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1.
Bipolar Disord ; 2024 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-39085171

RESUMEN

BACKGROUND: There has been increasing interest in examining the potential moderating effects that cognitive functioning has on treatment outcome in bipolar disorder (BD) and major depressive disorder (MDD). Therefore, the aim of this exploratory study was to examine the relationship between baseline cognitive function and treatment outcome in individuals with mood disorders who completed 12 months of interpersonal and social rhythm therapy (IPSRT), and were randomised to receive adjunctive cognitive remediation (CR) or no additional intervention. METHODS: Fifty-eight patients with mood disorders (BD, n = 36, MDD, n = 22), who were randomised to IPSRT-CR or IPSRT, underwent cognitive testing at baseline and completed follow-up mood measures after 12 months. General linear modelling was used to examine the relationship between baseline cognitive function (both objective and subjective) and change in mood symptom burden, and functioning, from baseline to treatment-end. RESULTS: Poorer baseline attention/executive function was associated with less change in mood symptom burden, particularly depressive symptoms, at treatment-end. Additionally, slower psychomotor speed at baseline was associated with less improvement in mania symptom burden. Subjective cognitive function at baseline was not related to change in mood symptom burden at treatment-end, and neither objective nor subjective cognitive function was associated with functional outcome. LIMITATIONS: Due to the exploratory nature of the study, there was no correction for multiple comparisons. CONCLUSION: Aspects of objective cognitive function were associated with treatment outcomes following psychotherapy. Further large-scale research is required to examine the role that cognitive function may have in determining various aspects of mood disorder recovery.

2.
J Adv Nurs ; 2023 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-38010816

RESUMEN

AIM: To synthesize research investigating suicide, suicide attempts, self-harm and suicide ideation in nursing and midwifery students, a group of interest due to high rates of suicide among qualified nurses. Specific areas of interest for this review included prevalence, factors which may contribute to or mitigate risk and suicide prevention interventions. DESIGN: A systematic review was conducted, and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. DATA SOURCES: Three electronic databases were searched, and additional articles identified using hand-searching. Studies were included if they examined suicide, suicide attempts, self-harm or suicide ideation in nursing or midwifery students. REVIEW METHODS: Studies were deduplicated and assessed for inclusion. Data from included studies were extracted, quality of studies assessed and data synthesized, informed by study focus, design and assessed quality. RESULTS: About 46 studies of largely moderate to low quality were identified. A high-quality study demonstrated increased risk of suicide in Swedish female nursing students, and increased risk of self-harm in nursing students of both sexes. Prevalence of suicide ideation did not appear to differ across course year, or between nursing students and students on other programmes. Psychiatric conditions, particularly depression, were associated with suicide ideation. Three studies related to suicide prevention interventions were identified. Integration of wellness initiatives into the curriculum and peer support were preferred interventions among nursing students and teaching staff. CONCLUSIONS: To understand the extent of suicide and self-harm among nursing and midwifery students there is a need for further epidemiological research stratified by programme of study. To develop prevention interventions and initiatives for nursing students, high-quality longitudinal studies should examine characteristics associated with suicide and self-harm. IMPACT: Current findings suggest interventions could include support for students experiencing mental health difficulties, foster peer support, and help develop wellness. No patient or public contribution.

3.
Acta Psychiatr Scand ; 145(3): 278-292, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34800298

RESUMEN

OBJECTIVE: To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. METHODS: A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). RESULTS: Sixty-eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT-CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18 months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes. CONCLUSIONS: Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.


