Nils Sjöström

Persistent nightmares are associated with repeat suicide attempt A prospective study

The aim of this prospective study was to determine if sleep disturbances and nightmares are associated with increased risk of repeat suicide attempt. Patients (n=165) aged 18-68 years who were admitted to medical or psychiatric wards after a suicide attempt completed an initial interview; 98 of these took part in a 2-month follow-up interview. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and two self-report instruments, the Uppsala Sleep Inventory and the Comprehensive Psychopathological Rating Scale (CPRS) Self-Rating Scale for Affective Syndromes, were administered both at baseline and follow-up. Data concerning repeat suicide attempts within 2 years were obtained from hospital records. Analyses were performed using Students t-test, chi-square test, and logistic regression. In total 42 patients (26%) made at least one repeat suicide attempt within 2 years. While neither difficulties initiating/maintaining sleep nor early morning awakening at baseline predicted repeat attempt, having frequent nightmares did (OR=3.15). The risk was further heightened when nightmares were reported at both baseline and 2-month follow-up (OR=5.20). These associations remained after adjusting for sex, axis-I DSM-IV diagnoses, and self-reported depression and anxiety symptom intensity. Our findings suggest that nightmares might constitute a marker for increased risk of suicidal behavior.

Does the Suicide Assessment Scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department.

PURPOSE To determine whether the modified version of the Suicide Assessment Scale (SUAS) can be utilised to predict risk of repeat suicidal behaviour. SUBJECTS AND METHODS Hundred and sixty-five patients aged 18 to 68 years who were admitted to emergency wards after a suicide attempt were interviewed. Follow-up interviews (n=96) were carried out after 2 months. Associations between SUAS scores and repeat attempt (fatal/non-fatal) during the following 3 years were analysed and the instruments ability to predict repetition was assessed. RESULTS High SUAS score (>30) was associated with repetition. The ability of the SUAS to correctly predict repeat suicidal behaviour in the entire study group was low (AUC=0.65, 95% CI=0.56-0.74) but better for those (n=42) who reported ongoing psychiatric treatment at follow-up (AUC=0.78, 95% CI 0.63-0.94). Among the latter group, all with baseline SUAS scores >30 made repeats. CONCLUSION The modified SUAS performed well as a screening instrument in psychiatric patients.

Violence and its prediction at a psychiatric hospital.

Aggressive behaviour in psychiatric inpatients was assessed before and after a training course for staff members. The Social Dysfunction Aggression Scale (SDAS) was used to report and assess aggressive behaviour over time, and the Staff Observation Aggression Scale (SOAS) to report and assess single aggressive incidents. In addition, the numbers of nursing staff members who were on sick leave because of injuries in the periods before and after the course were recorded and compared. No statistically significant reduction was found in the number of aggressive patients or in the number of staff members on sick leave. One interesting finding was a lower reporting on the SOAS of perceived aggressive incidents after the training course in comparison with the SDAS reports. Directed verbal aggressiveness and violence towards things were found to be predictors of violence.

Sense of coherence and suicidality in suicide attempters: A prospective study

The usefulness of the Sense of Coherence (SOC) scale in the nursing setting is well-established, and an association between SOC and suicidality has been suggested. The aim was to test whether low SOC at index attempt is an independent predictor of suicidality at 2-month follow-up and of risk for repeat attempt. The study, which had a prospective cross-sectional design, included patients admitted to hospital after a suicide attempt. They were interviewed by means of Structured Clinical Interview for DSM-IV. Participants (n=155) completed the SOC scale and the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. Suicidality was rated with the Suicide Assessment Scale. Instruments were employed again at follow-up. Non-fatal/fatal repetition within 3 years was determined by review of hospital records. Low SOC at baseline predicted high suicidality at follow-up. The association remained after adjustment for major depression and affective symptom burden. Repeat attempts were made by 54 persons. Low baseline SOC was associated with repeat attempt, but the association did not remain after adjustment for major depression and symptom burden. Low SOC ratings could be a marker of risk for high suicidality in the aftermath of a suicide attempt. The SOC scale could be incorporated in nursing assessments of suicide attempters.

Effectiveness of web-based versus folder support interventions for young informal carers of persons with mental illness: A randomized controlled trial

OBJECTIVE Compare the impact of two interventions, a web-based support and a folder support, for young persons who care for people who suffer from mental illness. METHODS This study was a randomized control trial, following the CONSORT statements, which compared the impact of two interventions. Primary outcome variable was stress, and secondary outcome variables were caring situation, general self-efficacy, well-being, health, and quality of life of young informal carers (N=241). Data were collected in June 2010 to April 2011, with self-assessment questionnaires, comparing the two interventions and also to detect changes. RESULTS The stress levels were high in both groups at baseline, but decreased in the folder group. The folder group had improvement in their caring situation (also different from the web group), general self-efficacy, well-being, and quality of life. The web group showed increase in well-being. CONCLUSION Young informal carers who take on the responsibility for people close to them; suffer consequences on their own health. They live in a life-situation characterized by high stress and low well-being. This signals a need for support. PRACTICE IMPLICATIONS The non-significant differences show that each intervention can be effective, and that it depends upon the individuals preferences. This highlights the importance of adopting person-centered approach, in which young persons can themselves choose support strategy.

Stigma and Burden Among Relatives of Persons With Schizophrenia: Results From the Swedish COAST Study.

OBJECTIVE The aim was to apply a structured questionnaire, the Inventory of Stigmatizing Experiences (ISE), to study experiences of stigma (associated stigma) among relatives of persons with schizophrenia who attended outpatient clinics, using an approach based on assertive community treatment in a Swedish major city. A second aim was to explore the relationship between associated stigma and overall burden among these relatives. METHODS Relatives (N=65) of persons taking oral antipsychotics who attended outpatient clinics completed a mailed questionnaire that included the ISE and the Burden Inventory for Relatives of Persons with Psychotic Disturbances. Associations were analyzed with ordinal logistic regression. RESULTS More than half of the relatives (53%) stated that their ill relative had been stigmatized, but only 18% (N=11) reported that they themselves had been stigmatized (responses of sometimes, often, or always). One-fifth of the relatives (23%) acknowledged that they avoided situations that might elicit stigma. Neither experienced stigma nor anticipated stigma was associated with overall burden level in ordinal logistic regression models. The impact of stigma on both the relatives personal quality of life and the familys quality of life were both significantly associated with overall burden after adjustment for patient age and level of functioning. CONCLUSIONS Stigma had an impact on quality of life at the personal and family levels, and this was associated with overall burden. Increased awareness among service providers may decrease the impact of stigma on relatives, but associations need to be examined in larger studies in diverse cultures and treatment settings.

Support for Young Informal Carers of Persons with Mental Illness: A Mixed-Method Study

The aim of this study was to explore how young (16–25 year old) informal carers of a person with a mental illness experience and use support. In a mixed method approach, we interviewed 12 young carers, and 241 completed a self-administered questionnaire. While the young carers strive to maintain control, their main support seems to be others in their lives, who often define the situation differently. The carers said web-support, counseling, and group counseling might be helpful, yet very few had any professional support. Young carers are greatly in need of support and it should be provided.

Managing stress in prehospital care: Strategies used by ambulance nurses

BACKGROUND Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. METHODS A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories). RESULTS AND CONCLUSION The study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions.