Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Public health aspects of mental health care: implications and risks in a state owned southern Nigerian Psychiatric Hospital

Public health issues appear often ignored in hospital settings and lack of public health infrastructure like basic  hygiene facilities, being part of basic human requirement, affects the quality of life and patient’s physical and mental  health states and outcomes. This cross-sectional descriptive study examined the often-neglected public health  aspects of mental health care as exemplified by the risks associated with environmental health neglect in a state- owned psychiatric hospital in South-south Nigeria. Data was collected using the National Health Management  Information System-based Health Facility Daily Attendance Register (Version 2013), while Hospital In-patient  Facilities Checklist (for Psychiatric Units) was used for facility assessment and its compliance to standards. The data analysis was done using SPSS software Version 17. Results showed deficiencies in environmental health  infrastructure like absence of toilet facilities, window panes and mosquito nets and protocol/facilities for handling  sharps, as well as lack of bed-sheets or laundry facilities and inadequate beds; with many patients lying on the  ground. The common infections recorded in the hospital were malaria (13.5%), acute gastroenteritis (9.4%), and  those affecting the skin (8.5%). Thus, new policies that would favour good infrastructure and high standard of environmental hygiene in psychiatric hospitals are suggested to improve patient outcome. Keywords: Public, health risk, neglect, psychiatric hospita

Penal characteristics as predictors of depression in a Southern Nigerian prison

This study examined the penal characteristics acting as predictors of depressive disorders among 400 prison inmates using the stratified random sampling technique and the Depression component of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analysis was performed with the SPSS software package (Version 17) with the test of significance set at p<0.05. Results revealed a prevalence of 14.8% mild depression; 14.2% moderate depression with somatic features; 6.2% severe depression without psychotic features; 4.5% severe depression with psychotic features and an overall prevalence of 37%. Significant penal factors were nature of crime, reasons for delay in trial, and duration of stay. `The most frequently violated criminal code was Criminal code 401 (Armed Robbery). Logistic regression analysis indicated that the strongest predictor of depression was the duration of time spent in prison (or: 1.43, ci=1.19-1.73, p=0.00). Our findings suggest that duration of stay in prison increases the risk of depression among inmates and that the penal predictors for depression during imprisonment could help identify people for mental health interventions. It is recommended that concerned agencies of government should, as a matter of urgent public health importance, consider reforming the criminal justice system to reduce the duration of  stay in prisons.Keywords: Crime, penal, depression, offender, prison population

The experiences of detained mental health service users: issues of dignity in care.

BACKGROUND: When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. METHODS: This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not). RESULTS: The service users considered their dignity and respect compromised by 1) not being 'heard' by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom. CONCLUSIONS: Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice

Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory

Purpose: This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. Methods: Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Results: Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. Conclusion: The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males

Deaths among adults under supervision of the England and Wales probation services: variation in individual and criminal justice-related factors by cause of death

Background: The mortality rate among people under probation supervision in the community is greater than that among incarcerated people and that among the general population. However, there is limited research on the distinct vulnerabilities and risks underlying the causes of death in this population. In this retrospective cohort study, we examined the individual and criminal justice-related factors associated with different causes of death. Factors were assessed in relation to the type of supervision, distinguishing between those under post-custodial release and those serving a community sentence. Results: The study utilised the official data held by His Majesty’s Prison and Probation Service in England and Wales on the deaths of men and women under probation supervision between 01 April 2019 and 31 March 2021 where the cause of death had been definitively recorded (n = 1770). The high risk of deaths primarily caused by external factors (i.e., suspected suicide (10%), homicide (5%), and drug-related death (26%)) in this population was confirmed. A Gaussian Graphical Model (GGM) demonstrated unique relationships with suspected suicide and drug-related deaths for known suicide risk, history of drug use and recent (< 28 days of death) enforcement action due to a breach of probation conditions. Our findings suggest that that familial violence and abuse may be relevant in suicide and drug-related deaths and that minority groups may experience disproportional risk to certain types of death. Conclusions: This study identified unique risk indicators and modifiable factors for deaths primarily caused by external factors in this population within the health and justice spheres. It emphasised the importance of addressing health inequalities in this population and improved joint-working across health and justice. This involves ensuring that research, policies, training, and services are responsive to the complex needs of those under probation supervision, including those serving community sentences. Only then can we hope to see lower rates of death within this population

Adolescent substance use and educational attainment: an integrative data analysis comparing cannabis and alcohol from three Australasian cohorts

Background: The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood. Methods: Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N = 2179–3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined. Results: After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR = 1.60, 95% CI = 1.09–2.35), university non-enrolment (OR = 1.51, 95% CI = 1.06–2.13), and degree non-attainment (OR = 1.96, 95% CI = 1.36–2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use. Conclusions: Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention

Self-harm in primary school-aged children: Prospective cohort study

Introduction No prospective studies have examined the prevalence, antecedents or concurrent characteristics associated with self-harm in non-treatment-seeking primary school-aged children. Methods In this cohort study from Melbourne, Australia we assessed 1239 children annually from age 8–9 years (wave 1) to 11–12 years (wave 4) on a range of health, social, educational and family measures. Past-year self-harm was assessed at wave 4. We estimated the prevalence of self-harm and used multivariable logistic regression to examine associations with concurrent and antecedent factors. Results 28 participants (3% of the 1059 with self-harm data; 18 girls [3%], 10 boys [2%]) reported self-harm at age 11–12 years. Antecedent (waves 1–3) predictors of self-harm were: persistent symptoms of depression (sex-age-socioeconomic status adjusted odds ratio [aOR]: 7.8; 95% confidence intervals [CI] 2.6 to 24) or anxiety (aOR: 5.1; 95%CI 2.1 to 12), frequent bullying victimisation (aOR: 24.6; 95%CI 3.8 to 158), and recent alcohol consumption (aOR: 2.9; 95%CI 1.2 to 7.1). Concurrent (wave 4) associations with self-harm were: having few friends (aOR: 8.7; 95%CI 3.2 to 24), poor emotional control (aOR: 4.2; 95%CI 1.9 to 9.6), antisocial behaviour (theft—aOR: 3.1; 95%CI 1.2 to 7.9; carrying a weapon—aOR: 6.9; 95%CI 3.1 to 15), and being in mid-puberty (aOR: 6.5; 95%CI 1.5 to 28) or late/post-puberty (aOR: 14.4; 95%CI 2.9 to 70)

The health of adolescents in detention : a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people