New Insights on Suicide Care from a Nursing Perspective

Research Paper Title

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.

Background

To explore nurses’ experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. A qualitative meta-synthesis.

Methods

Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019.

The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso’s method.

Results

Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: ‘Understanding suicidal behaviour as a consequence of suffering’, ‘Nurses’ personal distress in suicide care’, ‘The presence of the nurse as the axis of suicide care’ and, ‘Improving nurses’ relational competences for a better therapeutic environment’.

Conclusions

Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care.

Impact

This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

Reference

Clua-Garcia, R., Casanova-Garrigos, G. & Moreno-Poyato, A.R. (2021) Suicide care from the nursing perspective: A meta-synthesis of qualitative studies. Journal of Advanced Nursing. doi: 10.1111/jan.14789. Online ahead of print.

Interventions for Preventing Type 2 Diabetes in Adults with Mental Disorders in Low- & Middle-Income Countries

Research Paper Title

Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.

Background

The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs).

Therefore the aim of this study was to assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs.

Methods

The researchers searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. They also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020.

A randomised controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs.

Pairs of review authors working independently performed data extraction and risk of bias assessments. They conducted meta-analyses using random-effects models.

Results

One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review’s primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review’s secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions.

One study, which the researchers could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. They identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants).

There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence).

There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups.

Conclusions

Only one study reported data on the primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. The researchers are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.

Reference

Mishu, M.P., Uphoff, E., Aslam, F., Philip, S., Wright, J., Tirbhowan, N., Ajjan, R.A., Azdi, Z.A., Stubbs, B., Chhurchill, R. & Siddiqi, N. (2021) Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD013281.pub2.

Psychiatric Rehabilitation & Young Adults with Serious Mental Health Conditions

Research Paper Title

Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions.

Background

This study can inform psychiatric rehabilitation practice by describing the patterns of education, training, and employment activities among young adults with serious mental health conditions and identify potentially malleable factors that hinder or facilitate their ability to continuously pursue these activities.

Methods

One-time, in-person interviews were conducted with 55 young adults, ages 25-30, with serious mental health conditions in Massachusetts. The life story interview script asked participants about key life and mental health experiences and details about their education, training, and employment experiences.

Results

Young adult paths’ through post-secondary school, training, and work were often non-linear and included multiple starts and stops. Many young adults reported unsteady and inconsistent patterns of school and work engagement and only half were meaningfully engaged in education, employment, or training at the time of the interview. Employment often included service industry jobs with short tenures and most who had attempted post-secondary college had not obtained a degree. Barriers to continuous pursuit of school, training, or work included stress-induced anxiety or panic, increased symptomatology related to their mental health condition, and interpersonal conflicts. Flexible school, training, and work environments with supportive supervisors helped facilitate the continuous pursuit of these activities.

Conclusions

Psychiatric rehabilitation professionals need to help young adults with serious mental health conditions manage stress and anxiety and periods of increased symptomatology, navigate interpersonal challenges, and advocate for flexible and supportive accommodations. Early and blended education and employment supports would also be beneficial.

Reference

Sabella, K. (2021) Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions. Psychiatric Rehabilitation Journal. doi: 10.1037/prj0000470. Online ahead of print.

Refugee Children & Adolescents and PTSD

Research Paper Title

Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey.

Background

The researchers aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children.

Methods

The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively.

Results

20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD.

Conclusions

The results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.

Reference

Yektas, C., Erman, H. & Tufan, A.E. (2021) Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey. doi: 10.1080/08039488.2021.1880634. Online ahead of print.

Mental Health Inequalities in Non-Heterosexuals & Heterosexuals

Research Paper Title

The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples.

Background

Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples.

The aim of this study was to use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification.

Methods

The researchers analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. They explored bullying and discrimination as mediators.

Results

Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83-4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64-6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80-4.72; and AOR = 1.63; 95% CI 1.03-2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification.

Conclusions

Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.

Reference

Pitman, A., Marston, L., Lewis, G., Semlyen, J., McManus, S. & King, M. (2021) The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples. Psychological Medicine. doi: 10.1017/S0033291721000052. Online ahead of print.

Adolescents, Depression & Low Income Countries

Research Paper Title

Mind the brain gap: The worldwide distribution of neuroimaging research on adolescent depression.

Background

Adolescents comprise one fourth of the world’s population, with about 90% of them living in low- and middle-income countries (LMICs).

The incidence of depression markedly increases during adolescence, making the disorder a leading cause of disease-related disability in this age group.

However, most research on adolescent depression has been performed in high-income countries (HICs).

Methods

To ascertain the extent to which this disparity operates in neuroimaging research, a systematic review of the literature was performed.

Results

A total of 148 studies were identified, with neuroimaging data available for 4,729 adolescents with depression.

When stratified by income group, 122 (82%) studies originated from HICs, while 26 (18%) were conducted in LMICs, for a total of 3,705 and 1,024 adolescents with depression respectively.

A positive Spearman rank correlation was observed between country per capita income and sample size (rs=0.673, p = 0.023).

Conclusions

The results support the previous reports showing a large disparity between the number of studies and the adolescent population per world region.

Future research comparing neuroimaging findings across populations from HICs and LMICs may provide unique insights to enhance our understanding of the neurobiological processes underlying the development of depression.

Reference

Battel, L., Cunegatto, F., Viduani, A., Fisher, H.L., Kohrt, B.A., Mondelli, V., Swartz, J.R. & Kieling, C. (2021) Mind the brain gap: The worldwide distribution of neuroimaging research on adolescent depression. Neuroimage. doi: 10.1016/j.neuroimage.2021.117865. Online ahead of print.

