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Troya MI, Lonergan C, Cassidy E, Griffin E, Lovejoy SA, Mughal F, Russell V, Arensman E. Healthcare practitioners' views of self-harm management practices in older adults in Ireland: A qualitative study. Int J Geriatr Psychiatry 2024; 39:e6116. [PMID: 38925890 DOI: 10.1002/gps.6116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To explore healthcare practitioners' views on management practices of self-harm in older adults. METHODS Semi-structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included. Healthcare practitioners were recruited advertising via professional and clinical research networks, social media, and snowballing methods. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. RESULTS We conducted interviews with 20 healthcare practitioners from April to July 2023. Three main themes were generated: first, a perceived greater risk of suicide, and increased awareness of complexity in older adults' self-harm presentations. Second, integrated care as an avenue for improving the management of self-harm in older adults. Third, the importance of safety planning in risk assessments of older adults. CONCLUSIONS Healthcare practitioners viewed self-harm in older adults as complex, challenging, and associated with high suicide risk, approaching patients with care and caution. The need for integrated support and improved collaboration between relevant healthcare practitioners was identified. Suggestions were made for primary care having a lead role in identifying and managing older adults after self-harm. Increased mental health promotion and awareness of mental health and self-harm in this age group would help address current stigma and shame.
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Affiliation(s)
- M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Caoimhe Lonergan
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Sally Ann Lovejoy
- National Clinical Programme for Self-Harm and Suicide-Related Ideation, Office of the National Clinical Advisor and Group Lead, Dr. Steevens Hospital, Dublin, Ireland
| | | | - Vincent Russell
- National Clinical Programme for Self-Harm and Suicide-Related Ideation, Office of the National Clinical Advisor and Group Lead, Dr. Steevens Hospital, Dublin, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Steeg S, Mughal F, Kapur N, Gnani S, Robinson C. Social services utilisation and referrals after seeking help from health services for self-harm: a systematic review and narrative synthesis. BMJ PUBLIC HEALTH 2023; 1:e000559. [PMID: 38239434 PMCID: PMC7615544 DOI: 10.1136/bmjph-2023-000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Objectives Suicide prevention is a major public health challenge. Appropriate aftercare for self-harm is vital due to increased risks of suicide following self-harm. Many antecedents to self-harm involve social factors and there is strong rationale for social services-based self-harm aftercare. We aimed to review evidence for social service utilisation and referrals among people seeking help following self-harm. Design Systematic review with narrative synthesis. Data sources PubMed, PsycINFO, AMED, Social Policy and Practice, EMBASE, Medline, Web of Science, Social Care Online, citation lists of included articles and grey literature. Eligibility criteria Studies of people of any age in contact with health services following self-harm, with study outcomes including referrals to or utilisation of social workers and social services. Data extraction and synthesis Information was extracted from each included study using a proforma and quality was critically assessed by two reviewers. Narrative synthesis was used to review the evidence. Results From a total of 3414 studies retrieved, 10 reports of 7 studies were included. Study quality was generally high to moderate. All studies were based in emergency departments (EDs) and most were UK based. In studies based solely on ED data, low proportions were referred to social services (in most studies, 1%-4%, though it was up to 44% when social workers were involved in ED assessments). In one study using linked data, 15% (62/427) were referred to social services and 21% (466/2,205) attended social services over the subsequent 3-year period. Conclusions Overall, few patients were referred to social services after self-harm. Higher reported referral rates may reflect greater service availability, involvement of social workers in psychosocial assessments or better capture of referral activity. Social services-based and integrated approaches for self-harm aftercare are important future directions for suicide prevention. Improved links between social services and health services for people seeking support after self-harm are recommended.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Nav Kapur
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UK
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Implementation of national guidance for self-harm among general practice nurses: a qualitative exploration using the capabilities, opportunities, and motivations model of behaviour change (COM-B) and the theoretical domains framework. BMC Nurs 2023; 22:452. [PMID: 38041157 PMCID: PMC10693142 DOI: 10.1186/s12912-023-01360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Patients who self-harm may consult with primary care nurses, who have a safeguarding responsibility to recognise and respond to self-harm. However, the responses of nursing staff to self-harm are poorly understood, and opportunities to identify self-harm and signpost towards treatment may be missed. It is unclear how to support nursing staff to implement national guidelines. AIMS Among primary care nursing staff to: [1] Examine reported barriers and enablers to nurses' use of, and adherence to, national guidance for self-harm; and [2] Recommend potential intervention strategies to improve implementation of the NICE guidelines. METHODS Twelve telephone interviews partly structured around the capabilities, opportunities and motivations model of behaviour change (COM-B) were conducted with primary care nurses in the United Kingdom. The Theoretical Domains Framework was used as an analytical framework, while the Behaviour Change Wheel was used to identify exemplar behaviour change techniques and intervention functions. RESULTS Nursing staff identified a need to learn more about risk factors (knowledge), and strategies to initiate sensitive conversations about self-harm (cognitive and interpersonal skills) to support their professional competencies (professional role and identity). Prompts may support recall of the guidance and support a patient centred approach to self-harm within practices (memory, attention, and decision making). GPs, and other practice nurses offer guidance and support (social influences), which helps nurses to navigate referrals and restricted appointment lengths (environmental context and influences). CONCLUSIONS Two converging sets of themes relating to information delivery and resource availability need to be targeted. Nine groups of behaviour change techniques, and five intervention functions offer candidate solutions for future intervention design. Key targets for change include practical training to redress conversational skill gaps about self-harm, the integration of national guidance with local resources and practice-level protocols to support decision-making, and creating opportunities for team-based mentoring.