Asunto(s)
Remediación Cognitiva , Trastorno Depresivo Mayor , Adulto , Cognición , Trastorno Depresivo Mayor/terapia , Humanos , Trastornos del Humor/terapia , Psicoterapia
4.
Health Expect ; 25(4): 1703-1716, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35514094

RESUMEN

INTRODUCTION: There is limited research exploring how smoking cessation treatment should be implemented into lung cancer screening in the United Kingdom. This study aimed to understand attitudes and preferences regarding the integration of smoking cessation support within lung cancer screening from the perspective of those eligible. METHODS: Thirty-one lung cancer screening eligible individuals aged 55-80 years with current or former smoking histories were recruited using community outreach and social media. Two focus groups (three participants each) and 25 individual telephone interviews were conducted. Data were analysed using the framework approach to thematic analysis. RESULTS: Three themes were generated: (1) bringing lung cancer closer to home, where screening was viewed as providing an opportunity to motivate smoking cessation, depending on perceived personal risk and screening result; (2) a sensitive approach to cessation with the uptake of cessation support considered to be largely dependent on screening practitioners' communication style and expectations of stigma and (3) creating an equitable service that focuses on ease of access as a key determinant of uptake, where integrating cessation within the screening appointment may sustain increased quit motivation and prevent loss to follow-up. CONCLUSIONS: The integration of smoking cessation into lung cancer screening was viewed positively by those eligible to attend. Screening appointments providing personalized lung health information may increase cessation motivation. Services should proactively support participants with possible fatalistic views regarding risk and decreased cessation motivation upon receiving a good screening result. To increase engagement in cessation, services need to be person-centred. PATIENT OR PUBLIC CONTRIBUTION: This study has included patient and public involvement throughout, including input regarding study design, research materials, recruitment strategies and research summaries.


Asunto(s)
Actitud Frente a la Salud , Detección Precoz del Cáncer , Neoplasias Pulmonares , Cese del Hábito de Fumar , Anciano , Anciano de 80 o más Años , Actitud , Detección Precoz del Cáncer/psicología , Grupos Focales , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/prevención & control , Neoplasias Pulmonares/psicología , Persona de Mediana Edad , Motivación , Investigación Cualitativa , Cese del Hábito de Fumar/psicología , Reino Unido
5.
J Clin Nurs ; 31(11-12): 1588-1597, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34418192

RESUMEN

AIMS AND OBJECTIVES: To explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening. BACKGROUND: The efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation. DESIGN: Qualitative exploratory study. METHODS: Qualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed. RESULTS: Analysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important - but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information. CONCLUSIONS: Young women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening-based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer- and screening-based knowledge in young women. RELEVANCE TO CLINICAL PRACTICE: Findings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation.


Asunto(s)
Neoplasias del Cuello Uterino , Adulto , Detección Precoz del Cáncer , Inglaterra , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Tamizaje Masivo , Investigación Cualitativa , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control
6.
Aust N Z J Psychiatry ; 55(10): 944-957, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34278831

RESUMEN

OBJECTIVE: Neurocognitive impairment is considered a core feature of mood disorders. Research has shown that neurocognitive impairment often persists beyond mood symptom resolution and can have significant deleterious effects on interpersonal relationships, academic achievement, occupational functioning and independent living. As such, neurocognitive impairment has become an important target for intervention. In this systematic review, we aimed to examine the extant literature to ascertain whether current standard evidence-based psychotherapies can improve neurocognitive functioning in mood disorders. METHOD: Studies examining changes in neurocognitive functioning following evidence-based psychotherapy were identified using MEDLINE, PsycINFO and Web of Science databases. Given the heterogeneity of study procedures, treatment protocols and patient samples, a narrative rather than meta-analytic review technique was employed. RESULTS: Nineteen studies (21 articles) met inclusion criteria. There was preliminary evidence of improved executive functioning following evidence-based psychotherapy for Major Depressive Disorder and Bipolar Disorder. There was also some signal of reduced negative biases in emotional information processing following psychotherapy in depression. Due to methodological variability across studies however, it was difficult to draw clear conclusions. CONCLUSION: Findings from the current review suggest that evidence-based psychotherapies may influence some aspects of neurocognitive functioning in mood disorders. This continues to be an ongoing area of importance and warrants further research.