PHQ-9 & GAD-7 Data in a National Survey about COVID-19 Restrictions in Australia

Research paper Title

Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia.

Background

While the Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) are frequently used in mental health research, few studies have reported comprehensive data on these measures from population or community samples.

The aim of this study was to describe gender- and age-specific PHQ-9 and GAD-7 item and summary data contributed by those who completed this survey.

Methods

The PHQ-9 and GAD-7 were used as indicators of symptoms of depression and anxiety in a national online anonymous survey to assess the mental health of adults in Australia during the COVID-19 restrictions.

Data were analysed descriptively.

Results

Complete survey responses were contributed by 13,829 people.

For both measures, item-by-item results, summary statistics (mean, standard deviation, minimum, maximum, median and interquartile range) and prevalence of severity categories are reported for the whole sample, and disaggregated by gender and age groups.

Conclusions

These comprehensive data provide a useful point of comparison for future COVID-19-related or other research among population or community samples.

Other researchers are encouraged to report detailed PHQ-9 and GAD-7 data in the future, to enable and promote relevant between-group comparisons.

Reference

Stocker, R., Tran, T., Hammarberg, K., Nguyen, H., Rowe, H. & Fisher, J. (2021) Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia. Psychiatry Research. doi: 10.1016/j.psychres.2021.113792. Online ahead of print.

Is There Value in Targeted Screening & Intervention Programmes of Anxiety in Young Adult Offspring with Parental Mental Health Problems?

Research Paper Title

Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study.

Background

Epidemiological studies indicate that children of parents with mental health problems are at an increased risk of developing anxiety disorders.

Few studies have investigated this relationship in young adults.

Methods

Participants were from the Raine Study, which is a multi-generational birth cohort study in Australia. Maternal anxiety and depression in late childhood were assessed using the Depression, Anxiety, and Stress Scale (DASS-42), and paternal lifetime mental health problems were assessed using a self-reported questionnaire.

The short form of DASS-42 (DASS-21) was used to assess anxiety symptoms among offspring at age 20. Negative binomial regression model was used to quantify the association. Data were available for 1,220 mother-offspring and 1,190 father-offspring pairs.

Results

After adjusting for potential confounders, the researchers found an increased risk of anxiety in young adult offspring exposed to maternal anxiety in late childhood and paternal lifetime mental health problems. However, they observed no increased risks of anxiety in offspring exposed to maternal depressive symptoms. Their sensitivity analysis based on the log-binomial model (binary outcome) as well as the linear model (log-transformed data) confirmed the robustness of the main results.

Conclusions

The findings suggest there can be value to consider and apply targeted screening and intervention programmes of anxiety in the young adult offspring with parental mental health problems.

Reference

Ayano, G., Betts, K., Lin, A., Tait, R. & Alati, R. (2021) Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study. Psychiatry Research. doi: 10.1016/j.psychres.2021.113781. Online ahead of print.

Linking Age, COVID-19 & First Episodes Psychosis

Research Paper Title

Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, Italy.

Background

The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms.

The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalised in the first four months since lockdown in Milan.

Methods

The researchers recruited sixty-two patients hospitalised between 08 March to 08 July 2020 versus those first hospitalised in the same period in 2019.

The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes.

Results

Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse.

Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019.

Conclusions

These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.

Reference

Esposito, C.M., D’Agostino, A., Osso, B.D., Fiorentini, A., Prunas, C., Callari, A., Oldani, L., Fontana, E., Gargano, G., Viscardi, B., Giordano, B., D’Angelo, S., Widenmann, F., Macellaro, M., Giorgetti, F., Turtulici, N., Gambini, O. & Brambilla, P. (2021) Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, Italy. Psychiatry Research. doi: 10.1016/j.psychres.2021.113802. Online ahead of print.

Linking Depressive Symptoms & Academic Achievement in UK Adolescents

Research Paper Title

Depressive symptoms and academic achievement in UK adolescents: a cross-lagged analysis with genetic covariates.

Background

The relationship between adolescent depressive symptoms and academic achievement remains poorly understood. The aim of this study was to help clarify the nature and directionality of this association.

Methods

The researchers used a sample of 13,599 British adolescents (main sample of N=3,809 participants). They fitted cross-lagged panel models using four repeated measures of self-reported depressive symptoms and four measures of academic achievement based on British national records between 11-18 years, separately for male and female adolescents and considering polygenic risk scores (PRS) for educational attainment and depression, alongside other child and parental covariates.

Observational design, variation around measurement times, missing data.

Results

The researchers found evidence of an overall negative association that was stronger in boys (R=-0.21, 95% CI -0.31 to -0.11) than in girls (-0.13, -0.31 to 0.05). Higher depressive symptoms were associated with lower academic achievement at a later stage up to the end of compulsory education (16 years), when the direction of the association reversed, although girls with lower achievement also appeared vulnerable to depressive symptoms at previous stages. The genetic variables derived for this study showed stronger associations for academic achievement, but the PRS for depression also showed a negative association with academic achievement in girls. Child intelligence quotient and peer victimisation also showed relevant associations.

Conclusions

Depressive symptoms and academic achievement should be considered jointly when designing school-based programmes for children and adolescents, alongside gender, child ability and school experience. Including genetic information in research can help to disentangle average from time-varying effects.

Reference

Lopez-Lopez, J.A., Kwong, A.S.F., Washbrook, L., Tilling, K., Fazel, M.S. & Pearson, R.M. (2021) Depressive symptoms and academic achievement in UK adolescents: a cross-lagged analysis with genetic covariates. Journal of Affective Disorders. 284, pp.104-113. doi: 10.1016/j.jad.2021.01.091. Online ahead of print.