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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Implementation of national guidance for self-harm among general practice nurses: a qualitative exploration using the capabilities, opportunities, and motivations model of behaviour change (COM-B) and the theoretical domains framework. BMC Nurs 2023; 22:452. [PMID: 38041157 PMCID: PMC10693142 DOI: 10.1186/s12912-023-01360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Patients who self-harm may consult with primary care nurses, who have a safeguarding responsibility to recognise and respond to self-harm. However, the responses of nursing staff to self-harm are poorly understood, and opportunities to identify self-harm and signpost towards treatment may be missed. It is unclear how to support nursing staff to implement national guidelines. AIMS Among primary care nursing staff to: [1] Examine reported barriers and enablers to nurses' use of, and adherence to, national guidance for self-harm; and [2] Recommend potential intervention strategies to improve implementation of the NICE guidelines. METHODS Twelve telephone interviews partly structured around the capabilities, opportunities and motivations model of behaviour change (COM-B) were conducted with primary care nurses in the United Kingdom. The Theoretical Domains Framework was used as an analytical framework, while the Behaviour Change Wheel was used to identify exemplar behaviour change techniques and intervention functions. RESULTS Nursing staff identified a need to learn more about risk factors (knowledge), and strategies to initiate sensitive conversations about self-harm (cognitive and interpersonal skills) to support their professional competencies (professional role and identity). Prompts may support recall of the guidance and support a patient centred approach to self-harm within practices (memory, attention, and decision making). GPs, and other practice nurses offer guidance and support (social influences), which helps nurses to navigate referrals and restricted appointment lengths (environmental context and influences). CONCLUSIONS Two converging sets of themes relating to information delivery and resource availability need to be targeted. Nine groups of behaviour change techniques, and five intervention functions offer candidate solutions for future intervention design. Key targets for change include practical training to redress conversational skill gaps about self-harm, the integration of national guidance with local resources and practice-level protocols to support decision-making, and creating opportunities for team-based mentoring.
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Affiliation(s)
- Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
| | - Chris Keyworth
- The School of Psychology, The University of Leeds, Woodhouse Lane, Leeds, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The Nowgen Centre, Manchester, UK
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Emerson E, Llewellyn G. Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01608-8. [PMID: 37794308 DOI: 10.1007/s10578-023-01608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Centre of Research Excellence in Disability and Health, University of Melbourne, Melbourne, VIC, 3010, Australia
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Farkas BF, Takacs ZK, Kollárovics N, Balázs J. The prevalence of self-injury in adolescence: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02264-y. [PMID: 37486387 DOI: 10.1007/s00787-023-02264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years' worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: "self-injurious behavior," "prevalence," and "adolescence." Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.
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Affiliation(s)
| | - Zsofia K Takacs
- Faculty of Education and Psychology, Institute of Education, Eötvös Loránd University, Budapest, Hungary
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Nóra Kollárovics
- Mental Health Sciences Doctoral School, Semmelweis University, Budapest, Hungary
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Oslo New University College, Oslo, Norway
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Hotez E, Hudson S, Bastani A, Khorasani L, Hohmeister HC. A call for inclusive public health communication to promote the health of neurodivergent communities during and post-COVID-19. PUBLIC HEALTH IN PRACTICE 2023; 5:100388. [PMID: 37197313 PMCID: PMC10162469 DOI: 10.1016/j.puhip.2023.100388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, USA
| | | | - Asal Bastani
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, USA
| | - Laila Khorasani
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, USA
| | - Holly C. Hohmeister
- The Association of University Centers on Disability (AUCD), 1100 Wayne Ave., Suite 1000Silver Spring, MD 20910, USA
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Swift A, McConkey R, Curry P, Iriarte EG. Social-Emotional Difficulties in Irish Children Aged Five and Nine Years: A National, Longitudinal Study. CHILDREN-BASEL 2021; 8:children8080656. [PMID: 34438549 PMCID: PMC8392290 DOI: 10.3390/children8080656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
A small proportion of children experience social-emotional difficulties from early childhood onwards. Longitudinal studies with nationally representative samples are needed to identify the prevalence and the characteristics of children and families persistently experiencing these difficulties. Secondary analysis of data collected on over 7500 Irish children and with the Strengths and Difficulties Questionnaire as the primary indicator, found that 6% of children when they were five year olds and 8% when they were nine-years, had above threshold scores that warranted further investigation. A smaller proportion-2.9% had elevated scores at both ages. Logistic regression analyses found that children with one or more developmental disabilities were up to six times more likely to have sustained difficulties. There were also significant associations with the lower education attainment of primary caregivers and the socio-economic deprivation of families. Primary caregivers and teachers reported higher conflict in their relationships with these children. Although the number of Irish children presenting with continuing social-emotional difficulties is small, they can present an ongoing and future societal cost in terms of the impact on family relations and demands placed on educational, health and social services. This study identified the children and families who are at greatest risk and for whom targeted early intervention services could be provided.