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Affiliation(s)
- Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
| | - Chris Keyworth
- The School of Psychology, The University of Leeds, Woodhouse Lane, Leeds, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The Nowgen Centre, Manchester, UK
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Taliaferro LA, Westers NJ, Matsumiya B, Ingraham K, Muehlenkamp JJ, Hughes CE. Improving capacity to identify, assess, and manage adolescents engaging in non-suicidal self-injury using patient avatars. MEDICAL TEACHER 2023; 45:1283-1289. [PMID: 37232295 DOI: 10.1080/0142159x.2023.2216861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE We developed and evaluated a training comprising a didactic and virtual practice session with human-guided patient avatars to increase pediatric residents' competence to identify and assess non-suicidal self-injury (NSSI) and suicide risk. METHODS Thirty pediatric residents at three children's hospitals in Florida participated in the training and completed pre-, one-month post-, and three-months post-training surveys. One-way repeated measures ANOVA with post-hoc comparisons determined changes in confidence, comfort, behavioral intentions, attitudes, knowledge, and behavior over time. Qualitative responses provided feedback on the training, especially the novel practice session with adolescent patient avatars. RESULTS Three-months post-training residents expressed significantly greater confidence in talking to adolescents who self-injure, applying the SOARS method to assess self-injury, and assessing functions/reasons for self-injury; reported feeling significantly more comfortable asking about self-injury, well-equipped to handle the emotional aspects of self-injury, and comfortable treating adolescents who self-injure; reported greater behavioral intentions to talk to adolescents about self-injury, assess an adolescent's stage of change for stopping self-injury, and provide brief interventions for adolescents who self-injure; and used SOARS to evaluate current NSSI with a greater proportion of adolescent patients. Qualitative feedback expressed positive perceptions, especially related to the virtual-reality role-play session. CONCLUSIONS Incorporating an interactive, human-guided virtual experience using role-playing and feedback with patient avatars represents a viable option comparable to using typical standardized patients to expand the scalability of NSSI trainings for pediatric residents, especially when they occur virtually.
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Affiliation(s)
- Lindsay A Taliaferro
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | | | | | - Kate Ingraham
- College of Community Innovation and Education, University of Central Florida, Orlando, FL, USA
| | | | - Charles E Hughes
- Department of Computer Science, University of Central Florida, Orlando, FL, USA
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Hedna K, Jonson M, Sigström R, Åberg M, Wilhelmson K, Waern M. Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75. Aging Ment Health 2023; 27:2052-2060. [PMID: 36803189 DOI: 10.1080/13607863.2023.2179974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. METHOD Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. RESULTS There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. CONCLUSION The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna AB, Gothenburg, Sweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden
| | - Robert Sigström
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Mughal F, Bojanić L, Rodway C, Graney J, Ibrahim S, Quinlivan L, Steeg S, Tham SG, Turnbull P, Appleby L, Webb RT, Kapur N. Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series study. Br J Gen Pract 2023; 73:e478-e485. [PMID: 37130612 PMCID: PMC10170520 DOI: 10.3399/bjgp.2022.0589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Reducing suicide risk in middle-aged males (40-54 years) is a national priority. People have often presented to their GP within 3 months before suicide thus highlighting an opportunity for early intervention. AIM To describe the sociodemographic characteristics and identify antecedents in middle-aged males who recently consulted a GP before dying by suicide. DESIGN AND SETTING This study was a descriptive examination of suicide in a national consecutive sample of middle-aged males in 2017 in England, Scotland, and Wales. METHOD General population mortality data were obtained from the Office for National Statistics and National Records of Scotland. Information was collected about antecedents considered relevant to suicide from data sources. Logistic regression examined associations with final recent GP consultation. Males with lived experience were consulted during the