The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems

Background. Brief problem-solving therapy is regarded as a pragmatic treatment for deliberate self-harm (DSH) patients. A recent meta-analysis of randomized controlled trials (RCTs) evaluating this approach indicated a trend towards reduced repetition of DSH but the pooled odds ratio was not statistically significant. We have now examined other important outcomes using this procedure, namely depression, hopelessness and improvement in problems. Method. Six trials in which problem-solving therapy was compared with control treatment were identified from an extensive literature review of RCTs of treatments for DSH patients. Data concerning depression, hopelessness and improvement in problems were extracted. Where relevant statistical data (e.g. standard deviations) were missing these were imputed using various statistical methods. Results were pooled using meta-analytical procedures. Results. At follow-up, patients who were offered problem-solving therapy had significantly greater improvement in scores for depression (standardized mean difference =[minus sign]0·36; 95% CI [minus sign]0·61 to [minus sign]0·11) and hopelessness (weighted mean difference =[minus sign]3·2; 95% CI [minus sign]4·0 to [minus sign]2·41), and significantly more reported improvement in their problems (odds ratio = 2·31; 95% CI 1·29 to 4·13), than patients who were in the control treatment groups. Conclusions. Problem-solving therapy for DSH patients appears to produce better results than control treatment with regard to improvement in depression, hopelessness and problems. It is desirable that this finding is confirmed in a large trial, which will also allow adequate testing of the impact of this treatment on repetition of DSH

Young people's conceptualizations of the nature of cyberbullying: A systematic review and synthesis of qualitative research

© 2020 Elsevier Ltd Introduction: Cyberbullying is a serious public health problem facing young people. Adults do not have first-hand experience of being immersed in social media in their youth and this necessitates the inclusion of youth voice in efforts to understand and address cyberbullying. This study aimed to synthesize qualitative studies which had explored young people's conceptualizations of the nature of cyberbullying, with a view to informing conceptual and intervention development. Methods: A systematic review and meta-ethnographic synthesis of qualitative studies was conducted. Nine databases were searched from inception to July 2018. The Critical Appraisal Skills Program assessment tool was used to appraise the quality of included studies. Results: Of 4872 unique records identified, 79 were reviewed in detail and 13 studies comprising 753 young people from 12 countries were included. Five key concepts were identified: Intent, Repetition, Accessibility, Anonymity and Barriers to Disclosure. A “line of argument” illustrating young people's conceptualization of cyberbullying was developed. Conclusion: The significance of information and communication technology in young people's lives, and the complexity of the cyber world in which they connect, must be recognized in conceptualizations of cyebrbullying. The distinctive features of cyberbullying identified in young people's characterization can be used to inform bottom-up research and intervention efforts.This research was funded by the Health Research Board through the SPHeRE Programme SPHeRE/2013/

Childhood sexual abuse differentially predicts outcome of cognitive-behavioral therapy for deliberate self-harm.

De samenhang tussen somatische en psychische (dys)functie

Emotion regulation as mediator of treatment outcome in therapy for deliberate self-harm.

De samenhang tussen somatische en psychische (dys)functie

Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries

<p>Background: Variation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries.</p> <p>Methods: The process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings.</p> <p>Results: Analysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level ‘gatekeepers’, it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI.</p> <p>Conclusions: Exploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation.</p&gt

PROTECT: Relational Safety based Suicide Prevention Training Frameworks

Preventing suicide is a global priority and staff training is a core prevention strategy. However frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper is to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK; 333 – a recovery oriented model of inpatient/community crisis care and PROMISE – a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalise ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts, risk taking thresholds and increase rigour through time efficient crosschecks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualised solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning

Initial Validation of the Suicide Competency Assessment Form among Behavioral Health Staff in the National Health Services (NHS) Trust. Archives of Suicide Research

Objective: The Suicide Competency Assessment Form (SCAF) provides a framework for suicide prevention skills training. This study assessed SCAF psychometric properties in a sample of behavioral health staff. Method: A cross-sectional survey of National Health Services (NHS) staff from varying disciplines (N=170) was conducted. Results: The SCAF yielded a one-factor structure with high internal consistency. Nursing assistants reported lower SCAF scores compared to other professionals. SCAF scores demonstrated positive associations with prior suicide prevention training, job enthusiasm, and several suicide/self-injury prevention outcome expectations (i.e., optimism working with self-harming patients and perceived ability to help self-harming patients). SCAF scores further demonstrated incremental validity in the form of multivariate model associations with suicide/self-injury prevention outcome expectations. Improved job satisfaction mediated the pathway from SCAF scores to perceived ability to help self-harming patients. Conclusion: The SCAF can be utilized in suicide prevention training and clinical supervision

Cognitive-behavioural intervention for self-harm: randomised controlled trial.

FSW - Self-regulation models for health behavior and Psychopathology - Ou

Problem solving ability and repetition of deliberate self-harm: a multicentre study.

Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. Method. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. Results. Factor analysis identified five dimensions – Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance – characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems – was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. Conclusions. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH