Qualitative study investigating the professional and personal effects of patient suicide on general practitioners in Northern Ireland.

OBJECTIVE: There is a dearth in suicide literature addressing the impact on general practitioners (GPs) of losing a patient. We aimed to examine the personal and professional impact as well as the availability of support and why GPs did or did not use it. DESIGN: A qualitative study using one-to-one interviews with participants recruited using snowball sampling. SETTING: The study was conducted in a primary care setting. PARTICIPANTS: Interviews were held with 19 GPs within primary care in Northern Ireland. RESULTS: GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a 'good' GP who is regarded as having solid imperturbability. Fear of professional repercussions also plays a major role in deterring help-seeking. CONCLUSIONS: There is a need for a systemic culture shift within general practice which allows doctors to seek support when their physical or mental health require it. This may help prevent stress, burnout and early retirement.

Exploring the relationship between adoption and psychological trauma for children who are adopted from care: A longitudinal case study perspective.

Children who have been adopted from care are very likely to have experienced early adversity that may result in psychological trauma. A current debate in the field is whether adoption provides a pathway to healing for traumatised children, helping them to recover from past psychological harm, or creates trauma for children through the very nature of being an adopted child. OBJECTIVE: This study aimed to use longitudinal data pertaining to children who had been adopted from care to examine the relationship between being adopted from care and psychological trauma. PARTICIPANTS AND SETTING: Seventeen adopted children had been interviewed in their adoptive homes during the third wave of the Care Pathways and Outcomes study (McSherry et al., 2013), when they were aged between nine and 14 years old. Ten of these children were selected for specific consideration in this article. Checklists for early adversities and psychological trauma were used to support the creation of case studies that highlighted the extent of psychological trauma in the children's lives. RESULTS: The adopted children either experienced possible pre-care psychological trauma, with the impact of this reducing over time, in utero developmental harm due to their mother's alcohol misuse during pregnancy, inherited an intellectual disability, with the resultant difficulties superseding any concern regarding possible pre-care psychological trauma, or possible psychological trauma when moving from an established foster placement to adoption. Recommendations for policy and practice are provided.

Assessment of pain in people living with dementia at the end of life: a systematic review.

BACKGROUND: People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL). AIMS: To understand the best way to examine pain in people with dementia. METHODS: A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched. FINDINGS: A total of 15 articles were identified, which were qualitatively synthesised. CONCLUSION: There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.

Adverse and benevolent childhood experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): implications for trauma-focused therapies.

BACKGROUND: There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. OBJECTIVES: We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. METHODS: Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. RESULTS: Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. CONCLUSIONS: Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.

Objetivos: Nos propusimos evaluar, usando un modelo de variables latentes, si experiencias adversas y benignas en la infancia podrían ser mejor descritas como un continuo simple o bien como dos constructos correlacionados. También modelamos la relación entre experiencias adversas y benignas en la infancia y síntomas de TEPT y TEPT complejo (TEPTc) según la CIE-11 y exploramos si estas asociaciones eran indirectas a través del trauma psicológico.Métodos: Los datos fueron obtenidos de una muestra expuesta a trauma (N=275) que acudía a un centro especializado en trauma en el Reino Unido. Los participantes completaron mediciones sobre experiencias adversas y benignas en la infancia, exposición a trauma, y síntomas de TEPT y TEPTc.Resultados: Los hallazgos sugirieron que las experiencias adversas en la infancia operan sólo indirectamente en síntomas de TEPT y TEPTc a lo largo de exposición a trauma en la vida, con un importante efecto para TEPT. Las experiencias benignas en la infancia predijeron directamente sólo síntomas de TEPTc.Conclusiones: Las experiencias adversas y benignas parecen formar asociaciones particulares con síntomas de TEPT y TEPTc. Se requieren investigaciones futuras para explorar cómo las experiencias benignas pueden ser integradas en intervenciones psicológicas existentes para optimizar la recuperación de estrés traumático.

Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample.

BACKGROUND: Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual. OBJECTIVE: This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population. METHOD: This study used 14 indicators of childhood adversity as the basis for LCA. RESULTS: The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution. CONCLUSION: The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.

A community-based pilot randomised controlled study of life skills classes for individuals with low mood and depression.

BACKGROUND: Cognitive behavioural therapy (CBT) is recommended for the treatment of depression and anxiety. However, access is limited. Low-intensity approaches such as guided CBT self-help (bibliotherapy) can increase access to treatment and is recommended by UK guidelines. No previous research has explored the provision of group-based guidance/support for a bibliotherapy approach for depression and anxiety in community settings. The objective was to carry out a pilot study of a group guided self-help intervention, using community based recruitment methods. METHOD: A randomised controlled trial comparing an 8 week CBT group guided self-help intervention to usual care. Recruitment and the delivery of the intervention were carried out in Glasgow and Derry/Londonderry in partnership with national depression charities. Fifty-three people were randomised, however we refer only to the forty-six participants who provided baseline data: 16 males and 30 females, aged 16 or over, with a PHQ-9 score of ≥ 5, were recruited from the community. The mean age of the sample was 43.7 (sd = 13) and 93.5% of participants had suffered from low mood for a year or more. RESULTS: There was effective recruitment, randomisation, uptake and adherence with 21 Immediate Access (IA) and 25 Delayed Access Control (DAC) participants. The intervention was highly acceptable to participants attending on average 4.46 of the 8 sessions (sd 3.06), 65.2% attended more than half of all sessions. The mean satisfaction on the Client Satisfaction Questionnaire was 28 out of 32 (sd 4.8). The provisional results in the pilot suggest the intervention may improve both anxiety and depression. At three months, data collection was achieved from 74% of participants. The trial successfully provided estimates of the sample size needed for the future planned trial. CONCLUSIONS: Low-intensity group-based classes may offer an alternative method of managing depression and anxiety and warrant further research. TRIAL REGISTRATION: Current Controlled Trials ISRCTN84893887 . Registered 3 November 2011.