study. RESULTS In 2017, a quarter (n = 1516) of all suicide deaths were in middle-aged males. Data were attained on 242 males: 43% had their last GP consultation within 3 months of suicide; and a third of these males were unemployed and nearly half were living alone. Males who saw a GP recently before suicide were more likely to have had recent self-harm and work-related problems than males who had not. Having a current major physical illness, recent self-harm, presenting with a mental health problem, and recent work-related issues were associated with having a last GP consultation close to suicide. CONCLUSION Clinical factors were identified that GPs should be alert to when assessing middle-aged males. Personalised holistic management may have a role in preventing suicide in these individuals.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Division of Psychology and Mental Health, University of Manchester, Manchester; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Jane Graney
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Sarah Steeg
- School of Health Sciences, University of Manchester, Manchester
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Nav Kapur
- NCISH, School of Health Sciences, University of Manchester, Manchester; Manchester Academic Health Sciences Centre, Manchester; Greater Manchester Mental Health NHS Foundation Trust, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
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Mughal F, Clarke L, Connolly R, Lee AYT, Quinlivan L, Kapur N. Improving the management of self-harm in primary care. Br J Gen Pract 2023; 73:148-149. [PMID: 36997200 PMCID: PMC10049611 DOI: 10.3399/bjgp23x732297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
| | - Liam Clarke
- Paramedic, London Ambulance Service NHS Trust, London
| | - Rachel Connolly
- Systematic Reviewer, National Institute for Health and Care Excellence (NICE), Manchester
| | | | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, University of Manchester, Manchester
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester; Greater Manchester Mental Health NHS Foundation Trust; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester
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Culnane E, Efron D, Williams K, Marraffa C, Antolovich G, Prakash C, Loftus H. Carer perspectives of a transition to adult care model for adolescents with an intellectual disability and/or autism spectrum disorder with mental health comorbidities. Child Care Health Dev 2023; 49:281-291. [PMID: 35947107 DOI: 10.1111/cch.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/23/2022] [Accepted: 08/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transition to adult care for adolescents with an intellectual disability and/or autism spectrum disorder with coexisting mental health disorders, often termed 'dual disability', is complex. It requires a family-centred approach, with collaboration among health, disability and social services and early planning. AIM To describe carer perspectives of transition to adult care and the outcomes of a transition support intervention, Fearless, Tearless Transition, for adolescents with dual disabilities piloted at a tertiary children's hospital. METHODS Carers of adolescents with a dual disability were invited to complete a survey at the commencement of their participation in the Fearless, Tearless Transition model, and again at the conclusion of the project. Within this intervention, carers and adolescents were encouraged to attend dedicated transition clinics and participate in a shared care general practitioner (GP) and paediatrician process. RESULTS One hundred and fifty-one carers of adolescents with dual disabilities were included in Fearless, Tearless Transition. Of this cohort, 138 adolescents and their carers received support in a dedicated transition clinic with 99 carers completing the initial survey at the commencement of the model. Eighty-two per cent of carers reported moderate to high levels of anxiety about transitioning from paediatric to adult care with 39% feeling 'unprepared' about transition. Eighty-one per cent reported having inadequate access to respite care with 47% reporting a lack of access to services in the community and 56% expressing dissatisfaction with their GPs. One hundred and two families participated in the shared care process with 80 GPs and 33 paediatricians. Twenty-two carers completed the second survey reporting a modest but significant improvement in preparedness for transition to adult care. CONCLUSION This study highlights the potential to improve transition outcomes for adolescents with dual disabilities and their carers through early, centralized transition planning, consistent methods of assessing adolescent and carer needs and shared care.
