9 research outputs found
SAFETEL randomised controlled feasibility trial of a safety planning intervention with follow-up telephone contact to reduce suicidal behaviour: study protocol
Introduction:
There are no evidence-based
interventions that can be administered in hospital
settings following a general hospital admission after a
suicide attempt.
Aim:
To determine whether a safety planning intervention
(SPI) with follow-up telephone support (SAFETEL) is
feasible and acceptable to patients admitted to UK
hospitals following a suicide attempt.
Methods and Analysis:
Three-phase development and
feasibility study with embedded process evaluation. Phase
I comprises tailoring an SPI with telephone follow-up
originally designed for veterans in the USA, for use in the
UK. Phase II involves piloting the intervention with patients
(n=30) who have been hospitalised following a suicide
attempt. Phase III is a feasibility randomised controlled
trial of 120 patients who have been hospitalised following
a suicide attempt with a 6-month follow-up. Phase III
participants will be recruited from across four National
Health Service hospitals in Scotland and randomised
to receive either the SPI with telephone follow-up and
treatment as usual (n=80) or treatment as usual only
(n=40). The primary outcomes are feasibility outcomes and
include the acceptability of the intervention to participants
and intervention staff, the feasibility of delivery in this
setting, recruitment, retention and intervention adherence
as well as the feasibility of collecting the self-harm readmission to hospital outcome data. Statistical analyses
will include description of recruitment rates, intervention
adherence/use, response rates and estimates of the
primary outcome event rates, and intervention effect
size (Phase III). Thematic analyses will be conducted on
interview and focus group data.
Ethics and Dissemination:
The East of Scotland Research
Ethics Service (EoSRES) approved this study in March
2017 (GN17MH101 Ref: 17/ES/0036). The study results
will be disseminated via peer-reviewed publication and
conference presentations. A participant summary paper
will also be disseminated to patients, service providers and
policy makers alongside the main publication.
Trial Registration Number:
ISRCTN62181241
Mother–infant interaction in schizophrenia:Transmitting risk or resilience? A systematic review of the literature
Purpose:
The parent–infant relationship is an important context for identifying very early risk and resilience factors and targets for the development of preventative interventions. The aim of this study was to systematically review studies investigating the early caregiver–infant relationship and attachment in offspring of parents with schizophrenia.
Methods:
We searched computerized databases for relevant articles investigating the relationship between early caregiver–infant relationship and outcomes for offspring of a caregiver with a diagnosis of schizophrenia. Studies were assessed for risk of bias.
Results:
We identified 27 studies derived from 10 cohorts, comprising 208 women diagnosed with schizophrenia, 71 with other psychoses, 203 women with depression, 59 women with mania/bipolar disorder, 40 with personality disorder, 8 with unspecified mental disorders and 119 non-psychiatric controls. There was some evidence to support disturbances in maternal behaviour amongst those with a diagnosis of schizophrenia and there was more limited evidence of disturbances in infant behaviour and mutuality of interaction.
Conclusions:
Further research should investigate both sources of resilience and risk in the development of offspring of parents with a diagnosis of schizophrenia and psychosis. Given the lack of specificity observed in this review, these studies should also include maternal affective disorders including depressive and bipolar disorders
Wellbeing and resilience:Mechanisms of transmission of health and risk in parents with complex mental health problems and their offspring—The WARM Study
The WARM study is a longitudinal cohort study following infants of mothers with schizophrenia, bipolar disorder, depression and control from pregnancy to infant 1Â year of age.
Background:
Children of parents diagnosed with complex mental health problems including schizophrenia, bipolar disorder and depression, are at increased risk of developing mental health problems compared to the general population. Little is known regarding the early developmental trajectories of infants who are at ultra-high risk and in particular the balance of risk and protective factors expressed in the quality of early caregiver-interaction.
Methods/Design:
We are establishing a cohort of pregnant women with a lifetime diagnosis of schizophrenia, bipolar disorder, major depressive disorder and a non-psychiatric control group. Factors in the parents, the infant and the social environment will be evaluated at 1, 4, 16 and 52Â weeks in terms of evolution of very early indicators of developmental risk and resilience focusing on three possible environmental transmission mechanisms: stress, maternal caregiver representation, and caregiver-infant interaction.
Discussion:
The study will provide data on very early risk developmental status and associated psychosocial risk factors, which will be important for developing targeted preventive interventions for infants of parents with severe mental disorder
Do multimorbidity and deprivation influence patients' emotional expressions and doctors' responses in primary care consultations? - An exploratory study using multilevel analysis
Objective: To explore whether and how patient multimorbidity and socioeconomic deprivation conditions might influence patients’ emotional expression and doctors’ responses in the general practice (GP) consultations.Methods: Video recordings of 107 consultations (eight GPs) were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Multilevel logistic regressions modelled the probability of GP providing space response, considering patient multimorbidity, deprivation conditions and other contextual factors. Further multinomial regressions explored the possible impact of multimorbidity and deprivation on expression of and specific responses to patients’ emotional distress.Results: It was less likely for GPs to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas.Conclusion: Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes.Practice implications: Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes
SAFETEL: A pilot randomised controlled trial to assess the feasibility and acceptability of a safety planning and telephone follow-up intervention to reduce suicidal behaviour
Background:
A previous suicide attempt is an important predictor of future suicide. However, there are no evidence-based interventions administered in UK general hospital contexts to reduce suicidal behaviour in patients admitted following a suicide attempt. Consequently, the objective of this pilot randomised controlled trial was to explore whether a safety planning and telephone follow-up intervention (SAFETEL) was feasible and acceptable for individuals treated in hospital following a suicide attempt.
Methods:
In this three-phase study with an embedded process evaluation, a safety planning intervention was tailored to the UK context (Phase I), piloted (Phase II, n = 32), and tested in a feasibility randomised controlled trial (Phase III). In Phase III, participants were allocated to either the intervention (n = 80) or control group (n = 40) using telephone randomisation with a 2:1 ratio. The acceptability and feasibility of the trial and intervention procedures were evaluated using both qualitative (interviews and focus groups) and quantitative data. The number of hospital representations of suicidal behaviour was also collected 6 months after study recruitment based on electronic patient records.
Results:
Findings indicated that SAFETEL was both acceptable and feasible. Hospital staff reported the intervention fitted and complemented existing services, and patients reported that they favoured the simplicity and person-centred approach of the safety planning intervention.
Conclusions:
All progression criteria were met supporting further evaluation of the intervention in a full-scale clinical effectiveness trial