22 research outputs found
Group problem-solving skills training for self-harm: randomised controlled trial
Background: Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. Aims: To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. Method: A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up. Results: The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group. Conclusions: This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective
Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial
Background
Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear.
Methods
RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047.
Findings
Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths.
Interpretation
Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population
Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial
Background
Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain.
Methods
RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and
ClinicalTrials.gov
,
NCT00541047
.
Findings
Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths.
Interpretation
Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy.
Funding
Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society
First report of the Suicide Support and Information System.
The SSIS pilot study was conducted in County Cork over the period September 2008 – March 2011. The SSIS operates according to a stepped approach whereby step 1 involves pro-active facilitation of support for family members bereaved by suicide, followed by step 2: obtaining information from different sources including information from coroners’ records, family informants and health care professionals who had been in contact with the deceased in the year prior to death.
In total 178 cases of suicide and 12 open verdicts (total 190) were ascertained in the Cork region during the pilot phase of the SSIS, with very satisfactory response rates for the three information sources.
Key outcomes include:
• In 39.5% of cases the SSIS pro-actively facilitated bereavement and other support. In 47.5% of cases bereavement support had been obtained prior to contact with the SSIS team. In 8.2% of cases the bereaved did not wish to avail of formal bereavement support from a specific service, but they welcomed further contact with a member of the SSIS team. A small proportion (4.8%) did not wish to receive further contact following the initial letter from the SSIS team.
• Mental health risk factors associated with suicide included mood disorder of the deceased, mental disorder of family members, history of deliberate self harm and lifetime alcohol abuse in the year prior to death.
• Major precipitating factors in the month prior to suicide included significant losses, significant or perceived significant disruption of a primary relationship and significant life changes. Evidence was found for the impact of the economic recession in terms of job loss, increased suicide risk associated with specific occupations, financial problems and loss of possessions, such as house etc.
• Evidence was found for long term adversity in the lives of people who died by suicide, often starting in childhood or early adolescence and continuing in later life, such as mental and physical maltreatment, problems in making contact with others and loneliness over a long period of time.
• The majority of the deceased had been in contact with their GP or a mental health service in the year prior to death, and those who had contacted their GP had done so 4 times or more.
• Challenges exist in the contact with health services including difficulties in accessing health care services, difficulties in adhering to treatment appointments and lack of compliance with instructions related to prescribed medication.
• The SSIS has been able to use official data sooner than the CSO, which has facilitated the identification of emerging suicide clusters.
• Through the multiple sources of information accessed by the SSIS, contagion effects could be identified and direct and indirect relationships among the suicide cluster cases could be established.
• Even though the number of open verdicts was relatively small, comparison with confirmed suicide cases revealed more similarities than differences, such as alcohol consumption at time of death, history of deliberate self harm, a high prevalence of mood disorders and use of psychotropic medication.
• During the SSIS pilot phase, first analyses were performed to link the SSIS data with the data from the National Registry of Deliberate Self Harm (NRDSH). Examination of suicides and deaths classified as open verdicts ascertained by the SSIS between 2008 and 2010 showed that at least 10% of the cases had been medically treated for deliberate self harm in the Cork region over the time period 2007-2009.
Key recommendations:
1. The outcomes of the SSIS pilot study and the independent evaluation by the University of Manchester recommend the maintenance of the SSIS in Cork and expansion to other regions in the country, in particular regions with high rates of suicide and a history of suicide clusters. Recommended options for expansion of the SSIS include: a) Phased implementation in collaboration with the Department of Health and the Department of Justice and Equality;1 b) Phased implementation in collaboration with suicide bereavement support services.1
2. Pro-active facilitation of bereavement support would be the recommended approach for services working with families bereaved by suicide, ensuring that all families bereaved by suicide are offered bereavement support through the services currently in place.
3. It is recommended to increase the awareness of coroners of local bereavement services and materials and to offer these as a matter of course.
4. The association between the impact of the recession (unemployment, financial problems, loss of possessions) and suicide, as identified by the SSIS, underlines the fact that suicide prevention programmes should be prioritised during times of economic recession.
5. Based on the association between alcohol/drug abuse and suicide as identified by the SSIS, it is recommended that:
a) National strategies to increase awareness of the risks involved in the use and misuse of alcohol should be intensified, starting at pre-adolescent age
b) National strategies to reduce access to alcohol and drugs should be intensified
c) Active consultation and collaboration between the mental health services and addiction treatment services be arranged in the best interest of patients who present with dual diagnosis (psychiatric disorder and alcohol/drug abuse)
6. The fact that the majority of people who died by suicide had been in contact with their GP 4 times or more in the year prior to death provides evidence for increased suicide awareness and skills training for GPs.