Asunto(s)
Trastorno Bipolar , Trastorno Depresivo Mayor , Trastorno Bipolar/complicaciones , Trastorno Bipolar/terapia , Cognición , Trastorno Depresivo Mayor/terapia , Humanos , Trastornos del Humor , Psicoterapia
7.
J ECT ; 36(1): 10-17, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31990736

RESUMEN

OBJECTIVE: International guidelines suggest repeating cognitive testing at intervals throughout a course of electroconvulsive therapy (ECT) to monitor its effects on cognitive function. However, it is apparent that few services do this, and an optimal battery of testing has not yet been established. We aimed to evaluate the utility of such routine cognitive testing in a clinic where patients had been routinely tested at intervals throughout a course of ECT. METHODS: All patients referred for ECT at a public ECT clinic were offered routine cognitive testing to monitor cognitive function during their course of ECT. Testing was conducted at baseline and after 3, 6, and 9 treatments. Analyses examined whether change in individual measures predicted reduction in autobiographical memory at subsequent measures and whether the results that were given to clinicians informed treatment decisions. RESULTS: Changes in cognitive test results were not associated with clinician decisions to change treatment parameters. Only change in digit span forwards after 3 treatments was associated with later reduction in Colombia University Autobiographical Interview - Short Form (CUAMI-SF) of greater than 25%, with a larger improvement in digit span forwards being associated with greater chance of having a 25% reduction in CUAMI-SF. CONCLUSIONS: There was no evidence that the screening undertaken in this clinic had been helpful in determining treatment decisions or that changes in cognitive tests predicted in a reliable way who would later experience changes in autobiographical memory. However, follow-up testing was not completed reliably, and longer-term data regarding autobiographical memory were not collected.


Asunto(s)
Terapia Electroconvulsiva , Pruebas Neuropsicológicas , Adulto , Femenino , Humanos , Masculino , Memoria Episódica , Persona de Mediana Edad , Estudios Retrospectivos
8.
Aust N Z J Psychiatry ; 53(12): 1167-1178, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31146540

RESUMEN

OBJECTIVE: Post-traumatic stress disorder involves excessive retrieval of traumatic memories. Glucocorticoids impair declarative memory retrieval. This preliminary study examined the effect of acute hydrocortisone administration on brain activation in individuals with earthquake-related post-traumatic stress disorder compared with earthquake-exposed healthy individuals, during retrieval of traumatic memories. METHOD: Participants exposed to earthquakes with (n = 11) and without post-traumatic stress disorder (n = 11) underwent two functional magnetic resonance imaging scans, 1-week apart, in a double-blind, placebo-controlled, counter-balanced design. On one occasion, they received oral hydrocortisone (20 mg), and on the other, placebo, 1 hour before scanning. Symptom provocation involved script-driven imagery (traumatic and neutral scripts) and measures of self-reported anxiety. RESULTS: Arterial spin labelling showed that both post-traumatic stress disorder and trauma-exposed controls had significantly reduced cerebral blood flow in response to retrieval of traumatic versus neutral memories in the right hippocampus, parahippocampal gyrus, calcarine sulcus, middle and superior temporal gyrus, posterior cingulate, Heschl's gyrus, inferior parietal lobule, angular gyrus, middle occipital gyrus, supramarginal gyrus, lingual gyrus and cuneus, and the left prefrontal cortex. Hydrocortisone resulted in non-significant trends of increasing subjective distress and reduced regional cerebral blood flow in the left inferior frontal gyrus, left anterior cingulate gyrus, middle temporal gyrus, cerebellum, postcentral gyrus and right frontal pole, during the trauma script. CONCLUSION: Findings do not fit with some aspects of the accepted neurocircuitry model of post-traumatic stress disorder, i.e., failure of the medial prefrontal cortex to quieten hyperresponsive amygdala activity, and the potential therapeutic benefits of hydrocortisone. They do, however, provide further evidence that exposure to earthquake trauma, regardless of whether post-traumatic stress disorder eventuates, impacts brain activity and highlights the importance of inclusion of trauma-exposed comparisons in studies of post-traumatic stress disorder.