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Affiliation(s)
- Evelyn Culnane
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine Marraffa
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Giuliana Antolovich
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Chidambaram Prakash
- Department of Mental Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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9
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Mughal F, Chew-Graham CA, Babatunde OO, Saunders B, Meki A, Dikomitis L. The functions of self-harm in young people and their perspectives about future general practitioner-led care: A qualitative study. Health Expect 2023; 26:1180-1188. [PMID: 36797811 PMCID: PMC10154897 DOI: 10.1111/hex.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Self-harm in young people is a serious concern but a deeper understanding of the functions of self-harm in young people can tailor care and inform new clinical interventions to reduce repeat self-harm and suicide risk. General practitioners (GPs), as frontline healthcare professionals, have an important role in managing self-harm in young people. This study aimed to explore the functions of self-harm in young people and their perspectives on future GP-led care. METHODS A qualitative study using interviews with young people aged between 16 and 25 years with a personal history of self-harm was conducted. Interviews were transcribed and analysed using reflexive thematic analysis. FINDINGS Four distinct functions were identified: (1) handling emotional states; (2) self-punishment; (3) coping with mental illness and trauma; and (4) positive thoughts and protection. Young people valued GP-led support and felt future GP interventions should include self-help and be personalised. CONCLUSIONS These findings support clinicians, including GPs, to explore the functions of self-harm in young people aged 16-25 in a personalised approach to self-harm care. It should be noted that self-harm may serve more than one function for a young person and thus interventions should recognise this. PATIENT AND PUBLIC CONTRIBUTION A group consisting of young people with lived experience of self-harm, carers, the public, and those who work with young people who harm themselves conceived this study idea, informed recruitment methods and the interview topic guide, and supported the interpretation of findings.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele, UK.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | | | | | | | - Aula Meki
- Specialist Psychotherapies Service, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, UK
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10
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Waller G, Newbury-Birch D, Simpson D, Armstrong E, James B, Chapman L, Ahmed F, Ferguson J. The barriers and facilitators to the reporting and recording of self-harm in young people aged 18 and under: a systematic review. BMC Public Health 2023; 23:158. [PMID: 36694149 PMCID: PMC9871435 DOI: 10.1186/s12889-023-15046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND AIMS This systematic review sought to identify, explain and interpret the prominent or recurring themes relating to the barriers and facilitators of reporting and recording of self-harm in young people across different settings, such as the healthcare setting, schools and the criminal justice setting. METHODS A search strategy was developed to ensure all relevant literature around the reporting and recording of self-harm in young people was obtained. Literature searches were conducted in six databases and a grey literature search of policy documents and relevant material was also conducted. Due to the range of available literature, both quantitative and qualitative methodologies were considered for inclusion. RESULTS Following the completion of the literature searches and sifting, nineteen papers were eligible for inclusion. Facilitators to reporting self-harm across the different settings were found to be recognising self-harm behaviours, using passive screening, training and experience, positive communication, and safe, private information sharing. Barriers to reporting self-harm included confidentiality concerns, negative perceptions of young people, communication difficulties, stigma, staff lacking knowledge around self-harm, and a lack of time, money and resources. Facilitators to recording self-harm across the different settings included being open to discussing what is recorded, services working together and co-ordinated help. Barriers to recording self-harm were mainly around stigma, the information being recorded and the ability of staff being able to do so, and their length of professional experience. CONCLUSION Following the review of the current evidence, it was apparent that there was still progress to be made to improve the reporting and recording of self-harm in young people, across the different settings. Future work should concentrate on better understanding the facilitators, whilst aiming to ameliorate the barriers.
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Affiliation(s)
- Gillian Waller
- NHS Business Services Authority, Stella House, Newburn, Newcastle, NE15 8NY, UK.
| | - Dorothy Newbury-Birch
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Diane Simpson
- grid.7110.70000000105559901Faculty of Education and Society, University of Sunderland, Sunderland, SR6 0DD UK
| | - Emma Armstrong
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Becky James
- Department of Health and Social Care, Office for Health Improvement & Disparities, Newburn, Newcastle, NE15 8NY UK
| | - Lucy Chapman
- grid.433912.e0000 0001 0150 9675Durham County Council, County Hall, Durham, DH1 5UJ UK
| | - Farhin Ahmed
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Jennifer Ferguson
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
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11
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Hinze V, Ford T, Gjelsvik B, Byford S, Cipriani A, Montero-Marin J, Ganguli P. Service use and costs in adolescents with pain and suicidality: a cross-sectional study. EClinicalMedicine 2023; 55:101778. [PMID: 36712889 PMCID: PMC9874333 DOI: 10.1016/j.eclinm.2022.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Persistent/recurrent pain for more than three months and suicidality (suicide and self-harm related thoughts and behaviours) are serious and co-occurring health problems in adolescence, underscoring the need for targeted support. However, little is known about service use and costs in adolescents with pain-suicidality comorbidity, compared to those with either problem alone. This study aimed to shed light on service use and costs in adolescents with pain and/or suicidality, and the role of individual and school characteristics. Methods We analysed cross-sectional, pre-intervention data from a large cluster randomised controlled trial, collected between 2017 and 2019 on a representative sample of 8072 adolescents (55% female; aged 11-15 years; 76% white) in 84 schools in the UK. We explored service use settings, covering health, social, educational settings, and medication for mental health problems over three months. Data were analysed using descriptive statistics and two-part hurdle models to obtain odds ratios (ORs) and incident rate ratios (IRRs). Findings 9% of adolescents reported comorbidity between pain and suicidality, 11% only suicidality, 13% only pain, and 66% neither pain nor suicidality. Approximately 55% of adolescents used services, especially general practitioner visits, outpatient appointments for injuries and contacts with a school nurse or pharmacist. Compared to adolescents with neither pain nor suicidality: (i) adolescents with pain (OR 3.79, 95% CI 2.63-5.48), suicidality (1.68, 1.12-2.51), and pain-suicidality comorbidity (2.35, 1.26-4.41) were more likely to use services and (ii) if services were used, they were more likely to have higher total costs (Pain: IRR 1.25, 95% CI 1.11-1.42; Suicidality: 1.27, 1.11-1.46; Comorbidity: 1.57, 1.34-1.85). Interpretation In our study, adolescents with pain and suicidality reported increased contact with health, social, and educational services, which could provide an opportunity for suicide prevention. Given the diversity of identified settings, multi-sector suicide prevention strategies are paramount. Funding Wellcome Trust [WT104908/Z/14/Z; WT107496/Z/15/Z]; Stiftung Oskar-Helene-Heim.
