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Clinical Trial
. 2018 Oct 16;18(1):334.
doi: 10.1186/s12888-018-1921-6.

A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths

Yvonne F Awenat  1   2   3 , Sarah Peters  4   5   6 , Patricia A Gooding  4   5   6 , Daniel Pratt  4   5   7 , Emma Shaw-Núñez  4   7 , Kamelia Harris  4 , Gillian Haddock  4   5   7
Affiliations
Clinical Trial

A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths

Yvonne F Awenat et al. BMC Psychiatry. .

Abstract

Background: Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Inpatient suicides regularly occur with 10.4/100,000 such deaths recorded in the UK in 2016. Inpatient suicides are potentially the most avoidable of all suicides as inpatients have 24-h staff contact. Current inpatient treatment prioritizes maintenance of physical safety by observation, medication and general supportive measures, however efficacious and effective specific treatments are lacking. Psychological treatments have a growing evidence base for suicide prevention yet provision of inpatient therapy is uncommon. The present qualitative study aimed to understand the patient acceptability issues by investigating suicidal inpatients views and expectations of a novel suicide-focussed cognitive behavioural psychological therapy which was nested alongside a pilot clinical trial of the intervention.

Methods: Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment.

Results: Two main themes were identified. The first, 'A therapy that works', revealed inpatients' views of the necessary components for effective ward-based suicide-focused psychological therapy. The second, 'Concerns about in-patient suicide-focused therapy', depicted their fears about engaging in this treatment. Results suggested that suicide-focused psychological therapy was cautiously welcomed by inpatients' whose narratives expressed their needs, priorities and concerns. Further data analysis enabled formation of a user-informed model of suicide-focussed psychological therapy which offers guidance for researchers and clinicians.

Conclusions: We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. It is important that provision of ward-based psychological therapy for suicidal inpatients addresses the considerable context-specific challenges inherent in this setting.

Trial registration number: ISRCTN 17890126 , Registry: UK Clinical Trials Gateway, Date of registration: 22/04/15, Date of enrolment of first participant to the trial: 20/05/14 (retrospectively registered).

Keywords: Implementation; Psychiatric inpatients; Psychological therapy; Qualitative; Suicide prevention; User-views.

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Conflict of interest statement

Ethics approval and consent to participate

All participants provided written consent to participate. This research has been performed in accordance with the Declaration of Helsinki and ethical approval was granted by a statutory UK Research Ethics Committee (13/NW/0504).

Consent for publication

Not Applicable.

Competing interests

Yvonne Awenat is a Trustee for a North-West England mental health charity affiliated to Mind. All other authors confirm that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

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