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ABSTRACT: Background: Suicide has been conceived as involving a continuum, whereby suicidal plans and acts emerge from thoughts about suicide. Suicide prevention strategies need to determine whether different responses are needed at these points on the continuum. Aims: This study investigates factors that were perceived to counter suicidal ideation, plans, and acts. Method: The 36 participants, all of whom had had experiences of psychosis and some level of suicidality, were presented with a vignette describing a protagonist with psychotic symptoms. They were asked to indicate what would counter the suicidal thoughts, plans, and acts of the protagonist described in the vignette. Qualitative techniques were first used to code these free responses into themes/categories. Correspondence analysis was then applied to the frequency of responses in each of these categories. Results: Social support was identified as a strong counter to suicidal ideation but not as a counter to suicidal plans or acts. Help from health professionals was strongly related to the cessation of suicidal plans as were the opinions of the protagonist's children. Changing cognitions and strengthening psychological resources were more weakly associated with the cessation of suicidal ideation and plans. The protagonist's children were considered potentially helpful in addressing suicidal acts. Conclusion: These results suggest that both overlapping and nonoverlapping factors need to be considered in understanding suicide prevention, dependent on whether individuals are thinking about, planning, or attempting suicide.
Crisis The Journal of Crisis Intervention and Suicide Prevention 04/2013; · 1.09 Impact Factor
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Cognitive Therapy and Research 01/2013; 37:61-70. · 1.33 Impact Factor
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ABSTRACT: The broaden-and-build theory postulates that positive emotions broaden people's cognitions and actions, and facilitate the building of personal and social resources which enhance resilience in a range of clinical populations. The Broad-Minded Affective Coping procedure (BMAC) is a recently developed clinical technique which utilizes the recall of positive autobiographical memories and mental imagery to elicit positive affect. This study aims to investigate the ability of the BMAC to boost mood among 50 individuals diagnosed currently (n = 31) or previously (n = 19) with Posttraumatic Stress Disorder (PTSD). To assess mood, a series of Visual Analog Scales (VASs) and Likert scales measuring feelings of sadness, calmness, happiness, hopelessness, defeat and frustration were administrated at baseline, immediately following the completion of the BMAC and two hours and two days afterwards. Participants in the BMAC condition demonstrated greater increases in self-reported levels of positive emotions and greater reductions in self-reported levels of negative emotions following the BMAC technique compared to those in the control condition. The results suggest that the BMAC is a useful clinical technique which can be incorporated into other clinical interventions such as cognitive behavioral therapy to elicit positive affect and promote resilience.
Behaviour research and therapy 07/2012; 50(10):589-95. · 3.00 Impact Factor
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ABSTRACT: Attitudes about family interventions have been identified as a possible reason for the poor implementation of such treatments. The current study used Q methodology to investigate the attitudes of relatives of forensic service users and clinical staff towards family interventions in medium secure forensic units, particularly when facilitated by a web camera. Eighteen relatives and twenty-nine staff completed a sixty-one item Q sort to obtain their idiosyncratic views about family intervention. The results indicated that relatives and staff mostly held positive attitudes towards family intervention. Relatives showed some uncertainty towards family intervention that may reflect the lack of involvement they receive from the forensic service. Staff highlighted key barriers to successful implementation such as lack of dedicated staff time for family work and few staff adequately trained in family intervention. Despite agreement with the web-based forensic family intervention technique and its benefits, both staff and relatives predicted problems in the technique.
Journal of Psychiatric and Mental Health Nursing 06/2011; 19(2):162-73. · 0.80 Impact Factor
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ABSTRACT: The goal of the current study was to investigate psychological resilience in the older adults (>64 years) compared with that of the young ones (<26 years).
Questionnaire measures of depression, hopelessness, general health and resilience were administered to the participants. The resilience measure comprised three sub-scales of social support, emotional regulation and problem solving.
The older adults were the more resilient group especially with respect to emotional regulation ability and problem solving. The young ones had more resilience related to social support. Poor perceptions of general health and low energy levels predicted low levels of resilience regardless of age. Low hopelessness scores also predicted greater resilience in both groups. Experiencing higher levels of mental illness and physical dysfunction predicted high resilience scores especially for the social support resilience scale in the older adults. The negative effects of depression on resilience related to emotional regulation were countered by low hopelessness but only in the young adults.
These results highlight the importance of maintaining resilience-related coping skills in both young and older adults but indicate that different psychological processes underlie resilience across the lifespan.
International Journal of Geriatric Psychiatry 04/2011; 27(3):262-70. · 2.42 Impact Factor
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ABSTRACT: Recent years have seen growing interest into concepts of resilience, but minimal research has explored resilience to suicide and none has investigated resilience to suicide amongst clinical groups. The current study aimed to examine whether a proposed resilience factor, positive self-appraisals of the ability to cope with emotions, difficult situations and the ability to gain social support, could buffer against the negative impact of hopelessness amongst individuals with psychosis-spectrum disorders when measured cross-sectionally. Seventy-seven participants with schizophrenia-spectrum disorders completed self-report measures of suicidal ideation, hopelessness and positive self-appraisals. Positive self-appraisals were found to moderate the association between hopelessness and suicidal ideation. For those reporting high levels of positive self-appraisals, increased levels of hopelessness were significantly less likely to lead to suicidality. These results provide cross-sectional evidence suggest that positive self-appraisals may buffer individuals with psychosis against the pernicious impact of a well known clinical risk factor, hopelessness. Accounting for positive self-appraisals may improve identification of individuals at high risk of suicidality, and may be an important area to target for suicide interventions.
Behaviour research and therapy 09/2010; 48(9):883-9. · 3.00 Impact Factor
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ABSTRACT: The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events.
78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals.
Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality.
These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.
Behaviour research and therapy 10/2009; 48(3):179-86. · 3.00 Impact Factor
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ABSTRACT: This study aimed to investigate whether previous findings from a small retrospective study could be replicated prospectively. The previous study showed that patients with an existing diagnosis of psychosis or depression, admitted to a burns service, had longer hospital stays and longer wound healing times when compared with controls matched for burn injury but without a pre-existing psychiatric condition [1]. In this study it was hypothesised that those patients without pre-existing psychiatric diagnosis, but with high levels of psychological distress after burn would also show a similar pattern of delayed recovery to those with a pre-existing psychiatric illness. In addition, we examined potential mechanisms for slowed recovery, including; adherence with treatment; delayed discharge on social grounds and psychological distress. It was hypothesised that patients with pre-existing psychiatric diagnosis would exhibit poorer adherence and delayed placement due to social reasons, compared to patients without pre-existing psychiatric diagnoses. 107 consecutive admissions to a burns service over a seven-month period were included in the study. Psychiatric history and level of psychological distress post-burn were collected for all patients as part of routine psychological screening. Patients were compared on the following outcome variables: number of days spent in hospital and number of procedures required. 24% (n=27) were found to have a pre-existing psychiatric diagnosis. This group were also found to have significantly longer hospital stays (Mann-Whitney U=585.50, p<0.01) and required more surgical procedures than the group without a psychiatric history (Mann-Whitney U=569.00, p=<0.001). The pattern of results for the group with high psychological distress but without pre-existing psychiatric diagnoses mirrored that of the group with pre-existing psychiatric diagnoses, suggesting that heightened psychological distress alone, has a significant delaying effect upon the rate of recovery (Kruskal-Wallis X=24.75, p<0.01). An exploratory model entering all the variables stepwise at the same stage identified poor adherence and delayed discharge issues as making significant contributions to the final model (r=0.81 adjusted r(2)=62.9, F (4, 42)=20.48, p<0.001). In conclusion, this study supports the role of psychosocial factors, such as pre-existing psychiatric diagnosis and in hospital psychological distress, in contributing the recovery of survivors of burns. This suggests that identifying and working with these difficulties may impact not only on psychosocial, but also physical aspects of recovery.