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Affiliation(s)
- Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Hershel Smith Building, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK
| | - Bergljot Gjelsvik
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sarah Byford
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Poushali Ganguli
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
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12
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Tanaka K, Ikeuchi S. Difficulties in suicide prevention facing primary healthcare workers based on the characteristics of people with suicide risk and healthcare systems. J Adv Nurs 2022. [DOI: 10.1111/jan.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Koji Tanaka
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University Kanazawa Japan
| | - Satomi Ikeuchi
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University Kanazawa Japan
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13
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework. Br J Health Psychol 2022; 27:1275-1295. [PMID: 35416355 PMCID: PMC9790562 DOI: 10.1111/bjhp.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. DESIGN Qualitative interview study. METHODS Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. RESULTS GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). CONCLUSIONS Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
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Affiliation(s)
- Jessica Z. Leather
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Mental Health and SafetyUniversity of ManchesterManchester Academic Health Science CentreManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Stephen M. Campbell
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Primary Care and Health Services ResearchSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Christopher J. Armitage
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK,Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK,NIHR Manchester Biomedical Research CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreThe Nowgen CentreManchesterUK
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14
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Keyworth C, Quinlivan L, Leather JZ, Armitage CJ. Exploring the acceptability of a brief online theory-based intervention to prevent and reduce self-harm: a theoretically framed qualitative study. BJPsych Open 2022; 8:e184. [PMID: 36221254 PMCID: PMC9634605 DOI: 10.1192/bjo.2022.568] [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: 11/23/2022] Open
Abstract
BACKGROUND The volitional help sheet for self-harm equips people with the means of responding automatically to triggers for self-harm with coping strategies. Improving acceptability may be crucial to increasing effectiveness and reach. The Theoretical Framework of Acceptability (TFA) was developed to guide the assessment of intervention acceptability, but to date, no studies have applied the TFA to understand acceptability of interventions for self-harm. AIMS To apply the TFA to (a) explore people's experiences of a brief intervention to reduce repeat self-harm; and (b) understand the most prominent aspects of intervention acceptability, to make recommendations for intervention refinements and successful implementation. METHOD Sixteen semi-structured interviews were conducted with people who had previously self-harmed. The TFA informed a framework analysis in which findings were mapped onto the TFA. RESULTS Four TFA domains were identified that were associated with acceptability of the volitional help sheet for self-harm: affective attitude, burden, intervention coherence and perceived effectiveness. People were generally positive about using the volitional help sheet (affective attitude), understood the volitional help sheet and how it worked (intervention coherence), highlighted engagement as a motivating factor in using the volitional help sheet (perceived burden) and described how the volitional help sheet could be implemented by healthcare professionals (perceived effectiveness). CONCLUSIONS Further modifications could still be made, but it is hoped that this intervention provides a useful tool for individuals to construct their own personalised implementation intentions, and as part of longer-term support for preventing self-harm as delivered by healthcare professionals.