Asunto(s)
Amígdala del Cerebelo/fisiopatología , Terremotos , Glucocorticoides/administración & dosificación , Memoria , Corteza Prefrontal/fisiopatología , Trastornos por Estrés Postraumático/tratamiento farmacológico , Trastornos por Estrés Postraumático/fisiopatología , Adulto , Anciano , Amígdala del Cerebelo/diagnóstico por imagen , Mapeo Encefálico/métodos , Circulación Cerebrovascular/efectos de los fármacos , Estudios Cruzados , Desastres , Método Doble Ciego , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Prefrontal/diagnóstico por imagen , Trastornos por Estrés Postraumático/diagnóstico por imagen , Sobrevivientes
10.
Depress Anxiety ; 32(6): 437-44, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25677736

RESUMEN

BACKGROUND: Metacognitive therapy (MCT) is an innovative treatment model addressing patterns of negative thinking seen in emotional disorders. Unlike cognitive behavior therapy (CBT), MCT has strategies targeting dysfunctional cognitive and metacognitive processes underlying perseverative thinking patterns and attentional biases. The aim of this pilot study was to compare changes in neuropsychological functioning related to executive function and attention in outpatients with depression following treatment with MCT or CBT. METHODS: Forty-eight participants referred for outpatient treatment of depression were randomized to 12 weeks of MCT (n = 23) or CBT (n = 25). Mood severity and neuropsychological functioning were assessed at pretreatment, 4 weeks, and at end treatment (12 weeks). RESULTS: There were no significant group differences at pretreatment or 4 weeks on any neuropsychological test, although overall both groups showed a small improvement by 4 weeks. At end treatment, the MCT group demonstrated significantly greater improvement in performance on a task requiring spatial working memory and attention than the CBT group. Changes in executive functioning and attention were independent of change in mood symptoms. CONCLUSIONS: MCT may have an advantage over CBT in improving aspects of executive function, including attention. MCT's emphasis on attentional training and flexible control of thinking may have a beneficial effect on neuropsychological functioning, consistent with the purported mechanism of action.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo/terapia , Metacognición , Pruebas Neuropsicológicas , Adolescente , Adulto , Atención , Trastornos del Conocimiento/diagnóstico , Función Ejecutiva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Psicoterapia de Grupo , Pensamiento , Adulto Joven
11.
Crisis ; 45(2): 128-135, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38234244

RESUMEN

Background: Nursing professionals are an occupational group at increased risk of suicide, but little is known about self-harm in this population. Aims: To investigate the characteristics of nurses and midwives who present to hospital following self-harm. Method: We used data from the Oxford Monitoring System for Self-Harm to identify nurses and midwives who presented to the general hospital in Oxford during 2010-2020 following an episode of self-harm and received a psychosocial assessment. Results: During the eleven-year study period, 107 presentations of self-harm involving 81 nurses and midwives were identified. Self-poisoning was the most common self-harm method (71.6%), with antidepressants and paracetamol most frequently involved. Many had consumed alcohol before (43.8%) or during (25.3%) the self-harm act. Some individuals had high or very high suicide intent scores (22/70, 31.4%). Common problems preceding self-harm included problems with a partner (46.9%), psychiatric disorder (29.6%), and problems with employment (27.2%), family (24.7%), and alcohol (23.5%). A range of aftercare options were offered following presentation. Limitations: This study was limited to data from a single hospital. Conclusion: Prevention and management of self-harm within this occupational group requires preventative strategies and availability of interventions addressing the range of factors that may contribute to self-harm, especially relationship problems, psychiatric disorders, employment problems, and alcohol misuse.


Asunto(s)
Trastornos Mentales , Partería , Conducta Autodestructiva , Humanos , Embarazo , Femenino , Intento de Suicidio/psicología , Conducta Autodestructiva/psicología , Hospitales Generales
12.
Artículo en Inglés | MEDLINE | ID: mdl-39244728

