The impact of assessment on repeat deliberate self-harm

Deliberate self-harm is a pervasive issue that is the topic of worldwide clinical and research focus. Among the extensive research findings two salient issues emerge that provide the foundation for this study. The first is that a deliberate self-harm attempt is a significant risk factor for future attempts. The second is that a comprehensive assessment of a person presenting with an incident of deliberate self-harm can reduce further deliberate self-harming behaviour. A limitation of existing research is that no study has clearly identified the nature of assessments that impact on the likelihood of future self-harm attempts. The initial aim of this study was to replicate studies that explored the impact of an assessment after a deliberate self-harm episode, using Western Australian data. It was anticipated that the risk of a re-presentation will be reduced by increasing the likelihood that representation would take longer if an assessment was undertaken. It was also anticipated that some types of assessment would be more beneficial than others. A further aim of this study was to determine what the relevant health professionals believed led to this outcome, in particular, if one type of assessment was more beneficial than the others. In order to achieve these aims the research team examined data of patients who presented to the emergency departments of three teaching hospitals in Perth, Western Australia between 1995 and 2004 and had reported a deliberate self-harm attempt. A total of 8656 files were examined, from a total of 13,500 presentations during this period. Cox proportional hazards regression showed that compared to patients who had no assessment, the time between initial presentation and any further presentation for a self harm episode at one of the participating hospitals was significantly longer for those who received an assessment. Those who received either a social work assessment, or both a social work and mental health assessment, were significantly more likely to take longer to re-present. In an attempt to identify the content of the social work assessment that may have impacted on these findings the researcher interviewed six practitioners who undertook these assessments. These interviewees reported the relationship they established with patients; their exploration of the psychosocial context of the patient; and their conviction that the assessment is in itself an intervention, as the distinguishing factors of these assessments. Based on these findings, it is hypothesized that a psychosocial approach may be influential when conducting assessments of deliberate self harm. These assessments may benefit from a focus on developing a relationship with the client, combined with an attempt to resolve identified needs and should this occur during the assessment it may impact on future self harming behaviours

Essential Notes in Psychiatry

Psychiatry is one of the major specialties of medicine, and is concerned with the study and treatment of mental disorders. In recent times the field is growing with the discovery of effective therapies and interventions that alleviate suffering in people with mental disorders. This book of psychiatry is concise and clearly written so that it is usable for doctors in training, students and clinicians dealing with psychiatric illness in everyday practice. The book is a primer for those beginning to learn about emotional disorders and psychosocial consequences of severe physical and psychological trauma; and violence. Emphasis is placed on effective therapies and interventions for selected conditions such as dementia and suicide among others and the consequences of stress in the workplace. The book also highlights important causes of mental disorders in children

Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars

A cross-sectional complete enumeration postal survey was conducted to compare stress levels between specialist registrars (SpRs) in palliative medicine, clinical oncology and medical oncology. Four hundred and one UK-registered SpRs responded (response rate 63.1%). Levels of psychological distress and depression were measured by GHQ-12 and SCL-D: 102/390 (26.2%, 95% confidence interval (CI) = 21.8–30.5%)) scored >3 on GHQ-12 indicating psychological distress, 44/391 (11.3%, 95% CI = 8.1–14.4%) scored ≥1.5 on SCL-D indicative of depression. Suicidal ideation was indicated by 15 responders. There were no significant differences between specialties. The effect of stress on personal or family life was the dominant predictor of both psychological distress and depression, although dissatisfaction with choice of specialty and feeling underutilised also contributed. One in four SpRs experience stress. These results are similar to studies of general practitioner principals and consultants from other specialties. Stress needs to be managed if doctors are to survive professional life

Predicting suicidal behavior among Indian adults using childhood trauma, mental health questionnaires and machine learning cascade ensembles

Among young adults, suicide is India's leading cause of death, accounting for an alarming national suicide rate of around 16%. In recent years, machine learning algorithms have emerged to predict suicidal behavior using various behavioral traits. But to date, the efficacy of machine learning algorithms in predicting suicidal behavior in the Indian context has not been explored in literature. In this study, different machine learning algorithms and ensembles were developed to predict suicide behavior based on childhood trauma, different mental health parameters, and other behavioral factors. The dataset was acquired from 391 individuals from a wellness center in India. Information regarding their childhood trauma, psychological wellness, and other mental health issues was acquired through standardized questionnaires. Results revealed that cascade ensemble learning methods using a support vector machine, decision trees, and random forest were able to classify suicidal behavior with an accuracy of 95.04% using data from childhood trauma and mental health questionnaires. The study highlights the potential of using these machine learning ensembles to identify individuals with suicidal tendencies so that targeted interinterventions could be provided efficiently.Comment: 11 pages, presnted at the 4th International Conference on Frontiers in Computing and Systems (COMSYS 2023), Himachal Pradesh, October 202

Clinical overlap between Posttraumatic Stress Disorder and Borderline Personality Disorder in male veterans

