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Berry K, Ellis J, Pratt D, Haddock G. Reflections on working as and supervising trial therapists on trials of psychosocial interventions. BJPsych Open 2024; 10:e129. [PMID: 39051447 DOI: 10.1192/bjo.2024.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
This editorial provides an overview of the challenges and benefits of working as and supervising trial therapists from the perspective of investigators and trial therapists. Key differences between trial therapy and standard care are considered, with recommendations for best practice.
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Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; and Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Joanne Ellis
- Division of Nursing Midwifery and Social Work, University of Manchester, UK; and Pennine Care NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; and Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; and Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Crook R, Lennox C, Awenat Y, Edge D, Knowles S, Honeywell D, Gooding P, Haddock G, Brooks H, Pratt D. Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies. BJPsych Bull 2024:1-9. [PMID: 38708568 DOI: 10.1192/bjb.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
AIMS AND METHOD This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories. RESULTS Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term. CLINICAL IMPLICATIONS The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.
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Affiliation(s)
- Rebecca Crook
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Charlotte Lennox
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Yvonne Awenat
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Dawn Edge
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Patricia Gooding
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | | | - Daniel Pratt
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
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Xu X, Song J, Jia L. The influence of psychotherapy on individuals who have attempted suicide: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2024. [PMID: 38619529 DOI: 10.1111/jpm.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Suicide is a serious global public health issue, and a history of attempted suicide is the most critical indicator of suicide risk. There are limited studies on the effectiveness of psychotherapy in individuals who have attempted suicide, and other outcome measures related to suicide risk in suicide attempts have not been explored. AIM/QUESTION This study aimed to systematically review and perform a meta-analysis of the effectiveness of psychotherapy on individuals who have attempted suicide. METHODS This study conducted a comprehensive literature search of five major databases (PubMed, EMBASE, Cochrane, Web of Science, and Ovid). The protocol for this study is registered with PROSPERO (CRD42023464401) and follows the PRISMA guidelines. RESULTS This meta-analysis included a total of 34 trials from 32 literature sources. The study involved a total of 6600 participants. The results showed that psychotherapy had a positive effect on reducing the suicidal tendencies of individuals who have attempted suicide and effectively reduced the number of repeated suicide attempts as well as the levels of suicidal ideation, depression, anxiety and hopelessness. IMPLICATIONS FOR PRACTICE This study concludes that psychotherapy is effective in reducing the suicidal tendencies of individuals who have attempted suicide. Psychological therapy for individuals who have attempted suicide are crucial in preventing future suicidal behaviours.
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Affiliation(s)
- Xinqing Xu
- Department of Psychology, Shandong Second Medical University, Weifang, China
| | - Jingjing Song
- Department of Psychology, Shandong Second Medical University, Weifang, China
| | - Liping Jia
- Department of Psychology, Shandong Second Medical University, Weifang, China
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Pedrola-Pons A, Sanchez-Carro Y, Pemau A, Garcia-Ramos A, De la Torre-Luque A. Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: A systematic review. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 92:101948. [PMID: 38219472 DOI: 10.1016/j.ijlp.2023.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Suicidal behavior is an important public health problem, with a high prevalence in penitentiary context. Nowadays, there is a wide variety of specific treatment programs, aimed to prevent suicidal and self-injurious behavior in incarcerated people. These programs show relative efficiency depending on the model of the psychological intervention applied. This systematic review evaluates the efficiency of suicidal and self-injurious behavior prevention programs in prisons. METHOD Empirical studies, evaluating prevention programs for suicidal and self-injurious behavior in penitentiary context were considered for inclusion. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) directives were followed. Studies from 1990 to 2022 were reviewed, based on the review developed by Winicov (2019) that covered the time lapse between 1990 and 2015. Articles from 2015 to 2022 were located by database research (EBSCOHost, ScienceDirect, PubMed & ProQuest). RESULTS 44,050 potential studies were identified. Eighteen were included in this systematic review (9 studies by Winicov, 2019). 14 studies showed efficacy of intervention programs on self-injury behavior. The use of Cognitive Behavioral Therapy (CBT) reduced suicidal ideation. In addition, positive results were observed in 3 studies using third-generation therapies as an intervention. CONCLUSIONS Suicidal and self-injurious behavior in prison shows lower levels of incidence when specific treatment programs are applied. It's crucial to increase the evaluation in relation to the implementation of new treatment models (i.e., Dialectical Behavior Therapy - DBT, Acceptance and Commitment Therapy - ACT, Mindfulness, Functional Analytic Psychotherapy - FAP) as to better orientate prevention strategies. Further research is needed in gender sensitive interventions.
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Affiliation(s)
- Anna Pedrola-Pons
- Valencian International University, Spain; Institute of Social Work and Social Services (INTRESS), Spain
| | - Yolanda Sanchez-Carro
- Center for Biomedical Research in Mental Health (CIBERSAM), Carlos III Health Institute, Spain
| | | | | | - Alejandro De la Torre-Luque
- Complutense University of Madrid, Spain; Center for Biomedical Research in Mental Health (CIBERSAM), Carlos III Health Institute, Spain
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Ropaj E, Haddock G, Pratt D. Developing a consensus of recovery from suicidal ideations and behaviours: A Delphi study with experts by experience. PLoS One 2023; 18:e0291377. [PMID: 37729121 PMCID: PMC10511083 DOI: 10.1371/journal.pone.0291377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Understanding recovery in mental health has received significant attention and consequently, recovery has been incorporated into health policy across many countries in the Global North. In comparison, the concept of 'recovery' from suicidal thoughts and behaviours has received little attention. However, the few studies in this area appear to suggest that recovery is a complex and an idiosyncratic process with many contributing factors. This can present a challenge for clinicians and services seeking to become more recovery focused. Thus, it seems of importance to develop a consensus on how recovery from suicidal thoughts and behaviours is conceptualised. AIM The study aimed to use the Delphi design to establish a consensus of how recovery is defined by those with lived experience of suicidal thoughts and behaviours. The Delphi method draws on the expertise of a panel, often involving clinicians, researchers and lived experience experts to develop consensus over a topic by inviting them to rate the importance of, often a series of statements to a given topic area. METHOD Lived experience experts were asked to complete two rounds of questionnaires distributed online to capture their views on recovery. RESULTS A total of 196 individuals gave their views on the first round of the study and 97 gave their views on the second round. A final list of 110 statements was developed that 80% or more of participants defined as essential or important. Statements covered items that were important in defining, facilitation and hindering the process of recovery. CONCLUSION Findings are consistent with the wider literature that suggests that recovery is an idiosyncratic process, but with many commonly shared features. Here we also show that a comprehensive definition of recovery must include factors that hinder the process of recovery. Implications and recommendations for practice, policy development and future research are discussed.
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Affiliation(s)
- Esmira Ropaj
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Harris K, Gooding PA, Awenat Y, Haddock G, Cook L, Huggett C, Jones S, Lobban F, Peeney E, Pratt D, Peters S. Acceptability of a novel suicide prevention psychological therapy for people who experience non-affective psychosis. Psychol Psychother 2023; 96:560-576. [PMID: 36856293 PMCID: PMC10953419 DOI: 10.1111/papt.12456] [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: 12/19/2022] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. DESIGN Qualitative interview study. METHODS Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non-affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi-structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. RESULTS Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self-efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. CONCLUSIONS Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone).
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Affiliation(s)
- Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Leanne Cook
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Steven Jones
- Lancashire and South Cumbria NHS Foundation TrustLancashireUK
- Department of Health ResearchLancaster UniversityLancasterUK
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation TrustLancashireUK
- Department of Health ResearchLancaster UniversityLancasterUK
| | - Ellen Peeney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Academic Health Sciences Centre (MAHSC)ManchesterUK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health SciencesUniversity of ManchesterManchesterUK
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Pratt D, Crook R. Conducting prison-based research during the COVID-19 pandemic and the value of involving people with lived experience. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:223-228. [PMID: 37527197 DOI: 10.1002/cbm.2305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Daniel Pratt
- University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Suicide, Risk and Safety Research Unit, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK
| | - Rebecca Crook
- University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Suicide, Risk and Safety Research Unit, Manchester, UK
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Perry AE, Marshall D, Moe-Byrne T, Knowles S, Churchill R, Harden M, Parrott S, Schofield J, Williamson K, Ashton L. Effects of interventions on depression and anxiety in older people with physical health problems in the criminal justice system: a systematic review. THE LANCET. HEALTHY LONGEVITY 2023; 4:e431-e440. [PMID: 37543048 DOI: 10.1016/s2666-7568(23)00111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 08/07/2023] Open
Abstract
The demand for health care in older people involved in the criminal justice system is high. The prevalence of mental and physical health conditions for people living in prison is greater than in community populations. After systematically searching 21 databases, we found no targeted interventions to support depression or anxiety for this group of people. 24 studies (including interventions of yoga, creative-arts-based programmes, positive psychology, or mindfulness-based interventions and psychotherapy) did contain people older than 50 years, but this only represented a minority (10%) of the overall study population. No single study reported outcomes of physical health. Future interventions need to consider the needs and views of this vulnerable group. Specific gendered and coproduced interventions are required to enhance the implementation, feasibility, and acceptability of interventions that are delivered in prisons.
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Affiliation(s)
- Amanda E Perry
- Department of Health Sciences, University of York, York, UK.
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Sarah Knowles
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | | | - Kevin Williamson
- Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Lisa Ashton
- Department of Health Sciences, University of York, York, UK
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Bornheimer LA, Verdugo JL, Krasnick J, Jeffers N, Storey F, King CA, Taylor SF, Florence T, Himle JA. A cognitive-behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health: Preliminary findings of an open pilot study. SOCIAL WORK IN MENTAL HEALTH 2023; 21:538-560. [PMID: 37727221 PMCID: PMC10506844 DOI: 10.1080/15332985.2023.2186736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Suicide is a leading cause of death among schizophrenia spectrum disorder populations. This open pilot study examined a modified cognitive-behavioral suicide prevention treatment for clients in community mental health. Providers (n=5) were trained to deliver the treatment and clients (n=5) received it in 10 individual therapy sessions. Clients experienced improvements in suicide ideation, depression, hopelessness, general symptoms of psychosis, entrapment, defeat, approaches to coping, psychological stress, impulsivity, and the number of treatment barriers from baseline to post-treatment. Qualitative findings reinforced quantitative results of client improvements and provided important suggestions to strengthen the intervention and its delivery in community mental health.
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Affiliation(s)
- Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, Michigan
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | | | - Julie Krasnick
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Nakea Jeffers
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Frank Storey
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Cheryl A. King
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
- University of Michigan, Department of Psychology, Ann Arbor, Michigan
| | - Stephan F. Taylor
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | | | - Joseph A. Himle
- University of Michigan, School of Social Work, Ann Arbor, Michigan
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
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Peters S, Cook L, Littlewood D, Awenat Y, Drake R, Gill J, Gorton A, Haddock G, Harris K, Hozhabrafkan K, Huggett C, Kirby L, Pratt D, Gooding P. A systematic investigation of the short and long term experiences of taking part in research about suicidal thoughts and acts in the context of a randomised controlled trial. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stijelja S, Mishara BL. Preventing suicidal and self-Injurious behavior in correctional facilities: A systematic literature review and meta-analysis. EClinicalMedicine 2022; 51:101560. [PMID: 35898320 PMCID: PMC9309412 DOI: 10.1016/j.eclinm.2022.101560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Rates of suicide and self-harm are elevated in carceral institutions. Inmates are a vulnerable group since they are exposed to multiple risk factors. This paper critically reviews empirical research on programs to prevent suicidal and self-harmful behaviors in correctional facilities and summarizes effect sizes across studies. METHODS We searched PsychINFO, PubMed, IEEEXPLORE and the CRISE Documentation Centre Database to identify relevant articles published before June 2022. Inclusion criteria were: peer-reviewed and with outcome data on effectiveness of prevention activities. Two reviewers independently assessed 905 articles to determine inclusion eligibility. Quality was assessed by two independent reviewers using the Quality Assessment Tool for Quantitative Studies. Meta-analyses using random-effect models were used to pool effect sizes for each outcome. This review was conducted in accordance with PRISMA guidelines. FINDINGS Twenty-four of the 905 articles, published between 1980 and 2022, were included. Studies were frequently conducted in the United States (n=13; 54%) and used varying study designs; most frequently pre-post with no control group (n=9; 38%). Sample sizes and interventions varied considerably. Most were of moderate quality (n=21; 88%). On average, prevention programs in correctional facilities were effective in decreasing suicide deaths (pooled rate ratio of 0·35 [95% CI 0·23 to 0·55; p<0·001]; I2=68·01%), incidents of self-harm (pooled Hedges'g of -0·54 (95% CI: -1·03 to -0·05; p=0·031]; I2=81·34%), and suicidal ideation (pooled Hedges'g of -0·39 [95% CI: -0·65 to -0·14; p=0·003]; I2=47·09%). INTERPRETATION Prevention activities are effective in reducing suicide death, self-harm and suicidal ideation in correctional settings. Multicomponent programs, which include several preventive activities, seem to be most effective in reducing suicide deaths. Future evaluation studies should control for confounding variables by including control groups, having larger samples and limiting attrition. Standards for suicide prevention in jails and prisons should be included in National suicide prevention strategies. FUNDING None.
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Affiliation(s)
- Stefan Stijelja
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Brian L. Mishara
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Corresponding author at: CRISE-UQAM, C.P. 8888, Succ. Centre-ville, Montréal, Québec H3C 3P8, Canada.
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Thekkumkara SN, Jagannathan A, Muliyala KP, Murthy P. Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review. Indian J Psychol Med 2022; 44:211-217. [PMID: 35656427 PMCID: PMC9125461 DOI: 10.1177/02537176211061655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE OF THE REVIEW The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings. COLLECTION AND ANALYSIS OF DATA Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020. RESULTS AND CONCLUSIONS The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries.
