha Snowden
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Joan R. Asarnow
- Semel Institute of Neuroscience and Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul Moran
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Troy Tranah
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, United Kingdom
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
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15
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Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, Stahl D, Reavey P, Byford S, Heslin M, Ivens J, Crommelin M, Abdulla Z, Hayes D, Middleton K, Nnadi B, Taylor E. Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiatry 2018; 5:477-485. [PMID: 29731412 PMCID: PMC5994473 DOI: 10.1016/s2215-0366(18)30129-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care. METHODS Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964. FINDINGS Hospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17-63 vs 50 days, 19-125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02-2·81, p=0·04), which decreased to 1·65 (0·99-2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000-30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care. INTERPRETATION SDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies. FUNDING South London and Maudsley NHS Trust.
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Affiliation(s)
- Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | | | - Jason Poole
- South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychology, London South Bank University, London, UK
| | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mandy Sarhane
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Reavey
- Department of Psychology, London South Bank University, London, UK
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Ivens
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Zahra Abdulla
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Benita Nnadi
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Taylor
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Ougrin D, Asarnow JR. The end of family therapy for self-harm, or a new beginning? Lancet Psychiatry 2018; 5:188-189. [PMID: 29449179 DOI: 10.1016/s2215-0366(18)30043-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Dennis Ougrin
- Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Joan R Asarnow
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
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17
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Rowe SL, Patel K, French RS, Henderson C, Ougrin D, Slade M, Moran P. Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial. JMIR Ment Health 2018; 5:e10. [PMID: 29382626 PMCID: PMC5811653 DOI: 10.2196/mental.8098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/17/2017] [Accepted: 11/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adolescents who self-harm are often unsure how or where to get help. We developed a Web-based personalized decision aid (DA) designed to support young people in decision making about seeking help for their self-harm. OBJECTIVE The aim of this study was to evaluate the feasibility and acceptability of the DA intervention and the randomized controlled trial (RCT) in a school setting. METHODS We conducted a two-group, single blind, randomized controlled feasibility trial in a school setting. Participants aged 12 to 18 years who reported self-harm in the past 12 months were randomized to either a Web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomization, and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision making and help-seeking behavior. Qualitative interviews were conducted with young people, parents or carers, and staff and subjected to thematic analysis to explore their views of the DA and study processes. RESULTS Parental consent was a significant barrier to young people participating in the trial, with only 17.87% (208/1164) of parents or guardians who were contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 81.7% (170/208) of young people into the study. Of those young people screened, 13.5% (23/170) had self-harmed in the past year. Ten participants were randomized to receiving the DA, and 13 were randomized to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability, but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety, and self-harm may be more beneficial. CONCLUSIONS A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and the intervention are needed before generalizable research about DAs can be successfully conducted in a school setting. TRIAL REGISTRATION International Standard Randomized Controlled Trial registry: ISRCTN11230559; http://www.isrctn.com/ISRCTN11230559 (Archived by WebCite at http://www.webcitation.org/6wqErsYWG).
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Affiliation(s)
- Sarah L Rowe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Krisna Patel
- Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca S French
- Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dennis Ougrin
- Child and Adolescent Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
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18
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Tan JX, Fajardo MLR. Efficacy of multisystemic therapy in youths aged 10-17 with severe antisocial behaviour and emotional disorders: systematic review. LONDON JOURNAL OF PRIMARY CARE 2017; 9:95-103. [PMID: 29181092 PMCID: PMC5694795 DOI: 10.1080/17571472.2017.1362713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antisocial behaviour and conduct disorders are the most common behavioural and mental health problems in children and young people globally. An efficacious intervention is needed to manage these antisocial behaviours that have costly consequences. Multisystemic Therapy (MST), an intensive home-based intervention for youths with psychosocial and behavioural problems, is recommended under National Institute for Health and Clinical Excellence guidelines for conduct disorder. However, reviews on the efficacy of MST are mixed. AIM To review randomised controlled trials (RCTs) reporting efficacy of MST among youths presenting with antisocial behaviour and emotional disorder respectively. METHOD A systematic map term to subject heading search was conducted in PsycINFO, Embase, and Ovid Medline databases for articles up to November 2015. RCTs comparing MST vs.treatment as usual (TAU) in youths presenting with antisocial behaviour and emotional disorder were included. RESULTS 12 RCTs (n = 1425) reported efficacy of MST vs. TAU in youths presenting with antisocial behaviour and emotional disorder. Clinically significant treatment effects of MST showed a reduction of antisocial behaviour which includes delinquency. MST, vs. psychiatric hospitalisation, was associated with a reduction of suicidal attempts in youths presenting with psychiatric emergencies. 4 studies showed that MST was less costly than TAU in the short term, with further analysis required for long-term cost-effectiveness. CONCLUSION MST is an efficacious intervention for severe antisocial behaviours in reduction of delinquency and should be included in clinical practices. MST was shown to have a positive effect on emotional disorder but further research is needed to evaluate the efficacy of MST with emotional disorder. Further analysis is required to assess the services utilized for long-term cost effectiveness.