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Affiliation(s)
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Manchester Centre for Health Psychology, University of Manchester, UK; and Manchester Academic Health Science Centre, Manchester University Foundation Trust, UK
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15
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Hyer SM, Dixon MA. Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents' Management of Suicide. Int J Psychiatry Med 2022; 57:413-422. [PMID: 35853620 DOI: 10.1177/00912174221116732] [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: 11/16/2022]
Abstract
Suicide is a problem on the rise in the United States. One significant avenue to help reverse the trend is through family medicine and interventions within primary care clinics. This can be a significant stressor for many family medicine physicians to manage patients experiencing suicidal ideation within their busy schedule. Motivational Interviewing is an evidence-based method of interacting with patients in a healthy and collaborative manner. The literature is growing on how to use Motivational Interviewing in assessments of suicidal ideation. Additionally, Self-Determination Theory proposes that individuals have three basic needs: a sense of connection, a level of autonomy, and a degree of competence. These needs and the associated principles of intrinsic and extrinsic motivation help to explain why Motivational Interviewing can be so helpful in the change process. By examining the principles of Motivational Interviewing and Self-Determination Theory residents will be able to better create an environment conducive to collaborative sharing, honest discussion, and meaningful assessment to ensure safety for patients in primary care.
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Affiliation(s)
- Steven M Hyer
- Family Medicine Residency Clinic, 86541Eglin Air Force Base, Eglin AFB, FL, USA
| | - Mark A Dixon
- Social Work Residency, 140639Travis AFB, CA, USA
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16
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Supporting general practitioners in the assessment and management of suicide risk in young people: an evaluation of an educational resource in primary care. Prim Health Care Res Dev 2022; 23:e50. [PMID: 36043372 PMCID: PMC9433951 DOI: 10.1017/s1463423622000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: To conduct a local evaluation of the use of the educational resource: Suicide in Children and Young People: Tips for GPs, in practice and its impact on General Practitioners (GPs)’ clinical decision making. Background: This Royal College of General Practitioners (RCGP) resource was developed to support GPs in the assessment and management of suicide risk in young people. Method: The dissemination of the educational resource took place over a nine month period (February 2018–October 2018) across two Clinical Commissioning Groups in West Midlands. Subsequently, a survey questionnaire on GPs’ experiences of using the resource was sent to GPs in both Clinical Commissioning Groups (CCGs). Findings: Sixty-two GPs completed the survey: 21% reported that they had used the resource; most commonly for: (1) information; (2) assessing a young person; and (3) signposting themselves and young people to relevant resources. Five out of thirteen GPs (38.5%), who responded to the question about whether the resource had an impact on their clinical decision making, reported that it did; four (30.7%) responded that it did not; and four (30.7%) did not answer this question. Twenty out of thirty-two GPs (62.5%) agreed that suicide prevention training should be part of their NHS revalidation cycle. The generalizability of the findings is limited by the small sample size and possible response and social desirability bias. The survey questionnaire was not validated. Despite the limitations, this work can be useful in informing a future large-scale evaluation of the RCGP online resource to identify barriers and facilitators to its implementation.
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17
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O'Donohoe MS. General Practitioners’ Experiences of Self-harm in Primary Care. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Haris AM, Pitman A, Mughal F, Bakanaite E, Morant N, Rowe SL. Harm minimisation for self-harm: a cross-sectional survey of British clinicians' perspectives and practices. BMJ Open 2022; 12:e056199. [PMID: 35980724 PMCID: PMC9171231 DOI: 10.1136/bmjopen-2021-056199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Harm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice. DESIGN A cross-sectional study using an online survey consisting of fixed-choice and open-ended questions. SETTING Primary and secondary care practices in England, Scotland and Wales. PARTICIPANTS Snowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients. RESULTS Of the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one's wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace. CONCLUSIONS In our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians' perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.
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Affiliation(s)
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Faraz Mughal
- School of Medicine, Keele University, Keele, UK
- Affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, Greater Manchester, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah L Rowe
- Division of Psychiatry, University College London, London, UK
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19
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Jackson J, Farr M, Birnie K, Davies P, Mamluk L, O’Brien M, Spencer J, Morgan R, Costello C, Smith J, Banks J, Redaniel MT. Preventing male suicide through a psychosocial intervention that provides psychological support and tackles financial difficulties: a mixed method evaluation. BMC Psychiatry 2022; 22:333. [PMID: 35562796 PMCID: PMC9103598 DOI: 10.1186/s12888-022-03973-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To help resolve high suicide rates in Bristol, North Somerset and South Gloucestershire, the charity Second Step was commissioned to roll-out the Hope service offering a psychosocial intervention for men, supporting them through acute distress and addressing financial difficulties. This study evaluated the impact of the Hope service on men at risk of suicide experiencing financial and other difficulties. METHODS Mixed methods study using: (i) a prospective cohort study design to compare depression, suicidal ideation and financial self-efficacy scores of men aged 30-64, referred to the service between October 2018 and July 2020, at baseline and 6 months follow-up and between low and moderate to high-intensity service users; and (ii) a qualitative interview study to evaluate the acceptability and impact of the Hope service to Hope service users. RESULTS There was a 49% reduction in depression score (mean reduction - 10.0, 95% CI - 11.7 to - 8.3) and in the proportion of service users with suicidal ideation (percent reduction - 52.5, 95% CI - 64.1% to - 40.9%) at 6 months follow-up compared to baseline. Financial self-efficacy scores increased by 26% (mean increase 2.9, 95% CI 1.8 to 3.9). Qualitative accounts illustrated how 'Hope saved my life' for several men interviewed; most respondents described being able to move forward and tackle challenges with more confidence following the Hope intervention. Professional advice to tackle financial and other difficulties such as housing helped to relieve anxiety and stress and enable practical issues to be resolved. CONCLUSIONS The Hope service offered practical and emotional support to men who have experienced suicidal feelings, redundancy, homelessness and poverty and occupies an important space between mental health and social care provision. Hope demonstrates the value of an intervention which cuts across traditional boundaries between psychiatric care and social advice agencies to provide, what is, in effect, an integrated care service.
