Support received after bereavement by suicide and other sudden deaths: a cross-sectional UK study of 3432 young bereaved adults.

OBJECTIVE: To test the hypothesis that people bereaved by suicide are less likely to receive formal or informal support than people bereaved by other causes of sudden death. DESIGN: National cross-sectional study. SETTING: Adults working or studying at any UK higher education institution (HEI) in 2010. PARTICIPANTS: A total of 3432 eligible respondents aged 18-40 years bereaved by the sudden death of a close friend or relative, sampled from approximately 659 572 bereaved and non-bereaved staff and students at 37 of 164 UK HEIs invited to participate. EXPOSURES: Bereavement by suicide (n=614; 18%), by sudden unnatural causes (n=712; 21%) and by sudden natural causes (n=2106; 61%). MAIN OUTCOME MEASURES: Receipt of formal and informal support postbereavement; timing of valued support. RESULTS: 21% (725/3432) of our sample of bereaved adults reported receiving no formal or informal bereavement support, with no evidence for group differences. People bereaved by suicide were less likely to have received informal support than those bereaved by sudden natural causes (adjusted OR (AOR)=0.79; 95% CI 0.64 to 0.98) or unnatural causes (AOR=0.74; 95% CI 0.58 to 0.96) but did not differ from either comparison group on receipt of formal support. People bereaved by suicide were less likely to have received immediate support (AOR=0.73; 95% CI 0.59 to 0.90) and more likely to report delayed receipt of support (AOR=1.33; 95% CI 1.08 to 1.64) than people bereaved by sudden natural causes. Associations were not modified by gender, or age bereaved, but became non-significant when adjusting for stigma. CONCLUSIONS: People bereaved by suicide are less likely to receive informal support than people bereaved by other causes of sudden death and are more likely to perceive delays in accessing any support. This is concerning given their higher risk of suicide attempt and the recommendations within suicide prevention strategies regarding their need for support. STUDY REGISTRATION: http://www.ucl.ac.uk/psychiatry/bereavementstudy/.

Rating scales in general practice depression: psychometric analyses of the clinical interview for depression and the Hamilton rating scale.

BACKGROUND: Our objective was to investigate to what extent the Clinical Interview for Depression (CID) used in the general practice setting covers clinically valid subscales (depression, anxiety, and apathy) which can measure outcome of antidepressant therapy as well as identifying subsyndromes within major depressive disorder. The CID was compared to the Hamilton Depression Rating Scale (HAM-D17). METHODS: 146 patients from a previous study in general practice with the CID were investigated. The item response theory model established by Rasch was used to investigate the scalability (a scale׳s psychometric adequacy) of the subscales, and principal component analysis was used to identify subsyndromes with the symptoms of major depression according to DSM-5 or ICD-10. RESULTS: Whereas the HAM-D17 was found not to have an acceptable scalability, the three brief CID subscales for depression (six items), anxiety (five items), and apathy (five items) all had an acceptable scalability. Within the major depressive symptoms, principal component analysis identified the CID items of hypersomnia, increased appetite or weight gain as defining the subsyndrome of atypical depression. In total 29 patients (approximately 20%) had an atypical depression. LIMITATIONS: The samples were derived from a single study and were all rated by a single rater. CONCLUSION: The CID contains subscales of depression, anxiety, and apathy with an acceptable scalability for use in general practice. A subsyndrome of atypical depression is also a useful identifier in the treatment of depressed patients in general practice.

A controlled trial of personal construct psychotherapy for deliberate self-harm.

Evidence for the effectiveness of psychological therapies for people who self-harm is limited. Personal construct theory provides a model of self-harm and a framework for therapeutic intervention, which was evaluated in the present study. Sixty-four adults presenting to Accident and Emergency departments following self-harm were allocated to a personal construct psychotherapy or a 'normal clinical practice' condition. They completed various measures at assessment points pre- and post-therapy. Repetition of self-harm was assessed over a 3-year period. Participants in the intervention condition showed significantly greater reduction in suicidal ideation, hopelessness and depression post-treatment than the control group; and significantly more reconstruing at this point and 6-month follow-up. There was some evidence suggestive of a lower frequency of repetition of self-harm in the intervention than in the control group. It is concluded that brief personal construct psychotherapy may be effective for people who self-harm and merits further exploration.