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Affiliation(s)
- Jia Xuan Tan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
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19
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Appreciating Complexity in Adolescent Self-Harm Risk Factors: Psychological Profiling in a Longitudinal Community Sample. J Youth Adolesc 2017; 47:916-931. [DOI: 10.1007/s10964-017-0721-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/11/2017] [Indexed: 01/07/2023]
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20
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Runeson B, Odeberg J, Pettersson A, Edbom T, Jildevik Adamsson I, Waern M. Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PLoS One 2017; 12:e0180292. [PMID: 28723978 PMCID: PMC5517300 DOI: 10.1371/journal.pone.0180292] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 06/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt. Methods PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy. Results Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8–24) and specificity of 97% (96–98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97–97) and a specificity of 20% (20–21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78–95) and specificity of 42% (40–43). Conclusions Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy.
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Affiliation(s)
- Bo Runeson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- * E-mail:
| | - Jenny Odeberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Tobias Edbom
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Margda Waern
- Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden
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21
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Stanford S, Jones MP, Hudson JL. Rethinking pathology in adolescent self-harm: Towards a more complex understanding of risk factors. J Adolesc 2016; 54:32-41. [PMID: 27865103 DOI: 10.1016/j.adolescence.2016.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/28/2016] [Accepted: 11/09/2016] [Indexed: 12/19/2022]
Abstract
Researchers have begun to consider whether there may be more than one psychological profile to describe adolescents who engage in self-harm. Limited past research suggests multiple different profiles. Australian high school students (n = 1,521, age 11-19, 56.4% female) completed an online questionnaire reporting risk and protective factors and self-harm frequency. Non-hierarchical cluster analysis allocated 256 students who reported 6-month self-harm to mutually exclusive profiles based on psychological similarity. Five distinct psychological profiles were identified: 1) Psychologically 'normal'; 2) Anxiety symptoms; 3) Impulsive; 4) Pathological; and 5) Pathological-Impulsive. The proportion of adolescents that reported 11 or more episodes of self-harm varied from 5.7% in the psychologically 'Normal' group to 27.7% in the 'Pathological- Impulsive' group. These results indicate that multiple psychological profiles exist. Adolescents with different risk factors may require disparate strategies for treatment and prevention. Given the variability in profiles, screening may assist in detecting adolescents who self-harm.
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22
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Psychological characteristics of self-harming behavior in Korean adolescents. Asian J Psychiatr 2016; 23:119-124. [PMID: 27969068 DOI: 10.1016/j.ajp.2016.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/28/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk.
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Mars B, Cornish R, Heron J, Boyd A, Crane C, Hawton K, Lewis G, Tilling K, Macleod J, Gunnell D. Using Data Linkage to Investigate Inconsistent Reporting of Self-Harm and Questionnaire Non-Response. Arch Suicide Res 2016; 20:113-41. [PMID: 26789257 PMCID: PMC4841016 DOI: 10.1080/13811118.2015.1033121] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The objective of this study was to examine agreement between self-reported and medically recorded self-harm, and investigate whether the prevalence of self-harm differs in questionnaire responders vs. non-responders. A total of 4,810 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) completed a self-harm questionnaire at age 16 years. Data from consenting participants were linked to medical records (number available for analyses ranges from 205-3,027). The prevalence of self-harm leading to hospital admission was somewhat higher in questionnaire non-responders than responders (2.0 vs. 1.2%). Hospital attendance with self-harm was under-reported on the questionnaire. One third reported self-harm inconsistently over time; inconsistent reporters were less likely to have depression and fewer had self-harmed with suicidal intent. Self-harm prevalence estimates derived from self-report may be underestimated; more accurate figures may come from combining data from multiple sources.
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Affiliation(s)
- Becky Mars
- Correspondence concerning this article should be addressed to Dr. Becky Mars, School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK. E-mail:
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Nixon MK, Levesque C, Preyde M, Vanderkooy J, Cloutier PF. The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child Adolesc Psychiatry Ment Health 2015; 9:26. [PMID: 26157482 PMCID: PMC4495629 DOI: 10.1186/s13034-015-0056-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Ottawa Self-Injury Inventory (OSI) is a self-report measure that offers a comprehensive assessment of nonsuicidal self-injury (NSSI), including measurement of its functions and addictive features. In a preliminary investigation of self injuring college students who completed the OSI, exploratory analysis revealed four function factors (Internal Emotion Regulation, Social Influence, External Emotion Regulation and Sensation Seeking) and a single Addictive Features factor. Rates of NSSI are particularly high in inpatient psychiatry youth. The OSI can assistin both standardizing assessment regarding functions and potential addictive features and aid case formulation leading to informed treatment planning. This report will describe a confirmatory factor analysis (CFA) of the OSI on youth hospitalized in a psychiatric unit in southwestern Ontario. METHODS Demographic and self-report data were collected from all youth consecutively admitted to an adolescent in-patient unit who provided consent or assent. RESULTS The mean age of the sample was 15.71 years (SD = 1.5) and 76 (81 %) were female. The CFA proved the same four function factors relevant, as in the previous study on college students (χ (2)(183) = 231.98, p = .008; χ (2)/df = 1.27; CFI = .91; RMSEA = .05). The model yielded significant correlations between factors (rs = .44-.90, p < .001). Higher NSSI frequency was related to higher scores on each function factor (rs = .24-.29, p < .05), except the External Emotion Regulation factor (r = .11, p > .05). The factor structure of the Addictive Features function was also confirmed (χ (2)(14) = 21.96, p > .05; χ (2)/df = 1.57; CFI = .96; RMSEA = .08). All the items had significant path estimates (.52 to .80). Cronbach's alpha for the Addictive Features scale was .84 with a mean score of 16.22 (SD = 6.90). Higher Addictive Features scores were related to more frequent NSSI (r = .48, p < .001). CONCLUSIONS Results show further support for the OSI as a valid and reliable assessment tool in adolescents, in this case in a clinical setting, where results can inform case conceptualization and treatment planning.