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Affiliation(s)
- Sreekanth Nair Thekkumkara
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Aarti Jagannathan
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Krishna Prasad Muliyala
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pratima Murthy
- Professor of Psychiatry, Director National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Bornheimer LA, Li Verdugo J, Holzworth J, Im V, Smith FN, Sliwa H, Taylor SF, King CA, Florence T, Tarrier N, Himle JA. Modifying a cognitive behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health. Psychiatry Res 2022; 311:114505. [PMID: 35290884 PMCID: PMC9373852 DOI: 10.1016/j.psychres.2022.114505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022]
Abstract
Suicide is among the leading causes of death for adults with schizophrenia spectrum disorders. Given a paucity of evidence-based interventions tailored for psychosis, we sought to modify a promising Cognitive-Behavioral Suicide Prevention for psychosis (CBSPp) treatment for adults in US community mental health (CMH) settings using community-based participatory research methods. This article presents our modification methodology, stakeholder data and scholarly expert input, and CBSPp adaptations prior to future intervention testing. Stakeholder data (n = 25) were collected from clients, providers, and peer advocates in a CMH setting in Michigan. Findings were subsequently presented to a panel of scholarly experts in the fields of suicide and psychosis research, intervention research, and implementation science for input. Emerging themes from stakeholders include logistic, perceptual, and clinical challenges in the process of introducing this treatment in a CMH setting. Consistent with literature, buy-in and support for the delivery of a new treatment emerged as important factors in modifying and implementing CBSPp. A final modification list is presented in this paper and collaborations among stakeholders, researchers, and scholarly experts are essential to navigate psychosocial treatment innovation barriers with an overall goal of improving access, feasibility, and quality of this suicide prevention treatment.
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Affiliation(s)
- Lindsay A Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, Michigan; University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.
| | | | - Joshua Holzworth
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Vitalis Im
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Fonda N Smith
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Hannah Sliwa
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Stephan F Taylor
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Cheryl A King
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan; University of Michigan, Department of Psychology, Ann Arbor, Michigan
| | | | | | - Joseph A Himle
- University of Michigan, School of Social Work, Ann Arbor, Michigan; University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
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14
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Thekkumkara SN, Jagannathan A, Muliyala KP, Murthy P. Development and validation of a peer support programme for the prisoners with mental and substance use disorders in India. Indian J Psychiatry 2022; 64:316-321. [PMID: 35859557 PMCID: PMC9290426 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_416_21] [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: 05/20/2021] [Revised: 01/06/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands. AIM The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD). METHOD The PSP was developed by reviewing the literature and expert interviews and validated by seven experts. RESULT The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping. CONCLUSION This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings.
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Affiliation(s)
| | - Aarti Jagannathan
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | | | - Pratima Murthy
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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15
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Gooding PA, Harris K, Haddock G. Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3813. [PMID: 35409502 PMCID: PMC8997645 DOI: 10.3390/ijerph19073813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 01/03/2023]
Abstract
It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.
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Affiliation(s)
- Patricia A Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
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16
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Carter A, Butler A, Willoughby M, Janca E, Kinner SA, Southalan L, Fazel S, Borschmann R. Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system: A global systematic review. EClinicalMedicine 2022; 44:101266. [PMID: 35072018 PMCID: PMC8763634 DOI: 10.1016/j.eclinm.2021.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system. METHODS We searched Embase, PsycINFO, MEDLINE, and grey literature databases for articles published between 1 January 2000 and 1 June 2021. The protocol was registered with PROSPERO (CRD42020185989). FINDINGS Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult. INTERPRETATION More high-quality evidence from criminal justice settings other than adult prisons, particularly from low- and middle-income countries, should be considered a priority for future research. FUNDING This work was funded by the Australian government's National Suicide Prevention Taskforce. RB is supported by a National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant (EL2; GNT2008073). MW is supported by a NHMRC Postgraduate Scholarship (GNT1151103). SF was funded by the NIHR HTA Programme (HTA Project:16/159/09).
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Affiliation(s)
- Annie Carter
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amanda Butler
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Melissa Willoughby
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Emilia Janca
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stuart A. Kinner
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
- Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Southalan
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Seena Fazel
- Department of Psychiatry, University of Oxford; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health; Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Psychiatry, University of Oxford; Oxford Health NHS Foundation Trust, Oxford, UK
- Melbourne School of Psychological Sciences; The University of Melbourne, Parkville, Victoria, Australia
- Corresponding Author: A/Prof. Rohan Borschmann, PhD DClinPsych BBSc PG-Dip (Psych) MAPS, Dame Kate Campbell Senior Research Fellow / Psychologist, Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie street, Carlton, 3010, VIC Australia. Tel: +61 3 8344 0093; Fax: +61 3 8341 6212.
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17
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Dat NT, Mitsui N, Asakura S, Takanobu K, Fujii Y, Toyoshima K, Kako Y, Kusumi I. The Effectiveness of Self-Esteem-Related Interventions in Reducing Suicidal Behaviors: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:925423. [PMID: 35782451 PMCID: PMC9240430 DOI: 10.3389/fpsyt.2022.925423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Suicide is a serious social issue and is often treated using psychological interventions. The current systematic review and meta-analysis aimed to investigate the effectiveness of self-esteem-related interventions on suicidal behaviors. A systematic literature search for randomized controlled trials (RCTs) including a self-esteem component was conducted on 29 May 2021 and updated on 4 April 2022. In total, 12 studies were included in the systematic review and five studies were included in the meta-analysis. Small effect sizes were found for suicidal ideation at post intervention [g = -0.24, 95% CI (-0.48, 0.00)] and a 3-month follow-up [g = -0.36, 95% CI (-0.62, -0.11)]. However, these results should be interpreted cautiously due to the limited number of included studies and varied sample population. In conclusion, the current review suggests that future intervention studies should incorporate self-esteem enhancement in the treatment of suicidal behaviors, especially for suicidal ideation. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=250882.
