Recruiting and retaining participants in three randomised controlled trials of psychological interventions conducted on acute psychiatric wards: top ten tips for success

Suicide attempts in Martinique and Reunion Island and appointments no-show

OBJECTIVES

Studies on suicidal behaviors in the French overseas territories remain rare. Although mental health resources are limited, some patients identified as being at risk of suicide do not attend the specialist consultations scheduled after identification or screening. Thus, the objective of our study was, firstly to provide a descriptive profile of patients followed up for a suicide attempt in Martinique and Reunion Island, and secondly to explore the risk factors associated with appointments no-show during follow-up.

METHODS

We conducted an ancillary retrospective cross-sectional study using data from the APSOM study. Data were collected on 255 patients aged at least 16, admitted to hospital emergency departments after a suicide attempt and followed up in ambulatory care, including 137 in Martinique and 118 in Reunion Island. The characteristics of the sample were described by means [min, max] and proportions [95% confidence intervals]. Differences according to the presence of appointments no-show or not were analyzed using comparison tests of means and percentages (Chi2, Fisher and Wilcoxon). Factors associated with appointments no-show were analyzed using a bootstrapped multivariate logistic regression model.

RESULTS

The mean age of patients was 35 years [16-84 years]. Women were predominant with a sex ratio of 2.4:1 (71% women). Unemployment affected 37% [28%, 46%] of patients in Martinique and 49% [40%, 59%] in Reunion Island. Psychoactive substances consumption at the time of the suicidal act was observed in 36% [27%, 45%] of patients in Martinique and 34% [26%, 44%] in Reunion Island. The average number of suicide attempts was two per patient [1-20]. Finally, we found no significant association with appointments no-show except for center. Patients from Reunion Island were associated with better compliance than patients from Martinique (OR: 0.20 [0.05-0.65], P<0.012).

CONCLUSION

Our study provides a description of suicide attempts admitted to hospital and followed up in ambulatory care in two French overseas territories and suggests interesting approaches for adapting prevention strategies to the socioeconomic context and cultural realities of these territories, particularly outreach interventions for the most vulnerable patients.

Autopsy of a failed trial part 1: A qualitative investigation of clinician's views on and experiences of the implementation of the DAISIES trial in UK-based intensive eating disorder services

OBJECTIVE

The DAISIES trial, comparing inpatient and stepped-care day patient treatment for adults with severe anorexia nervosa was prematurely terminated in March 2022 due to poor recruitment. This qualitative study seeks to understand the difficulties faced during the trial by investigating stakeholders' views on and experiences of its implementation.

METHOD

Semi-structured interview and focus group transcripts, and trial management and oversight group meeting minutes from May 2020-June 2022 were analysed using thematic analysis. Participants were 47 clinicians and co-investigators involved with the DAISIES trial. The Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was applied to the interpretive themes to classify barriers and facilitators to implementation.

RESULTS

Five themes were identified: incompatible participation interests; changing standard practice; concerns around clinical management; systemic capacity and capability issues; and Covid-19 disrupting implementation. Applying the NASSS framework indicated the greatest implementation challenges to arise with the adopters (e.g. patients, clinicians), the organisational systems (e.g. service capacity), and the wider socio-political context (e.g. Covid-19 closing services).

CONCLUSIONS

Our findings emphasise the top-down impact of systemic-level research implementation challenges. The impact of the Covid-19 pandemic accentuated pre-existing organisational barriers to trial implementation within intensive eating disorder services, further limiting the capacity for research.