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Affiliation(s)
- Joni Jackson
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Michelle Farr
- grid.5337.20000 0004 1936 7603The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Birnie
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippa Davies
- grid.5337.20000 0004 1936 7603The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Loubaba Mamluk
- grid.5337.20000 0004 1936 7603The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | | | | | - Jonathan Banks
- grid.5337.20000 0004 1936 7603The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- grid.5337.20000 0004 1936 7603The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Medical School, University of Bristol, 9th floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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20
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Steeg S, Carr M, Trefan L, Ashcroft D, Kapur N, Nielsen E, McMillan B, Webb R. Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study. BMJ Open 2022; 12:e052613. [PMID: 35165109 PMCID: PMC8844953 DOI: 10.1136/bmjopen-2021-052613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm. DESIGN Retrospective cohort study. SETTING UK primary care. PARTICIPANTS 4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020-10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019). OUTCOME MEASURES Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile. RESULTS Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. CONCLUSIONS Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Matthew Carr
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Laszlo Trefan
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emma Nielsen
- Self-harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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21
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The potential of general practice to support young people who self-harm: a narrative review. BJGP Open 2022; 6:BJGPO.2021.0159. [PMID: 35135818 PMCID: PMC8958734 DOI: 10.3399/bjgpo.2021.0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Self-harm in young people is a growing public health concern. Young people commonly present to their GP for help with self-harm, and thus general practice may be a key setting to support young people who have self-harmed. Aim To examine the potential of general practice to support young people aged 10–25 years who have harmed themselves. Design & setting A narrative review of published and grey literature. Method The Scale for the Assessment of Narrative Review Articles (SANRA) was used to guide a narrative review to examine the potential of general practice to support young people who have self-harmed. The evidence is presented textually. Results The included evidence showed that GPs have a key role in supporting young people, and they sometimes relied on gut feeling when handling uncertainty on how to help young people who had self-harmed. Young people described the importance of initial clinician responses after disclosing self-harm, and if they were perceived to be negative, the self-harm could become worse. Conclusion In context of the evidence included, this review found that general practice is a key setting for the identification and management of self-harm in young people; but improvements are needed to enhance general practice care for young people to fulfil its potential.
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22
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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Hawgood J, Krysinska K, Mooney M, Ozols I, Andriessen K, Betterridge C, De Leo D, Kõlves K. Suicidology Post Graduate Curriculum: Priority Topics and Delivery Mechanisms for Suicide Prevention Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9926. [PMID: 34574848 PMCID: PMC8469380 DOI: 10.3390/ijerph18189926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There has been limited attention to the development and delivery of tertiary suicide prevention curricula. The aim of this work was to describe the status of postgraduate suicide prevention education, with specific attention on examining the needs of the suicide prevention sector in Australia. METHOD An online survey was completed by 76 stakeholders in Australia. Current curriculum learning outcomes from Griffith University's postgraduate suicidology programs guided the development of the survey. RESULTS Four key learning domains were rated highest in importance by stakeholders. According to most stakeholders, skills-based qualifications were the most relevant type of qualification, and online modulized education was the most preferred delivery mode. Half of stakeholders supported suicide prevention professional development through a combination of financial support and study leave. CONCLUSIONS The survey provided invaluable feedback regarding the priorities of Australia's suicide prevention sector for content domains and delivery mechanisms for tertiary suicidology education. The findings showed the preferred type of organizational (employer) support that may be provided for employees to undertake such education. These findings will inform the future developments of Griffith University's suicidology programs and may motivate other universities to consider offering same or a similar type of education to support the suicide prevention sector toward saving lives.
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Affiliation(s)
- Jacinta Hawgood
- World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4111, Australia; (M.M.); (D.D.L.); (K.K.)