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Affiliation(s)
- Nguyen Tan Dat
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuyuki Mitsui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Asakura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,The Department of Psychiatry, Health Care Center of Hokkaido University, Sapporo, Japan
| | - Keisuke Takanobu
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yutaka Fujii
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,The Department of Psychiatry, Health Care Center of Hokkaido University, Sapporo, Japan
| | - Kuniyoshi Toyoshima
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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18
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Favril L. Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review. Psychol Belg 2021; 61:341-355. [PMID: 34900324 PMCID: PMC8622377 DOI: 10.5334/pb.1072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Suicide is a global public health concern that affects all echelons of society, albeit not equally so. Compared with adults in the general population, incarcerated offenders are at increased risk to consider, attempt, and die by suicide, which represents a substantial burden of morbidity and mortality in prisons worldwide. This review synthesises recent literature pertaining to the epidemiology, risk factors, and prevention of suicidal thoughts and behaviour among prisoners, and outlines a framework which emphasises the interplay between individuals (importation) and their surroundings (deprivation). The available evidence suggests that prison-specific stressors may exacerbate risk of suicide in an already vulnerable population characterised by complex health and social care needs. Emerging data point to differential mechanisms through which prisoners come to think about suicide and subsequently progress to suicidal behaviour. As risk of suicide is determined by a complex web of synergistically interacting factors, its management and prevention demands a cross-sectoral policy and service response that includes targeted interventions aimed at high-risk prisoners in combination with population strategies that promote the health and wellbeing of all people in prison.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, BE
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19
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Sobanski T, Josfeld S, Peikert G, Wagner G. Psychotherapeutic interventions for the prevention of suicide re-attempts: a systematic review. Psychol Med 2021; 51:2525-2540. [PMID: 34608856 DOI: 10.1017/s0033291721003081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A history of suicide attempt (SA) is a strong predictor of future suicide re-attempts or suicide. The aim of this systematic review is to evaluate the efficacy of psychotherapeutic interventions specifically designed for the prevention of suicide re-attempts. A systematic search from 1980 to June 2020 was performed via the databases PubMed and Google Scholar. Only randomized controlled trials were included which clearly differentiated suicidal self-harm from non-suicidal self-injury in terms of intent to die. Moreover, psychotherapeutic interventions had to be focused on suicidal behaviour and the numbers of suicide re-attempts had to be used as outcome variables. By this procedure, 18 studies were identified. Statistical comparison of all studies revealed that psychotherapeutic interventions in general were significantly more efficacious than control conditions in reducing the risk of future suicidal behaviour nearly by a third. Separate analyses revealed that cognitive-behavioural therapy as well as two different psychodynamic approaches were significantly more efficacious than control conditions. Dialectical behaviour therapy and elementary problem-solving therapy were not superior to control conditions in reducing the number of SAs. However, methodological reasons may explain to some extent these negative results. Considering the great significance of suicidal behaviour, there is unquestionably an urgent need for further development of psychotherapeutic techniques for the prevention of suicide re-attempts. Based on the encouraging results of this systematic review, it can be assumed that laying the focus on suicidal episodes might be the key intervention for preventing suicide re-attempts and suicides.
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Affiliation(s)
- Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken GmbH, Rainweg 68, 07318Saalfeld, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Sebastian Josfeld
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Gregor Peikert
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
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20
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Huggett C, Gooding P, Haddock G, Pratt D. The Relationship between the Therapeutic Alliance and Suicidal Experiences in People with Psychosis Receiving Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010706. [PMID: 34682451 PMCID: PMC8535896 DOI: 10.3390/ijerph182010706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/25/2023]
Abstract
Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress.
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Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
- Correspondence:
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
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21
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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22
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Hemming L, Shaw J, Haddock G, Carter LA, Pratt D. A Cross-Sectional Study Investigating the Relationship Between Alexithymia and Suicide, Violence, and Dual Harm in Male Prisoners. Front Psychiatry 2021; 12:670863. [PMID: 33995152 PMCID: PMC8116549 DOI: 10.3389/fpsyt.2021.670863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Suicide and violence are common within male prisoners. One suggested risk factor for both behaviors is alexithymia. Alexithymia describes a deficit in identifying and describing feelings and is also related to externally oriented thinking. This study aimed to explore the relationship between alexithymia, suicide, violence and dual harm in male prisoners. Methods: Eighty male prisoners were recruited from three prisons. Participants were asked to complete a battery of questionnaires including measures of alexithymia (TAS-20), suicide ideation (ASIQ), suicide behavior, violence ideation (SIV), violence behavior, depression (BDI-II), hopelessness (BHS), impulsivity (DII) and anger (NAS-PI). Regression analyses and ANOVAS were conducted to assess the association between alexithymia (and its subcomponents) with six outcomes; suicide ideation, suicide behavior, violence ideation, violence behavior, dual harm ideation and dual harm behavior. Results: Alexithymia was a univariate predictor of suicide ideation, though was not a significant predictor when considered in a multivariate model. Alexithymia was a significant multivariate predictor of suicide behavior. Alexithymia was not a significant multivariate predictor of violence ideation or behavior. There were no significant differences in alexithymia or subscales between those with suicide ideation/behavior alone, violence ideation/behavior alone and those with dual harm ideation/behavior. Conclusion: In male prisoners, alexithymia appears an important univariate predictor of suicide and violence, though the current study suggests no significant contribution above other well-known correlates of suicide and violence.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Lesley-Anne Carter
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
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23
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Dhingra K, Mitchell SM, Davies B, Anestis MD, Anestis JC. Suicide Ideation Among Male Prisoners: Preliminary Evidence That Psychopathic Traits are Indirectly Linked to Suicide Ideation Through Thwarted Interpersonal Needs. Suicide Life Threat Behav 2020; 50:823-837. [PMID: 32175630 PMCID: PMC7483615 DOI: 10.1111/sltb.12632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The relation between psychopathic traits and suicide ideation (SI) is frequently discussed but little research has examined potential mechanisms underlying this association. The interpersonal theory of suicide (ITS) proposes two mechanisms in the pathogenesis of suicidal desire: thwarted belongingness (TB) and perceived burdensomeness (PB). This study cross-sectionally tested TB and PB as possible explanatory links in the relation between psychopathic traits and SI. METHOD Archival data from 784 male U.K. prisoners (Mage = 37.21, SD = 9.97) were analyzed using structural equation modeling. RESULTS Psychopathic traits were indirectly associated with SI through more specific suicide-promoting processes - namely TB and PB. More specifically, results indicated that Egocentricity and Stimulus Seeking were indirectly associated with SI through PB and TB in combination. However, results indicated specific indirect effects of TB in the relations between the Antisocial Behavior, Egocentricity, and Stimulus Seeking facets, and SI, whereas specific indirect effects for PB were only significant in the relations between Egocentricity and Stimulus Seeking facets and SI. CONCLUSION Preliminary results are consistent with the ITS and suggest that psychopathic traits may be distal risk markers for SI and provide direction for future research that could inform suicide prevention efforts among male prisoners high in such traits.
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Affiliation(s)
- Katie Dhingra
- School of Social Sciences, Leeds Beckett University, England, LS1 3HE
| | - Sean M. Mitchell
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Box Psych, Rochester, NY 14642
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Bill Davies
- School of Social Sciences, Leeds Beckett University, England, LS1 3HE
| | - Michael D. Anestis
- School of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406
| | - Joye C. Anestis
- School of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406
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Gooding PA, Pratt D, Awenat Y, Drake R, Elliott R, Emsley R, Huggett C, Jones S, Kapur N, Lobban F, Peters S, Haddock G. A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol. BMC Psychiatry 2020; 20:306. [PMID: 32546129 PMCID: PMC7298803 DOI: 10.1186/s12888-020-02697-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. METHODS The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders. DISCUSSION This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious. TRIAL REGISTRATION ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
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Affiliation(s)
- Patricia A Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK.
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Rachel Elliott
- Manchester Centre for Health Economics, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Steven Jones
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Navneet Kapur
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Fiona Lobban
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
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Angelakis I, Austin JL, Gooding P. Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review. Psychol Med 2020; 50:1-10. [PMID: 31663847 PMCID: PMC6945324 DOI: 10.1017/s0033291719002848] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022]
Abstract
In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18-81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18-27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86-3.86], physical abuse (OR 2.16, 95% CI 1.60-2.91), emotional abuse (OR 2.70, 95% CI 1.92-3.79), emotional neglect (OR 2.29, 95% CI 1.69-3.10), physical neglect (OR 1.57, 95% CI 1.27-1.94) and combined abuse (OR 3.09, 95% CI 2.14-4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.
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Affiliation(s)
- Ioannis Angelakis
- University of South Wales, School of Psychology, Pontypridd, Wales, UK
| | | | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
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Hemming L, Bhatti P, Shaw J, Haddock G, Pratt D. Words Don't Come Easy: How Male Prisoners' Difficulties Identifying and Discussing Feelings Relate to Suicide and Violence. Front Psychiatry 2020; 11:581390. [PMID: 33362602 PMCID: PMC7758448 DOI: 10.3389/fpsyt.2020.581390] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Suicide and violence are prevalent within male prisons in the UK. It has been suggested that alexithymia may be associated with both suicide and violence. Alexithymia can be defined as an inability to identify or discuss emotions. The present study aimed to qualitatively explore male prisoners' experiences of alexithymia and how these experiences may relate to suicide and violence. Fifteen male prisoners were recruited from two prisons in the North West of England. All participants had experienced suicidal and/or violent thoughts and/or behaviors in the past 3 months, and all screened positive on an established measure of alexithymia. Participants took part in a qualitative interview during which they were also given the opportunity to provide drawings of their emotions. Data were transcribed and analyzed using thematic analysis, with a collaborative approach taken between researchers and an individual with lived experience of residing in prison. The results indicated that male prisoners tended not to talk about their emotions with others, due to external pressures of residing in prison in addition to internal difficulties with recognizing and articulating emotions. Not discussing emotions with others was associated with a build-up of emotions which could result in either an emotional overload or an absence of emotions. Both experiences were perceived to be associated with hurting self or others, however, participants also identified a "safety valve" where it was acknowledged that using more adaptive approaches to releasing emotions could prevent harm to self and others. These findings suggest three main clinical implications; (1) a cultural shift in male prisons is needed which encourages open communication of emotions (2) individualized support is needed for those identified as experiencing a difficulty in recognizing and articulating emotions and (3) prison staff should encourage alternative ways of releasing emotions such as by using harm minimization or distraction techniques.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Peer Bhatti
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Perry A, Waterman MG, House A, Wright-Hughes A, Greenhalgh J, Farrin A, Richardson G, Hopton AK, Wright N. Problem-solving training: assessing the feasibility and acceptability of delivering and evaluating a problem-solving training model for front-line prison staff and prisoners who self-harm. BMJ Open 2019; 9:e026095. [PMID: 31585968 PMCID: PMC6797432 DOI: 10.1136/bmjopen-2018-026095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/24/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study. DESIGN AND SETTING A mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK. PARTICIPANTS (i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks. INTERVENTION The intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies. OUTCOMES We assessed the study processes-coverage of training; recruitment and retention rates and adequacy of intervention delivery-and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere. RESULTS Recruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to 'treatment as usual'. Outcome measures of self-harm, quality of life and depression were found to be acceptable. CONCLUSIONS The intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.
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Affiliation(s)
| | | | - Allan House
- Academic Unit of Psychiatry, University of Leeds, Leeds, UK
| | | | | | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Nat Wright
- Spectrum Community Health CIC, Wakefield, UK
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A systematic review of behavioral health interventions for suicidal and self-harming individuals in prisons and jails. Heliyon 2019; 5:e02379. [PMID: 31517115 PMCID: PMC6734330 DOI: 10.1016/j.heliyon.2019.e02379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/24/2019] [Accepted: 08/23/2019] [Indexed: 11/20/2022] Open
Abstract
This article reviews evaluation studies of interventions aimed at preventing and reducing incidents of suicide and self-harm among incarcerated individuals. Study design, sample characteristics, intervention procedures, study measures, and relevant results of each study are reviewed. The outcomes of interest include severity and frequency of self-harm episodes and suicidal ideation, scores on adaptive coping methods, scoring on the Beck Hopelessness scale and risk scores. The six evaluated studies are peer-reviewed, published between 1990 and 2015, and took place in the United States, the United Kingdom, and Pakistan. Treatment modalities widely vary across studies and include cognitive behavioral therapy, dialectical behavioral therapy, peer programming, staff intervention training, and uniquely-designed courses that incorporate various aspects from other treatment modalities. Due to the nature of the studies, only one multi-randomized controlled trial was identified. All identified studies had a pre- and post-treatment design either lacking a comparison group or containing 1–2 comparison groups and conduct follow-up of varying times. While Cognitive Behavioral Therapy (CBT) interventions and uniquely-tailored intervention programs suggest promising results, the general absence of comparison groups, the shortage of relevant evaluation studies and the inconsistency of behavioral outcome measurements compromise the capacity of this review. Further, definitional variances, particularly for self-injury (self-harm, non-suicidal self-injury [NSSI], deliberate self-harm, suicidal behavior, etc.) affect the ability to synthesize study results. This article aims to synthesize the literature results to identify the most effective interventions that would benefit from additional research.
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Perry AE, Waterman MG, House AO, Greenhalgh J. Implementation of a problem-solving training initiative to reduce self-harm in prisons: a qualitative perspective of prison staff, field researchers and prisoners at risk of self-harm. HEALTH & JUSTICE 2019; 7:14. [PMID: 31368051 PMCID: PMC6717963 DOI: 10.1186/s40352-019-0094-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Social problem-solving is one technique used to help reduce incidence of self-harm. Our study evaluated the feasibility and acceptability of the adaptation and implementation of a brief Problem-Solving Training (PST) intervention to reduce self-harm in prisons. METHODS The process involved i) adaptation of the training materials using focus groups with prison staff and prisoners, ii) training frontline prison staff to use the skills, and iii) implementation of the skills with prisoners at risk of self-harm. Qualitative interviews were conducted with prison staff, prisoners and field researchers and were analysed using a thematic framework to produce a model of the barriers and facilitators to the process. RESULTS We conducted 43 interviews across three prison sites. The interviews included 19 prison staff, 18 prisoners and six field researcher meetings. The adaptation to the training and intervention materials were well received. The findings identified the need to support training using a collaborative and flexible approach. Prisoner engagement was affected by their own personal circumstances and by a range of contextual issues relating to the prison environment. Implementation of the skills by prison staff were hindered by resource constraints, the prison environment and staff attitudes. CONCLUSIONS We found that it was feasible to adapt an existing intervention and contextualise it within the prison environment. Although we could train large numbers of staff it was deemed unfeasible for staff to implement the problem-solving skills to prisoners at risk of self-harm. Prisoners who engaged with the intervention reported a range of benefits. Alternative implementation mechanisms to tackle the contextual barriers proposed by staff and prisoners included delivery of the intervention using an educational setting and/or use of a prisoner peer-led scheme.
