1
|
Grenyer BFS, Bailey RC. Implementing a whole-of-service stepped care approach to personality disorder treatment: Impact of training and service redesign on clinician attitudes and skills. Personal Ment Health 2024; 18:93-106. [PMID: 38504144 DOI: 10.1002/pmh.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 09/16/2023] [Indexed: 03/21/2024]
Abstract
Personality disorders are a highly prevalent mental health condition. Historically, clinician attitudes have been negative, and only a small number have specialised training. This study evaluated clinician attitudes and confidence in working with people with personality disorder following the combination of training and implementation of a stepped care whole-of-service approach. A total of 102 multidisciplinary mental health clinicians were trained to implement the stepped care approach, and completed surveys prior to implementation and at 12 months follow up. Clinicians delivered manualised structured psychological therapy as part of the model. Measures assessed changes in attitudes and confidence, and impact of the service changes and therapy approach. Qualitative responses elucidated core themes. Evaluation at 12 months post training and service redesign showed improvements in clinician skills, confidence, theoretical knowledge and attitudes. Qualitative thematic analysis found core themes of improved understanding, clinical skills and improvements in the accessibility and timeliness of treatment. Implementing a whole-of-service model featuring stepped care therapies enhanced clinician attitudes, confidence, skills and knowledge in working with people with personality disorders. Clinicians identified that the whole-of-service model also improved accessibility to treatment, and quality of clinical care to the consumer and their carers.
Collapse
Affiliation(s)
- Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rachel C Bailey
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
2
|
Campbell C, Dodd J, Francetic I. Outcomes for university students following emergency care presentation for deliberate self-harm: a retrospective observational study of emergency departments in England for 2017/2018. BMJ Open 2024; 14:e078672. [PMID: 38320836 PMCID: PMC10860022 DOI: 10.1136/bmjopen-2023-078672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Identify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm. DESIGN Retrospective cross-sectional observational study. SETTING Patients visiting 129 public hospital emergency departments across England between April 2017 and March 2018. PARTICIPANTS 14 074 patients aged 18-23 visiting emergency departments for conditions linked to deliberate self-harm, 1016 of which were identified as university-aged students. OUTCOME MEASURES We study various outcomes across the entire patient pathway in the emergency department: waiting time to initial assessment on arrival at the emergency department, count of investigations delivered, discharge destination (patients refusing treatment or leave before being seen, referred to another provider or admitted to inpatient care, discharged with no follow-up) and unplanned follow-up visit within 7 days. RESULTS We find a statistically significant difference of 0.262 (-0.491 to -0.0327) less investigations delivered to students compared with non-students (about 8% compared with the baseline number of investigations for non-students). Stratified analyses reveal that this difference is concentrated among students visiting the emergency department outside of regular working hours (-0.485 (-0.850 to -0.120)) and students visiting for repeated deliberate self-harm episodes (-0.881 (-1.510 to -0.252)). Unplanned reattendance within 7 days is lower among students visiting emergency departments during out of hours (-0.0306 (-0.0576 to -0.00363)), while students arriving by ambulance are less likely to be referred to another provider (-0.0708 (-0.140 to -0.00182)) compared with non-students. CONCLUSIONS We find evidence of less-intense investigations being delivered to patients aged 18-23 identified as students compared with non-students visiting emergency departments after an episode of deliberate self-harm. Given the high risk of suicide attempts after episodes of deliberate self-harm among students, our findings may highlight the need for more focused interventions on this group of patients.
Collapse
Affiliation(s)
- Catherine Campbell
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Joe Dodd
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Igor Francetic
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Dubov A, Krakower DS, Rockwood N, Montgomery S, Shoptaw S. Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs. J Gen Intern Med 2023; 38:2928-2935. [PMID: 36964426 PMCID: PMC10593689 DOI: 10.1007/s11606-023-08040-7] [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] [Received: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Multiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers' (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use. METHODS We conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians' explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments. RESULTS A minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs' intent to prescribe PrEP to PWID. CONCLUSIONS PCPs' bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.
Collapse
Affiliation(s)
- Alex Dubov
- School of Behavioral Health, Loma Linda University, Loma Linda, CA USA
| | - Douglas S. Krakower
- Division of Infectious Diseases, Department of Population Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Nicholas Rockwood
- School of Behavioral Health, Loma Linda University, Loma Linda, CA USA
| | | | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA USA
| |
Collapse
|
4
|
Revisiting Social Stigma in Non-suicidal Self-injury: A Narrative Review. CONSORTIUM PSYCHIATRICUM 2022. [DOI: 10.17816/cp196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is highly prevalent in our community. Yet, there is a significant discrepancy between the number of individuals engaging in NSSI and those who seek treatment for NSSI. This discrepancy can be due to the high social stigma associated with the behavior. The impact of NSSI stigma is significant and can impair the quality of life in the individuals engaging in NSSI, delay help-seeking, reduce access to mental health care and further fuel misinformation. Even though the symptomatology, risks, and demographics of NSSI have received attention in terms of research, there is limited literature on NSSI stigma and its consequences. With that background set, this review provides a birds-eye view of the different levels of stigma in NSSI (public, self, and health care), associated discrimination, the various aspects of such stigmatization (NSSI-related language, physical scarring, misinformation, the media), and, finally, the collaborative clinical-outreach interventions for mitigating NSSI-associated social stigma. If NSSI is indeed recognized as a clinical disorder, future research would need to focus on these constructs of stigma and treat them with the same importance as the one given to clinical studies of intervention and symptomatology in NSSI.
Collapse
|
5
|
Poyraz Fındık OT, Erdoğdu AB, Fadıloğlu E, Rodopman Arman A. Emergency Department Visits for Non-suicidal Self-harm, Suicidal Ideation, and Suicide Attempts in Children and Adolescents. Child Psychiatry Hum Dev 2022; 53:289-299. [PMID: 33523341 DOI: 10.1007/s10578-021-01125-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Self-harm presentations to emergency departments (ED) have become a growing concern, yet little is known about self-harm visits in pediatric EDs. This study aimed to investigate the clinical and demographic characteristics of patients who presented to the pediatric ED between 2012 and 2017 with non-suicidal self-harm (NSSH, n = 63, 60.3% female, M = 14.25 years), suicidal ideation (SI, n = 75, 57.3% female, M = 14.83 years), and suicide attempts (SA, n = 461, 82.9% female, M = 15.41 years). Also, predictors of SA were investigated. Of the patients, 79.4% had at least a psychiatric disorder. Depression was the most common diagnosis in the SI and SA groups, and autism spectrum disorder and intellectual disability were the leading diagnoses in the NSSH group. Self-poisoning was the most common method, and older age, female sex, having relational problems, and prior or current psychiatric admissions were the most important predictive factors of SA. NSSH, SI, and SA exhibit different features in early life. EDs provide an important opportunity for initiating developmentally appropriate interventions to reduce future risks.