RESUMEN

INTRODUCTION: Prior mental healthcare utilisation presents an important window of opportunity for providing suicide prevention interventions. To date, no reviews have consolidated the help-seeking needs of individuals in contact with mental health services. This warrants further attention given this group may have different needs for interventions compared with the general population who have not sought help previously. AIM: The purpose of this rapid scoping review was to summarise the available literature on help-seeking needs related to suicide prevention among individuals in contact with mental health services from healthcare settings. METHOD: Cochrane rapid review and Joanna Briggs Institute scoping review methodologies were adapted, and databases, including MEDLINE, Scopus, CINAHL, PsycInfo and EMBASE, were searched. RESULTS: A total of 42 primary studies were included in analysis. Reported barriers and facilitators to help-seeking behaviours identified within studies were mapped onto the socio-ecological model. Barriers and facilitators identified included knowledge and attitudes towards healthcare utilisation, family and peer support, interactions with healthcare professionals, provision of holistic care, and the creation of a supportive atmosphere and safe space to promote open discussions of suicide-related concerns. DISCUSSION: The findings of this review offer valuable insights into areas for improvement in addressing help-seeking needs for individuals who are in contact with health services related to suicide prevention. IMPLICATION FOR RESEARCH: The findings serve as a foundation for shaping mental health initiatives informing approaches and care delivery tailored towards individuals who are in contact with health services. The reported barriers and facilitators offer insights to inform the development of mental health support tools to enhance care and considerations for evaluations.

13.
Stud Health Technol Inform ; 312: 101-106, 2024 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-38372319

RESUMEN

This paper maps suicide help-seeking needs identified in the literature, on to the features and functionalities of suicide prevention mobile apps using the adapted ecological model, thereby revealing existing gaps between help-seeking needs and available apps. This paper builds upon previous work by our team, which includes 1) a rapid scoping review aimed at identifying barriers and facilitators of help-seeking related to suicide within psychiatric populations, and 2) a review of suicide prevention apps, including a content analysis of app features and functionalities.


Asunto(s)
Servicios de Salud Mental , Aplicaciones Móviles , Suicidio , Telemedicina , Humanos , Prevención del Suicidio , Suicidio/psicología
14.
J Affect Disord ; 331: 393-404, 2023 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-36933670

RESUMEN

BACKGROUND: Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297). METHODS: MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 1996 onwards exploring suicidal thoughts and behaviours among nurses and midwives were included. Quality of included studies was assessed. Articles were subjected to narrative synthesis informed by suicide data examined, study design, and quality. PRISMA guidelines were followed. RESULTS: A total of 100 studies were eligible for inclusion in the review. Articles examining suicide exclusively among midwives were absent from the literature. Several studies confirmed that nursing professionals, especially female, are at increased risk of suicide, particularly by self-poisoning. Factors contributing to risk include psychiatric disorders, alcohol and substance misuse, physical health problems, and occupational and interpersonal difficulties. In studies of non-fatal suicidal behaviours, including during the COVID-19 pandemic, psychiatric, psychological, physical and occupational factors were contributory. There has been little investigation of interventions for prevention of suicide in nurses. LIMITATIONS: Only articles published in English language were reviewed. CONCLUSIONS: The findings highlight the risk of suicide in nurses. They also show a combination of factors contribute to suicide and non-fatal suicidal behaviour in nurses, with psychiatric, psychological, physical health, occupational and substance misuse (especially alcohol) problems being particularly important. The limited evidence regarding prevention measures indicates a major need to develop primary and secondary interventions for this at-risk occupational group, for example, education regarding enhancing wellbeing and safe alcohol use, alongside accessible psychological support.


Asunto(s)
COVID-19 , Partería , Conducta Autodestructiva , Trastornos Relacionados con Sustancias , Humanos , Femenino , Embarazo , Ideación Suicida , Prevalencia , Pandemias , COVID-19/epidemiología , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Trastornos Relacionados con Sustancias/epidemiología
15.
Artículo en Inglés | MEDLINE | ID: mdl-37904647

RESUMEN

WHAT IS KNOWN ON THE SUBJECT: Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. ABSTRACT: INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. AIM: We explored the experiences of clinical staff who work with patients who self-harm by ligature. METHOD: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. RESULTS: 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. DISCUSSION: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. IMPLICATIONS FOR PRACTICE: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.

