‘Everything’s from the inside out with PCOS’:exploring women’s experiences of living with Polycystic Ovary Syndrome (PCOS) and co-morbidities through Skype™ interviews

Polycystic ovary syndrome is an endocrine disorder affecting 1 in 10 women. Women with polycystic ovary syndrome can experience co-morbidities, including depressive symptoms. This research explores the experience of living with polycystic ovary syndrome and co-morbidities. Totally, 10 participants with polycystic ovary syndrome took part in Skype™ interviews and analysed using thematic analysis. Four themes emerged from the data: change (to life plans and changing nature of condition); support (healthcare professionals, education and relationships); co-morbidities (living with other conditions and depression, self-harm and suicidal ideation) and identity (feminine identity and us and them). The findings highlight the need for screening of women with polycystic ovary syndrome for depressive disorders.

Differences in treatment and intervention needs of girls arrested for status versus criminal offenses

The purpose of this research was to explore the differences in factors associated with girls' status and criminal arrests. This study used data from six juvenile justice programs in multiple states, which was derived from the Juvenile Assessment and Intervention System (JAIS). The sample of 908 adolescent girls (ages 13-19) was ethnically and racially diverse (41% African American, 32% white, 12% Hispanic, 11% Native American and 4% Other). A structural equation model (SEM) was analyzed which tested the potential effects of adolescent substance use, truancy, suicidal ideation/attempt, self-harm, peer legal trouble, parental criminal history and parental and non-parental abuse on type of offense (status and criminal) and whether any of these relationships varied as a function of race/ethnicity. ^ Complex relationships emerged regarding both status and more serious criminal arrests. One of the most important findings was that distinct and different patterns of factors were associated with status arrests compared to criminal arrests. For example, truancy and parental abuse were directly associated with status offenses, whereas parental criminal history was directly related to criminal arrests. However, both status and criminal arrests shared common associations, including substance use, which signifies that certain variables are influential regarding both non-criminal and more serious crimes. In addition, significant meditating influences were observed which help to explain some underlying mechanisms involved in girls' arrest patterns. Finally, race/ethnicity moderated a key relationship, which has serious implications for treatment. ^ In conclusion, the present study is an important contribution to research regarding girls' delinquency in that it overcomes limitations in the existing literature in four primary areas: (1) it utilizes a large, multi-state, ethnically and racially diverse sample of justice system-involved girls, (2) it examines numerous co-occurring factors influencing delinquency from multiple domains (family, school, peers, etc.) simultaneously, (3) it formally examines race/ethnicity as a moderator of these multivariate relationships, and (4) it looks at status and criminal arrests independently in order to highlight possible differences in the patterning of risk factors associated with each. These findings have important implications for prevention, treatment and interventions with girls involved in the juvenile justice system.^

Factors associated with hospitalization after suicide spectrum behaviors: results from a multicentre study in Spain

Objectives: to identify factors associated with admission after suicide spectrum behaviors. Methods: Patient's characteristics, the nature of their suicidal behavior, admission rates between centres, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in three Spanish cities. Results: Intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors and psychiatric diagnosis of schizophrenia, mood or personality disorder were independently associated with being admitted. There was a three-fold between-centre difference in the rate of hospitalization. Conclusions: widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.

Sjuksköterskors erfarenheter och upplevelser av att vårda patienter med självskadebeteende : en kvalitativ intervjustudie

Bakgrund: Självskadebeteende är ett sedan länge förekommande fenomen som kan vara framträdande hos patienter med en oförmåga att reglera affekter. Det innebär ett lidande för patienterna och det bidrar till en känslomässig påverkan hos sjuksköterskorna. För att skapa en gynnsam omvårdnadsrelation behövs resurser, kunskap, kompetens och stöd för sjuksköterskorna i omvårdnaden. Syfte: Beskriva sjuksköterskans erfarenheter och upplevelser av att vårda patienter med självskadebeteende. Metod: Data samlades in från sex sjuksköterskor genom kvalitativa semi-strukturerade intervjuer med stöd av en intervjuguide. Materialet har analyserats med kvalitativ innehållsanalys. Resultat: Det framkom fyra kategorier "Att självskada", "Behov av kompetens", "Ge omvårdnad" och "Känslomässig påverkan". Sjuksköterskorna lyfte svårigheter i omvårdnaden, behovet av kompetens och den känslomässiga påverkan de drabbades av i mötet med patienter med självskadebeteende. Slutsats: Självskadebeteende skapar många olika känslor hos sjuksköterskorna, både positiva och negativa. Sjuksköterskorna upplevde att patienter med självskadebeteende var en svår, men intressant grupp att arbeta med. Tidsbrist, stress och upprepade självskadehandlingar var påfrestande och de känslor som uppkom hos sjuksköterskorna var inte alltid lätta för dem att hantera. Sjuksköterskorna poängterade vikten av att fånga upp patienter i tid men beskrev även svårigheterna i att kunna göra det. Sjuksköterskorna efterfrågade utökat stöd, kunskap och bättre resurser för att känna sig trygga i sin yrkesroll samt för att kunna erbjuda patienter med självskadebeteende en god och säker omvårdnad.