Collapse
Affiliation(s)
- Onur Tuğçe Poyraz Fındık
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Pendik Research and Training Hospital, Istanbul, Turkey.
| | - Ayşe Burcu Erdoğdu
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Eray Fadıloğlu
- Child and Psychiatry Clinic, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Ayşe Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Lee SE, Yim M, Hur JW. Beneath the surface: Clinical and psychosocial correlates of posting nonsuicidal self-injury content online among female young adults. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Ruybal AL, Siegel JT. Increasing social support for women with postpartum depression through attribution theory guided vignettes and video messages: The understudied role of effort. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2021. [DOI: 10.1016/j.jesp.2021.104197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Chakraborti K, Arensman E, Leahy D. The Experience and Meaning of Repeated Self-Harm Among Patients Presenting to Irish Hospital Emergency Departments. Issues Ment Health Nurs 2021; 42:942-950. [PMID: 33978551 DOI: 10.1080/01612840.2021.1913681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-harm is a global public health concern in terms of increasing morbidity in addition to causing considerable financial implications for the health sector. Patients presenting with a history of self-harm are at increased risk of self-harm repetition and suicide. Research exploring the patient's experience of engaging in multiple self-harm episodes is lacking. This study aimed to explore the experiences and meaning of self-harm repetition, among patients who presented to three urban hospital emergency departments in Ireland. METHOD A subset of participants with a history of five or more self-harm attempts from an ongoing study, 'Improving Prediction and Risk Assessment of Self-Harm and Suicide' was selected for this article. Interview transcripts from four participants were selected for analysis using Interpretative Phenomenological Analysis. The qualitative software package NVivo 11 was used to store and organise data into themes. RESULTS Data were analysed based on four participants (two males and two females) ranging in age from 25 to 56 years. Three of the four participants reported a history of early traumatic emotional, physical and sexual abuse. Four superordinate themes were generated from the data, 'Significance of self-harm to the person', 'Trajectory of self-harm progression', 'Impact of abuse in adult life' and 'The road to recovery'. CONCLUSION Self-harm was used as a coping mechanism for participants who experienced distressing life events such as emotional and sexual abuse. The qualitative themes identified in this study have implications for the development of adequate medical and mental health support systems for patients with histories of repeated self-harm.
Collapse
Affiliation(s)
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Dorothy Leahy
- Clinical Psychology, School of Psychology, University College Dublin, Dublin Ireland
| |
Collapse
|
9
|
Sandel DB, Jomar K, Johnson SL, Dickson JM, Dandy S, Forrester R, Taylor PJ. Beliefs About One's Non-Suicidal Self-Injury: The Experiences of Self-Injury Questionnaire (ESIQ). Arch Suicide Res 2021; 25:458-474. [PMID: 31997727 DOI: 10.1080/13811118.2020.1712285] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The goal of this study was to develop and validate a measure of self-rated positive and negative beliefs about one's non-suicidal self-injury (NSSI), the Experiences of Self-Injury Questionnaire (ESIQ). METHOD Psychometric properties and validation against NSSI severity and shame were tested in two U.S. and two U.K. samples of individuals who endorsed a history of NSSI. RESULTS Exploratory and confirmatory factor analyses indicated five factors. Subscales were labeled Positive Beliefs, Personal Dislike, Interpersonal Concern, Emotional Suppression, and Emotional Expression. The Positive Beliefs Subscale covers beliefs that NSSI is valuable. Scores on this subscale were associated with endorsement of NSSI frequency, NSSI urges, and perceived likelihood of future NSSI. Other subscales showed validity in that they all showed unique effects on outcome indices of NSSI severity or shame. CONCLUSION The ESIQ shows promise as a brief reliable measure of beliefs about and experiences of NSSI.
Collapse
|
10
|
Hao J, Li W, Li J, Liu Y. Why are we unwilling to help sometimes? Reconsideration and integration of the attribution-affect model and the arousal: cost-reward model. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Gray N, Hasking P, Boyes ME. The impact of ambivalence on recovery from non-suicidal self-injury: considerations for health professionals. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-07-2020-0093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Non-suicidal self-injury (NSSI) is a growing public health concern. Continued NSSI is often associated with negative outcomes, yet the behaviour usually serves a purpose for individuals who self-injure (e.g. emotional relief). As such, individuals who self-injure often experience ambivalence about the behaviour. The purpose of this paper is to highlight the importance of recognising ambivalence as a natural and expected part of the recovery process.
Design/methodology/approach
This paper draws on literature regarding NSSI recovery, ambivalence towards stopping the behaviour and challenges for both clients and health professionals.
Findings
This paper argues that ambivalence towards self-injury can be challenging for both clients and health professionals. Clients may feel shame and sense of failure if they experience a setback; health professionals may experience frustration towards clients who continue to self-injure despite treatment.
Originality/value
Validation of the clients’ experience can have significant positive outcomes in treatment and help-seeking behaviours. Acknowledgement of client ambivalence during the recovery process will serve to validate clients’ experience and facilitate rapport. Health professionals who accept ambivalence as a natural part of the recovery process may experience less frustration with clients who continue to self-injure.
Collapse
|
12
|
Michaud L, Greenway KT, Corbeil S, Bourquin C, Richard-Devantoy S. Countertransference towards suicidal patients: a systematic review. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01424-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractCountertransference towards suicidal patients may blur healthcare professionals’ clinical judgment and lead to suboptimal decision-making. We conducted a systematic review of the quantitative studies on this topic. Following PRISMA guidelines, various databases were searched for studies measuring countertransference in healthcare professionals treating suicidal patients. Two authors independently performed screening and the quality of included studies was formally assessed. Ten studies were identified (3/5/2 of low/intermediate/high quality, respectively). Cross-sectional studies showed evidence for specific and adverse countertransference (e.g., disinterest, anxiety, overwhelming, rejection, helplessness or distress) towards suicidal patients. Furthermore, countertransference was prospectively associated with suicidal behavior and ideation in studies that explored this issue, but the meaning of this association remains to be clarified. Healthcare professionals’ characteristics (e.g. professional background, gender, personality traits) influenced countertransference. Suicidal patients elicit adverse countertransference, which should be addressed in clinical practice and through dedicated training.
Collapse
|
13
|
Moran R, Gutman LM. Mental health training to improve communication with children and adolescents: A process evaluation. J Clin Nurs 2020; 30:415-432. [PMID: 33141507 DOI: 10.1111/jocn.15551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE To characterise the intervention components, mechanisms of change and barriers to implementation of an intervention to improve communication behaviour of hospital staff surrounding mental health with children and adolescents. BACKGROUND Healthcare professionals consistently report a lack of confidence and knowledge to care for young people experiencing mental health difficulties. We Can Talk is a one-day training, delivered to hospital staff, which provides tools to improve their communication with children and adolescents about mental health. Initial evaluation suggests the training improved confidence and skills regarding communication; however, the effective intervention components and mechanisms of change are not yet understood. DESIGN A process evaluation was conducted using a qualitative research design. METHODS Document analysis of the training manual, using the Behaviour Change Technique Taxonomy, characterised intervention components. Ten interviews with paediatric staff from an east London hospital were conducted post-intervention. Using the Theoretical Domains Framework, the mechanisms of change and remaining barriers to communication were coded thematically. COREQ checklist was used in the reporting of the study. RESULTS Twenty behaviour change techniques were identified. Communication about mental health was mainly facilitated through improving the knowledge, cognitive and interpersonal skills, and beliefs about capabilities of healthcare professionals. A small number of staff continued to experience barriers to communication including a lack of opportunity for communication, beliefs that their professional role is not suited to supporting mental health and nervousness. Behaviour change techniques are highlighted to address remaining barriers reported post-intervention. CONCLUSIONS Using validated and systematic behaviour change tools, this process evaluation contributes to the translation of evidence to clinical practice for more effective, sustainable and transparent mental health care, reducing the research-practice gap in this area. RELEVANCE TO CLINICAL PRACTICE These findings can facilitate implementation of evidence-based practice and inform interventions, improving clinical practice and outcomes for children and adolescents.