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia; (K.K.); (K.A.)
| | - Maddeline Mooney
- World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4111, Australia; (M.M.); (D.D.L.); (K.K.)
| | - Ingrid Ozols
- Department of Psychiatry, The University of Melbourne, Melbourne 3002, Australia;
- Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3800, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia; (K.K.); (K.A.)
| | | | - Diego De Leo
- World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4111, Australia; (M.M.); (D.D.L.); (K.K.)
| | - Kairi Kõlves
- World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4111, Australia; (M.M.); (D.D.L.); (K.K.)
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Keyworth C, O'Connor R, Quinlivan L, Armitage CJ. Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation. J Med Internet Res 2021; 23:e28349. [PMID: 34518153 PMCID: PMC8479604 DOI: 10.2196/28349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. OBJECTIVE This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. METHODS We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. RESULTS Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=-15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). CONCLUSIONS Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rory O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
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25
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Abstract
Suicide is significant public health concern within the United States. Research results are mixed about the effectiveness of universal screening and interventions with patients who are at-risk for suicide. Primary care is a logical intervention point to mitigate risk among patients in each of these areas. The Department of Veterans Affairs and Department of Defense have developed comprehensive guidelines for the assessment and management of suicidal patients. This approach involves specific screening tools, risk stratification by categories and interventions used by clinicians to help reduce risk levels in their patients. This article aims to provide a model, built on the principles of these guidelines, which primary care physicians can use to identify, assess and intervene with patients who are at-risk for suicide.
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Why GPs need to be involved in mental health research. Br J Gen Pract 2021; 71:365. [PMID: 34326082 DOI: 10.3399/bjgp21x716657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Mughal F, Gorton HC, Michail M, Robinson J, Saini P. Suicide Prevention in Primary Care. CRISIS 2021; 42:241-246. [PMID: 34184574 DOI: 10.1027/0227-5910/a000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Staffordshire, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK.,Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | | | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Pooja Saini
- Faculty of Health, School of Psychology, Liverpool John Moores University, UK
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Experiences of general practice care for self-harm: a qualitative study of young people's perspectives. Br J Gen Pract 2021; 71:e744-e752. [PMID: 33950851 PMCID: PMC8340729 DOI: 10.3399/bjgp.2021.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-harm is a growing concern and rates of self-harm in young people (aged 12-25 years) presenting to general practice are rising. There is, however, little evidence about young people's experiences of GP care and on accessing general practice. AIM To explore the help-seeking behaviours, experiences of GP care, and access to general practice of young people who self-harm. DESIGN AND SETTING In this qualitative study, semi-structured interviews were conducted with young people aged 16-25 years from England with previous self-harm behaviour. METHOD Interviews with 13 young people took place between April and November 2019. Young people were recruited from the community, third-sector organisations, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings. RESULTS Young people described the avenues of help-seeking they employ and reflected on the mixed experiences of seeing GPs that can influence future help-seeking. Preconceptions and a lack of knowledge about accessing general practice were found to be barriers to help-seeking. GPs who attempt to understand the young person and establish relationship-based care can facilitate young people accessing general practice for self-harm. CONCLUSION It is important young people are aware of how to access general practice and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.
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Suicide prevention and COVID-19: the role of primary care during the pandemic and beyond. Br J Gen Pract 2021; 71:200-201. [PMID: 33926869 DOI: 10.3399/bjgp21x715637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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30
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Bellairs-Walsh I, Perry Y, Krysinska K, Byrne SJ, Boland A, Michail M, Lamblin M, Gibson KL, Lin A, Li TY, Hetrick S, Robinson J. Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives. BMJ Open 2020; 10:e038855. [PMID: 33115897 PMCID: PMC7594366 DOI: 10.1136/bmjopen-2020-038855] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people's opinions and experiences related to GPs' practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people's perspectives. This study aimed to explore young people's views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs. DESIGN, SETTING AND PARTICIPANTS Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16-24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis. RESULTS Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist-disliking the terms 'risk' and 'risk assessment', and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs' attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations. CONCLUSIONS Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yael Perry
- Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Karolina Krysinska
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sadhbh J Byrne
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Boland
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michelle Lamblin
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kerry L Gibson
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Tina Yutong Li
- Orygen, Parkville, Victoria, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Sarah Hetrick
- Orygen, Parkville, Victoria, Australia
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jo Robinson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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New models of care in general practice for the youth mental health transition boundary. BJGP Open 2020; 4:bjgpopen20X101133. [PMID: 33023869 PMCID: PMC7880174 DOI: 10.3399/bjgpopen20x101133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
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