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Affiliation(s)
- Ann Swift
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland; (A.S.); (P.C.); (E.G.I.)
| | - Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Newtownabbey BT37 0QB, UK
- Correspondence:
| | - Philip Curry
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland; (A.S.); (P.C.); (E.G.I.)
| | - Edurne Garcia Iriarte
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland; (A.S.); (P.C.); (E.G.I.)
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Shen J, Wang Y, Kurpad N, Schena DA. A Systematic Review on the Impact of Hot and Cool Executive Functions on Pediatric Injury Risks: a Meta-Analytic Structural Equation Modeling Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:366-377. [PMID: 34212300 DOI: 10.1007/s11121-021-01271-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/29/2022]
Abstract
Injury is a leading cause of morbidity and mortality among children in the USA. Understanding the impact of executive functions (EFs) on the risk of injuries is crucial for developing effective interventions. However, literature has failed to examine the relationship between multiple EFs and injury domains. The present paper quantitatively synthesized research on cool and hot EFs and children's intentional and unintentional injury risks using a novel meta-analytic structural equation modeling (MASEM) approach. A systematic review was conducted in the following databases: PsycINFO, Scopus, SafetyLit, Cochrane Central, and PubMed (Medline). After screening titles, abstracts, and full texts, a total of 31 studies were eligible for the MASEM analysis. One-stage MASEM was conducted on six conceptualized path analysis models according to the complexity of exogenous and endogenous variables. The MASEM models suggested that hot and cool EFs were negatively associated with children's risk of injury or injury-related risk behaviors regardless of mean age and proportion of females. Among cool EF skills, inhibitory control, but not working memory or cognitive flexibility, was significantly associated with risks of unintentional injuries. Emotion regulation was the dominant hot EF skill examined in the literature and was found significantly associated with risks of non-suicidal self-injuries (NSSIs). EF has a significant impact on children's risk of both unintentional and intentional injuries. Future research should focus on the combined force of hot and cool EF on children's risks of injuries and injury-related risk behaviors.
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Coburn Hall, 850 Broadway St, Lowell, MA, 01854, USA.