Collapse
Affiliation(s)
- Rachel Moran
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Leslie Morrison Gutman
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| |
Collapse
|
14
|
Gagnon J, Hasking PA. Australian psychologists' attitudes towards suicide and self‐harm. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/j.1742-9536.2011.00030.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Gagnon
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Penelope A. Hasking
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
15
|
Wilson N, Langan-Martin J. Burnout and attitudes toward deliberate self harm amongst UK junior doctors. PSYCHOL HEALTH MED 2020; 26:162-176. [PMID: 33125265 DOI: 10.1080/13548506.2020.1840599] [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] [Indexed: 10/23/2022]
Abstract
Deliberate self-harm (DSH) is a major global health problem and a significant risk factor for death by suicide. Despite this, those who suffer are often confronted with negative attitudes from healthcare professionals whilst seeking help, with detrimental consequences for treatment outcomes. While several factors may affect attitudes to DSH amongst healthcare professionals, there is now growing evidence to suggest an association with burnout. As current levels of burnout amongst junior doctors are estimated to be high, understanding the nature of this association is crucial. The over-arching aim of this project is therefore to explore junior doctors' attitudes toward DSH in comparison with other presenting conditions and to explore any possible relationship these may have with features of burnout. We conducted an online cross-sectional survey of junior doctors working within NHS Greater Glasgow and Clyde. After collecting sociodemographic information, participants were presented with both the abbreviated Maslach Burnout Inventory and the Medical Condition Regard Scale for patients presenting with; Chronic Obstructive Pulmonary Disease (COPD), Type I Diabetes Mellitus (T1DM), Schizophrenia and DSH. Significant differences in attitudes according to presenting complaints/conditions were identified. Participants reported the highest regard for TIDM and lowest regard for DSH, varying as a function of speciality and years of NHS service. 21% of participants were experiencing 'burnout' to a high degree, and scores also varied as a function of speciality and years of NHS service. No association between burnout and attitudes were observed for any of the investigated diagnoses. Our findings highlight the desperate need for evidence-based interventions to address burnout and negative attitudes toward DSH amongst junior doctors. Moreover, they may suggest that these attitudes worsen through the course of junior doctor training. We would therefore advocate for further research to assess the efficacy of interventions designed to address this.
Collapse
Affiliation(s)
- N Wilson
- Department of Health and Well-being, University of Glasgow , Glasgow, Scotland
| | - J Langan-Martin
- Department of Health and Well-being, University of Glasgow , Glasgow, Scotland
| |
Collapse
|
16
|
Abstract
The current study examined how the theory of planned behavior (TPB) constructs predict college students' intent to ask about suicide and refer a potentially suicidal peer to support. Using an experimental design, 420 college students (Mage = 19.61, SD = 1.50 yrs) were randomly assigned to read one of four vignettes depicting a peer in distress that varied suicide risk severity (low vs. high) and perceived causes of the distress (internal vs. external). Participants read their vignette and answered questions measuring TPB constructs and items assessing intent to ask about suicide and intent to refer the peer to services. Results indicated that subjective norms were associated with intent to ask about suicide and attitudes impact intent to refer. Only the interaction between risk severity and perceived behavioral control in predicting intent to refer and intent to ask were significant. Peers who perceive risk to be high are more likely to refer peers regardless of perceived behavioral control and are increasingly more likely to ask about suicide as perceived behavioral control increases. When risk severity is low and perceived behavioral control is low, peers are less likely to refer or ask about suicide. The theory of planned behavior has relevance to understanding peer intent to intervene with an at-risk peer and may be beneficial to guiding the development of effective suicide prevention programs.
Collapse
|
17
|
Park Y, Mahdy JC, Ammerman BA. How others respond to non‐suicidal
self‐injury
disclosure: A systematic review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2020. [DOI: 10.1002/casp.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yeonsoo Park
- Department of Psychology University of Notre Dame Notre Dame Indiana USA
| | - Jasmine C. Mahdy
- Department of Psychology University of Guelph Guelph Ontario Canada
| | - Brooke A. Ammerman
- Department of Psychology University of Notre Dame Notre Dame Indiana USA
| |
Collapse
|
18
|
Traina G, Feiring E. 'There is no such thing as getting sick justly or unjustly' - a qualitative study of clinicians' beliefs on the relevance of personal responsibility as a basis for health prioritisation. BMC Health Serv Res 2020; 20:497. [PMID: 32493300 PMCID: PMC7268691 DOI: 10.1186/s12913-020-05364-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Concerns have been raised regarding the reasonableness of using personal health responsibility as a principle or criterion for setting priorities in healthcare. While this debate continues, little is known about clinicians' views on the role of patient responsibility in clinical contexts. This paper contributes to the knowledge on the empirical relevance of personal responsibility for priority setting at the clinical level. METHODS A qualitative study of Norwegian clinicians (n = 15) was designed, using semi-structured interviews with vignettes to elicit beliefs on the relevance of personal responsibility as a basis for health prioritisation. Sampling was undertaken purposefully. The interviews were conducted in three hospital trusts in South-Eastern Norway between May 2018 and February 2019 and were analysed with conceptually driven thematic analysis. RESULTS The findings suggest that clinicians endorsed a general principle of personal health responsibility but were reluctant to introduce personal health responsibility as a formal priority setting criterion. Five main objections were cited, relating to avoidability, causality, harshness, intrusiveness, and inequity. Still, both retrospective and prospective attributions of personal responsibility were perceived as relevant in specific clinical settings. The most prominent argument in favour of personal health responsibility was grounded in the idea that holding patients responsible for their conduct would contribute to the efficient use of healthcare resources. Other arguments included fairness to others, desert and autonomy, but such standpoints were controversial and held only marginal relevance. CONCLUSIONS Our study provides important novel insights into the clinicians' beliefs about personal health responsibility improving the empirical knowledge concerning its fairness and potential applications to healthcare prioritisation. These findings suggest that although personal health responsibility would be difficult to implement as a steering criterion within the main priority setting framework, there might be clinical contexts where it could figure in prioritisation practices. Additional research on personal health responsibility would benefit from considering the multiple clinical encounters that shape doctor-patient relationships and that create the information basis for eligibility and prioritisation for treatment.
Collapse
Affiliation(s)
- Gloria Traina
- Department of Health Management and Health Economics, University of Oslo, Post box 1089 Blindern, 0317, Oslo, Norway.
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Post box 1089 Blindern, 0317, Oslo, Norway
| |
Collapse
|
19
|
Michaud L, Ligier F, Bourquin C, Corbeil S, Saraga M, Stiefel F, Séguin M, Turecki G, Richard-Devantoy S. Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders. J Affect Disord 2020; 265:669-678. [PMID: 32090784 DOI: 10.1016/j.jad.2019.11.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). METHODS Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. RESULTS Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). LIMITATIONS Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. CONCLUSIONS Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.