Burns: journal of the International Society for Burn Injuries 10/2009; 36(2):183-91. · 1.95 Impact Factor
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ABSTRACT: A proportion of patients who suffer from schizophrenia exhibit persistent psychotic symptoms in spite of the prescription of neuroleptic medication. Two aspects of the management of persistent positive symptoms are described. These are recent developments in the psychological management of such symptoms together with a summary of factors which might be related to the outcome of such interventions. A brief review of factors associated with medication non-compliance and interventions aimed at reducing such non-compliance is also included. Ongoing research suggests that these recent developments show promise in enhancing the outcome in this patient group, particularly if the techniques can be disseminated throughout services.
07/2009; 6(2-3):201-215.
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ABSTRACT: The concepts of defeat and entrapment have been employed in evolutionary accounts of clinical phenomena such as depression and suicide. Recently theorists have argued that both concepts may be best conceptualised as a single distinct factor. The current study is the first to empirically test this assertion. A sample of 305 students completed measures of defeat and entrapment. Their responses were then analysed via exploratory factor analysis. The results strongly suggest that a single factor underlies both defeat and entrapment. These findings have considerable implications for past studies and theoretical accounts that rely on the distinction between defeat and entrapment.
Personality and Individual Differences. 01/2009; 47:795-797.
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ABSTRACT: Ovarian cancer patients may experience psychological disorders due to the aggressive nature of the illness and treatment. We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders. Patients were assessed in a prospective longitudinal study at the beginning of chemotherapy treatment, mid-treatment, end of treatment and 3 months follow-up for depression, anxiety, perceived social support, neuroticism and cognitive strategies to control unwanted thoughts. A total of 121 patients were recruited and 85 patients were assessed at all four time points. Three different longitudinal profiles of anxiety and depression caseness were found: non-cases (never cases), occasional cases (cases on at least one but not all four occasions) and stable cases (cases on all four occasions). Most of the women were occasional cases of anxiety (52%, 44), whereas for depression, the majority of women were non-cases (55%, 47). A subset of patients were stable cases of anxiety (22%, 19). Neuroticism and marital status were significant independent predictors of anxiety caseness profile. Neuroticism and use of anti-depressants were independent predictors of depression caseness profile. Social support was not related to psychological morbidity.
British Journal of Cancer 12/2008; 99(11):1794-801. · 5.04 Impact Factor
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ABSTRACT: A variety of factors are related to noncompliance in schizophrenia. However, little attention has been paid to what causes noncompliance. Reactance may be important. However, the direction of the observed relationship between reactance, freedom of choice and taking medication has not been confirmed. 95 college students were asked to read a story about an individual suffering from their first episode. There were two possible endings, one in which treatment was presented with little freedom of choice and one in which there was a high degree of freedom of choice. Participants also completed measures of their reactance and a rating of their likelihood of taking medication if they had experienced the circumstances described in the story. Reactance prone participants rated themselves as being less likely to take medication if their freedom of choice was restricted. Restriction of freedom of choice for nonreactance prone participants had no effect on their compliance ratings. Thus restricting patients' freedom of choice, early in their illnesses, may cause them to be noncompliant if they are prone to reactance. The relevance of these findings to clinical situations is discussed together with the limitations of the study.
Acta Psychiatrica Scandinavica 07/2008; 106(s413):69 - 106. · 4.22 Impact Factor
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ABSTRACT: Research with nonpsychotic patients has indicated that the therapeutic alliance makes an important contribution to outcome of psychological treatments. Although recent years have seen a resurgence of enthusiasm for psychotherapeutic interventions for psychotic patients, particularly following the publication of large-scale RCTs of cognitive-behaviour therapy (CBT) for schizophrenia patients, there have been few attempts to assess the contribution that the patient–therapist relationship makes to these interventions, which have been usually described in terms of particular techniques. However, in a study of psychodynamic therapy for chronic schizophrenia patients, Frank and Gunderson (1990) reported that patients were slow to form an adequate alliance, although the quality of the alliance was a predictor of long-term outcome.In this paper, we will review evidence from previous studies, and present data on the therapeutic alliance and other process variables taken during a large randomized controlled trial of CBT for first and second episode schizophrenia patients (the SoCRATES study). A total of 315 patients entered the study, and were randomized to treatment as usual, supportive counselling or CBT, with a 5-week therapy envelope commencing within 2 weeks of admission to hospital. Baseline and follow-up assessments were conducted by psychiatrists blind to group assignment, and 75% of the patients were retained in the study at 18 month follow-up. We have reported the main outcome data elsewhere; statistically significant but modest benefits were found for both CBT and counselling. Therapeutic alliance measures were completed by both patients and therapists in thetwo psychological treatment groups at the third and 10th session. All measures had acceptable reliability but therapist assessments of the alliance correlated poorly with patients' perceptions. Both patient and therapist alliance ratings at session 3 predicted duration of treatment. Duration of treatment, in turn, predicted therapy response. The findings indicate the importance of investigating process variables as mediators of response to treatments for early psychosis.
