Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Background

Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway.

Aims

To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment.

Objectives

To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK.

Data sources

Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites.

Review methods

A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines.

Results

From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan.

Limitations

Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment.

Conclusions

No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement.

Study registration

This study is registered as PROSPERO CRD42021276671.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

“Mirror, Mirror, Am I as My Coach Sees Me?”: Discrepancy Between Athlete Self-Appraisals and Reflected Appraisals of Their Coach, and Relations With Athlete Burnout

Using a person-centered approach, this study was conducted to identify (a) specific athlete profiles in terms of degree of discrepancy between their self-appraisals and the reflected appraisals of their coach and (b) the relations between these profiles and athlete burnout. Athletes (N = 369; Mage = 21.15 years) fulfilled measures of self-appraisals, reflected appraisals of their coach, and burnout. Latent profile analysis allowed the identification of three profiles: concordance (84%), positive discrepancy (11%), and negative discrepancy (5%). Analyses revealed relationships between athletes’ profile membership and the three dimensions of burnout: emotional and physical exhaustion, sport devaluation, and reduced sense of accomplishment. More specifically, results indicated that athletes with a positive discrepancy profile (i.e., who rated themselves more positively than they think their coaches see them) were more at risk of burnout. This study contributes to existing research on psychosocial determinants of athlete burnout in the context of the coach–athlete relationship.

Associations between prosocial behavior, externalizing behaviors, and internalizing symptoms during adolescence: A meta-analysis

INTRODUCTION

The purpose of this study was to conduct a meta-analysis investigating the consistency and strength of relations between prosocial behavior, externalizing behaviors, and internalizing symptoms from preadolescence (i.e., 1-9 years) to late adolescence (i.e., 19-25 years). This study directly addresses inconsistencies and gaps in the available literature by providing the field with a detailed, synthesized description of these associations.

METHOD

Fifty-five studies met the inclusion criteria, containing 742 independent correlational effect sizes. Statistical information and other study information was coded and entered into Comprehensive Meta-analysis III software, which was used to analyze results.

RESULTS

Results showed that higher levels of prosocial behavior were significantly associated with lower levels of externalizing behaviors, as expected. Additionally, more reported prosocial behavior was related to less reported internalizing symptoms. Follow-up analyses revealed specific relationships between prosocial behavior and aggression, deviant peer association, risky sexual behavior, substance use, delinquency/general externalizing behavior, depression, and general internalizing behaviors (i.e., emotional problems, negative emotionality). A variety of moderators of these associations were considered, including age and sex.

CONCLUSIONS

Findings are discussed in the context of the broader research literature, weaknesses in the field are noted, and numerous meaningful directions for future research are presented.

Influence of school factors on emotional disorder risk in Vietnamese middle school students

Background

This study examined how school factors such as school violence, academic problems, problems with teachers, and discipline problems influence the risk of emotional disorders in middle school students.

Participants and procedure

Our sample included 1085 middle school students, whose age ranges from 11 to 14, from Hanoi, which is a major city, and Backan, which is a rural area. Measurements included: 1) an emotional disorder scale (EDS) that was developed by the authors and 2) a self-report questionnaire using a Likert scale about relevant school factors, including school violence, academic problems, problems with teachers, and discipline problems. We developed the EDS based on the stress, anxiety, and depression symptoms specified in the DSM-5 and the Conners Emotional Disorder Subscale that included somatic, affective, cognitive, and behavioral symptom manifestations.

Results

The results showed that school factors were significantly correlated with emotional disorder risk in middle school students. School violence, academic problems, and problems with teachers could predict 39.6% of emotional disorder risk in middle school students, among which academic problems have the strongest effect and could best predict emotional disorder risk. These results suggest that future research should scrutinize ac-ademic pressure that middle school students face in order to develop emotional disorder prevention programs that help students.

Conclusions

School factors, especially academic problems, had a negative influence on students. We suggest that educa-tors should consider reducing the academic challenge and workload for prevention of emotional disorder risk in middle school students. Additionally, it is necessary to develop a curriculum that meets the cognitive and cultural needs of students from rural areas.

[“Tit for Tat?” The development of prosocial behavior and its relationship to externalizing and internalizing problems]

Supporting other human beings is a fundamental aspect of human societies. Such so-called prosocial behavior is expressed in helping others, cooperating and sharing with them. This article gives an overview both of the development of prosocial behavior across childhood and of the relationship between prosociality and externalizing and internalizing problems. Especially externalizing problems are negatively associated with prosocial behavior, whereas the relationships with prosocial behavior are more heterogeneous for internalizing problems. Studies investigating developmental trajectories demonstrate that prosocial behavior and externalizing problems are not opposite ends of a continuum. Rather, they are two independent dimensions that may also co-occur in development. The same applies to internalizing problems, which can co-occur with pronounced prosociality as well as with low prosociality.