National Office for Suicide Prevention annual report 2010

International research informs us that any economic downturn leads to an increase in suicides. In one recent article in the Lancet it was stated that a 1.0% increase in unemployment led to 0.7% increase in suicides. Such analysis is startling and in Ireland more than relevant as our suicide numbers rose dramatically in 2009 and 2010. Provisional figures for 2009 indicated a record number of 527 recorded suicides and even though there was a slight fall in 2010 the figure remains unacceptably high. It is likely that when the year of occurrence figures for these years are published the numbers will be even higher This year we have included a section in Chapter 5 on the year on year difference between ‘provisional’ (year of registration) data and ‘official’ (year of occurrence) data which highlights the reason why these two data sets cannot be directly compared. We also acknowledge that some undetermined deaths can also be classified as suicides. Ongoing analysis of this data is therefore important. What is particularly worrying and perhaps not unexpected is the rise in suicides in the middle age groups, both men and women. Such a dramatic increase can largely be attributed to the fracturing and resulting stress and pressure on individuals which has occurred in our society due to the economic downturn.   .

Demographic trends in suicide in the UK and Ireland 1980 - 2010.

Background Ireland has the 17th highest suicide rate in the EU and the 4th highest among 15 to 24-year-old males (WHO 2012). Suicide is the leading cause of death in this age group; death by hanging accounted for 69 % of suicides in 2010. Methods This study examines youth suicide rates from 1980 to 2010 in Ireland and compares them to the rates in Northern Ireland, Scotland, England and Wales. Irish data were obtained from the Central Statistics Office and their annual reports on Vital Statistics. Northern Irish data were obtained from the Northern Ireland Statistics and Research Agency website; Scottish data were from the General Register Office for Scotland and English/Welsh data from the Office for National Statistics website. Results There has been a threefold increase in young male suicide in Ireland over the past three decades (8.9 - 29.7 per 100,000). In contrast, there has been approximately a threefold reduction in deaths by road traffic accidents in young men in the same period (42.7 - 16.2 per 100,000). Suicide rates in young men are similar in Scotland and Northern Ireland for the same period but are 50 % lower in England and Wales. Despite the rates of hanging as a method of suicide increasing in all jurisdictions, the overall rate in England and Wales has continued to decline. Conclusion The suicide rate in Ireland remains very high and strategies to address this are urgently required. Our study indicates that national suicide prevention strategies can be effective.

Death by Suicide: A Report Based on the Northern Ireland Coroner’s Database

Funded by HSC R&D Division, Public Health Agency Why did we start? Potentially new information, especially relating to the characteristics of those who had died by suicide was made available through the Coroner’s Office.  The information made available to us covered deaths that occurred in the years 2005 to the end of 2011. What did we do? First we addressed the descriptive characteristics associated with this group of individuals. These descriptive characteristics included information relating to (1) means by which the death occurred (2) gender, age and employment status of the person (3) prior attempts (4)  alcohol and prescription use around time of death (5) adverse events (6) use of health services and (7) mental and physical health problems. Second we examined area level residential location in terms of Local Government Districts, and Wards within Northern Ireland. To address this area level of analysis, standardised mortality ratios (SMRs) were used.      

Understanding Suicide and Help-seeking in Urban and Rural Areas in Northern Ireland

Funded by HSC R&D Division, Public Health Agency Why did we start? Most people who complete suicide are in contact with their family doctors or other services in the months prior to death. A better understanding of the nature of these contacts and the various pathways experienced by suicidal people should reveal the gaps and barriers to effective service provision. We also need better information about the difficulties experienced by family carers, both prior to the death and afterwards. Of particular interest to policy makers in Northern Ireland was a concern that people from rural areas may be at increasing risk of suicide. We were commissioned by the Health and Social Care R&D Division of the Northern Ireland Public Health Agency to address the gaps in our understanding of suicide in NI. What did we do? We undertook a mixed methods study in which we examined the records of 403 people who took their own lives over a two-year period between March 2007 and February 2009. We linked these data to GP records and then examined help-seeking pathways of people and their contacts with services. We did in-depth face-to-face interviews with 72 bereaved relatives and friends who discussed their understanding of the events and circumstances surrounding the death, the experience of seeking help for the family member, the personal impact of the suicide, and use of support services. Additionally, we interviewed 19 General Practitioners about their experiences of managing people who died by suicide.            