Collapse
Affiliation(s)
- Laurent Michaud
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland.
| | - Fabienne Ligier
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Pôle Universitaire de Psychiatrie de l'enfant et de l'adolescent - Centre Psychothérapique de Nancy, Laxou, France
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Sylvie Corbeil
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Michael Saraga
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Monique Séguin
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Canada
| | - Gustavo Turecki
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| |
Collapse
|
20
|
Guzmán EM, Tezanos KM, Chang BP, Cha CB. Examining the impact of emergency care settings on suicidal patients: A call to action. Gen Hosp Psychiatry 2020; 63:9-13. [PMID: 30077397 DOI: 10.1016/j.genhosppsych.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The emergency department (ED) offers a critical and unique opportunity to assess and intervene on suicide risk. Despite its potential benefits, the ED setting presents several potential sources of stress. The present paper calls attention to how suicidal patients may be especially vulnerable to stressful ED experiences. METHOD This research synthesis cites the growing literature on ED-related stressors, as they have been shown to affect both psychiatric and nonpsychiatric patient populations. RESULTS We identified specific interpersonal, physical, and temporal features of the ED that have been shown to affect multiple patient populations, including suicidal individuals. Beyond this, there appears to be broad underutilization of therapeutic care in ED settings. CONCLUSIONS It is important to consider how the ED setting may be both helpful and harmful toward suicidal patients. We conclude with recommended domains of study and methodological considerations when pursuing these future directions. The proposed research agenda would help address this known high risk period around hospitalization and discharge, and ultimately optimize suicide prevention efforts.
Collapse
Affiliation(s)
- Eleonora M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Katherine M Tezanos
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, United States of America
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America.
| |
Collapse
|
21
|
Douglas C, Standard-Goldson A, James K, Abel W. Nurses' perception of preparedness for moving mental health care from psychiatric to general hospitals in Jamaica. Rev Panam Salud Publica 2019; 42:e158. [PMID: 31093186 PMCID: PMC6385992 DOI: 10.26633/rpsp.2018.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives To examine nurses' perception of readiness to care for patients with mental illness at two general hospitals in St. Catherine, Jamaica. Methods This mixed-methods, cross-sectional study was conducted among nurses on the medical wards of two hospitals. A 39-item, self-administered questionnaire containing open- and closed-ended questions and personal interviews was used to assess the nurses' preparedness to care for mentally ill patients; their awareness regarding protocol for care of mentally ill patients; their attitudes towards the integration of mental health care into the general hospital setting; and any associations between these and select variables, e.g., education level, work experience; and perceptions of the integration process. Results In all, 105 nurses completed the questionnaire (response rate: 80%) and six nursing supervisors were interviewed. Almost all (99%) felt the ward was unsuitable for admitting mentally ill patients; 95% felt inadequately prepared; and 73% were not aware that a standard management protocol for treating patients with mental illness was available. Staff training was deemed important. It was felt that a special area should be established for managing mentally ill patients. Conclusions The shift of mental health services was a strategic policy decision aligned with the recommendations and support of the Pan American Health Organization. This study shows the need for medication, equipment, implementation of standard operating procedures, adequate accommodation for patients, and staff trained to provide quality care for patients with mental illness.
Collapse
Affiliation(s)
- Claudine Douglas
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies Mona Campus, Kingston, Jamaica
| | - Aileen Standard-Goldson
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies Mona Campus, Kingston, Jamaica
| | - Kenneth James
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies Mona Campus, Kingston, Jamaica
| | - Wendel Abel
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies Mona Campus, Kingston, Jamaica
| |
Collapse
|
22
|
Goldstone D, Bantjes J. Mental health care providers talk about their experiences preventing suicide in people with substance use disorders in South Africa: implications for clinical practice. Int J Psychiatry Clin Pract 2019; 23:40-48. [PMID: 29448854 DOI: 10.1080/13651501.2018.1438628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study explored mental health care providers' experiences of preventing suicide in people with substance use disorders and their perceptions of factors related to clinical practice that contributed to these experiences. METHODS In-depth, semistructured interviews were conducted with 18 mental health care providers working in South Africa. Thematic analysis was used to analyse the data inductively with Atlas.ti software. RESULTS Participants described feeling hopeless, helpless, powerless and guilty and needed to debrief from their experiences of preventing suicide. They perceived their experiences to be related to the difficulties of treating substance use disorders, the difficulties of assessing and managing suicide risk and how treating substance use might increase suicide risk. CONCLUSIONS The ways in which mental health care providers think about suicide and make sense of their experiences affects their perceived abilities to prevent suicide. Educating mental health care providers to transcend the limitations of risk factor approaches to suicide prevention and utilise evidence-based strategies for treating substance use disorders and associated problems, may be important to empower them and make them feel competent in suicide prevention. Empowering people with substance use disorders may help prevent suicide and may require collaboration between mental health care providers and allied professionals.
Collapse
Affiliation(s)
- Daniel Goldstone
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Jason Bantjes
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| |
Collapse
|
23
|
Rayner G, Blackburn J, Edward KL, Stephenson J, Ousey K. Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis. Int J Ment Health Nurs 2019; 28:40-53. [PMID: 30387232 DOI: 10.1111/inm.12550] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 12/01/2022]
Abstract
Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.
Collapse
Affiliation(s)
- Gillian Rayner
- Department of Counselling and Psychotherapy, School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, UK
| | - Joanna Blackburn
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Karen-Leigh Edward
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.,School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria
| | - John Stephenson
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.,School of Nursing, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
24
|
Zaninotto L, Qian J, Sun Y, Bassi G, Solmi M, Salcuni S. Gender, Personality Traits and Experience With Psychiatric Patients as Predictors of Stigma in Italian Psychology Students. Front Public Health 2018; 6:362. [PMID: 30619803 PMCID: PMC6305330 DOI: 10.3389/fpubh.2018.00362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/26/2018] [Indexed: 01/19/2023] Open
Abstract
A sample of undergraduate Psychology students (n = 1005), prevalently females (82.4%), mean age 20.5 (sd 2.5), was examined regarding their attitudes toward people suffering from mental illness. The survey instrument included a brief form for demographic variables, the Attribution Questionnaire-9 (AQ-9), the Ten Items Personality Inventory (TIPI), and two questions exploring attitudes toward open-door and restraint-free policies in Psychiatry. Higher levels of stigmatizing attitudes were found in males (Pity, Blame, Help, and Avoidance) and in those (76.5%) who had never had any experience with psychiatric patients (Danger, Fear, Blame, Segregation, Help, Avoidance and Coercion). A similar trend was also found in those who don't share the policy of no seclusion/restraint, while subjects who are favorable to open-door policies reported higher Coercion scores. No correlations were found between dimensions of stigma and personality traits. A machine learning approach was then used to explore the role of demographic, academic and personality variables as predictors of stigmatizing attitudes. Agreeableness and Extraversion emerged as the most relevant predictors for blaming attitudes, while Emotional Stability and Openness appeared to be the most effective contributors to Anger. Our results confirmed that a training experience in Psychiatry might successfully reduce stigma in Psychology students. Further research, with increased generalizability of samples and more reliable instruments, should address the role of personality traits and gender on attitudes toward people suffering from mental illness.