16.
Int J Ment Health Nurs ; 31(6): 1513-1522, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36008915

RESUMEN

Media impact on suicide is well-established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID-19 pandemic. Print and online newspaper reports about suicide in nurses (including students) published in the UK between January 2018 and August 2021 were obtained and data extracted for analysis in collaboration with Samaritans' media advisory team. Content and quality of newspaper reports were examined using a content analysis approach. The study was compliant with the STROBE checklist. Nurse or student nurse suicides were reported in 134 articles, including 50 individual suicides. Most articles were acceptable against Samaritans' media guidelines. However, common problems included absence of signposting to support organizations and lack of suicide prevention messages. A minority of articles included methods of suicide within article headlines (18, 13.4%) and sensationalist or romanticizing language (14, 10.7%). Most contained occupation-related content. Many named the individual's specific hospital or university and a substantial proportion included occupation-related images. Working on the frontline was the most reported link between COVID-19 and nurse suicide. While reporting on suicide among nurses and students was largely acceptable, quality of reporting was variable. Occupation was often discussed, and most articles published during COVID-19 linked suicide to the pandemic. The research findings can help shape guidance on reporting of suicide in specific professions and occupations, including nursing, to encourage responsible reporting and reduce inadvertent promotion of suicide.


Asunto(s)
COVID-19 , Prevención del Suicidio , Humanos , COVID-19/epidemiología , Pandemias , Lenguaje , Universidades , Medios de Comunicación de Masas
17.
Cancer Epidemiol Biomarkers Prev ; 31(7): 1275-1283, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-35511754

RESUMEN

Individuals with morbidity experience worse breast cancer outcomes compared with those without. This meta-analysis assessed the impact of morbidity on breast cancer-screening attendance and subsequent early detection (PROSPERO pre-registration CRD42020204918). MEDLINE, PsychInfo, and CINAHL were searched. Included articles published from 1988 measured organized breast-screening mammography attendance using medical records by women with morbidity compared with those without. Morbidities were assigned to nine diagnostic clusters. Data were pooled using random-effects inverse meta-analyses to produce odds ratios (OR) for attendance. 25 study samples (28 articles) were included. Data were available from 17,755,075 individuals, including at least 1,408,246 participants with one or more conditions;16,250,556 had none. Individuals with any morbidity had lower odds of attending breast screening compared with controls [k = 25; OR, 0.76; 95% confidence interval (CI), 0.70-0.81; P = <0.001; I2 = 99%]. Six morbidity clusters had lower odds of attendance. The lowest were for neurological, psychiatric, and disability conditions; ORs ranged from 0.45 to 0.59 compared with those without. Morbidity presents a clear barrier for breast-screening attendance, exacerbating health inequalities and, includes a larger number of conditions than previously identified. Consensus is required to determine a standardized approach on how best to identify those with morbidity and determine solutions for overcoming barriers to screening participation based on specific morbidity profiles.


Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Femenino , Humanos , Mamografía , Tamizaje Masivo , Morbilidad
18.
J Affect Disord ; 318: 224-230, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36055530

RESUMEN

BACKGROUND: To date, few studies have examined baseline cognitive function as a predictor of clinical outcome following treatment in bipolar disorder (BD). The aim of this analysis was therefore to examine the relationship between baseline cognitive function and treatment outcome in a sample of young adults with BD receiving Interpersonal Social Rhythm Therapy (IPSRT) or Specialist Supportive Care (SSC) with adjunctive pharmacotherapy. METHODS: Eighty-six BD patients underwent baseline cognitive testing and completed 18 months of IPSRT or SCC. Univariate analyses examined the relationship between baseline cognitive function (global and individual cognitive domains) and change in mood symptom burden, and psychosocial functioning, from baseline to treatment-end. RESULTS: Baseline global cognition was not predictive of change in mood symptom burden over 18 months of treatment. However, poorer baseline psychomotor speed performance was associated with less improvement in mood symptom burden at treatment-end. Neither baseline global cognition nor individual cognitive domain scores were associated with change in psychosocial functioning. LIMITATIONS: Due to the exploratory nature of the study, correction was not made for multiple comparisons. Data was obtained from a relatively small sample and has been the subject of prior analysis, thereby increasing the likelihood of chance findings. CONCLUSION: Although global cognition was not associated with outcome, when examining individual domains, poorer baseline psychomotor speed predicted less change in mood symptom burden following 18-months of psychotherapy and pharmacotherapy. This suggests that pre-treatment measures of psychomotor speed may help to identify those who require additional, and more targeted, intervention. Further large-scale research is required.


