1
|
Onay Z, Sidis A, Robinson L, Deane FP. Young people's pathways to a specialist suicide prevention service and the influence of caregiver prior suicidality and mental health treatment. Early Interv Psychiatry 2024. [PMID: 38356407 DOI: 10.1111/eip.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognized, caregivers also play a significant role in these pathways. Caregiver's familiarity with mental health issues may influence an adolescent's PtC. This study explores the relationship between a caregiver's prior suicidality and mental health treatment on their children's pathways to entering a specialist suicide prevention treatment program. METHOD Caregivers (n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child's onset of symptoms, help-seeking, PtC and the caregiver's prior suicidality and mental health treatment. RESULTS Parents were the source most likely to recognize the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. CONCLUSION Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver's prior experience of suicidality to these pathways. These complexities warrant further exploration to minimize obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers.
Collapse
Affiliation(s)
- Zozan Onay
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anna Sidis
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
2
|
Waters E, Ong B, Mikes-Liu K, McCloughen A, Rosen A, Mayers S, Sidis A, Dawson L, Buus N. Open Dialogue, need-adapted mental health care, and implementation fidelity: A discussion paper. Int J Ment Health Nurs 2021; 30:811-816. [PMID: 33848029 DOI: 10.1111/inm.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer's needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.
Collapse
Affiliation(s)
- Edward Waters
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Benjamin Ong
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Child and Youth Mental Health Service, Penrith, New South Wales, Australia
| | - Kristof Mikes-Liu
- Faculty of Medicine and Health, Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Mental Health Service, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Andrea McCloughen
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alan Rosen
- Illawarra Institute for Mental Health (iiMH), University of Wollongong, Wollongong, New South Wales, Australia.,Brain & Mind Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - Steven Mayers
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Anna Sidis
- Northfields Clinic, School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lisa Dawson
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Niels Buus
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Patterson P, Noke M, McDonald FEJ, Kelly-Dalgety E, Sidis A, Jones BL. Life Imprint and meaning reconstruction for young people who have experienced the death of a family member from cancer. Psychooncology 2019; 28:1938-1941. [PMID: 31237725 DOI: 10.1002/pon.5159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Pandora Patterson
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Noke
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Fiona E J McDonald
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Kelly-Dalgety
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Anna Sidis
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Barbara L Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
| |
Collapse
|
4
|
Hickie IB, Scott EM, Hermens DF, Naismith SL, Guastella AJ, Kaur M, Sidis A, Whitwell B, Glozier N, Davenport T, Pantelis C, Wood SJ, McGorry PD. Applying clinical staging to young people who present for mental health care. Early Interv Psychiatry 2013; 7:31-43. [PMID: 22672533 DOI: 10.1111/j.1751-7893.2012.00366.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The study aims to apply clinical staging to young people who present for mental health care; to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people; and to report longitudinal estimates of progression from less to more severe stages. METHODS The study uses cross-sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical 'stage' (i.e. 'help-seeking', 'attenuated syndrome', 'discrete disorder' or 'persistent or recurrent illness'). RESULTS Young people (n = 209, mean age = 19.9 years (range = 12-30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest 'help-seeking' stage, 54% to the 'attenuated syndrome' stage, 25% to the 'discrete disorder' stage and 11% to the later 'persistent or recurrent illness' stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the 'attenuated syndrome' stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the 'help-seeking', 19% of the 'attenuated syndrome' and 33% of the 'discrete disorder' groups. CONCLUSION Among young people presenting for mental health care, most are clinically staged as having 'attenuated syndromes'. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.