Estudo Preliminar de Adaptação e Validação da Escala de Avaliação do Eu Resiliente: resiliência, autodano e ideação suicida em adolescentes

Introdução: Em Portugal, são escassos os instrumentos validados para a população adolescente, que avaliem o importante construto da resiliência. Assim, o principal objetivo deste estudo consistiu na adaptação e validação preliminar da Escala de Avaliação do EU Resiliente (EAER) para adolescentes portugueses. Como segundo objetivo pretendemos, ainda, explorar as associações, na mesma amostra, entre a resiliência, o autodano e a ideação suicida na adolescência. Método: A amostra foi constituída por 226 adolescentes (sexo masculino, n = 139, 61,5%), entre os 12 e os 18 anos, que preencheram um protocolo composto por um questionário sociodemográfico, pela Escala de Avaliação do EU Resiliente (EAER), pelo Questionário de Impulso, Autodano e Ideação Suicida na Adolescência (QIAIS-A) e pela Escala de autoconceito. Resultados: Os resultados obtidos mostraram que a EAER possui boa fidelidade/consistência interna (α = 0,857) e boa estabilidade temporal (r = 0,720). Uma análise de componentes principais mostrou que a EAER apresenta três fatores: fator suporte externo, fator forças pessoais internas e fator estratégias de coping. Encontraram-se correlações negativas entre a resiliência e o autodano e ideação suicida e correlações positivas entre a resiliência e o autoconceito, confirmando-se a validade divergente e convergente da EAER. Verificaram-se níveis elevados de resiliência nos adolescentes da nossa amostra (M = 58,69; DP = 6,67). Na amostra total, 61,5% (n = 139) apresentou ideação suicida e 26,5% (n = 60) apresentou comportamentos de autodano. Conclusão: No seu conjunto, a EAER possui boas características psicométricas, pelo que pode ser considerada uma escala válida e útil e que pode ser usada com segurança na avaliação da resiliência em adolescentes portugueses. Com este estudo alargámos o leque de instrumentos válidos para a medição da resiliência em adolescentes e contribuímos para o avanço da investigação na área da adolescência em Portugal. / Introduction: In Portugal, there are few validated instruments to the adolescent population, to assess the important construct of resilience. Thus, the main objective of this study was the preliminary adaptation and validation of the Escala de Avaliação do EU Resiliente (EAER) to Portuguese adolescents. As a second objective, there is an intention to also explore the associations, on the same sample, between resilience, self-harm and suicidal ideation in adolescence. Method: The sample consisted of 226 adolescents (male, n = 139, 61.5%), between 12 and 18 years, who filled in a protocol consisting of a sociodemographic questionnaire, by the Escala de Avaliação do EU Resiliente (EAER), by the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A) and by the Self-concept Scale. Results: The results showed that the EAER has good fidelity/internal consistency (α = 0.857) and good temporal stability (r = 0.720). A principal component analysis showed that EAER has three factors: external support factor, internal personal strengths factor and coping strategies factor. There were negative correlations between resilience and the self-harm and suicidal ideation and positive correlations between resilience and self-concept, confirming the divergent and convergent validity of EAER. There were high levels of resilience in the adolescents of the sample (M = 58.69, SD = 6.67). In the total sample, 61.5% (n = 139) had suicidal ideation and 26,5% (n = 60) had self-harm behaviors. Conclusion: As a whole, the EAER has good psychometric properties, therefore it can be considered a valid and useful range, and can be safely used in the evaluation of resilience in Portuguese adolescents. With this study we have extended the range of valid instruments for the measurement of resilience in adolescents and contributed to the advance of research in the adolescence area in Portugal.

Cultivating Subjectivities: The Class Politics of Convivial Labor in the Interstitial Spaces of Neoliberal Neglect

Thesis (Ph.D.)--University of Washington, 2016-08

Role of assessment components and recent adverse outcomes in risk estimation and prediction: use of the Short Term Assessment of Risk and Treatability (START) in an adult secure inpatient mental health service

The Short Term Assessment of Risk and Treatability is a structured judgement tool used to inform risk estimation for multiple adverse outcomes. In research, risk estimates outperform the tool's strength and vulnerability scales for violence prediction. Little is known about what its’component parts contribute to the assignment of risk estimates and how those estimates fare in prediction of non-violent adverse outcomes compared with the structured components. START assessment and outcomes data from a secure mental health service (N=84) was collected. Binomial and multinomial regression analyses determined the contribution of selected elements of the START structured domain and recent adverse risk events to risk estimates and outcomes prediction for violence, self-harm/suicidality, victimisation, and self-neglect. START vulnerabilities and lifetime history of violence, predicted the violence risk estimate; self-harm and victimisation estimates were predicted only by corresponding recent adverse events. Recent adverse events uniquely predicted all corresponding outcomes, with the exception of self-neglect which was predicted by the strength scale. Only for victimisation did the risk estimate outperform prediction based on the START components and recent adverse events. In the absence of recent corresponding risk behaviour, restrictions imposed on the basis of START-informed risk estimates could be unwarranted and may be unethical.

