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Dunlop BJ, Lea J. It's not just in my head: An intersectional, social and systems-based framework in gender and sexuality diversity. Psychol Psychother 2023; 96:1-15. [PMID: 36351776 PMCID: PMC10099476 DOI: 10.1111/papt.12438] [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: 08/11/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context. AIMS In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context. MATERIALS AND METHODS Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented. RESULTS The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories. DISCUSSION Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level. CONCLUSION Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.
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Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - James Lea
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Brown AC, Latham C, Danquah AN, Dunlop BJ, Taylor PJ. "Cover up your arms, you're triggering people": A Mixed-Methods Investigation of Shame in those who Self-Injure. Psychol Psychother 2022; 95:701-716. [PMID: 35411671 PMCID: PMC9543642 DOI: 10.1111/papt.12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shame can be a powerfully aversive emotion that is associated with a wide variety of mental health difficulties including non-suicidal self-injury (NSSI). This study used a novel mixed-methods design (Qualitative Experiential Sequence Tracking; QUEST) to investigate the experiences of shame in a sample of individuals who self-injure. METHODS Six participants received prompts to complete brief online diaries three times per day over a period of 2 weeks. These diaries captured information about the experience of negative emotions, especially shame. Participants then underwent an individualised qualitative interview about their experiences over the previous 2 weeks. RESULTS Thematic analysis suggested that participants experienced shame as a social and relational emotion. Further themes included shame being associated with feelings of failure, being trapped, dangerous or contaminated, and hidden or exposed. The phenomenology of shame, and coping with shame, were also themes. NSSI could occur as a response to shame, but often shame was triggered or exacerbated by the responses of others to NSSI. CONCLUSIONS Consistent with previous research, shame was described as an aversive emotion occurring within interpersonal and broader societal contexts and involving a negative self-focus. A lack of compassion or understanding in response to NSSI, or anticipation of negative responses from others often triggered more intense shame than the NSSI itself. Future studies could use QUEST methodology with more diverse samples or different populations to further investigate experiences of shame.
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Affiliation(s)
- Alexandra C. Brown
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | | | - Adam N. Danquah
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | - Brendan J. Dunlop
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
| | - Peter J. Taylor
- Division of Psychology & Mental HealthSchool of Health SciencesUniversity of ManchesterManchester Academic Health Sciences CentreManchesterUK
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Dunlop BJ, Coleman SE, Hartley S, Carter LA, Taylor PJ. Self-injury in young bisexual people: A microlongitudinal investigation (SIBL) of thwarted belongingness and self-esteem on non-suicidal self-injury. Suicide Life Threat Behav 2022; 52:317-328. [PMID: 34890052 DOI: 10.1111/sltb.12823] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/25/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bisexual people are at an elevated risk for non-suicidal self-injury (NSSI). Psychological factors including self-esteem and thwarted belongingness may help explain this risk. The aim of the current study was to investigate associations between self-esteem, thwarted belongingness and NSSI urges and behavior in young bisexual people. METHODS Participants aged 16-25 from 25 countries took part in this microlongitudinal online survey study (N = 207). Mixed-effects linear and logistic regression were used for analysis, given the nested structure of data. Analysis examined the relationship between self-esteem and thwarted belongingness on NSSI urges and behavior at the same point in time, and lagged by one week. RESULTS At the same timepoint, self-esteem and thwarted belongingness both had significant between- and within-person associations with NSSI urges and behavior. For lagged models, self-esteem had significant between-person effects on urges, and thwarted belongingness had significant within-person effects. For NSSI behavior, both variables were only associated with between-person effects. CONCLUSION Findings support previous research suggesting the importance of self-esteem in explaining NSSI among sexual minorities. Preventative and intervention strategies to improve self-esteem may help reduce NSSI risk. Future studies should focus upon the experiences of bisexual people with intersecting identities and ensure that studies are statistically powered from inception to detect effects.
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Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sophie E Coleman
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.,Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Peter J Taylor
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
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Coleman SE, Dunlop BJ, Hartley S, Taylor PJ. The relationship between rumination and NSSI: A systematic review and meta-analysis. Br J Clin Psychol 2021; 61:405-443. [PMID: 34806214 DOI: 10.1111/bjc.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rumination is a cognitive process that has been implicated in the onset and maintenance of a variety of psychological difficulties. The purpose of this review and meta-analysis was to examine the nature and strength of the relationship between rumination and non-suicidal self-injury (NSSI). METHODS The protocol for this review was pre-registered (CRD42019148186). A literature search of electronic databases PsycINFO, CINAHL, MEDLINE, and Web of Science was performed from the earliest date available to March 2020. Thirty-nine eligible papers were identified. An additional seven papers were identified from a search conducted in September 2021, resulting in a total of 46 papers. Separate meta-analyses were undertaken for NSSI frequency and NSSI history, with studies grouped by rumination type (depressive, transdiagnostic, anger, brooding, reflection, catastrophising, overall). Moderator analyses were also conducted along with a narrative synthesis of adjusted associations and longitudinal studies. RESULTS Rumination had a positive small association with NSSI frequency and a positive moderate association with NSSI history. The adjusted associations yielded mixed findings and most longitudinal research found rumination to be associated with prospective NSSI. LIMITATIONS Most included studies had a moderate risk of bias and used a student sample. A limitation of this review was that only English language papers were included. CONCLUSIONS Findings indicate that rumination is associated with NSSI, but more so the likelihood of engaging in NSSI overall than the frequency. Rumination-focused techniques for NSSI may therefore be of benefit. Further research is needed to understand this association, particularly with longitudinal studies that focus on state rumination rather than stable trait rumination. PRACTITIONER POINTS Rumination was found to have a small to moderate association with NSSI. Some individuals who engage in NSSI may benefit from psychological techniques that target rumination. Most of the studies included had a moderate risk of bias.
