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Andrew C Page and Geoff Hook - Enhancing routine feedback to prevent self-harm

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Presentation by Andrew C Page and Geoff Page of Perth Clinic. Enhancing routine feedback to prevent self-harm within inpatient care

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Andrew C Page and Geoff Hook - Enhancing routine feedback to prevent self-harm

  1. 1. Enhancing routine feedback to prevent self-harm within inpatient care Andrew C Page Geoff Hooke School of Psychological Science, UWA Perth Clinic
  2. 2. The Zero Suicide Goal (The Age: 12 July 2019)
  3. 3. “Zero Suicide” • In US, organized by Suicide Prevention Resource Center (SPRC). – Create buy-in toward reduction in suicide rates – Train workforce – Identifying people at risk • (Zero Suicide, 2018)
  4. 4. Zero Suicide Strategy risks … Train workforce Identifying people at risk
  5. 5. … And …
  6. 6. • “Our analyses showed that science could only predict future suicidal thoughts and behaviors about as well as random guessing …This was extremely humbling — after decades of research, science had produced no meaningful advances in suicide prediction.” (American Psychological Association, 2016). • Risk guidelines should not be abandoned … “As most of these guidelines were produced by expert consensus, there is reason to believe that they may be useful and effective.”
  7. 7. Acquiring the capability to suicide • Why do so few people who desire suicide go on to attempt? Suicide AttemptSuicidal Ideation Thwarted Belongingness Perceived Burdensomeness Acquired Capability
  8. 8. The University of Western Australia DI-5 Daily Symptom Index Over the last day At no time Some of the time < half of the time > half of time Most of the time All of the time I have felt anxious 0 1 2 3 4 5 I have felt depressed 0 1 2 3 4 5 I have felt worthless 0 1 2 3 4 5 I have thoughts about killing myself 0 1 2 3 4 5 I have felt that I am not coping 0 1 2 3 4 5 Dyer, Hooke, & Page; 2013
  9. 9. The University of Western Australia Day 1 Score on Suicide Question Not Known 4-51-2 30 Estimated 8% 2% 4% 18% 8% 23% Risk Day 2 Score on Suicide Question 3-50-2 Restifo, Kashyap, Hooke, & Page, 2015; Psychotherapy Research
  10. 10. The University of Western Australia
  11. 11. Example of PCOSS attendance screen “on track” status indicated in blue “off track” status indicated in red Click here to view patient graph Blue graphs = CBT program Red graphs = Inpatients Symptoms Red = High on Suicide item Wellbeing
  12. 12. Mobile Access 
  13. 13. Therapists iPad View of Patient Progress
  14. 14. Progress Graph
  15. 15. Validity of Alert  9,104 were randomly selected (Affective Disorder = 6,091, Anxiety Disorder = 2,425, Personality Disorder = 588, 74% Female, Age = 40.3 years) for equal periods before and after feedback  The enhanced feedback period was associated within a significant reduction in total self-harm incidents over a 3 year period (Odds Ratio = 0.59)  Fewer patients engaging in a high number of self-harm incidents (i.e., > 4)  But effect not significant when matched in terms of diagnosis
  16. 16. Suicide AttemptSuicidal Ideation Thwarted Belongingness Perceived Burdensomeness Acquired Capability
  17. 17. Fluid Vulnerability Theory (Rudd, 2006; Bryan & Rudd, 2016)
  18. 18. High Low Phase 1 Phase 2 Stable - High Switch - High Switch - Low Stable - Low Thwarted Belongingness
  19. 19. Results: Interpersonal Factors and Ideation IDEATION 1 IDEATION 2 IDEATION 3 INTERPERS. 1 INTERPERS. 2 INTERPERS. 3 0.67**0.69** 0.16** 0.13* 0.40**0.45** 0.76** 0.63** 0.41** 0.08* 0.11** 0.19** 0.17** Day 1 Day 2 Day 3 Kyron, Hooke, & Page (2018). J Consulting and Clinical Psychology
  20. 20. Model 1: Self-Report Model 2: Model1 + Dynamic Change Model 3: Model2 + Demographics Model 4: Model3 + Prior history & Diagnosis (Kyron, Hooke, & Page, submitted)
  21. 21. Model predicts ~ 85% ACC. An individual classified at risk is ~40 times more likely to self harm. Individuals who are not classified as being at risk have 99.1% chance that they will not self harm or attempt suicide.
  22. 22. (Kyron, Hooke, & Page, 2018) -0.50 0.00 0.50 1.00 1.50 T - 2 T - 1 T0 T + 1 SuicidalIdeation No Incident NSSI -0.50 0.00 0.50 1.00 1.50 T - 2 T - 1 T 0 T + 1 PerceivedBurdensomeness No Incident NSSI -0.50 0.00 0.50 1.00 1.50 T - 2 T - 1 T0 T + 1 ThwartedBelongingness No Incident NSSI -0.50 0.00 0.50 1.00 1.50 T - 2 T - 1 T0 T + 1 Interaction No Incident NSSI

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