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Affiliation(s)
- Amanda E. Perry
- Department of Health Sciences, University of York, Fulford, York, YO10 5DD UK
| | | | - Allan O. House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Joanne Greenhalgh
- Sociology and Social Policy, Faculty of Education and Social Science and Law, University of Leeds, Leeds, LS2 9JT UK
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Mental disorders and mental health symptoms during imprisonment: A three-year follow-up study. PLoS One 2019; 14:e0213711. [PMID: 30870479 PMCID: PMC6417738 DOI: 10.1371/journal.pone.0213711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the course of mental disorders during imprisonment are scarce. Longitudinal studies from high-income Western countries point to improvements of symptoms over time. The aim of the present study was to assess mental disorders and symptoms three years after baseline evaluation at imprisonment and to determine predictors of change in a South American prison context. METHODS Consecutively admitted prisoners in Santiago de Chile were assessed at intake and reassessed after three years using the Mini International Neuropsychiatric Interview and the Symptom-Check-List 90 Revised (SCL-90-R). The global severity index (GSI) was calculated with standard deviations (SD) and compared using paired t-tests. The prevalence of mental disorders at baseline and at follow-up were compared using McNemar tests. Analyses of variance were conducted to evaluate whether prespecified socio-demographic variables and disorders at baseline predicted symptom change at follow-up. RESULTS 73 (94%) out of 78 prisoners participated. The prevalence of major mental illnesses was lower at follow-up: 47 (64%) at intake vs. 23 (32%) at follow-up had major depression (p<0.001); 22 (30%) at intake vs. 10 (14%) at follow-up had psychosis (p = 0.008). The mean GSI improved from 1.97 (SD 0.65) at intake to 1.16 (SD 0.82) at follow-up (p<0.001). Depression at baseline (F = 9.39; [Formula: see text] = 0.137; β = -0.67; p = 0.003) and working or studying during imprisonment (F = 10.61; [Formula: see text] = 0.152; β = -0.71; p = 0.002) were associated with strong improvement of the GSI at follow-up, whereas psychosis at intake was associated with relatively small symptom improvement (F = 12.11; [Formula: see text] = 0.17; β = 0.81; p = 0.001). CONCLUSIONS In a resource poor prison context in South America, mental health symptoms and disorders improve considerably over three years during imprisonment. This applies especially to people with depression at intake. Offers to work or study during imprisonment may improve mental health outcomes.
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Haddock G, Pratt D, Gooding PA, Peters S, Emsley R, Evans E, Kelly J, Huggett C, Munro A, Harris K, Davies L, Awenat Y. Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial. BJPsych Open 2019; 5:e14. [PMID: 30762509 PMCID: PMC6381415 DOI: 10.1192/bjo.2018.85] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.AimsOur primary objective was to determine whether cognitive-behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide. METHOD A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline. RESULTS A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.DiscussionPsychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.Declaration of interestThe trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.
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Affiliation(s)
- Gillian Haddock
- Professor of Clinical Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - Daniel Pratt
- Senior Lecturer in Clinical Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - Patricia A. Gooding
- Senior Lecturer in Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - Sarah Peters
- Senior Lecturer in Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester and Manchester Academic Health Sciences Centre, UK
| | - Richard Emsley
- Professor of Medical Statistics and Trials Methodology, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre; and Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Emma Evans
- Trial Therapist, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - James Kelly
- Clinical Psychologist, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester; Manchester Academic Health Sciences Centre; and Lancashirecare NHS Foundation Trust, UK
| | - Charlotte Huggett
- Research Assistant, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - Ailsa Munro
- Research Assistant, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
| | - Kamelia Harris
- Research Assistant, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester and Manchester Academic Health Sciences Centre, UK
| | - Linda Davies
- Professor of Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester and Manchester Academic Health Sciences Centre, UK
| | - Yvonne Awenat
- Research Fellow, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust (formerly Manchester Mental Health and Social Care Trust) and Manchester Academic Health Sciences Centre, UK
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Favril L, Wittouck C, Audenaert K, Vander Laenen F. A 17-Year National Study of Prison Suicides in Belgium. CRISIS 2018; 40:42-53. [PMID: 30052079 DOI: 10.1027/0227-5910/a000531] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Suicide is a leading cause of mortality in prisoners worldwide, yet empirical data on this matter are lacking in Belgium. AIMS This study sought to describe characteristics associated with a consecutive series of suicides in Belgian prisons from 2000 to 2016 inclusive, in order to inform suicide prevention strategies. METHOD All documented cases of suicide ( N = 262) were reviewed using a standardized assessment checklist. Official records were abstracted for prisoners' sociodemographic, criminological, and clinical information, as well as for suicide-related characteristics. RESULTS Over the 17-year study period, suicides accounted for one third of all deaths in Belgian prisons. The average annual suicide rate in Belgium from 2000 to 2016 was 156.2 per 100,000 prisoners. Examination of all cases highlights both individual (psychiatric disorders and a history of suicide attempt) and situational (the early period of incarceration, interfacility transfers, and placement in solitary confinement) factors common in many prison suicides; some of them amenable to (clinical) management, which presents several potential avenues for suicide prevention. LIMITATIONS Given the absence of a matched control group, no conclusions could be ascertained regarding risk factors. CONCLUSION Suicide is a common, preventable cause of death among prisoners in Belgium. The results underscore the timely need for national standards and guidelines for suicide prevention in Belgian prisons.
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Affiliation(s)
- Louis Favril
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
| | - Ciska Wittouck
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Kurt Audenaert
- 2 Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Freya Vander Laenen
- 1 Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Belgium
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Awenat YF, Moore C, Gooding PA, Ulph F, Mirza A, Pratt D. Improving the quality of prison research: A qualitative study of ex-offender service user involvement in prison suicide prevention research. Health Expect 2018; 21:100-109. [PMID: 28640480 PMCID: PMC5750753 DOI: 10.1111/hex.12590] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Suicide is the leading cause of avoidable death in prisons worldwide and suicide prevention is an international priority. Consequently, there is an urgent need to develop evidence-based treatments. We conducted a randomized controlled trial of a novel suicide prevention psychological therapy for male prisoners. To promote ecological validity by addressing the "real-world" situation of suicidal prisoners, we involved a consultant group of ex-offenders with past experience of being suicidal during imprisonment. Service user involvement in prison research is challenging and underdeveloped. OBJECTIVE We aimed to investigate the ex-offender service user consultants' experiences of being involved in the research. DESIGN Individual qualitative interviews were conducted and analysed using an Interpretative Phenomenology Analysis (IPA) framework. SETTING/PARTICIPANTS The study was conducted at a university in North England, UK, comprising four ex-offenders with experience of being suicidal during past imprisonments. RESULTS Two superordinate themes were identified: "Working Together" depicted participants' perceptions of the pivotal role of good relationships with researchers, and "Journey of Change" outlined how participants' involvement in the research impacted on their personal lives. DISCUSSION Little is known about how to successfully involve ex-offender service users in research. Our results indicate the conditions necessary for successfully engaging ex-offender service users in research and have important implications for improving the quality of prison research. CONCLUSIONS Involving forensic service users in research is feasible and should be encouraged, as despite certain challenges, it is highly rewarding both for the research and the ex-offender service users.
