A feasibility study highlighting challenges in evaluating a structured, psychological treatment for self-harm in adult psychiatric inpatient settings. (December 2019)

• Record Type: Journal Article
• Authors: Fife, Sarah; Blumenfeld, Frances; Williams, Claire; Wood, Lisa
• Is Part Of: Psychiatry research. Volume 282(2019)
• Publication Date: 2019-12
• Subjects: Self-har -- Feasibility -- Dialectical-behavioural therapy; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2019.112609
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Findings indicated that it was feasible and acceptable to run the CWC group and research study on an inpatient ward. There were several challenges in recruiting to target (80% achieved) and retaining participants in the groups and the research ( n = 9; 38%). There were three initial factors affecting recruitment, including (i) availability of the study team, (ii) screening methods, and (iii) inconsistencies with the conceptualisation of self-harm by patients and clinicians. Overall, being discharged from the ward accounted for the most common reason people did not attend the groups (45%). A number of implementation issues were identified, and future studies should utilise recommendations from this study to inform future group and study designs. Abstract: Background: Despite being the most common reason for admission to psychiatric inpatient services, no evidence-based treatment currently exists for self-harm in this setting. Dialectical Behavioural Therapy (DBT) trials have found promising results in treating self-harm in outpatient settings; however findings for inpatient settings are still limited. Method: A single-arm feasibility trial was conducted examining a DBT-informed 'Coping with Crisis' (CwC) group protocol, which focused on self-harm and crisis management strategies. Twenty-four participants were recruited from an inpatient ward in a National Health Service (NHS) Trust in the UK. The Inventory of Statements about Self-Injury and Distress Tolerance Scale were administered at baseline and post-therapy. Data was collected on the rates of recruitment, retention, session attendance, outcome measure completion, adverse events and participant feedback, in order to inform the design of a main study. Results: Findings indicated that it was feasible to run the CWC group and research study on an inpatient ward. However, there were several challenges in recruiting to target (80% achieved) and retaining participants (38% of consented participants completed). A number of implementation issues were identified and recommendations have been made to inform future group and study designs.