ABSTRACT
BACKGROUND: Research is sparse which examines pathways to suicide, and resilience to suicide, in people who are particularly vulnerable to suicide, for example, prison inmates. The purpose of this study was to examine the ways in which perceptions of self-esteem and coping ability interacted with defeat and entrapment to both amplify suicidal thoughts and feelings, and to act as a buffer against suicidal thoughts and feelings. METHODS: Participants were 65 male prisoners at high risk of suicide. A cross-sectional questionnaire design was used. Questionnaire measures of depression, defeat, entrapment, self-esteem, coping ability and suicidal probability were administered. RESULTS: For the hopelessness component of the suicide probability measure, high levels of coping ability together with low levels of defeat resulted in the lowest levels of suicidality indicative of a resilience factor. In contrast, low levels of coping skills together with high levels of entrapment were a high risk factor for this hopelessness component of suicide. This pattern of results pertained when controlling for depression levels. CONCLUSIONS: This is the first study to examine interactions between defeat, entrapment and appraisals of self-esteem and coping ability. Therapeutic interventions would benefit from boosting perceptions and appraisals of coping ability, in particular, in people who are at high risk for suicide.
Subject(s)
Adaptation, Psychological , Depression/psychology , Prisoners/psychology , Resilience, Psychological , Self Concept , Suicide Prevention , Suicide , Adult , Cross-Sectional Studies , Humans , Male , Middle Aged , Risk Assessment/methods , Risk Factors , Self-Assessment , Suicidal Ideation , Suicide/psychology , Surveys and Questionnaires , United KingdomABSTRACT
BACKGROUND: Prisoners have an exceptional risk of suicide. Cognitive-behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive-behavioural suicide prevention (CBSP) therapy for suicidal male prisoners. METHOD: A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209). RESULTS: Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = -0.72, 95% confidence interval -1.71 to 0.09; baseline mean TAU: 1.39 (S.D. = 3.28) v. CBSP: 1.06 (S.D. = 2.10), 6 months mean TAU: 1.48 (S.D. = 3.23) v. CBSP: 0.58 (S.D. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group. CONCLUSIONS: The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.
Subject(s)
Cognitive Behavioral Therapy/methods , Depression/therapy , Patient Compliance , Prisoners/psychology , Suicide Prevention , Adult , Affect , Attention , Cognition , England , Humans , Male , Middle Aged , Pilot Projects , Problem Solving , Psychiatric Status Rating Scales , Self Concept , Self Report , Treatment Outcome , Young AdultABSTRACT
An exchange for 1 day a week between a clinical nurse specialist and a lecturer gave rise to the opportunity to evaluate the introduction of case management on a newly created rehabilitation floor at an elderly care hospital. The aims of the study were to examine the feelings and concerns of new case managers, their conception of case management and their perceived educational needs. Qualitative research methods were employed to achieve the aims. Rigour was addressed, in part, through concurrent analysis of data with data collection, which encouraged probing of issues important to research participants. Thematic categories are presented under the headings: 'structure' and 'process'. The data collected revealed vividly that, as with any change, the people involved experienced anxieties and/or confusion over their new roles, but that some of the problems arose from the relocation of staff when the rehabilitation floor was established. Despite these difficulties, there was general enthusiasm for the potential of case management.
Subject(s)
Attitude of Health Personnel , Case Management/organization & administration , Job Description , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Rehabilitation/nursing , Aged , Geriatric Nursing , Humans , Nurse Clinicians , Nursing Methodology Research , Nursing Staff, Hospital/education , Organizational Innovation , Outcome and Process Assessment, Health CareABSTRACT
The author describes the development of a leg ulcer clinic, based on an electric model of care, which draws on her experience as a clinical nurse specialist. The philosophy of the clinic recognises that a 'legs specific' approach offers only short term solutions, and that a holistic method, which encourages patients to examine their own situation, is more appropriate.