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Affiliation(s)
- Mary K Nixon
- Queen Alexandra Centre for Children’s Health, 2400 Arbutus Rd, Victoria, BC V8N 1V7 Canada
| | - Christine Levesque
- University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Michèle Preyde
- College of Social and Applied Human Sciences, University of Guelph, 50 Stone Road East Mackinnon 138, Guelph, ON N1G 2 W1 Canada
| | - John Vanderkooy
- Homewood Health Centre, 150 Delhi St, Guelph, ON N1E 6 K9 Canada
| | - Paula F. Cloutier
- Mental Health Research, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8 L1 Canada
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Berk MS, Asarnow JR. Assessment of suicidal youth in the emergency department. Suicide Life Threat Behav 2015; 45:345-59. [PMID: 25327838 DOI: 10.1111/sltb.12133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow-up care. We examined self-reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self-reports. Results showed fair agreement between parents and youth on the reason for the ED visit (e.g., SI vs. SA) and greater agreement between independent judges and youths than between judges and parents. In accordance with accepted definitions of suicide attempts (e.g., Crosby, Ortega, & Melanson, 2011; O'Carroll, Berman, Maris, Moscicki, Tanney, & Silverman, 1996, p. 237; Posner, Oquendo, Gould, Stanley, & Davies, 2007, p. 1035; Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007, p. 248), most youth with SA as the reason for the ED visit reported some intent to die associated with the attempt. Finally, youth presenting to the ED with SA did not differ clinically from youth presenting with SI, and almost half of youths with SI reported past suicide attempts. These results highlight the need to emphasize adolescents' reports in clinical decision making, suggest adolescents' defined suicide attempts similarly to published definitions, and show that assessment of past SAs, as well as present suicidal thoughts and behaviors, is critical in determining future risk.
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Affiliation(s)
- Michele S Berk
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joan R Asarnow
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ougrin D, Zundel T, Corrigall R, Padmore J, Loh C. Innovations in Practice: pilot evaluation of the supported discharge service (SDS): clinical outcomes and service use. Child Adolesc Ment Health 2014; 19:265-269. [PMID: 32878355 DOI: 10.1111/camh.12038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Supported Discharge Service (SDS) is a model of enhanced care in the community for adolescents after inpatient discharge. METHODS This study comprised the first 20 patients referred to SDS, largely those with delayed discharges. Service use and clinical outcomes were collected and predictors of total contact time were investigated. RESULTS Significant improvements had been made with SDS. Higher baseline Strengths and Difficulties Questionnaire (SDQ) conduct scores were associated with less contact time. CONCLUSIONS SDS is a feasible model of care. Adolescents with conduct problems may benefit from engagement strategies. Further rigorous evaluation of the model is required.
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Affiliation(s)
- Dennis Ougrin
- Child and Adolescent Psychiatry, King's College London, London, UK
| | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jane Padmore
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Cheryl Loh
- Department of Psychological Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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Ougrin D, Boege I, Stahl D, Banarsee R, Taylor E. Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up. Arch Dis Child 2013; 98:772-6. [PMID: 23709314 DOI: 10.1136/archdischild-2012-303200] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND An earlier randomised controlled trial demonstrated improved treatment engagement in adolescents who received Therapeutic Assessment (TA) versus Assessment As Usual (AAU), following an emergency presentation with self-harm. OBJECTIVES To determine 2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency (A&E) self-harm presentations and treatment engagement. METHOD Patients in the TA groups (n=35) and the AAU group (n=34) were followed up 2 years after the initial assessment. Their primary and secondary care electronic records were analysed. RESULTS There was no significant difference in the frequency of self-harm resulting in A&E presentations between the two groups (OR 0.69, 95% CI 0.23 to 2.13, p=0.53). Treatment engagement remained higher in the TA group than the AAU group. CONCLUSIONS TA is not associated with a lower frequency of A&E self-harm presentations. The effect of TA on engagement is maintained 2 years after the initial assessment. Interventions to reduce self-harm in adolescents are needed. TRIAL REGISTRATION ISRCTN 81605131, http://www.controlled-trials.com/ISRCTN81605131/
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Affiliation(s)
- Dennis Ougrin
- Department of Child , and Adolescent Psychiatry, King's College London, Institute of Psychiatry, , London, UK
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