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Affiliation(s)
- Yvonne F. Awenat
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Science Centre, MAHSCManchesterUK
- Institute of Brain, Behaviour and Mental HealthUniversity of ManchesterManchesterUK
- Centre for New Treatments and Understanding in Mental health CENTRUMUniversity of ManchesterManchesterUK
- Manchester Mental Health and Social Care NHS TrustManchesterUK
| | - Currie Moore
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Patricia A. Gooding
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Science Centre, MAHSCManchesterUK
- Institute of Brain, Behaviour and Mental HealthUniversity of ManchesterManchesterUK
- Centre for New Treatments and Understanding in Mental health CENTRUMUniversity of ManchesterManchesterUK
| | - Fiona Ulph
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Institute of Brain, Behaviour and Mental HealthUniversity of ManchesterManchesterUK
- Centre for New Treatments and Understanding in Mental health CENTRUMUniversity of ManchesterManchesterUK
| | - Aisha Mirza
- Manchester Mental Health and Social Care NHS TrustManchesterUK
| | - Daniel Pratt
- Division of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
- Manchester Academic Health Science Centre, MAHSCManchesterUK
- Centre for New Treatments and Understanding in Mental health CENTRUMUniversity of ManchesterManchesterUK
- Manchester Mental Health and Social Care NHS TrustManchesterUK
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Bartoli C, Berland-Benhaim C, Tuchtan-Torrents L, Kintz P, Leonetti G, Pelissier-Alicot AL. Suicide by Medication Overdose in Prison: A Study of Three Cases. J Forensic Sci 2017; 63:1316-1320. [DOI: 10.1111/1556-4029.13671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Christophe Bartoli
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | | | - Lucile Tuchtan-Torrents
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | - Pascal Kintz
- X-Pertise Consulting; 84 route de Saverne 67205 Oberhausbergen France
- IML; Strasbourg France
| | - Georges Leonetti
- CNRS; EFS; ADES; Aix Marseille Univ; Marseille France
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
| | - Anne-Laure Pelissier-Alicot
- Service de Médecine Légale; APHM, CHU Timone; Marseille France
- INSERM; INMED; 1 Aix Marseille Univ, CNRS, EFS, ADES; Marseille France
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Abstract
BACKGROUND Male suicide rates are higher than their female counterparts in almost every country around the world. Several developed countries have attempted to implement suicide prevention programmes, but few have specifically targeted men. AIMS To identify what is currently known about suicide prevention strategies, programmes, and interventions of relevance to men. METHOD A scoping review guided by Arksey and O'Malley's five-stage framework. RESULTS Twenty-two studies were included. Thematic analysis identified three categories: (i) male suicide prevention interventions; (ii) factors or coping strategies that interrupt the suicidal process in men; (iii) men's perspectives on service provision. Interventions included awareness campaigns; training of community "gatekeepers"; psychological support; and educational initiatives targeted to either GPs or depressed or suicidal men. Men emphasised the need to receive support from a trusted and respected individual, preferably in an informal setting. Connecting with others, reframing help-seeking as masculine, and the use of emotional regulation techniques were all identified as factors with potential to interrupt the suicidal process. CONCLUSIONS This review demonstrates the need for further research examining the perspectives of suicidal middle-aged men and their close family and friends.
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Affiliation(s)
- Sophia Struszczyk
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
| | - Paul Michael Galdas
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
| | - Paul Alexander Tiffin
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
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Balon R. Clinical Factor 2015. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:327-336. [PMID: 27744435 DOI: 10.1159/000448788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Richard Balon
- Department of Psychiatry and Behavioral Neurosciences and Department of Anesthesiology, Wayne State University School of Medicine, Detroit, Mich., USA
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Awenat YF, Shaw-Núñez E, Kelly J, Law H, Ahmed S, Welford M, Tarrier N, Gooding PA. A qualitative analysis of the experiences of people with psychosis of a novel cognitive behavioural therapy targeting suicidality. PSYCHOSIS 2016. [DOI: 10.1080/17522439.2016.1198827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Yvonne F. Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Centre for New Treatments and Understanding in Mental Health (CENTRUM), University of Manchester, Manchester, UK
| | - Emma Shaw-Núñez
- Research and Innovation, Manchester Mental Health and Social Care NHS Trust, Manchester, UK
| | - James Kelly
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Sehar Ahmed
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Mary Welford
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Tarrier
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Psychology, Institute of Psychiatry, London, UK
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Centre for New Treatments and Understanding in Mental Health (CENTRUM), University of Manchester, Manchester, UK
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Haddock G, Davies L, Evans E, Emsley R, Gooding P, Heaney L, Jones S, Kelly J, Munro A, Peters S, Pratt D, Tarrier N, Windfuhr K, Awenat Y. Investigating the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards (the 'INSITE' trial): study protocol for a randomised controlled trial. Trials 2016; 17:79. [PMID: 26869076 PMCID: PMC4751630 DOI: 10.1186/s13063-016-1192-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a major cause of preventable death, and suicidal behaviour is prevalent in acute psychiatric wards. People admitted to acute psychiatric wards often experience repeated episodes of suicidal behaviour, causing great distress and heavy use of NHS services. There is little research investigating effective psychological treatments for suicidal patients in inpatient settings although previous research has found support for psychological therapies which specifically target suicidal behaviour. This paper describes the protocol of a single blind RCT to investigate the acceptability and feasibility of a cognitive behavioural intervention targeting suicidality (CBSP) for suicidal people in acute psychiatric wards. METHODS/DESIGN A single blind RCT comparing treatment as usual (TAU) to TAU plus Cognitive Behavioural Suicide Prevention (CBSP) therapy (TAU + CBSP). Sixty participants (aged 18-65 years) who are suicidal, or have been within the past 3 months, will be recruited from NHS trusts in the North West of England. Our primary objective is to determine whether CBSP is feasible, acceptable and efficacious when compared to patients who receive TAU alone. Secondary aims are the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use and psychological factors associated with suicide. Assessments take place at baseline, 6 weeks and 6 months (end of treatment). The analysis will report on the feasibility and acceptability of CBSP. Qualitative data from staff and service users will inform feasibility and acceptability data. DISCUSSION Psychiatric inpatients are a high-risk group and the use of psychological therapies in these settings is rare and requires evaluation. This study is essential to investigate the unique contextual challenges involved in delivering psychological therapy to suicidal inpatients and to identify any necessary modifications required within inpatient settings. The findings will inform a larger, definitive trial. TRIAL REGISTRATION 15 March 2012, PB-PG-1111-26026, NIHR ISRCTN17890126 .