7. In areas with emerging suicide clusters, it is recommended to encourage involvement of GPs and other primary care professionals in a response plan and in early identification of people at risk of suicidal behaviour.
8. It is recommended to improve access to health care services for people who have engaged in deliberate self harm, people at high risk of suicide and people with multiple mental health and social problems.
9. In areas with emerging suicide clusters, the HSE-NOSP guidelines for responding to suicide clusters should be implemented and supported by additional capacity and specialist expertise as a matter of priority.
10. Comparing the characteristics of confirmed cases of suicide to open verdicts, the SSIS identified more similarities than differences, which underlines the need for further in-depth investigation into cases classified as open verdicts
Second report of the Suicide Support and Information System.
This is the second report of the Suicide Support and Information System (SSIS). The first report of the SSIS was published in July 2012 (Arensman et al, 2012).
In 2008, The National Office for Suicide Prevention(NOSP) commissioned the National Suicide Research Foundation to establish a National Suicide Support and Information System in line with Action 25.2 of the Reach Out National Strategy for Action on Suicide Prevention 2005-2014 (HSE, 2005). The first SSIS report provided outcomes of the implementation of the SSIS during the pilot phase in the Cork region, descriptive characteristics of people who died by suicide and who were recorded by the SSIS, and details of a large cluster of suicide among young men identified by the SSIS.
In total, 307 cases were recorded by the SSIS between September 2008 and June 2012 (275 suicides and 32 open verdicts fulfilling the case finding criteria). Coroner checklists were completed for all 307 cases
Unfortunately, not all alternative explanations were considered by Tyrer and colleagues (2003 a
Alcohol Involvement in suicide and self-harm.
BACKGROUND: Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior.
AIMS: This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations.
METHOD: Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland.
RESULTS: Alcohol consumption was detected in the toxicology of 44% out of 307 suicide cases. Only younger age was significantly associated with having consumed alcohol among suicides. Alcohol consumption was noted in the case notes in 21% out of 8,145 self-harm presentations. Logistic regression analyses indicated that variables associated with having consumed alcohol in a self-harm presentation included male gender, older age, overdose as a method, not being admitted to a psychiatric ward, and presenting out-of-hours.
LIMITATIONS: Data was limited to routinely collected variables by the two different monitoring systems.
CONCLUSION: Alcohol consumption commonly precedes suicidal behavior, and several factors differentiated alcohol-related suicidal acts. Self-harm cases, in particular, differ in profile when alcohol is consumed and may require a tailored clinical approach to minimize risk of further nonfatal or fatal self-harm
Mediating effects of coping style on associations between mental health factors and self-harm among adolescents.
There is evidence for an association between suicidal behavior and coping style among adolescents
The mental and physical health profile of people who died by suicide: findings from the Suicide Support and Information System.
PURPOSE
There is limited research on the associations between factors relating to mental and physical health in people who died by suicide.
METHODS
Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems.
RESULTS
The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s).
CONCLUSIONS
Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm
Suicide among Young People and Adults in Ireland: Method Characteristics, Toxicological Analysis and Substance Abuse Histories Compared.
Information on factors associated with suicide among young individuals in Ireland is limited. The aim of this study was to identify socio-demographic characteristics and circumstances of death associated with age among individuals who died by suicide.The study examined 121 consecutive suicides (2007-2012) occurring in the southern eastern part of Ireland (Cork city and county). Data were obtained from coroners, family informants, and health care professionals. A comparison was made between 15-24-year-old and 25-34-year-old individuals. Socio-demographic characteristics of the deceased, methods of suicide, history of alcohol and drug abuse, and findings from toxicological analysis of blood and urine samples taken at post mortem were included. Pearson's χ2 tests and binary logistic regression analysis were performed.Alcohol and/or drugs were detected through toxicological analysis for the majority of the total sample (79.5%), which did not differentiate between 15-24-year-old and 25-34-year-old individuals (74.1% and 86.2% respectively). Compared to 25-34-year-old individuals, 15-24-year-old individuals were more likely to engage in suicide by hanging (88.5%). Younger individuals were less likely to die by intentional drug overdose and carbon monoxide poisoning compared to older individuals. Younger individuals who died between Saturday and Monday were more likely to have had alcohol before dying. Substance abuse histories were similar in the two age groups.Based on this research it is recommended that strategies to reduce substance abuse be applied among 25-34-year-old individuals at risk of suicide. The wide use of hanging in young people should be taken into consideration for future means restriction strategies