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1.
Psychol Med ; 47(13): 2238-2245, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28397618

ABSTRACT

BACKGROUND: Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents. METHOD: A national consecutive case series in England and Wales (2006-2012) was examined. RESULTS: There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding. CONCLUSIONS: We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.


Subject(s)
Inpatients/statistics & numerical data , Mental Health Services/statistics & numerical data , Patient Safety/statistics & numerical data , Suicide/statistics & numerical data , Adult , Aged , Aged, 80 and over , England/epidemiology , Female , Humans , Male , Middle Aged , Patient Safety/standards , Wales/epidemiology , Young Adult
2.
Psychol Med ; 46(16): 3407-3417, 2016 12.
Article in English | MEDLINE | ID: mdl-27650367

ABSTRACT

BACKGROUND: Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses. METHOD: Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899). RESULTS: Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency. CONCLUSIONS: A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.


Subject(s)
Mental Disorders/epidemiology , Primary Health Care/statistics & numerical data , Psychotropic Drugs/therapeutic use , Suicide/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , England/epidemiology , Female , Humans , Male , Mental Disorders/drug therapy , Mental Health Services , Middle Aged , Odds Ratio , Referral and Consultation , Risk Factors , Young Adult
3.
Psychol Med ; 43(1): 61-71, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22591851

ABSTRACT

BACKGROUND: Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time. METHOD: A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data. RESULTS: Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100,000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually. CONCLUSIONS: The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.


Subject(s)
Inpatients , Mental Disorders/epidemiology , Suicide , Adolescent , Adult , Aged , England/epidemiology , Female , Hospitals, Psychiatric/trends , Humans , Longitudinal Studies , Male , Middle Aged , Suicide/trends , Time Factors , Young Adult
4.
J Exp Child Psychol ; 80(2): 160-73, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11529673

ABSTRACT

Seventy-five 6- to 11-year-old children were administered tests of phonological awareness, verbal short term memory (STM), and visual-verbal paired associate learning (PA learning) to investigate their relationship with word recognition and decoding skills. Phonological awareness was a stronger concurrent predictor of word recognition than verbal STM, and phonological awareness but not verbal STM was a predictor of learning in the PA learning task. Importantly, measures of phonological awareness and PA learning both accounted for independent variance in word reading, even when decoding skill was controlled. The results suggest that PA learning and phonological awareness tasks tap two separate mechanisms involved in learning to read. The results are discussed in relation to current theories of reading development.


Subject(s)
Child Development , Paired-Associate Learning , Reading , Speech Perception/physiology , Child , Female , Humans , Male , Memory/physiology , Phonetics , Predictive Value of Tests , Psychological Tests , Random Allocation
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