The associated features, high rates of comorbidity and chronicity of Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) raise questions regarding the distinctiveness of the two disorders. The present study expands upon previous literature by providing an investigation of clinical features across two groups: PTSD only and comorbid PTSD and BPD in a sample of male veterans (n=178). Results suggest that the two groups were distinct, with the comorbid group displaying higher levels of depression, hostility, alcohol use and general psychopathology. Groups did not differ on rates of personal trauma, adult sexual abuse, childhood sexual abuse, attack, accident or disaster. The two groups did differ significantly on rates of childhood violence

Post-traumatic stress disorder: The hidden epidemic and its effect on society

Post Traumatic Stress Disorder, a debilitating and sometimes disabling mental disorder, is emerging as one that is costly to society from many perspectives. PTSD sufferers commonly experience an inability to function normally within the workplace or within their social and family relationships. The disorder triggers strong emotional responses, changes social interaction and precipitates primary and secondary deviant behavior. This work focuses on non war related civilian incidence of the disorder. It examines the causes, circumstances and processes leading to the onset of the disorder and explores societal reaction to PTSD sufferers. Central to the work are the individual case studies of PTSD sufferers which examine the individual circumstances leading to the onset of the disorder, the personal effects of the condition on the sufferers and those around them and their difficulty experienced in obtaining adequate treatment for their condition and in functioning normally within society

Developing a Predictive Model of Depression and Suicidal Tendencies in Pilots

The mental health of commercial airline pilots is as important as their physical health because of their immense responsibility for the safety of their passengers and crews. Pilot suicides that end in fatal aircraft crashes result in many injuries and deaths. Although depression and suicidal tendencies are common across all genders, ages, ethnicities, and backgrounds, the mental health of aviation pilots has been challenging to evaluate and quantify through routine flight medical exams. The purpose of this study was to determine predictive factors of depression and suicidal tendencies among commercial airline pilots. Previous research has determined predictive factors of depression and suicidal tendencies in both the general population and specific subgroups, such as police and military personal. There has been little research focused on predicting depression and suicidal tendencies in 14 C.F.R. Part 121 airline pilots; thus, exposing a significant gap in the related aviation literature. This study employed a non-experimental correlational research design to investigate depression and suicidal tendencies among commercial airline pilots. From 728 responses to the online questionnaire website, 570 cases qualified for analysis. Thirteen exogenous variables were assessed through structural equation modeling (SEM) to identify predictors of Depression and Suicidal Tendencies, the endogenous variables. The results indicated support for three hypotheses, and two other significant relationships were discovered. Level of Stress and Job Satisfaction had significant influence on Depression, while Self-Reported Childhood Trauma, Level of Stress, and Depression had significant influence on Suicidal Tendencies. Level of Stress was positively related to Depression, suggesting Depression scores increase with Stress scores. Job Satisfaction was negatively related to Depression, suggesting Depression scores decrease with increases in Job Satisfaction scores. Stress, Childhood Trauma, and Depression were positively related to Suicidal Tendencies, suggesting the score for Suicidal Tendencies increases with an increase in Stress, Childhood Trauma, or Depression. The results also indicated a significant relationship between the COVID-19 control variable and Depression, but not with Suicidal Tendencies. There was no change in model fit when the control variable was removed, suggesting minimal effects of a perceived threat from COVID-19 on both Depression and Suicidal Tendencies. The initial SEM model explained 7.3% of the variance in Depression and 2.1% of the variance in Suicidal Tendencies. The final SEM model showed improvement in the amount of variance explained in both Depression and Suicidal Tendencies, explaining 8.1% of the variance in Depression and 27.1% of the variance in Suicidal Tendencies. The findings from this research provide insights into predicting the mental health of airline pilots. This information can benefit regulating agencies and airline hiring operations to ensure the safety of commercial air travel

Self-reported stress sources and personal problems among psychotherapists

There have been many speculations about the mental health of psychotherapists and the unique stress sources inherent in their profession, yet research to date has been meager. The present study focused on potential therapist stressors within the therapy session and the professional role. Specifically, the purposes of this exploratory study were: (1) to describe and clarify sources of stress which originate in client sessions and the professional role; (2) to explore certain irrational beliefs which therapists may hold and which may contribute to their own stress; and (3) to determine the extent of personal problems and disorders among therapists;Self-reported background characteristics of 264 psychotherapists served as independent variables, while written responses to an anonymous questionnaire provided the data base of dependent variables. Subjects made ratings of stress and frequency of occurrence for certain client behaviors, therapist experiences, and irrational beliefs. In addition, information was gathered on the incidence and treatment of personal problems among the therapists;Results revealed specific aspects of the therapists\u27 weekly routine which were stressful. Certain irrational beliefs also contributed to stress, particularly beliefs that one should operate at peak efficiency and enthusiasm at all times. Older and more experienced therapists reported less stress than younger, inexperienced therapists. Other therapist characteristics related to stress level included work setting, therapist sex, and caseload size;Over half these subjects had experienced relationship difficulties and depression. Data are given for these and other problems and treatment. A substantial proportion of therapists had been in therapy, but many had been reluctant to seek therapy for a variety of reasons;The findings are of interest to training program directors as well as to practicing therapists. Future research is needed to expand on individual differences in stress; to delineate coping strategies; to further explore cognitive stressors; and to specify the problems therapists experience and the treatment they are likely to receive