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Eckerström J, Rosendahl I, Lindkvist RM, Amin R, Carlborg A, Flyckt L, Jayaram-Lindström N. Effects of Patient-Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister-Based Study. Int J Ment Health Nurs 2024. [PMID: 38855833 DOI: 10.1111/inm.13371] [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: 09/19/2023] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient-initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self-harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1-3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register-based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013-2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference-in-differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3-year follow-up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6-month mark for the PIBA group (β = -1.436, SE = 1.531), expanding to 3 days fewer at the 12-month follow-up (β = -3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12-month (β = 0.960, SE = 0.456) and 18-month follow-up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44-0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost-effectiveness, both in relation to health care for the individual and cost-effectiveness in relation to recovery and health.
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Affiliation(s)
- Joachim Eckerström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Rose-Marie Lindkvist
- Department of Clinical Sciences Malmö, Psychiatry, Lund University, Lund, Sweden
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Karolinska, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Lena Flyckt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
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Uddin T, Pitman A, Benson G, Kamal Z, Hawton K, Rowe S. Attitudes toward and experiences of clinical and non-clinical services among individuals who self-harm or attempt suicide: a systematic review. Psychol Med 2024; 54:13-31. [PMID: 37772412 DOI: 10.1017/s0033291723002805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. This systematic review summarized the literature published since then to July 2022 to examine contemporary attitudes toward and experience of clinical and non-clinical services among individuals who self-harm and their relatives. We systematically searched for literature using seven databases. Quality of studies was assessed using the Mixed-Methods Appraisal Tool and findings were summarized using a narrative synthesis. We identified 29 studies that met our inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes toward clinical management and organizational barriers across services. Generally, more positive attitudes were found toward non-clinical services providing therapeutic contact, such as voluntary sector organizations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in attitudes toward and experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centered and compassionate care and deliver more effective, acceptable and accessible services.
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Affiliation(s)
- Tasnim Uddin
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Alexandra Pitman
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gemma Benson
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Zeast Kamal
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Rowe
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
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Lindgren T, Westdahl J, Stjernswärd S, Saliba-Gustafsson EA, Flyckt L, Jayaram-Lindström N, Eckerström J. Psychiatry Nurses' Experiences of Patient-Initiated Brief Admission from Inpatient and Outpatient Perspectives: A Qualitative Exploratory Study. Issues Ment Health Nurs 2024; 45:66-75. [PMID: 37982740 DOI: 10.1080/01612840.2023.2270059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Patient-initiated brief admission (PIBA) allows patients to decide when admission to psychiatric care is necessary. This may prevent long-term hospitalisation and promote patient participation. Research on psychiatric nurses' experiences with PIBA is lacking, therefore 11 nurses were interviewed and data analysed using content analysis. Prominent categories were: improved personal development for the patient, more equal nurse-patient relationship, rapid access to a safe environment and strengthened professional collaboration. PIBA is a helpful intervention for patients in crisis, giving both patients and nurses a sense of security. Future studies should explore how this impacts nurses' work environment and job satisfaction.
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Affiliation(s)
- Timmy Lindgren
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Josefine Westdahl
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Erika A Saliba-Gustafsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Lena Flyckt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Joachim Eckerström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
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Hultsjö S, Rosenlund H, Wadsten L, Wärdig R. Relatives' experiences of brief admission in borderline personality disorder and self-harming behaviour. Nurs Open 2023; 10:2338-2348. [PMID: 36403239 PMCID: PMC10006650 DOI: 10.1002/nop2.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/03/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of this study is to describe experiences of brief admission (BA) of people with borderline personality disorder and self-harming behaviour, from the perspective of their relatives. DESIGN A descriptive qualitative design was chosen. METHODS Twelve relatives of people with borderline personality disorder and self-harming behaviour who had access to BA were interviewed. Data were analysed with qualitative conventional content analysis. RESULTS One overarching category: Hope for the future and three categories occurred: Breathing space, Personal responsibility and Structure. BA created hope for the future and the relatives appreciated that BA is a freer and easily accessible form of care that enables help at an early stage, compared with usual care. When BA functions, the structure and pre-determined days of care give relatives a breathing space, and the uncertainty diminishes for the children, as the parent can still be present during inpatient care. The lack of places was described as a disadvantage of BA.
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Affiliation(s)
- Sally Hultsjö
- Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden
| | - Hanna Rosenlund
- Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden
| | - Lisa Wadsten
- Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden
| | - Rikard Wärdig
- Division of Nursing and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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