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Affiliation(s)
- Sophie E Coleman
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Brendan J Dunlop
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - Samantha Hartley
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK.,Pennine Care NHS Foundation Trust, Greater Manchester, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, UK
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Dunlop BJ, Hunter C, Shafti M, Coleman SE, Hartley S, Taylor PJ. ‘Why is it so different now I’m bisexual?’: young bisexual people’s experiences of identity, belonging, self-injury, and COVID19. Psychology & Sexuality 2021. [DOI: 10.1080/19419899.2021.1924241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Child Development Centre, Scott Hospital, Plymouth, United Kingdom, Devon
| | - Matina Shafti
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sophie E Coleman
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Pennine Care Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, Greater Manchester, UK
| | - Peter J Taylor
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Dunlop BJ, Hartley S, Oladokun O, Taylor PJ. Corrigendum to Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. Journal of Affective Disorders, 276 (2020) 1159-1172. J Affect Disord 2020; 277:1055. [PMID: 33019964 DOI: 10.1016/j.jad.2020.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom.
| | - Samantha Hartley
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom; Pennine Care NHS Foundation Trust,, Old Street, Ashton-Under-Lyne, Greater Manchester, United Kingdom
| | - Olayinka Oladokun
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom; Pennine Care NHS Foundation Trust,, Old Street, Ashton-Under-Lyne, Greater Manchester, United Kingdom
| | - Peter J Taylor
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom
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Dunlop BJ, Hartley S, Oladokun O, Taylor PJ. Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. J Affect Disord 2020; 276:1159-1172. [PMID: 32823255 DOI: 10.1016/j.jad.2020.07.103] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Received: 03/24/2020] [Revised: 05/18/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bisexual people have been found to be at increased risk of non-suicidal self-injury (NSSI) when compared to heterosexual and gay or lesbian people. The purpose of this review was to update the estimated risk of NSSI for bisexual people and to examine variables that have been associated with NSSI in this population. METHODS The protocol for this paper was pre-registered (CRD42019145299). An electronic search of PsycINFO, CINAHL Plus, PubMed, Ovid Online and Web of Science was undertaken from earliest available date to October 2019. Twenty-four eligible papers were identified. Meta-analyses, including moderator analysis, were conducted to ascertain NSSI risk and a narrative synthesis was undertaken of predictors and correlates. All studies were assessed for risk of bias. RESULTS Bisexual people had up to six times the odds of engaging in NSSI compared to other sexualities. Mental health variables of anxiety and depression symptoms were found to be most commonly associated with NSSI for this population. The majority of studies had moderate risk of bias. This review demonstrates that bisexual people have an elevated risk of engaging in NSSI. Increased incidence of anxiety and depression and exposure to negative life events may explain this increased risk. LIMITATIONS Studies were found to be consistently cross-sectional in design and limited to western cultures. A limitation of this review was that only English language papers were included. CONCLUSIONS Results are clinically relevant as they suggest early identification and prevention of NSSI can be achieved. Future research should examine bisexual people independently of others.
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Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom.
| | - Samantha Hartley
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom
| | - Olayinka Oladokun
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom
| | - Peter J Taylor
- Division of Psychology and Mental Health, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom
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Dunlop SW, Dunlop BJ, Brown M. Plastic pollution in paradise: Daily accumulation rates of marine litter on Cousine Island, Seychelles. Mar Pollut Bull 2020; 151:110803. [PMID: 32056598 DOI: 10.1016/j.marpolbul.2019.110803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
The daily accumulation rates, composition, sizes and potential sources of marine litter collected on a remote island within the Western Indian Ocean were investigated. In total, 9119 items of marine litter were collected during 40 surveys, which equated to 0.0082 items·m-1·d-1. Between 2003 and 2019 there was a significant increase in the amount of litter deposited, with the highest daily accumulation rate recorded in 2019 (0.0255 items·m-1·year-1). All specific litter types increased over time and also differed significantly in their accumulation rates, with polystyrene fragments/pieces (0.00249 items·m-1·d-1), plastic items (0.00135 items·m-1·d-1) and plastic bottles (0.0011 items·m-1·d-1) being the most commonly encountered during this study. The majority of the litter found was ≤5 cm in size. Nearly all (>80%) litter collected was made of or contained some form of plastic. Recommendations for improved management of litter and the importance of establishing regular beach clean-ups within the Seychelles are briefly discussed.