Asunto(s)
Trastorno Bipolar , Afecto , Trastorno Bipolar/complicaciones , Trastorno Bipolar/tratamiento farmacológico , Cognición , Humanos , Pruebas Neuropsicológicas , Psicoterapia , Adulto Joven
19.
Front Psychiatry ; 9: 382, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30210368

RESUMEN

Background: Research suggests that only 50% of patients with major depression respond to psychotherapy or pharmacological treatment, and relapse is common. Therefore, there is interest in elucidating factors that help predict clinical response. Cognitive impairment is a key feature of depression, which often persists beyond remission; thus, the aim of this systematic review was to determine whether baseline cognitive functioning can predict treatment outcomes in individuals with depression. Method: Studies examining cognitive predictors of treatment response in depression were identified using Pub Med and Web of Science databases. Given the heterogeneity of outcome measures, the variety of treatment protocols, and the differing ways in which data was presented and analyzed, a narrative rather than meta-analytic review technique was used. Results: 39 studies met inclusion criteria. Findings in younger adult samples were inconclusive. There was some evidence for a predictive effect of executive function and to a lesser extent, psychomotor speed, on treatment response. There was no evidence of learning or memory being associated with treatment response. In older-aged samples, the evidence was much more consistent, suggesting that poor executive function predicts poor response to SSRIs. Conclusions: Findings from the present review suggest that certain aspects of cognitive functioning, particularly executive function, may be useful in predicting treatment response in depression. This is certainly the case in elderly samples, with evidence suggesting that poor executive functioning predicts poor response to SSRIs. With further research, baseline cognitive functioning may serve as a factor which helps guide clinical decision making. Moreover, cognitive deficits may become targets for specific pharmacological or psychological treatments, with the hope of improving overall outcome.

20.
J Affect Disord ; 225: 91-96, 2018 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-28802727

RESUMEN

OBJECTIVE: The current study aimed to examine the neural correlates of processing genuine compared with posed emotional expressions, in depressed and healthy subjects using a novel functional magnetic resonance imaging (fMRI) paradigm METHOD: During fMRI scanning, sixteen depressed patients and ten healthy controls performed an Emotion Categorisation Task, whereby participants were asked to distinguish between genuine and non-genuine (posed or neutral) facial displays of happiness and sadness. RESULTS: Compared to controls, the depressed group showed greater activation whilst processing genuine versus posed facial displays of sadness, in the left medial orbitofrontal cortex, caudate and putamen. The depressed group also showed greater activation whilst processing genuine facial displays of sadness relative to neutral displays, in the bilateral medial frontal/orbitofrontal cortex, left dorsolateral prefrontal cortex, right dorsal anterior cingulate, bilateral posterior cingulate, right superior parietal lobe, left lingual gyrus and cuneus. No differences were found between the two groups for happy facial displays. LIMITATIONS: Relatively small sample sizes and due to the exploratory nature of the study, no correction was made for multiple comparisons. CONCLUSION: The findings of this exploratory study suggest that depressed individuals may show a different pattern of brain activation in response to genuine versus posed facial displays of sadness, compared to healthy individuals. This may have important implications for future studies that wish to examine the neural correlates of facial emotion processing in depression.


Asunto(s)
Encéfalo/patología , Depresión/patología , Expresión Facial , Felicidad , Adulto , Estudios de Casos y Controles , Corteza Cerebral/patología , Depresión/psicología , Femenino , Giro del Cíngulo/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Lóbulo Parietal/patología , Corteza Prefrontal/patología
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