The impact of Covid-19 pandemic on hospices : a systematic integrated review and synthesis of recommendations for policy and practice

Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care

Adolescents' reactions to participating in ethically sensitive research: A prospective self-report study

Background: Conducting psychological research with adolescents is imperative for better understanding, prevention and treatment of mental illness. However there is concern that research addressing topics such as mental illness, substance use and suicidality has potential to distress participants, particularly youth. Method: We administered a questionnaire to 1973 adolescents (13-18 years) at two time points, one year apart. Participants responded to items regarding nonsuicidal self-injury, psychological distress, history of physical and/or sexual abuse, adverse life events, alcohol use, suicidal behaviour, self-efficacy, and coping skills as well as two open-ended questions regarding whether they enjoyed participating in the research and whether participation worried or upset them. Results: Most youth (74 %) enjoyed participation and cited altruistic reasons and a greater self-awareness as reasons. Those reporting being upset by the questionnaire (15 %) reported poorer psychological functioning than their peers. Youth who were upset by their participation at baseline, but who reported enjoying the questionnaire at follow-up reported improved psychosocial functioning over time, while the reverse was true for those who initially enjoyed participation but later reported the questionnaire upset them. Conclusions: Results suggest researchers acknowledge benefits for young people who participate in research, but also be mindful of the potential for distress among the most at risk youth

Attachment and emotion regulation: Developmental targets for NSSI prevention and intervention

Non-suicidal self-injury (NSSI), for example self-cutting, is physically damaging behaviour often used to change emotional states, but without suicidal intent. Most common among adolescents and young adults, NSSI is associated with considerable distress and increased risk of later suicide. Early parent-child relationships form the context for how people regulate emotional states, and therefore may offer an explanation as to why some people are less able to change their emotional states in healthier ways. This research found that the quality of parent-child relationships and poor emotion regulation were associated with increased likelihood of self-injury. Prevention and intervention strategies are recommended

Opening the black box of daily life in nonsuicidal self-injury research: With great opportunity comes great responsibility

Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.</jats:p

Opening the Black Box of Daily Life in Non-Suicidal Self-Injury Research: With Great Opportunity Comes Great Responsibility

Although non-suicidal self-injury (NSSI) - deliberate damaging of body tissue without suicidal intent - is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this vision paper, we review new research pathways to improve our ability to understand, predict and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about: (I) the dynamic course of NSSI, (II) the real-time predictors thereof and ability to detect acute risk, (III) the ecological validity of theoretical models, (IV) the functional mechanisms and outcomes of NSSI, and (V) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (e.g., inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, and researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research

Longitudinal analysis of adolescent NSSI: the role of intrapersonal and interpersonal factors

Non-suicidal self-injury (NSSI) occurs in approximately 10 % of adolescents. To establish effective prevention and intervention initiatives, it is important to understand onset, maintenance and cessation of NSSI. We explored whether the relationships between interpersonal factors (i.e. attachment, social support) and NSSI were mediated by intrapersonal factors (i.e. emotion regulation, self-esteem, self-efficacy). Participants were 1973 students (1414 female and 559 male) aged between 12 and 18 years (M=13.89, SD=0.97) recruited from 40 Australian high schools. Participants completed a questionnaire at two time-points with a 12-month interval. At baseline, 8.3 % of adolescents engaged in NSSI, increasing to 11.9 % at follow-up. Family support was most salient in onset, maintenance and cessation of NSSI. Attachment anxiety was related to NSSI onset. Of the intrapersonal variables, self-esteem and self-efficacy were significant in predicting onset of NSSI. Self-esteem, self-efficacy and cognitive reappraisal mediated the relationship between attachment anxiety and NSSI onset. A combination of interpersonal and intrapersonal variables contributes to the onset, maintenance and cessation of NSSI in adolescence. Perceived family support appears to be an important safeguard against NSSI. Strategies targeting family functioning and teaching cognitive reappraisal techniques to adolescents may reduce the number engaging in NSSI

Brief online suicide risk assessment of adults does not affect state mood, even in the context of elevated suicidality self-stigma, suicidal ideation, and psychological distress.

There is a prevailing concern that suicide assessment poses an iatrogenic risk, whereby exposure to suicide-related materials may cause undue distress. The primary aim of the current repeated-measures study is to assess whether online suicide risk assessment affects state mood, and if self-stigma or coping related to suicidal ideation are predictors of mood change. The Australian participants (N = 662 participants, Mage = 34.9, SD = 12.3, 57.1% female), recruited through a crowd-sourcing platform, completed a visual analogue mood measure before and after The Suicide Ideation Attributes Scale (SIDAS), an assessment tool, and then self-stigma and coping measures; a modified version of the Internalised Stigma Scale, and the Brief COPE, respectively. State mood did not change from pre- to post-suicide risk assessment in the overall sample, t(662) = -0.16, p = .868, d = -0.01. Contrary to the hypotheses, neither self-stigma nor coping were related to mood change following exposure to the SIDAS. The multiple regression model was not significant, F(9,643) = 1.16, p = 0.31., nor was any single predictor including gender (Men, Women, and Non-binary participants; see results), current Suicide risk β = -0.04, t = -0.80, or psychological distress (as measured by the Depression, Anxiety, Distress Scale) β = -0.09, t = -1.76, p = 0.08. These findings suggest that online exposure to a suicide risk tool is unlikely to be iatrogenic in relation to state mood, even in the context of elevated self-stigma, suicidal ideation and psychological distress

Digital safety plan effectiveness and use: Findings from a three-month longitudinal study

Few studies have examined the effectiveness of self-guided smartphone apps for suicide safety planning, despite their increasing use. Participants (n = 610) were self-selected users of the Beyond Now suicide prevention safety planning app with a history of suicidal thoughts and behaviours. Surveys were completed (baseline, one and three months), safety plan content and app usage data was shared. Repeated-measures ANOVAs examined changes in suicidal ideation and suicide-related coping over three months. Multiple regression models were used to predict suicidal ideation and suicide-related coping at one- and three-month follow-ups with plan-related variables: perceived usefulness, personalised content, app use time and co-authoring of the plan with a third party. Significant reductions in suicidal ideation and increases in suicide-related coping were found over three months. Higher suicide-related coping at three months predicted lower suicidal ideation. Higher perceived usefulness and personalised content at three months were associated with higher suicide-related coping, but not suicidal ideation. App use time and co-authoring were not significantly related to suicidal ideation or suicide-related coping. Practitioners should empower clients to create safety plans with personalised (not generic) strategies that a client perceives to be useful. Such plans may strengthen beliefs about coping with suicidal ideation, which in turn reduces suicidal ideation over time