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Affiliation(s)
- Gillian Haddock
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Linda Davies
- Centre for Health Economics, Institute of Population Health, Manchester University, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Emma Evans
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Manchester Mental Health and Social Care NHS Trust, Manchester, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Patricia Gooding
- School of Psychological Sciences, Manchester University, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
| | - Lisa Heaney
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Sarah Jones
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - James Kelly
- Lancashire Care NHS Foundation Trust, Early Intervention Service, Accrington, UK.
| | - Ailsa Munro
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Sarah Peters
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Daniel Pratt
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Nicholas Tarrier
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Manchester University, 2nd Floor, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Yvonne Awenat
- School of Psychological Sciences, Manchester University, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
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Baier A, Fritsch R, Ignatyev Y, Priebe S, Mundt AP. The course of major depression during imprisonment - A one year cohort study. J Affect Disord 2016; 189:207-13. [PMID: 26451505 DOI: 10.1016/j.jad.2015.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/25/2015] [Accepted: 09/05/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND First longitudinal studies in prisoners point to improvements of depressive symptoms during imprisonment. The aim of the present study was to assess the course of major depressive disorder during imprisonment and to identify factors influencing remission. METHODS Prisoners with major depressive disorder in a sample of consecutive admissions to the penal justice system in Santiago de Chile were reassessed after one year of imprisonment. Psychiatric diagnoses were established using the Mini-International Neuropsychiatric Interview; psychological symptoms were assessed with the Symptom-Check-List 90 Revised (SCL-90-R). Mean symptom scores were compared at baseline and follow-up using Student's t-test. Odds ratios (OR) of comorbid disorders and socio-demographic factors at baseline to predict depression at follow-up were calculated. RESULTS N=79 out of 80 inmates (99%) with major depression at baseline were included. Thirty-five prisoners (44%) had major depression at follow-up. The mean global severity score and all mean subscale scores of the SCL-90-R improved. High suicide risk was present in 37 prisoners (47%) at admission and in 11 (14%) at follow-up. The comorbid diagnosis of PTSD (OR 6.3; p<0.001) at admission and having been previously imprisoned (OR 2.5; p=0.05) predicted major depressive disorder at follow-up. LIMITATIONS The study could not account for temporary improvements between the assessments. CONCLUSION In spite of important symptom improvements, only about half of the prisoners with major depression at admission remit after one year of imprisonment. New interventions should target people with major depression and comorbid PTSD at admission.
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Affiliation(s)
- Alicia Baier
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte Universitätsmedizin Berlin, Germany; Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Rosemarie Fritsch
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile; Department of Psychiatry, Universidad de los Andes, Chile
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte Universitätsmedizin Berlin, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, United Kingdom
| | - Adrian P Mundt
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, United Kingdom; Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; Escuela de Medicina sede Puerto Montt, Universidad San Sebastián, Chile; Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Gooding P, Tarrier N, Dunn G, Shaw J, Awenat Y, Ulph F, Pratt D. Effect of hopelessness on the links between psychiatric symptoms and suicidality in a vulnerable population at risk of suicide. Psychiatry Res 2015; 230:464-71. [PMID: 26429147 DOI: 10.1016/j.psychres.2015.09.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/30/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to examine the impact of two risk factors working together on a measure of suicide probability in a highly vulnerable group who were male prisoners identified as being at risk of self harm. The first risk factor was psychiatric symptoms, including general psychiatric symptoms and symptoms of personality disorder. The second risk factor was psychological precursors of suicidal thoughts and behaviours which were defeat, entrapment, and hopelessness. Sixty-five male prisoners from a high secure prison in NW England, UK, were recruited, all of whom were considered at risk of suicide by prison staff. General psychiatric symptoms and symptoms of personality disorders predicted the probability of suicide. Hopelessness amplified the strength of the positive relationship between general psychiatric symptoms and suicide probability. These amplification effects acted most strongly on suicidal ideation as opposed to negative self evaluations or hostility. In contrast, defeat, entrapment and hopelessness did not affect the relationship between personality disorders and suicide probability. Clinical assessments of highly vulnerable individuals, as exemplified by prisoners, should include measures of a range of general psychiatric symptoms, together with measures of psychological components, in particular perceptions of hopelessness.
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Affiliation(s)
- Patricia Gooding
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK.
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK; Department of Psychology, Institute of Psychiatry, King's College, London, UK
| | - Graham Dunn
- Institute of Population Health, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Jennifer Shaw
- Manchester Health Science Centre (MAHSC), Manchester, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Yvonne Awenat
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Fiona Ulph
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Daniel Pratt
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK; Manchester Mental Health and Social Care NHS Trust, Manchester, UK
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41
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Gooding P, Tarrier N, Dunn G, Shaw J, Awenat Y, Ulph F, Pratt D. The moderating effects of coping and self-esteem on the relationship between defeat, entrapment and suicidality in a sample of prisoners at high risk of suicide. Eur Psychiatry 2015; 30:988-94. [PMID: 26497469 PMCID: PMC4682192 DOI: 10.1016/j.eurpsy.2015.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/30/2015] [Accepted: 09/05/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Research is sparse which examines pathways to suicide, and resilience to suicide, in people who are particularly vulnerable to suicide, for example, prison inmates. The purpose of this study was to examine the ways in which perceptions of self-esteem and coping ability interacted with defeat and entrapment to both amplify suicidal thoughts and feelings, and to act as a buffer against suicidal thoughts and feelings. METHODS Participants were 65 male prisoners at high risk of suicide. A cross-sectional questionnaire design was used. Questionnaire measures of depression, defeat, entrapment, self-esteem, coping ability and suicidal probability were administered. RESULTS For the hopelessness component of the suicide probability measure, high levels of coping ability together with low levels of defeat resulted in the lowest levels of suicidality indicative of a resilience factor. In contrast, low levels of coping skills together with high levels of entrapment were a high risk factor for this hopelessness component of suicide. This pattern of results pertained when controlling for depression levels. CONCLUSIONS This is the first study to examine interactions between defeat, entrapment and appraisals of self-esteem and coping ability. Therapeutic interventions would benefit from boosting perceptions and appraisals of coping ability, in particular, in people who are at high risk for suicide.
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Affiliation(s)
- P Gooding
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK.
| | - N Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK; Department of Psychology, Institute of Psychiatry, King's College, London, UK
| | - G Dunn
- Institute of Population Health, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - J Shaw
- Manchester Health Science Centre (MAHSC), Manchester, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Y Awenat
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - F Ulph
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - D Pratt
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK; Manchester Mental Health and Social Care NHS Trust, Manchester, UK
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