ABSTRACT
BACKGROUND: Female nurses appear to have an increased risk of suicide but the reasons are unknown. METHOD: We have concluded a study of nurse suicides (N = 106) in England and Wales, including a psychological autopsy study (N = 42) and case-control comparison with living nurses (N = 84). RESULTS: Nearly three-quarters of the nurse suicides had previous contact with psychiatric services and almost half had been psychiatric in-patients in the past. There were particularly marked differences between the cases and controls for current psychiatric disorder (90.5% v. 7.1%, OR = 68.5), personality disorder (38.1% v. 12%, OR = 32), and history of deliberate self-harm (71.4% v. 2.4%, OR = 58.5). Family background and social factors (especially concerning interpersonal relationships) also distinguished the two groups. Smoking and serious alcohol abuse were much more frequent in the suicides. There was some indication that while many of the suicides were in contact with psychiatric services, care may not have been optimal in some cases. CONCLUSIONS: The most important strategies for suicide prevention in nurses are in prevention, detection and management of psychiatric disorders. In assessing suicide risk a history of DSH and the presence of comorbid psychiatric and personality disorders are particularly important.
Subject(s)
Cause of Death , Nurses/statistics & numerical data , Suicide/statistics & numerical data , Adult , Alcoholism/mortality , Alcoholism/psychology , Case-Control Studies , Comorbidity , Cross-Sectional Studies , England/epidemiology , Female , Humans , Incidence , Mental Disorders/mortality , Mental Disorders/psychology , Middle Aged , Nurses/psychology , Personality Assessment , Risk , Smoking/mortality , Smoking/psychology , Suicide/psychology , Wales/epidemiologySubject(s)
Anesthesia, Inhalation/methods , Masks , Odorants , Child , Child, Preschool , Humans , InfantABSTRACT
BACKGROUND: We set out to investigate whether community nurses could be trained in problem-solving therapy and, once trained, how effective they would be in treating emotional disorders in primary care. METHOD: Seventy patients with an emotional disorder in primary care were randomly allocated to receive either problem-solving therapy from a trained community nurse or treatment as usual from their general practitioner. Interview and self-rated assessments of clinical and economic outcome were made pretreatment, at eight weeks and at 26 weeks after treatment. RESULTS: There was no difference in clinical outcome between patients who received problem-solving treatment and patients who received the general practitioner's usual treatment. However, patients who received problem-solving treatment had fewer disability days and fewer days off work. The health care cost of problem-solving was greater than that of the general practitioner's usual treatment but this was more than offset by savings in the cost of days off work. CONCLUSIONS: Problem-solving treatment can be given by trained community nurses. The clinical effectiveness and cost-benefit of the treatment will depend on the selection of appropriate patients.
