Ann Sheridan

Improving social functioning and reducing social isolation and loneliness among people with enduring mental illness: Report of a randomised controlled trial of supported socialisation

Background: This randomised controlled trial examined if for people with enduring mental illness, being supported to socialise leads to improved social functioning, increased self-esteem and extended social networks; a reduction in social isolation, social, emotional and family loneliness and a reduction in illness symptoms, namely depression. Methods: A prospective randomised controlled trial was undertaken from November 2007 to September 2011. Service users with a diagnosis of enduring mental illness (>18 years) were invited to participate. Participants were randomly allocated to intervention or control group conditions in a 1:1 ratio. Intervention group participants were matched with a volunteer partner, asked to engage in social/leisure activities for 2 hours weekly over a 9-month period, and received a €20 stipend monthly. Control group participants received a €20 monthly stipend and were asked to engage in a weekly social/leisure activity. Social functioning, the primary outcome, was measured using the Social Functioning Scale (SFS) at three time points (baseline, midpoint and endpoint). Findings: In all, 107 people completed this study. There were no significant differences between control and intervention groups at the commencement of the intervention on demographic characteristics or the main outcome measures of interest. Overall social functioning positively changed throughout the three time points from a mean of 99·7 (standard deviation (SD) = 15.1) at baseline, to a mean of 106.0 (SD = 27.0) at the endpoint for the control group, and from a mean of 100·4 (SD = 15.0) at Time 1 for the intervention group, to a mean of 104.1 (SD = 23.4) at the endpoint for the intervention group. Conclusions: The intervention showed no statistical differences between the control and intervention groups on primary or secondary outcome measures. The stipend and the stipend plus volunteer partner led to an increase in recreational social functioning; a decrease in levels of social loneliness, in depression and in the proportion living within a vulnerable social network.

A Pilot Study to Evaluate the Introduction of an Interprofessional Problem-based Learning Module

Patient care is complex and demands that health professionals work together effectively. Interprofessional education (IPE) encourages collaboration by educating students from different professions together. This study examined the effectiveness of IPE in terms of changing students’ perceptions of teamwork, professional identity, role, competency and autonomy, and the need for interdisciplinary co-operation. Two multidisciplinary cohorts of health science students (n=51 and n=48) elected to participate in a problem-based learning module (PBL). The module included problems addressing areas of professional identity and cases requiring a multidisciplinary team approach. Evaluation was undertaken using the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IPES). Regarding the RIPLS, both cohorts reported significant (p<0.05) improvements in their perceptions of teamwork, collaboration, and positive professional identity. Regarding the IEPS students’ perceptions of professional competency and autonomy improved significantly (p<0.05) in both cohorts. An IPE module delivered using PBL appears valuable for professional development.

Factors affecting patient participation in clinical trials in Ireland: A narrative review

Objective Clinical trials have long been considered the ‘gold standard’ of research generated evidence in health care. Patient recruitment is an important determinant in the success of the trials, yet little focus is placed on the decision making process of patients towards recruitment. Our objective was to identify the key factors pertaining to patient participation in clinical trials, to better understand the identified low participation rate of patients in one clinical research facility within Ireland. Design Narrative literature review of studies focussing on factors which may act to facilitate or deter patient participation in clinical trials. Studies were identified from Medline, PubMed, Cochrane Library and CINAHL. Results Sixty-one studies were included in the narrative review: Forty-eight of these papers focused specifically on the patients perspective of participating in clinical trials. The remaining thirteen related to carers, family and health care professional perspectives of participation. The primary factor influencing participation in clinical trials amongst patients was related to personal factors and these were collectively associated with obtaining a form of personal gain through participation. Cancer was identified as the leading disease entity included in clinical trials followed by HIV and cardiovascular disease. Conclusion The vast majority of literature relating to participation in clinical trials emanates predominantly from high income countries, with 63% originating from the USA. No studies for inclusion in this review were identified from low income or developing countries and therefore limits the generalizability of the influencing factors.

Motivations for adolescent self‐harm and the implications for mental health nurses

Accessible summary What is known on the subject?Self‐harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self‐harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self‐harm. &NA; What does this paper add to existing knowledge?This paper identifies the reasons for self‐harm in a community sample of young people and finds that the functions of self‐harm differ for different people and that there may be multiple reasons for self‐harm.Findings provide support for the affect‐regulation model of self‐harm which states that young people self‐harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self‐harm is an attempt to influence how other people respond to them. &NA; What are the implications for practice?Self‐harm for most young people serves at least one specific function and is an indication of distress.There is a requirement for a non‐pathologizing response towards young people who self‐harm; self‐harm should be understood as a meaningful behaviour rather than a symptom of an illness.Mental health nurses need to understand the multiple functions of self‐harm. A better understanding of the individualized meaning behind self‐harm can positively impact on attitudes towards young people who self‐harm and provide for improved mental health service provision. Introduction: Although self‐harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self‐harm contributes to negative perceptions about those who self‐harm and a poor healthcare experience. Aim & Methods: This study identifies motivations behind self‐harm in school‐based adolescents using a cross‐sectional survey. Motivations behind self‐harm were elicited using a scale and open‐ended responses. Results: Of the 856 adolescents who completed the survey across 11 postprimary schools, 103 reported a history of self‐harm. The most commonly endorsed reason for self‐harm was to ‘get relief from a terrible state of mind’ (79%). Open‐ended responses were consistent with scale responses with most reporting that they self‐harmed to relieve distressing emotions. Discussion: Findings provide support for the affect‐regulation model of self‐harm with support also demonstrated for the self‐punishment and antidissociation models. There was little support for the interpersonal influence model suggesting that the commonly held belief that self‐harm is attention‐seeking is one attributed by others to young people, and not widely reported by young people themselves. Implications for practice: Mental health services need to be responsive to the needs of young people who self‐harm which requires eliciting and understanding the individual and multiple meanings behind self‐harm to best inform treatment options.