Acta Psychiatrica Scandinavica 07/2008; 106(s413):69 - 106. · 4.22 Impact Factor
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ABSTRACT: To determine whether a 24-week, needs-based cognitive-behaviourally oriented family intervention for patients suffering from schizophrenia led to improved relapse profiles over a 5-year follow-up period.
The case notes of 60 patients who had participated in a randomized, controlled effectiveness trial were examined to determine relapse rates over a 5-year period.
Patients were less likely to relapse over the 5-year follow-up when they received the needs-based family intervention, especially in relation to exacerbations of symptoms not requiring inpatient admissions: 86.7% of control participants relapsed compared with 53.3% (P = 0.01). Survival analysis indicated that the relapse risk was 2.5 times higher for patients receiving routine care, compared with those receiving family intervention. A similar trend was observed for the final 4 years of follow-up.
The present study provides some tentative support for the long-term effectiveness of family-based interventions for the management of schizophrenia in general mental health services.
Acta Psychiatrica Scandinavica 01/2008; 116(6):447-52. · 4.22 Impact Factor
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ABSTRACT: The National Burn Care Review Committee [National Burn Care Review Committee. National Burns Care Review. Standards and Strategy for Burn Care; 2001] recommend routine psychosocial screening for all burned in-patients, as well as access to different levels of psychological input. This paper aims to report on: (1) a system which integrates routine clinical practice, psychological screening and a system of data collection to identify level of need; (2) an audit of the range of levels of psychological input required to meet this need. All consecutive admissions (n=72) to a regional burns unit were screened within a week of admission using the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale (IES) and a screening tool developed in the unit. Clinical input was provided as required and recorded. Thirty-five percent reported a previous mental health problem. Forty percent fell into 'borderline' or 'caseness' on the HADS. Fifteen percent met a level of clinical 'caseness' on both the intrusions and avoidance subscales of the IES. Sixty-three percent required some level of psychological input during their in-patient stay. Given the high level of need identified and the range of levels of psychological intervention identified, a system of routine screening and a tiered model of psychological care is proposed to best utilise psychological resources.
Burns 10/2007; 33(6):736-46. · 1.96 Impact Factor
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ABSTRACT: Background
There appears to be a strong
connection between suicidality and the experience of
trauma. The study investigated suicidality in chronic
civilian post–traumatic stress disorder (PTSD).
Method
Ninety–four participants suffering from chronic PTSD
were assessed for suicidal ideation, plans and attempts
since the index trauma as part of a comprehensive assessment.
The prevalence of these was assessed and
characteristics of those reporting suicide–related
thoughts and behaviour were investigated through logistic
and multinominal regression analyses.
Results
Over half of the sample (56.4%) reported some aspect of
suicidality with 38.3% reporting ideation, 8.5% reporting
suicide plans and 9.6% having made suicide attempts
since the trauma. Of the nine participants who
reported suicide attempts, six had made more than one
attempt. The proportions of participants who reported
suicidality in this sample were significantly greater than
reported within the general population, when comparisons
were made with an epidemiological study. Logistic
regression analysis indicated that a unit increase in life
impairment (OR = 3.1) and depression (OR = 1.14)
scores were independently and significantly associated
with suicidality. Multinominal regression indicated that
life impairment (OR = 2.71) and depression (OR = 1.13)
scores were associated with the presence of suicidal
ideation compared to no ideation, and life impairment
(OR = 5.75), depression (OR = 1.2) scores and receiving
psychotropic medication (OR = 10.6) were associated
with the presence of plans and attempts compared to no
suicidal behaviour.
Conclusions
Suicide risk is elevated
in those suffering from chronic PTSD and is associated
with impaired functioning in combination with depression.
Social Psychiatry and Psychiatric Epidemiology 07/2004; 39(8):655-661. · 2.70 Impact Factor
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ABSTRACT: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance.
Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds.
Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months.
In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.
Psychological Medicine 03/2004; 34(2):285-92. · 6.16 Impact Factor
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ABSTRACT: This study examined the psychometric properties of the Family Questionnaire (FQ): a self-report measure of relatives' perceptions of the behaviours and symptoms of schizophrenic patients in terms of three dimensions: the frequency of symptoms, the relatives' concern (primary appraisal) and their ability to cope (secondary appraisal) with the symptoms.
Factor analysis of the FQ, test-retest and inter-rater reliability, and measures of validity were examined.
Factor analysis supported the validity of five subscales labelled negative symptoms, antisocial behaviours, interpersonal problems, affective symptoms and psychotic symptoms. Test-retest reliability for all scales was good and the prediction that there would be limited correspondence between two different relatives' scores was supported for the subscales of negative symptoms and affective symptoms. Concurrent measures of relatives' distress, burden and patients' symptomatology indicated that the FQ showed acceptable validity. In particular, the study showed that high expressed emotion relatives have higher scores on the appraisal dimensions of some subscales.
The study provides evidence that the FQ is a useful tool for measuring relatives' perceptions of schizophrenic illness, particularly within the context of family interventions where it may be utilized to help to understand the factors mediating relatives' burden and distress.
Acta Psychiatrica Scandinavica 11/2003; 108(4):290-6. · 4.22 Impact Factor
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ABSTRACT: . A variety of factors are related to compliance with medication in schizophrenia, but little attention has been paid to the role of families. Carers' knowledge or expressed emotion (EE) may be related to compliance. The aim of the present study was to evaluate the relevance of these two factors, as well as their relationships with other variables for the prediction of compliance.
A sample of patient-carer pairs (N = 79) involved in a family intervention for schizophrenia trial was recruited. Compliance, symptoms, social functioning and attitudes to their carers were assessed in patients. Carers' EE, knowledge and psychopathology were also evaluated.
A number of factors were related to compliance, including carers' EE and patients' psychotic symptoms, which contributed independently to not taking medication. Carers' knowledge about schizophrenia and other groups of symptoms was not related to compliance.
EE may be an important factor to account for in the understanding of patients' compliance and the direction of the relationship between EE and compliance should be the subject of further study.
Psychological Medicine 02/2003; 33(1):91-6. · 6.16 Impact Factor
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ABSTRACT: Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression occurring regularly with the onset of winter.
The study was a prospective naturalistic follow-up of the emergence of symptoms of seasonal depression with the passage of time and change in seasons. Participants were screened during summer for SAD. Participants were excluded if they were depressed (BDI > 14) during the summer reruitment. Eligible participants prospectively monitored their mood and anxiety by completing the BDI and BAI every 2 weeks from 1 September through to the 31 March.
Forty-five participants met criterion for SAD were included in the final data analyses. Depression scores rose gradually over the 30 week period reaching a peak median score around weeks 22 to 24 (January-February). The 'hallmark' physiological symptoms (changes in sleep, appetite and fatigue) emerged earlier in the winter period than cognitive symptoms. The emergence of anxiety symptoms was highly correlated with depressive symptoms, although the median anxiety scores did not reach a clinically significant level. Low self-esteem and poor perceived social support were significantly related to an earlier onset in the emergence of depressive symptoms. Both these factors together resulted in the speediest onset of depression. Poor perceived social support, but not low self-esteem, was associated with earlier emergence of anxiety symptoms.
Physiological symptoms may activate negative cognitions in individuals with risk factors of low self-esteem and poor social support so that the disorder is precipitated earlier and is of longer duration.
Psychological Medicine 12/2002; 32(8):1425-34. · 6.16 Impact Factor