Performance of protective factors assessment in risk prediction for adults: systematic review and meta-analysis

Protective factors are neglected in risk assessment in adult psychiatric and criminal justice populations. This review investigated the predictive efficacy of selected tools that assess protective factors. Five databases were searched using comprehensive terms for records up to June 2014, resulting in 17 studies (n = 2,198). Results were combined in a multilevel meta-analysis using the R (R Core Team, R: A Language and Environment for Statistical Computing, Vienna, Austria: R Foundation for Statistical Computing, 2015) metafor package (Viechtbauer, Journal of Statistical Software, 2010, 36, 1). Prediction of outcomes was poor relative to a reference category of violent offending, with the exception of prediction of discharge from secure units. There were no significant differences between the predictive efficacy of risk scales, protective scales, and summary judgments. Protective factor assessment may be clinically useful, but more development is required. Claims that use of these tools is therapeutically beneficial require testing.

Mental health and suicidal behaviors in adolescents from a Portuguese island

Background: Adolescent suicidal behaviors are a public health priority. Objectives: Suicidal behavior is an understudied field in the Azores, and the few existing research studies with Portuguese adolescents only include young people from Mainland Portugal. This study aims at analyzing the adolescent student population from this island region so as to describe the current situation and plan community intervention projects in this area to meet the identified needs. Methodology: This is a non-experimental, quantitative and descriptive-correlational study with the purpose of describing phenomena and finding associations between variables. Results: The results showed that 17.9% of the 484 sampled adolescents reported self-harm behaviors, with 12.7% reporting self-cutting and 5.2% medication overdose or ingestion of toxic substances. Around 15.5% of the adolescents reported suicidal ideation. Additionally, they showed high levels of depressive symptoms (19.9%), ranging from moderate (12%) to severe (7.9%). Conclusion: Adolescents had more self-harm behaviors, more severe depressive symptoms, a lower self-concept and fewer coping strategies than similar populations in mainland Portugal.

Can we predict agitation in patients with suicide attempts in the emergency department?

Background: The agitation in patients presenting to the emergency department (ED) after suicide attempts is common and an important problem. Objective: To establish whether we can predict agitated patients among suicide attempt patients in ED. Methods: This is a cross-sectional observational study of adult suicide attempt events in ED. Information was collected prospectively on a specially designed data-collection form. Patients aged 16 years old and above who presented to the ED for care due to suicide attempts were included in the study. Suicide attempts were grouped as aggressive and non-aggressive attempts. Results: A total of 533 patients were included. Forty-three of these patients had agitation in ED (8%). Non-aggressive suicide attempts were referred to psychiatry services more than aggressive ones (73.6%, n=345 vs 32.8%, n=21, P<0.0001). Agitation in ED and being male increased aggressive suicide attempt risk 3.5 (95% CI:1.6-7.6) and 3.2 times (95% CI:1.8-5.5), respectively. Agitation was statistically more frequent among these patients: those on antidepressant overdose, with previous suicide attempt; with aggressive suicide attempt; and those with confusion; and unconsciousness (P<0.05). Conclusion: Patients who attempted suicide and whose risk of harm to others included those with: antidepressant overdose, aggressive suicide attempt and the unconscious. Response teams should be prepared for these subgroups.

The incorporation of violence by women video artists

This paper examines the way in which women video artists embodied violence in their video pieces as a strategy of critique of the patriarchal regime. Since the 1960s several generations of women artists used different strategies of self-harm or explored the physical and mental limits of their bodies to express the anguish of those who are excluded from the patriarchal society on sexist and/or racist grounds. Considering the guiding line that covers three fields – art, gender, and feminist social movements – as well as their key thinkers and scholars in Sociology, Fine Arts and the Humanities, we have built the object of study of this essay, namely, the relationship between women's video art focused on the body, violence and gender along with feminist social movements in the period ranging from 1967 to 2007, in a Western context. The methodology used had as its primary goal to create a link between the micro-sociological level of expressions, body gestures and behaviours in the videos and the macro-sociological level of broader, institutionalized social forces that are at the origin of inequalities, such as dimensions of gender and «race». This study concluded that at least since the 1960s there is the denunciation by women video artists of the general circumstances women live under, while enduring violence of various kinds, such as socio-cultural, psychological and sexual violence against women.