Psychological distress and professional help‐seeking: a prospective national study

The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18–75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help‐seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress.     

Hearing the voices of young people who self‐harm: Implications for service providers

The incidence of adolescent self‐harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self‐harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self‐harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young people's experiences of help and support for self‐harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self‐harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.     

Re‐presentation and suicide rates in emergency department patients who self‐harm

Objective: To investigate adult presentations to North Shore Hospital, Auckland, New Zealand, following deliberate self‐harm, determine re‐presentation and suicide rates and investigate the characteristics of those patients who re‐present. Methods: Retrospective review of a cohort of adult patients presenting to North Shore Hospital Emergency Care Centre in Auckland, New Zealand, with deliberate self‐harm between 1 January 2001 and 31 August 2002, using data from the National Minimum Data Set and Hospital Discharge Database. The re‐presentation rate was calculated as the percentage of patients presenting a second time within 1 year of their index presentation. The suicide rate was calculated as the percentage of patients with a coroner's verdict of suicide within 1 year of their index presentation of deliberate self‐harm. Results: There were 1055 presentations by 754 people during the presentation period. Of these 754 people, 136 presented for a second time within a year of the index case (136/754 [18.0%, 95% CI 15.5–21.0]). Eight of the seven hundred and fifty‐four people went on to commit suicide within 1 year (8/754 [1.1%, 95% CI 0.5–2.1]). Self‐poisoning was the most common method of self‐harm. Minor tranquillizers were used more commonly in the group who re‐presented. Conclusion: Re‐presentation and suicide rates in our study were similar to previously published rates. Further research is needed to identify strategies to reduce re‐presentations and excess mortality in all people who deliberately self‐harm.     

Self‐care agency,lifestyle, and physical condition predict future frailty in community‐dwelling older people

The purpose of this 2 year longitudinal study was to identify the relationship between self‐care agency, lifestyle, physical condition, and frailty among community‐dwelling older people in a rural area of Japan. The participants were 133 older individuals aged 65 years or above. Data collection was conducted via face‐to‐face interviews using self‐administered questionnaires. Background information, such as age, sex, current employment status, family structure, medication use, comorbidities, and knee and lower back pain, were assessed. The definition of frailty was based on the Frailty Checklist. Self‐care agency, lifestyle habits, and locomotive syndrome were assessed using specific assessment scores. Logistic regression analysis showed that locomotive syndrome, knee and lower back pain, and stroke are risk factors for frailty. Among the factors associated with frailty, current employment, regular exercise, and self‐care agency were recognized as preventive factors of depression, decreased cognitive function, and being housebound. Our findings suggest that enhancing self‐care agency, regular exercise, and self‐management skills for chronic illness and disability may decrease the progression of frailty among older people.     

Emergency department nurse's attitudes towards patients who self‐harm: A meta‐analysis

Self‐harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self‐harm injuries, and positive therapeutic patient–nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self‐harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta‐analyses examined the attitudes of ED nurses towards patients who self‐harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta‐analysis. The Self‐Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta‐analysis. The Attitudes Towards Deliberate Self‐Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta‐analysis. Results demonstrated limited empathy and negativity towards patients who self‐harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self‐harm educational content for ED staff should include areas of knowledge building including explanations and causes of self‐harm; range, forms, and functions of self‐harm; staff responses to self‐harm; assessment, management, and interventions; professional practice issues.