Suicide ideation in older people: a qualitative review and Meta-aggregation of Asian studies.

Aims: To appraise and synthesize qualitative studies examining older Asian people's experiences of suicidal ideation. Design: Qualitative review and meta-aggregation. Data sources: Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity. Review methods: This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute's System for the Unified Management of the Assessment and Review of Information. Results: Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review-The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age. Conclusion: Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.

Taking care of our future doctors: a service evaluation of a medical student mental health service.

BACKGROUND: Studies suggest medical students experience high levels of mental distress during training but are less likely, than other students, to access care due to stigma and concerns regarding career progression. In response, The School of Clinical Medicine, University of Cambridge supported the development of the 'Clinical Student Mental Health Service' to provide specialist input for this vulnerable group. This study evaluates the efficiency and effectiveness of this service. METHODS: Using mixed-methods, cross-sectional analysis of validated psychiatric rating scales and qualitative feedback, 89 responses were analysed from 143 clinical students referred, between 2015 and 2019. The care pathway included initial review by a psychiatrist, who triaged students to psychologists delivering therapies including: Cognitive Behavioural Therapy, Interpersonal Therapy, Eye Movement Desensitization Reprocessing Therapy or Cognitive Analytic Therapy. Efficiency was assessed by waiting times for psychiatry and psychology interventions, and number of sessions. Academic outcomes included school intermission and graduation. Clinical effectiveness was analysed by measuring global distress, depression, anxiety, functioning and suicidal risk. Pre/post intervention changes were captured using t-test and McNemar test with thematic analysis of qualitative feedback. RESULTS: Referral rates increased from 3.93% (22/560) in 2015 to 6.74% (45/668) in 2018. Median waiting times for initial psychiatric assessment and start of therapy was 26 and 33 days, respectively. All graduating students moved on to work as junior doctors. Levels of distress, (t = 7.73, p < 0.001, df = 31), depression (t = 7.26, p < 0.001, df = 34) anxiety (Z = - 4.63, p < 0.001) and suicide risk (Z = - 3.89, p < 0.001) were significantly reduced. Participant's functioning was significantly improved (p < 0.001, 99.5% CI 4.55 to 14.62). Feedback indicated high satisfaction with the rapid access and flexibility of the service and the team clinicians. CONCLUSIONS: A significant proportion of medical students attending the service scored highly on validated rating scales measuring emotional distress, suicidality and mental illness. Reassuringly they benefitted from timely specialist mental health input, showing improvements in mental well-being and improved functioning. The development and design of this service might serve as an exemplar for medical schools developing similar support for their students.

A comparison of the full Mini Nutritional Assessment, short-form Mini Nutritional Assessment, and Subjective Global Assessment to predict the risk of protein-energy malnutrition in patients on peritoneal dialysis: a cross-sectional study.

BACKGROUND: The full Mini Nutritional Assessment (full-MNA) and short-form MNA (MNA-SF) are simple and effective nutrition screening scales, but their usefulness for identifying patients with peritoneal dialysis (PD) at risk of protein-calorie malnutrition (PEM) has not been investigated. OBJECTIVES: This study was aimed to investigate the convergent validity of the full-MNA and MNA-SF for identifying patients with PD at risk of PEM. DESIGN: A cross-sectional study. SETTING: A hospital-managed dialysis center. PARTICIPANTS: 80 adult ambulatory PD patients. METHODS: Patients were interviewed for personal data and rated with the full-MNA, MNA-SF and the Subjective Global Assessment (SGA) for nutritional status. The consistency among the scales was assessed with kappa coefficients. The ability of each scale to differentiate undernutrition was evaluated with external standards including serum albumin and creatinine concentrations, mid-arm and calf circumferences, and dialysis-related indicators. Statistical significance was evaluated with Wilcoxon rank-sum test. RESULTS: The full-MNA and MNA-SF showed low agreements with the SGA (kappa=0.346 and 0.185, respectively). The full-MNA and MNA-SF performed better than the SGA in differentiating undernutrition according to the external standards. However, contrary to general expectation, MNA-SF rated a significantly smaller proportion of subjects at risk of undernutrition. CONCLUSION: The full-MNA and MNA-SF are more able than the SGA in identifying PD patients at risk of PEM. However, MNA-SF rates a smaller proportion of PD patients at risk of undernutrition than the full-MNA. The use of MNA-SF as a stand-alone unit requires further confirmation.