Collapse
Affiliation(s)
- Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Williams LM, Sidis A, Gordon E, Meares RA. "Missing links" in borderline personality disorder: loss of neural synchrony relates to lack of emotion regulation and impulse control. J Psychiatry Neurosci 2006; 31:181-8. [PMID: 16699604 PMCID: PMC1449878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Symptoms of borderline personality disorder (BPD) may reflect distinct breakdowns in the integration of posterior and frontal brain networks. We used a high temporal resolution measure (40-Hz gamma phase synchrony) of brain activity to examine the connectivity of brain function in BPD. METHODS Unmedicated patients with BPD (n = 15) and age-and sex-matched healthy control subjects (n = 15) undertook a task requiring discrimination of salient from background tones. In response to salient stimuli, the magnitude and latency of peak gamma phase synchrony for early (0-150 ms post stimulus) and late (250-500 ms post stimulus) phases were calculated for frontal and posterior regions and for left and right hemispheres. We recorded skin conductance responses (SCRs) and reaction time (RT) simultaneously to examine the contribution of arousal and performance. RESULTS Compared with controls, patients with BPD had a significant delay in early posterior gamma synchrony and a reduction in right hemisphere late gamma synchrony in response to salient stimuli. Both SCR onset and RT were also delayed in BPD, but independently from differences in synchrony. The delay in posterior synchrony was associated with cognitive symptoms, and reduced right hemisphere synchrony was associated with impulsivity. CONCLUSIONS These findings suggest that distinct impairments in the functional connectivity of neural systems for orienting to salient input underlie core dimensions of cognitive disturbance and poor impulse control in BPD.
Collapse
Affiliation(s)
- Leanne M Williams
- Brain Dynamics Centre, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
6
|
Vibert N, MacDougall HG, de Waele C, Gilchrist DP, Burgess AM, Sidis A, Migliaccio A, Curthoys IS, Vidal PP. Variability in the control of head movements in seated humans: a link with whiplash injuries? J Physiol 2001; 532:851-68. [PMID: 11313451 PMCID: PMC2278578 DOI: 10.1111/j.1469-7793.2001.0851e.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to determine how context and on-line sensory information are combined to control posture in seated subjects submitted to high-jerk, passive linear accelerations. Subjects were seated with eyes closed on a servo-controlled linear sled. They were asked to relax and received brief accelerations either sideways or in the fore-aft direction. The stimuli had an abrupt onset, comparable to the jerk experienced during a minor car collision. Rotation and translation of the head and body were measured using an Optotrak system. In some of the subjects, surface electromyographic (EMG) responses of selected neck and/or back muscles were recorded simultaneously. For each subject, responses were highly stereotyped from the first trial, and showed little sign of habituation or sensitisation. Comparable results were obtained with sideways and fore-aft accelerations. During each impulse, the head lagged behind the trunk for several tens of milliseconds. The subjects' head movement responses were distributed as a continuum in between two extreme categories. The 'stiff' subjects showed little rotation or translation of the head relative to the trunk for the whole duration of the impulse. In contrast, the 'floppy' subjects showed a large roll or pitch of the head relative to the trunk in the direction opposite to the sled movement. This response appeared as an exaggerated 'inertial' response to the impulse. Surface EMG recordings showed that most of the stiff subjects were not contracting their superficial neck or back muscles. We think they relied on bilateral contractions of their deep, axial musculature to keep the head-neck ensemble in line with the trunk during the movement. About half of the floppy subjects displayed reflex activation of the neck muscles on the side opposite to the direction of acceleration, which occurred before or during the head movement and tended to exaggerate it. The other floppy subjects seemed to rely on only the passive biomechanical properties of their head-neck ensemble to compensate for the perturbation. In our study, proprioception was the sole source of sensory information as long as the head did not move. We therefore presume that the EMG responses and head movements we observed were mainly triggered by the activation of stretch receptors in the hips, trunk and/or neck. The visualisation of an imaginary reference in space during sideways impulses significantly reduced the head roll exhibited by floppy subjects. This suggests that the adoption by the central nervous system of an extrinsic, 'allocentric' frame of reference instead of an intrinsic, 'egocentric' one may be instrumental for the selection of the stiff strategy. The response of floppy subjects appeared to be maladaptive and likely to increase the risk of whiplash injury during motor vehicle accidents. Evolution of postural control may not have taken into account the implications of passive, high-acceleration perturbations affecting seated subjects.
Collapse
Affiliation(s)
- N Vibert
- Laboratoire de Neurobiologie des Reseaux Sensorimoteurs, CNRS, ESA 7060, 45 rue des Saints-Peres, 75270 Paris cedex 06, France.
| | | | | | | | | | | | | | | | | |
Collapse
|