Collapse
Affiliation(s)
- Leonardo Zaninotto
- Department of Mental Health, Local Health Unit n. 6 (“Euganea”), Padova, Italy
| | - Jia Qian
- Department of Information Engineering, University of Padova, Padova, Italy
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Yao Sun
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Giulia Bassi
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| |
Collapse
|
25
|
Day NJS, Hunt A, Cortis-Jones L, Grenyer BFS. Clinician attitudes towards borderline personality disorder: A 15-year comparison. Personal Ment Health 2018; 12:309-320. [PMID: 30094955 DOI: 10.1002/pmh.1429] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/11/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022]
Abstract
Stigma towards people with borderline personality disorder has been a common theme reported within mental health services staff. A longitudinal, mixed method design investigated attitudes of mental health staff working at the same public health service in 2000 and 2015. Participants from both the 2000 and 2015 samples completed a short 10-item version of the Attitude to Personality Disorders Questionnaire and identical qualitative questions. The 2015 sample also completed the Attitude to Deliberate Self-Harm Questionnaire and the Attitude and Skills Questionnaire. Qualitatively, the 2000 sample endorsed much more negative descriptions (e.g. 'attention seeking' and 'manipulative'), and the 2015 sample focused more on treatment approaches and skills (e.g. 'management plan' and 'empathy'). Quantitatively, the 2015 sample endorsed more positive attitudes than the 2000 sample. This positive attitudinal shift is an encouraging step in successful treatment of borderline personality disorder and may reflect a changing landscape of the mental health system and greater awareness and use of effective treatments. © 2018 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Nicholas J S Day
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Annalise Hunt
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Louise Cortis-Jones
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
26
|
Lloyd B, Blazely A, Phillips L. Stigma towards individuals who self harm: impact of gender and disclosure. JOURNAL OF PUBLIC MENTAL HEALTH 2018. [DOI: 10.1108/jpmh-02-2018-0016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Non-suicidal self-injury (NSSI) is reasonably common, particularly among young people with prevalence rates of up to 25 per cent reported. Many factors contribute towards NSSI, including depression, anxiety and history of abuse and NSSI is a risk factor for suicide. Many people who engage in NSSI do not seek help, potentially due to concern about sigmatising attitudes. The purpose of this paper is to investigate the impact of gender and disclosure on stigmatising attitudes towards individuals who engage in NSSI.
Design/methodology/approach
Participants were 384 first-year university students (77.4 per cent female; mean age 19.50 years (SD=3.53)) who completed measures of stigmatising attitudes in response to vignettes featuring individuals who engaged in self-harming behaviour. Vignettes varied in the gender of the individual as well as whether the NSSI was disclosed or not.
Findings
The results support the attribution model of public discrimination in relation to NSSI stigma. Perceptions of higher personal responsibility for NSSI behaviour and higher levels of danger and manipulation were positively associated with stigmatizing attitudes and behaviours. Male research participants reported significantly higher levels of stigmatizing attitudes and behaviours than females.
Social implications
The level of stigmatising attitudes towards individuals who engage in NSSI is significant and may impact on help-seeking behaviour.
Originality/value
Between 10 and 25 per cent of adolescents engage in some form of NSSI, but only a minority seek help to address this behaviour. This study suggests that attitudes by peers may influence help-seeking. Further research is required outside of tertiary education settings.
Collapse
|
27
|
Butler A, Young JT, Kinner SA, Borschmann R. Self-harm and suicidal behaviour among incarcerated adults in the Australian Capital Territory. HEALTH & JUSTICE 2018; 6:13. [PMID: 30109499 PMCID: PMC6091405 DOI: 10.1186/s40352-018-0071-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/03/2018] [Indexed: 06/03/2023]
Abstract
BACKGROUND Suicide is the leading cause of death in prisons worldwide. Improved understanding of the factors associated with suicide is necessary to inform targeted suicide prevention and interventions. Here we aim to (a) document the prevalence of suicide attempts, suicidal ideation, self-harm, and mental disorder; and (b) identify demographic, mental health, and criminal justice correlates of suicidal ideation, in a sample of incarcerated adults in Australia. METHODS Data were obtained from the 2016 Detainee Health and Wellbeing Survey conducted in the Alexander Maconochie Centre, the Australian Capital Territory's only adult prison. Interviews with 98 incarcerated adults were conducted in October 2016. Descriptive statistics were calculated for all measures. Crude differences between participants who reported experiencing suicidal ideation in their lifetime and those who did not were compared using Fisher's exact test. RESULTS Nearly half of the participants (48%, n = 47) reported lifetime suicidal ideation and 31% (n = 30) reported attempting suicide at some point in their lives. Eighteen participants (18%) reported a lifetime history of having engaged in self-harm. Factors significantly associated with suicidal ideation included lifetime history of mental disorder, self-harm, experiencing a drug overdose, and being hospitalized in the past 12 months. CONCLUSION The burden of suicidal ideation and prior suicide attempts among people in prison is substantial. Incarceration is a pivotal opportunity to identify people with a history of mental health problems and target interventions aimed at reducing adverse outcomes including suicide mortality.
Collapse
Affiliation(s)
- Amanda Butler
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC Canada
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jesse T. Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Stuart A. Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
- Griffith Criminology Institute, Griffith University, Mt Gravatt, Australia
- Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
- Health Service and Population Research Department; Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
28
|
Nielsen E, Townsend E. Public Perceptions of Self-Harm: Perceived Motivations of (and Willingness to Help in Response to) Adolescent Self-Harm. Arch Suicide Res 2018; 22:479-495. [PMID: 28980884 DOI: 10.1080/13811118.2017.1358223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated public perceptions of, and responses to, adolescent self-harm-an under-researched topic, given that the majority of self-harm in this group is not disclosed to formal support services. Participants (N = 355, aged 18-67 years) were presented with 1 of 10 vignettes and completed self-report measures assessing perceived motivations for self-harm and helping/rejecting responses. Vignettes were manipulated across conditions for stated motivation, controllability of stated cause, and presentation format. Results indicate that stated motivation for self-harm, controllability of stated cause, and presentation format affect perceived motivations. Further, participants demonstrate an understanding of the complex nature of self-harm, indicating an appreciation that an individual may hold multiple motivations simultaneously. Perceived motivations for self-harm are associated with the endorsement of helping/rejecting behaviors. These relationships are important to explore, given the critical importance of initial responses to self-harm on subsequent disclosures and help-seeking.
Collapse
|
29
|
Briggs A. Nurses' attitudes to supporting people who are suicidal in emergency departments. Emerg Nurse 2018; 26:30-36. [PMID: 29726128 DOI: 10.7748/en.2018.e1785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
Abstract
The aim of this study is to determine emergency nurses' knowledge about, and perceived ability to support, people who are suicidal. A questionnaire consisting of 34 questions was sent out to 113 adult emergency nurses employed in two emergency departments. A total of 38 responded. Findings highlight differences in attitudes and show a correlation between suicide prevention training and nurses' perceived competence to triage people who are suicidal. The article makes recommendations for future research, as well as nurse education and training on suicide prevention, to improve attitudes and increase emergency nurses' ability to respond effectively to people who are suicidal.