| | - Yan Wang
- Department of Psychology, University of Massachusetts Lowell, Coburn Hall, 850 Broadway St, Lowell, MA, 01854, USA
| | - Nayantara Kurpad
- Department of Psychology, University of Massachusetts Lowell, Coburn Hall, 850 Broadway St, Lowell, MA, 01854, USA
| | - David A Schena
- Department of Psychology, University of Massachusetts Lowell, Coburn Hall, 850 Broadway St, Lowell, MA, 01854, USA
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Quinones S, Palermo TM, Lukongo TM, Luchemba P, Mitti R, Devries K, de Groot R, Khurshid A, Kuper H. Disability status and multi-dimensional personal well-being among adolescents in the Southern Highlands Region of Tanzania: results of a cross-sectional study. BMJ Open 2021; 11:e044077. [PMID: 34016661 PMCID: PMC8141426 DOI: 10.1136/bmjopen-2020-044077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Examine how disability status among adolescents is associated with the following domains of personal well-being: schooling, livelihoods, health, violence and psychosocial well-being. It is hypothesised that adolescents with a disability will have greater deficits in these areas of well-being compared with their healthier counterparts. DESIGN Cross-sectional data from 2018 were obtained from the second round of an on-going study of adolescents living in poor households in two regions of the Southern Highlands of Tanzania (Iringa and Mbeya). We use the Washington Group (WG) Short Set indicators to measure disability and undertook logistic and linear multivariate regressions to understand the association between disability and the outcomes of interest. PARTICIPANTS The sample included 2274 participants aged 15-20 years living in households participating in a government social protection programme targeted to households living in extreme poverty. RESULTS Overall, 310 participants (14%) were classified as having disabilities. Outcomes not associated with disability status included literacy, schooling, livelihoods and self-efficacy. Adolescents with disabilities were less likely to report good or very good health (adjusted OR (aOR)=0.39, 95% CI 0.29 to 0.52) and had increased odds of reporting depressive symptoms in (aOR=1.46, 95% CI 1.11 to 1.90), emotional violence (aOR=2.18, 95% CI 1.49 to 3.20) and physical violence (aOR=1.71, 95% CI 1.13 to 2.59), compared with those without disabilities. Reports of depression were higher among men, and violence was more prevalent among women. Patterns of association were generally similar between men and women, although the association of disability with markers of well-being reached statistical significance more often among men. CONCLUSION This study highlights areas where adolescents with disabilities are falling behind their peers in terms of personal well-being. These findings suggest that interventions may be needed to mainstream disability in programmes and policies aiming to improve well-being, mental health and violence prevention among adolescents. TRIAL REGISTRATION NUMBER Pan African Clinical Trial Registry (PACTR201804003008116).
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Affiliation(s)
- Sarah Quinones
- Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tia M Palermo
- Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tumpe Mnyawami Lukongo
- Research and Development Unit, Tanzania Social Action Fund, Dodoma, United Republic of Tanzania
| | - Paul Luchemba
- Monitoring and Evaluation Unit, Tanzania Social Action Fund, Dodoma, United Republic of Tanzania
| | | | - Karen Devries
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Emerson E, Fortune N, Aitken Z, Hatton C, Stancliffe R, Llewellyn G. The wellbeing of working-age adults with and without disability in the UK: Associations with age, gender, ethnicity, partnership status, educational attainment and employment status. Disabil Health J 2020; 13:100889. [PMID: 32046927 DOI: 10.1016/j.dhjo.2020.100889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/21/2019] [Accepted: 01/24/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Few population-based studies have examined the association between disability and personal wellbeing (PWB) among working-age adults. OBJECTIVE/HYPOTHESIS To determine: (1) the magnitude of differences in wellbeing between working-age adults with and without disability in contemporary samples representative of the UK population; and (2) whether the size of any observed differences between people with and without disability is moderated by age, gender, ethnicity, partnership status, educational attainment or employment status. METHODS Secondary analysis of data from three national cross-sectional surveys. RESULTS In each survey, people with disability scored lower than people without disability on all four indicators of PWB. Adjusting for the main effects of potentially moderating variables reduced the effect size of disability on PWB by an average of 24%. Subsequently adjusting for the two-way interaction terms between disability and potentially moderating variables reduced the effect size of disability (main effect) on PWB by an additional average of 73%. PWB among people with disability was significantly lower for: (1) men; (2) younger people; (3) those who belong to the majority ethnic group (white British); (4) those without a partner; and (5) people with lower socio-economic position. CONCLUSIONS Our findings indicate that demographic characteristics and exposure to specific social determinants of poor health play a major role in the negative association between disability and personal wellbeing. A more sophisticated understanding of how social determinants interact to produce inequities associated with identities such as disability, gender, race, sexuality, and class (intersectionality) can inform effective policy interventions.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia; Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Zoe Aitken
- Melbourne School Population and Global Health, The University of Melbourne, Victoria, 3010, Australia; Centre of Research Excellence in Disability and Health, University of Melbourne, Victoria, 3010, Australia
| | - Chris Hatton
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Roger Stancliffe
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
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