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Ribeiro Coimbra LR, Noakes A. A systematic review into healthcare professionals' attitudes towards self-harm in children and young people and its impact on care provision. J Child Health Care 2022; 26:290-306. [PMID: 33929264 DOI: 10.1177/13674935211014405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-harming behaviours in children and young people are an alarming reality, with provision of effective treatment historically compromised. The present systematic literature review highlights attitudes displayed by healthcare professionals towards this health problem, providing valuable insight by analysing how these attitudes can impact patient care. Ten studies were included, allowing creation of a narrative synthesis of qualitative, quantitative and mixed-methods evidence. Six themes emerged: negativity, positivity, worry or fear, the emotional impact of working with these patients, professional roles and ward-dependent concerns. Overall, professional negativity towards this patient group, in the form of apprehensiveness, was accentuated by fear of worsening their symptoms. The attitude aforementioned impacts on treatment by hindering creation of meaningful therapeutic relationships. Educational opportunities that increase healthcare professionals' knowledge of self-harm have the potential to provide invaluable power by promoting positive attitudes.
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Affiliation(s)
| | - Amy Noakes
- Senior Lecturer, School of Health and Social Care, 4914London South Bank University, London, UK
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Griffiths H, Duffy F, Duffy L, Brown S, Hockaday H, Eliasson E, Graham J, Smith J, Thomson A, Schwannauer M. Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial. BMC Psychiatry 2019; 19:167. [PMID: 31170947 PMCID: PMC6554935 DOI: 10.1186/s12888-019-2158-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 05/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. METHODS The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables. RESULTS Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm. CONCLUSIONS It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population. TRIAL REGISTRATION NCT02771691 ; Trial Registration Date: 25/04/2016.
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Affiliation(s)
- Helen Griffiths
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Fiona Duffy
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Louise Duffy
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Sarah Brown
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Harriet Hockaday
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Emma Eliasson
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Jessica Graham
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Julie Smith
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Alice Thomson
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Matthias Schwannauer
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
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Curtis S, Thorn P, McRoberts A, Hetrick S, Rice S, Robinson J. Caring for Young People Who Self-Harm: A Review of Perspectives from Families and Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E950. [PMID: 29747476 PMCID: PMC5981989 DOI: 10.3390/ijerph15050950] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/24/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022]
Abstract
Self-harm among young people remains largely stigmatised and misunderstood. Parents have been identified as key facilitators in the help-seeking process, yet they typically report feeling ill-equipped to support the young person in their care. The aim of this review was to examine the perspectives of both young people (aged 12⁻28) and parents and to develop the conceptual framework for a future qualitative study. A systematic search of MEDLINE and PsycINFO was performed to identify articles that focused on the experiences of family members and young people related to managing the discovery of self-harm. Fourteen articles were included for review. Four addressed the perspectives of young people and 10 reported on the impact of adolescent self-harm on parents. The impact of self-harm is substantial and there exists a discrepancy between the most common parental responses and the preferences of young people. In addition, parents are often reluctant to seek help for themselves due to feelings of shame and guilt. This highlights the need for accessible resources that seek to alleviate parents’ distress, influence the strategies implemented to manage the young person’s self-harm behaviour, reduce self-blame of family members, and increase the likelihood of parental help seeking.
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Affiliation(s)
- Sophie Curtis
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Pinar Thorn
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Alison McRoberts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC 3052, Australia.
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia.
- Department of Psychological Medicine, Faculty of Health and Medical Sciences, The University of Auckland, Auckland 1010, New Zealand.
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia.
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