Collapse
|
30
|
Heyland M, Delaney KR, Shattell M. Steps to Achieve Universal Suicide Screening in Emergency Departments: A Call to Action. J Psychosoc Nurs Ment Health Serv 2018; 56:21-26. [PMID: 29741746 DOI: 10.3928/02793695-20180503-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2018] [Indexed: 11/20/2022]
Abstract
American individuals attempt suicide at alarmingly high rates of approximately 1.1 million times per year. Yet the United States has failed to adopt a systematic approach to suicide prevention, particularly via universal screening. Given the increasing number of individuals with suicidal ideation presenting to emergency departments (EDs), all patients who present to the ED for treatment should be screened, as opposed to only individuals with mental health complaints. In the current article, barriers to suicide screening in the ED are discussed, as well as strategies to move ED providers toward the goal of universal screening. The current article entreats nurses to be leaders in achieving universal screening and provides practical actions to begin the process. Specific recommendations for action include improving training, increasing lethal means assessment, and achieving compliance with The Joint Commission suicide screening guidelines. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 21-26.].
Collapse
|
31
|
Borschmann R, Young JT, Moran P, Spittal MJ, Snow K, Mok K, Kinner SA. Accuracy and predictive value of incarcerated adults' accounts of their self-harm histories: findings froman Australian prospective data linkage study. CMAJ Open 2017; 5:E694-E701. [PMID: 28893844 PMCID: PMC5621944 DOI: 10.9778/cmajo.20170058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-harm is prevalent in prison populations and is a well-established risk factor for suicide. Researchers typically rely on self-report to measure self-harm, yet the accuracy and predictive value of self-report in prison populations is unclear. Using a large, representative sample of incarcerated men and women, we aimed to examine the level of agreement between self-reported self-harm history and historical medical records, and investigate the association between self-harm history and medically verified self-harm after release from prison. METHODS During confidential interviews with 1315 adults conducted within 6 weeks of expected release from 1 of 7 prisons in Queensland, Australia, participants were asked about the occurrence of lifetime self-harm. Responses were compared with prison medical records and linked both retrospectively and prospectively with ambulance, emergency department and hospital records to identify instances of medically verified self-harm. Follow-up interviews roughly 1, 3 and 6 months after release covered the same domains assessed in the baseline interview as well as self-reported criminal activity and contact with health care, social and criminal justice services since release. RESULTS Agreement between self-reported and medically verified history of self-harm was poor, with 64 (37.6%) of 170 participants with a history of medically verified self-harm disclosing a history of self-harm at baseline. Participants with a medically verified history of self-harm were more likely than other participants to self-harm during the follow-up period. Compared to the unconfirmed-negative group, the true-positive (adjusted hazard ratio [HR] 6.2 [95% confidence interval (CI) 3.3-10.4]), false-negative (adjusted HR 4.0 [95% CI 2.2-6.7]) and unconfirmed-positive (adjusted HR 2.2 [95% CI 1.2-3.9]) groups were at increased risk for self-harm after release from prison. INTERPRETATION Self-reported history of self-harm should not be considered a sensitive indicator of prior self-harm or of future self-harm risk in incarcerated adults. To identify those who should be targeted for preventive strategies, triangulation of data from multiple verifiable sources should be performed whenever possible.
Collapse
Affiliation(s)
- Rohan Borschmann
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Jesse T Young
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Paul Moran
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Matthew J Spittal
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Kathryn Snow
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Katherine Mok
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Stuart A Kinner
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| |
Collapse
|
32
|
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017; 18:19. [PMID: 28249596 PMCID: PMC5333436 DOI: 10.1186/s12910-017-0179-8] [Citation(s) in RCA: 1129] [Impact Index Per Article: 161.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
Collapse
Affiliation(s)
- Chloë FitzGerald
- Institute for Ethics, History, and the Humanities, Faculty of Medicine University of Geneva, Genève, Switzerland.
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine University of Geneva, Genève, Switzerland
| |
Collapse
|
33
|
Kumar N, Rajendra R, Majgi SM, Krishna M, Keenan P, Jones S. Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study. Indian J Psychol Med 2016; 38:547-552. [PMID: 28031591 PMCID: PMC5178039 DOI: 10.4103/0253-7176.194920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. METHODS A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). RESULTS Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. CONCLUSION There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.
Collapse
Affiliation(s)
- Narendra Kumar
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Rajagopal Rajendra
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Sumanth Mallikarjuna Majgi
- Department of Preventive and Social Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Murali Krishna
- Department of Psychiatry, Wellcome DBT Trust Research Fellow, Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, Karnataka, India
| | - Paul Keenan
- Postgraduate Studies Centre, Faculty of Health and Social Care, Edge Hill University, Aintree Campus, Liverpool, United Kingdom
| | - Steve Jones
- Postgraduate Studies Centre, Faculty of Health and Social Care, Edge Hill University, Aintree Campus, Liverpool, United Kingdom
| |
Collapse
|
34
|
Santos JC, Simões RMP, Erse MPQDA, Façanha JDN, Marques LAFA. Impact of "+Contigo" training on the knowledge and attitudes of health care professionals about suicide. Rev Lat Am Enfermagem 2016; 22:679-84. [PMID: 25296153 PMCID: PMC4292649 DOI: 10.1590/0104-1169.3503.2467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/08/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to evaluate the results of "+Contigo" training, developed by nurses and directed at 66 health professionals of integrated school health teams in Primary Health Care. METHOD quantitative with data collection through the Suicide Behavior Attitude Questionnaire, administered before and after the training. RESULTS significant increases were observed in suicide prevention knowledge and in changing attitudes of health professionals towards individuals with suicidal behavior. CONCLUSION these results allow us to affirm that nurses hold scientific and pedagogical knowledge that grant them a privileged position in the health teams, to develop training aimed at health professionals involved in suicide prevention.
Collapse
Affiliation(s)
| | - Rosa Maria Pereira Simões
- Casa de Saúde Rainha Santa Isabel, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Coimbra, Portugal
| | | | | | | |
Collapse
|
35
|
Alevriadou A, Pavlidou K. Teachers' interpersonal style and its relationship to emotions, causal attributions, and type of challenging behaviors displayed by students with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2016; 20:213-227. [PMID: 26283661 DOI: 10.1177/1744629515599108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
Teachers' interpersonal style is a new field of research in the study of students with intellectual disabilities and challenging behaviors in school context. In the present study, we investigate emotions and causal attributions of three basic types of challenging behaviors: aggression, stereotypy, and self-injury, in relation to teachers' interpersonal style. One hundred and seventy seven Greek general and special educator teachers participated in the study by completing a three-scaled questionnaire. Statistical analysis revealed that the type of challenging behaviors affected causal attributions. According to regression analysis, emotions, teaching experience, expertise in special education, and gender explained a significant amount of variance in interpersonal style. Emotions were found to have a mediating role in the relationship between causal attributions and interpersonal style of "willingness to support," when challenging behaviors were attributed to stable causes or causes under the control of the individual with intellectual disabilities.