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Affiliation(s)
- S W Dunlop
- Cousine Island Company, Grand Anse, Praslin, Seychelles.
| | - B J Dunlop
- Cousine Island Company, Grand Anse, Praslin, Seychelles
| | - M Brown
- Centre for Functional Biodiversity, School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Todd MM, Chadwick HS, Shapiro HM, Dunlop BJ, Marshall LF, Dueck R. The neurologic effects of thiopental therapy following experimental cardiac arrest in cats. Anesthesiology 1982; 57:76-86. [PMID: 7091747 DOI: 10.1097/00000542-198208000-00003] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To define the utility of high-dose barbiturate therapy following an episode of complete global cerebral ischemia, we investigate the effects of 60 mg/kg of thiopental given to cats five minutes after resuscitation from 12, 14, or 16 min of electrically induced ventricular fibrillation (VF). All aspects of the arrest, resuscitation, with post-arrest care were carefully controlled, with the EEG becoming isoelectric 20-25 s after the onset mean resuscitation time of 2.5 +/- 0.2 (SEM) min. For any given duration of VF, there were no differences (control vs thiopental) in any pre- or post-arrest parameters (blood pressure, blood gases, electrolytes, etc.) A total of 68 resuscitated cats were entered into various treatment and control groups, and all but one group received 20-24 h of post-resuscitation paralysis, mechanical ventilation, and ICU support before being extubated. Cats received an additional six days of aggressive nursing care, and daily examinations were performed with the assignment of a neurologic deficit score (NDS) between 0 (normal) and (brain dead). Autopsies were performed to determine the cause of death in animals which died before the end of the seven-day observation period. The early post-arrest period was marked by the occurrence of repetitive, rhythmic bursts of high-frequency electroencephalographic (EEG) activity (? seizures) in 38 per cent of control animals (16/42, all arrest times combined). Ten of these animals died as a result of severe neurologic injuries. By contrast, only 12 per cent of treated cats (3/26) developed similar EEG patterns (P less than 0.05) and there were no neurologic deaths in the thiopental groups. The differences in the incidence of neurologic deaths (control vs. thiopental) was significant (P less than 0.02). The change in overall mortality did not quite reach significance (36 per cent vs. 21 per cent), and treatment had no effect on the incidence of deaths due to cardiovascular causes (e.g., myocardial infarctions). In spite of the effects on mortality, treatment had no effect on the neurologic function of survivors (assessed by NDS). These findings suggest that thiopental improved survival rates by suppressing an unusual post-arrest EEG pattern (? anticonvulsant effect), but had no additional cerebral protective effects.
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Abstract
A minimally invasive and standardized means of resuscitating cats from defined periods of ventricular fibrillation (VF) has been developed using methods little different from human cardiopulmonary resuscitation techniques. After a 12 min arrest, the rate of successful resuscitation is greater than 90%, witha resuscitation time of 2.5 +/- 0.7 (SD) min, and a 7 day survival of 70%. All deaths could be related to a specific electroencephalographic event observed acutely post-resuscitation, and were not due to obvious non-neurologic complications. The post-arrest variation in a variety of parameters (blood pressure, blood gases, etc.) was minimal, and the degree of neurologic damage was severe enough to permit evaluation. Such a model is clinically relevant, and may be useful in studying the pathophysiology of global ischemia, and assessing different types of post-arrest therapy.
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Gilroy BA, Rockoff MA, Dunlop BJ, Shapiro HM. Cardiopulmonary resuscitation in the nonhuman primate. J Am Vet Med Assoc 1980; 177:867-9. [PMID: 7451328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Seventeen adult male Cynamolgus monkeys were subjected to potassium chloride-induced cardiopulmonary arrests of 10 to 12 minutes. Pupils became dilated and fixed at a mean interval of 30 +/- 11 seconds, and the electroencephalogram became isoelectric at a mean interval of 34 +/- 13 seconds. The monkeys were resuscitated by means of oxygen, external cardiac message, epinephrine, calcium, and bicarbonate. The mean time required to resuscitate the monkeys was 140 +/- 70 seconds. After resuscitation, the monkeys were kept in an intensive care unit. Pupillary responsiveness and electroencephalographic activity were slow to return, with mean intervals of 90 +/- 85 and 108 +/- 36 minutes, respectively. Although all 17 monkeys were resuscitated, only 9 survived 96 hours or more. Of the 9 survivors, 2 appeared neurologically normal, 3 were moderately impaired, and 4 were severely impaired.
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