Subjective and objective quality of life at first presentation with psychosis.

Quality of life (QOL) in first‐episode psychosis (FEP) is impaired when compared to non‐clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL.

Comparison of generic and disease-specific measures of quality of life in first-episode psychosis

BACKGROUND Quality of life (QOL) is now recognised as an important measure of outcome that could potentially influence clinical decision-making for those with a first-episode psychosis (FEP). A number of QOL instruments are available however; many differ in their conceptual orientation which may have serious implications for the outcome of QOL studies, interpretation of findings and clinical utility. We aimed to compare two commonly used tools representing both generic and disease-specific constructs to examine whether both tools appraise the same underlying QOL traits and also whether disease-specific tools retain their psychometric properties when used in FEP groups. METHODS We assessed 159 consecutive individuals presenting with FEP in a defined catchment area with two commonly used QOL tools and examined the findings using the multi-trait multi-method matrix. RESULTS Similarly named domains of QOL between both tools (Psychological Wellbeing, Physical Health, Social Relations) showed good convergent validity using confirmatory factor analysis. However, discriminant validity was not established given that domains loading onto their indicated latent factors were more strongly correlated with their non-corresponding latent factors. CONCLUSIONS A major consideration in undertaking the present study was to assess the extent to which the outcome of QOL studies in FEP were valid and that systematic error did not provide another plausible explanation for findings. Establishing convergent validity demonstrates that either tool could be used satisfactorily to measure the QOL construct identified however; we did not establish discriminant validity. Doing so would have demonstrated that QOL domains are substantively different in that they contain some unique piece of information determining clinical utility. These findings are important for our understanding of multi-dimensional models of QOL.

Friendship and money: A qualitative study of service users’ experiences of participating in a supported socialisation programme:

Background: Social opportunities can be limited in the lives of people with enduring mental illness (EMI) due to psychiatric stigma, restricted home environments and employment barriers. Supported socialisation programmes have the potential to redress the impact of social isolation. Aim: To explore the experiences of service users with EMI taking part in a supported socialisation programme, using written diary entries. Methods: This article reports on the qualitative component of a randomised controlled trial of supported socialisation for people with EMI (published previously in this journal). Trial participation involved (1) being matched with a volunteer partner and engaging in social/leisure activities while receiving a stipend of €20 or (2) receiving this stipend only and engaging in self-driven socialisation. Participants completed written diaries documenting their perspectives on their experiences of supported socialisation. Data were analysed using Thematic Analysis. Results: Experiences of participation were characterised by involvement ‘normalising’ life, fostering a sense of connectedness, improving physical health, and facilitating engagement with culture. Taking part helped participants integrate socialising into their identity, enhanced their perceived capacity to be social, and cemented/expanded social networks. Participants also experienced significant obstacles to socialisation. Conclusion: Supported socialisation can increase confidence, social competence and self-agency; buffer against psychiatric stigma; build social capital; and afford opportunities to enhance social integration, inclusion and belonging.

Predictors of change in social networks, support and satisfaction following a first episode psychosis: A cohort study

BACKGROUND Diminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention. METHODS During the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n=158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinicians evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured. RESULTS A number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n=129, Median=24.5mths, IQR=7.25-69.25; Mann-Whitney U=11.78, p=0.008). Social support at baseline and at one year was predicted by homelessness (t=-2.98, p=0.001, CI -4.74 to -1.21), duration of untreated psychosis (t=-0.86, p=0.031, CI -1.65 to -0.08) and premorbid adjustment (t=-2.26, p=0.017, CI -4.11 to -0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome. CONCLUSIONS Improved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.

Developing and implementing a clinical patient information system: a mental health perspective:

The Hospitaller Order of St John of God is involved in providing health, educational and social services to people with mental health problems and learning difficulties in the Republic of Ireland. As part of its development plan the Order is engaging in the development of a comprehensive Mental Health Information System encompassing both community and hospital-based services. This system is being developed by local practitioners with the assistance of an external facilitator. The Order is also extensively involved in developing legal and ethical protocols to ensure the system meets all requirements of data protection legislation both nationally and at European levels. Within the overall system, the nursing component is the first part to have been operationalized and some initial evaluation of its efficacy has been conducted. The purpose of this paper is to present the work of the nursing department at St John of God Hospital, Dublin, in the development, implementation and initial evaluation of a computerized patient information system.

Disagreement between Service-users and Clinicians Assessment of Physical Health during Early Psychosis

Physical illnesses account for the majority of excess deaths following psychosis; access to care and treatment is inequitable and schizophrenia has now been dubbed the life‐shortening disease. We compared service‐users and clinicians perspectives of their physical health assuming that one of the fundamental issues in prompting screening and treatment is the view that health is poor.