Collapse
|
36
|
Ward-Ciesielski EF, Schumacher JA, Bagge CL. Relations Between Nonsuicidal Self-Injury and Suicide Attempt Characteristics in a Sample of Recent Suicide Attempters. CRISIS 2016; 37:310-313. [DOI: 10.1027/0227-5910/a000400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Although nonsuicidal self-injury (NSSI) is known to be associated with increased risk of death by suicide and suicide attempts, minimal research has focused on comparing recent suicide attempters with and without NSSI on suicide attempt characteristics (frequency and severity of suicide attempts). Understanding how NSSI impacts suicide attempt characteristics can help providers to enhance their assessment and treatment strategies so as to prevent future suicidal behaviors. Aims: The present study investigated the extent to which a history of NSSI was related to the frequency and severity of suicide attempts in a sample of recent suicide attempters. Method: Participants included 171 adult patients who presented to the hospital within 24 hr of a suicide attempt. Information about their suicide attempts and NSSI was gathered using self-report questionnaires and interviews. Results: Suicide attempters with a history of NSSI reported significantly more suicide attempts and more suicide attempts requiring medical attention, after controlling for important clinical covariates. Conclusion: NSSI was uniquely associated with suicide attempt characteristics, highlighting the importance of NSSI in suicide assessment, prevention, and treatment efforts.
Collapse
Affiliation(s)
- Erin F. Ward-Ciesielski
- The University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson, MS, USA
- Hofstra University, Department of Psychology, Hempstead, NY, USA
| | - Julie A. Schumacher
- The University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson, MS, USA
| | - Courtney L. Bagge
- The University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson, MS, USA
| |
Collapse
|
37
|
Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study. Int Emerg Nurs 2016; 25:37-42. [DOI: 10.1016/j.ienj.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/05/2015] [Accepted: 07/16/2015] [Indexed: 11/23/2022]
|
38
|
Tapola V, Wahlström J, Lappalainen R. Effects of training on attitudes of psychiatric personnel towards patients who self-injure. Nurs Open 2016; 3:140-151. [PMID: 27708824 PMCID: PMC5047340 DOI: 10.1002/nop2.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/22/2016] [Indexed: 11/11/2022] Open
Abstract
Background Improving attitudes of personnel towards self‐injurious patients leads to better working alliance and contributes to better patient outcomes. Previous research into the improvement of these attitudes has recorded the need for specific training in evidence‐based assessment and treatment of self‐injurious patients. Aim The current study describes the attitudes towards self‐injurious patients among psychiatric personnel. The study also evaluates the effect of a structured clinical training program on psychiatric personnel's attitudes towards patients who self‐injure. It further examines whether age, education, frequency of self‐injurious patients contact, and work experience of the personnel are associated with the existing attitudes. Methods Psychiatric personnel (N = 50) attended a four‐day training program, presenting evidence‐based knowledge regarding self‐injury assessment and treatment, using group exercises and reflective learning principles. The personnel completed the Understanding Suicidal Patients Questionnaire (USP) anonymously PreTraining, on 17 January 2014, and PostTraining, on 20 June 2014. The mean differences as well as single USP items before and after the training were tested by unpaired t‐test. Two‐way ANOVA was used to test impact of background variables on the USP scores. Results The training program had statistically significant impact (P < 0·01) on the following individual items of the USP scale: Patients who have tried to commit suicide are usually treated well in my work unit (d = 1·02); A person who has made several suicide attempt is at greater risk of committing suicide (d = 0·64); Because the patients who have tried to commit suicide have emotional problems, they need the best possible treatment (d = 0·57). The results also suggested that the frequency of patient contact had impact on attitudes towards self‐injurious patients.
Collapse
Affiliation(s)
- Vojna Tapola
- Department of Psychology University of Jyväskylä P.O. 35 FI-40014 Jyväskylä Finland
| | - Jarl Wahlström
- Department of Psychology University of Jyväskylä P.O. 35 FI-40014 Jyväskylä Finland
| | - Raimo Lappalainen
- Department of Psychology University of Jyväskylä P.O. 35 FI-40014 Jyväskylä Finland
| |
Collapse
|
39
|
Halmer TC, Beall RC, Shah AA, Dark C. Health Policy Considerations in Treating Mental and Behavioral Health Emergencies in the United States. Emerg Med Clin North Am 2015; 33:875-91. [DOI: 10.1016/j.emc.2015.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Abstract
Abstract. Nonsuicidal self-injury (NSSI) is a prevalent, pervasive, clinically significant behavior in adolescents, frequently associated with serious social, physical, and psychological consequences. It is characterized by high comorbidity with various disorders. Therefore, NSSI has been included as a research diagnosis in the Diagnostic and statistical manual of mental disorders (5th ed., American Psychiatric Association (APA; 2013) ; DSM-5; Section 3), as a condition requiring further study for possible future official adoption. This is a positive step toward providing researchers with a uniform definition and criteria. This state-of-the-art article gives an overview of prevalence rates, comorbidity, clinical correlates, functions, and risk factors as well as treatment and dealing with adolescents with NSSI and their Internet activities. Furthermore, the association and differences between NSSI and suicidality as well as borderline personality disorder are reviewed. The article concludes with future directions for research, for example, the dimensional approach to classification of the Research Domain Criteria project.
Collapse
Affiliation(s)
- Tina In-Albon
- University of Koblenz-Landau, Clinical Child and Adolescent Psychology and Psychotherapy, Landau, Germany
| |
Collapse
|
41
|
Hay A, Majumder P, Fosker H, Karim K, O'Reilly M. The views and opinions of CAMHS professionals on their role and the role of others in attending to children who self-harm. Clin Child Psychol Psychiatry 2015; 20:289-303. [PMID: 24366958 DOI: 10.1177/1359104513514068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals' views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this.
Collapse
Affiliation(s)
| | | | - Hannah Fosker
- East Midlands Healthcare Workforce Deanery, Leicester, UK
| | | | | |
Collapse
|
42
|
Perboell PW, Hammer NM, Oestergaard B, Konradsen H. Danish emergency nurses' attitudes towards self-harm – a cross-sectional study. Int Emerg Nurs 2015; 23:144-9. [DOI: 10.1016/j.ienj.2014.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
|
43
|
Tapola V, Wahlström J, Kuittinen M, Lappalainen R. The co-occurrence of nonsuicidal and suicidal self-injurious acts in adult women: A pilot study of similarities and differences. NORDIC PSYCHOLOGY 2015. [DOI: 10.1080/19012276.2014.997784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
44
|
Rees N, Rapport F, Thomas G, John A, Snooks H. Perceptions of paramedic and emergency care workers of those who self harm: a systematic review of the quantitative literature. J Psychosom Res 2014; 77:449-56. [PMID: 25263398 DOI: 10.1016/j.jpsychores.2014.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The U.K. has one of the highest rates of self harm in Europe at 400 per 100,000 of population. Paramedics and emergency staff may be the first professionals encountered, therefore understanding their views and approaches to care is crucial. The aim of this study was to systematically review published quantitative literature relating to paramedic and emergency workers' perceptions and experiences of caring for people who self harm. METHODS CINAHL®, MEDLINE®, OVID ® and Psych INFO® databases were searched, PRISMA guidelines were followed, two researchers independently screened titles, abstracts and full papers against a priori eligibility criteria. Data synthesis was achieved by extracting and descriptively analysing study characteristics and findings. RESULTS 16 studies met inclusion criteria; one included ambulance staff, all used questionnaires. Training, policies and guidelines improved staff knowledge and confidence in caring for people who self harm. Limited access to training was reported, ranging from 75% to 90% of staff lacking any. Limited departmental guidelines were also reported. Staff in acute settings exhibited increased feelings of negativity, becoming less positive closer to front line care. Recent studies report positive attitudes amongst emergency staff. DISCUSSION Despite guidelines indicating need for education and policies to guide staff in self harm care, there is limited evidence of this happening in practice. The lack of literature including paramedics suggests a gap in our understanding about care for self harm patients. This gap warrants greater attention in order to improve care for patients who self harm in their first point of contact.
