Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives

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.

Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach

BACKGROUND

Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions.

OBJECTIVE

This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign.

METHODS

In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators.

RESULTS

The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services.

CONCLUSIONS

This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

Simultaneous identification of two cyclohexanone oxidation genes from an environmental Brevibacterium isolate using mRNA differential display

The technique of mRNA differential display was used to identify simultaneously two metabolic genes involved in the degradation of cyclohexanone in a new halotolerant Brevibacterium environmental isolate. In a strategy based only on the knowledge that cyclohexanone oxidation was inducible in this strain, the mRNA population of cells exposed to cyclohexanone was compared to that of control cells using reverse transcription-PCR reactions primed with a collection of 81 arbitrary oligonucleotides. Three DNA fragments encoding segments of flavin monooxygenases were isolated with this technique, leading to the identification of the genes of two distinct cyclohexanone monooxygenases, the enzymes responsible for the oxidation of cyclohexanone. Each monooxygenase was expressed in Escherichia coli and characterized. This work validates the application of mRNA differential display for the discovery of new microbial metabolic genes.

Comparison of two pre-surgical skin preparation techniques

A one-step iodophor skin preparation solution was compared to chlorhexidine gluconate application as a pre-operative skin preparation method in 100 animals undergoing elective ovariohysterectomy. Pre-operative and intra-operative skin cultures demonstrated no difference in antiseptic efficacy. No animal in the study demonstrated signs of systemic infection, and no adverse local effects from either antiseptic were seen. The iodophor solution evaluated (DuraPrep) is a safe and effective pre-operative skin preparation agent in small animal patients undergoing clean surgical procedures.

Effects of stimulus velocity and acceleration on smooth pursuit in motor neuron disease

Sinusoidal smooth pursuit eye movements were evaluated in 11 normals, five moderately and four severely affected motor neuron disease (MND) patients, using two target amplitudes and a range of frequencies. This enabled us to examine separately the effects of peak target velocity and acceleration on pursuit gain. Moderately affected patients showed an acceleration, but not a velocity saturation; severely impaired patients' performance declined with increased velocity. Smooth pursuit eye movements are thus impaired in MND, but the nature of this pursuit deficit is complex and changes with the progression of the disease.

Aspirated dental calculus in a dog

Aspiration of a dental calculus, with lodgement of the calculus in a mainstem bronchus, was identified in a dog after dental prophylaxis. The calculus was located by use of radiography and bronchoscopy, and was removed via thoracotomy. Aspiration is a possible complication of dental prophylaxis. Endotracheal intubation with a properly inflated cuff, and thoroughly rinsing the oral cavity after prophylaxis, may avoid this and similar complications.

Femoral capital physeal fractures in dogs: 34 cases (1979-1989)

Complications associated with femoral capital physeal (CP) fractures in 34 dogs were evaluated. Fractures were surgically repaired, using divergent K-wires or lag screws; radiographic follow-up was available for 21 CP fractures. In all cases, radiographic abnormalities such as degenerative joint disease and resorption of the femoral neck and/or head were seen. Changes were more severe when fracture occurred at an early age. For 4 of 21 dogs (20%), femoral head and neck excision was performed because of complications associated with CP fracture repair. Prognosis for femoral CP fractures is guarded, although affected dogs should be able to function as pets.

Comparison of nerve regeneration through different types of neural prostheses

Rat sciatic nerve regeneration through three synthetic neural prostheses was compared with regeneration through nerve allografts. The synthetic prostheses were either nonpermeable nonabsorbable (Silastic), permeable absorbable (polyglactin mesh), or permeable nonabsorbable (polypropylene mesh). Animals were evaluated at 10, 24, and 90 days. Functional analysis of nerve regeneration was performed by noninvasive methods: electromyography and walking tracks. Nerve tissue was examined with routine histologic and immunofluorescent techniques. A compressive neuropathy developed with the use of the Silastic implant. A neutrophilic inflammatory infiltrate was consistently associated with implantation of the polyglactin mesh. A strong connective tissue response was noted around the polypropylene mesh. Early recovery of nerve function was seen with the Silastic implants, however, overall nerve function was best in the nerve allograft and polypropylene mesh groups. Polyglactin implantation increases the local inflammatory response and should not be used for nerve anastomoses. If Silastic entubulation is used, it should be removed between 24 and 90 days.

Use of external coaptation for the treatment of avascular necrosis of the femoral head in a dog

Avascular necrosis of the femoral head was diagnosed in a 5-month-old Schipperke, before the development of femoral head and neck collapse and resultant degenerative joint disease. External coaptation, consisting of an Ehmer sling, was used to prevent the bearing of weight during revascularization and reossification of the subchondral bone. Results of pelvic radiography (at 10 and 24 weeks) indicated that the early use of conservative treatment was successful in promoting resolution of the aseptic necrosis and in maintaining normal coxofemoral anatomic features and function.

Malignant fibrous histiocytoma in a cat

A large proliferative soft tissue mass found on the forelimb of an adult cat was identified as a malignant fibrous histiocytoma through cytologic and histologic examinations. This is a rare tumor of mesenchymal cell origin, which has been previously reported in cats, dogs, horses, and human beings. In this cat metastasis to the local lymph node was found.

Comparison of sciatic nerve regeneration through silicone tubes and nerve allografts

Sciatic nerve regeneration through implanted silicone tubes was compared to allogenic nerve grafting in 30 adult female Sprague-Dawley rats. Regeneration was assessed at 10, 24, and 90 days post-transection. Axonal regrowth through the implanted neural prostheses was evaluated with electromyography and histologic examination.