Collapse
Affiliation(s)
- Nigel Rees
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
| | - Frances Rapport
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Gareth Thomas
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Ann John
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Helen Snooks
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| |
Collapse
|
45
|
Clarke D, Usick R, Sanderson A, Giles-Smith L, Baker J. Emergency department staff attitudes towards mental health consumers: a literature review and thematic content analysis. Int J Ment Health Nurs 2014; 23:273-84. [PMID: 23980913 DOI: 10.1111/inm.12040] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Visits to the emergency department (ED) for mental health reasons account for 10-15% of all visits. Consumers of mental health ED services, however, report that they often feel sent to the back of the queue and that their mental health concerns are not taken seriously, suggesting that societal stigma has impacted their care in the ED. In this study, we systematically explore the research concerning the attitudes of ED professional staff towards those who present with issues related to mental health. Four themes emerge from the literature: consumer perspectives, whose tenor is generally one of negativity; staff-reported attitudes and influencing factors, such as age, experience, and confidence in working with mental health presentations; the environmental climate of the ED, which might not be conducive to good mental health care; and interventions that have been used to evaluate changes in attitudes.
Collapse
Affiliation(s)
- Diana Clarke
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | |
Collapse
|
46
|
Cleaver K, Meerabeau L, Maras P. Attitudes towards young people who self-harm: age, an influencing factor. J Adv Nurs 2014; 70:2884-96. [DOI: 10.1111/jan.12451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Karen Cleaver
- Faculty of Education & Health; University of Greenwich; London UK
| | - Liz Meerabeau
- Faculty of Education & Health; University of Greenwich; London UK
| | - Pam Maras
- Faculty of Education and Health; University of Greenwich; School of Health & Social Care; London UK
| |
Collapse
|
47
|
Grimholt TK, Haavet OR, Jacobsen D, Sandvik L, Ekeberg O. Perceived competence and attitudes towards patients with suicidal behaviour: a survey of general practitioners, psychiatrists and internists. BMC Health Serv Res 2014; 14:208. [PMID: 24886154 PMCID: PMC4048050 DOI: 10.1186/1472-6963-14-208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Competence and attitudes to suicidal behaviour among physicians are important to provide high-quality care for a large patient group. The aim was to study different physicians’ attitudes towards suicidal behaviour and their perceived competence to care for suicidal patients. Methods A random selection (n = 750) of all registered General Practitioners, Psychiatrists and Internists in Norway received a questionnaire. The response rate was 40%. The Understanding of Suicidal Patients Scale (USP; scores < 23 = positive attitude) and items about suicide in case of incurable illness from the Attitudes Towards Suicide Questionnaire were used. Five-point Likert scales were used to measure self-perceived competence, level of commitment, empathy and irritation felt towards patients with somatic and psychiatric diagnoses. Questions about training were included. Results The physicians held positive attitudes towards suicide attempters (USP = 20.3, 95% CI: 19.6–20.9). Internists and males were significantly less positive. There were no significant differences in the physicians in their attitudes toward suicide in case of incurable illness according to specialty. The physicians were most irritated and less committed to substance misuse patients. Self perceived competence was relatively high. Forty-three percent had participated in courses about suicide assessment and treatment. Conclusions The physicians reported positive attitudes and relatively high competence. They were least committed to treat patients with substance misuse. None of the professional groups thought that patients with incurable illness should be given help to commit suicide. Further customized education with focus on substance misuse might be useful.
Collapse
Affiliation(s)
- Tine K Grimholt
- Department of Acute Medicine, Oslo University Hospital, Pb, 4950 Nydalen, Oslo 0424, Norway.
| | | | | | | | | |
Collapse
|
48
|
Martin C, Chapman R. A mixed method study to determine the attitude of Australian emergency health professionals towards patients who present with deliberate self-poisoning. Int Emerg Nurs 2014; 22:98-104. [DOI: 10.1016/j.ienj.2013.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 11/16/2022]
|
49
|
Baker A, Wright K, Hansen E. A qualitative study exploring female patients' experiences of self-harm in a medium secure unit. J Psychiatr Ment Health Nurs 2013; 20:821-9. [PMID: 23216978 DOI: 10.1111/jpm.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/27/2022]
Abstract
This study utilized a social constructivist model and reports upon interviews conducted with five female patients in a medium secure service. Their perception of self-harm is considered. Six themes emerged from the data, 'the traumatized individual', 'interrupted maturation process', 'the hidden experience', 'crossing the line', 'individual and systemic repercussions', 'nascent potential protection'. In addition to the six themes that emerged, we concluded that, although individual perceptions of self-harm varied, commonalities existed across accounts and that individual formulation may assist both patients and staff to gain a personalized understanding, thus, enabling less harmful ways of coping to be established.
Collapse
Affiliation(s)
- A Baker
- Bronte House, Ashworth Hospital, Liverpool, Merseyside, UK
| | | | | |
Collapse
|
50
|
Giles GM, Scott K, Manchester D. Staff-reported antecedents to aggression in a post-acute brain injury treatment programme: what are they and what implications do they have for treatment? Neuropsychol Rehabil 2013; 23:732-54. [PMID: 23782342 PMCID: PMC3805424 DOI: 10.1080/09602011.2013.805147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Research in psychiatric settings has found that staff attribute the majority of inpatient aggression to immediate environmental stressors. We sought to determine if staff working with persons with brain injury-related severe and chronic impairment make similar causal attributions. If immediate environmental stressors precipitate the majority of aggressive incidents in this client group, it is possible an increased focus on the management of factors that initiate client aggression may be helpful. The research was conducted in a low-demand treatment programme for individuals with chronic cognitive impairment due to acquired brain injury. Over a six-week period, 63 staff and a research assistant reported on 508 aggressive incidents. Staff views as to the causes of client aggression were elicited within 72 hours of observing an aggressive incident. Staff descriptions of causes were categorised using qualitative methods and analysed both qualitatively and quantitatively. Aggression towards staff was predominantly preceded by (a) actions that interrupted or redirected a client behaviour, (b) an activity demand, or (c) a physical intrusion. The majority of aggressive incidents appeared hostile/angry in nature and were not considered by staff to be pre-meditated. Common treatment approaches can be usefully augmented by a renewed focus on interventions aimed at reducing antecedents that provoke aggression. Possible approaches for achieving this are considered.
Collapse
|