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Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

Investigating the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards (the ‘INSITE’ trial): study protocol for a randomised controlled trial

Published in: Trials | Issue 1/2016

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Abstract

Background

Suicide is a major cause of preventable death, and suicidal behaviour is prevalent in acute psychiatric wards. People admitted to acute psychiatric wards often experience repeated episodes of suicidal behaviour, causing great distress and heavy use of NHS services. There is little research investigating effective psychological treatments for suicidal patients in inpatient settings although previous research has found support for psychological therapies which specifically target suicidal behaviour. This paper describes the protocol of a single blind RCT to investigate the acceptability and feasibility of a cognitive behavioural intervention targeting suicidality (CBSP) for suicidal people in acute psychiatric wards.

Methods/Design

A single blind RCT comparing treatment as usual (TAU) to TAU plus Cognitive Behavioural Suicide Prevention (CBSP) therapy (TAU + CBSP). Sixty participants (aged 18–65 years) who are suicidal, or have been within the past 3 months, will be recruited from NHS trusts in the North West of England. Our primary objective is to determine whether CBSP is feasible, acceptable and efficacious when compared to patients who receive TAU alone. Secondary aims are the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use and psychological factors associated with suicide. Assessments take place at baseline, 6 weeks and 6 months (end of treatment). The analysis will report on the feasibility and acceptability of CBSP. Qualitative data from staff and service users will inform feasibility and acceptability data.

Discussion

Psychiatric inpatients are a high-risk group and the use of psychological therapies in these settings is rare and requires evaluation. This study is essential to investigate the unique contextual challenges involved in delivering psychological therapy to suicidal inpatients and to identify any necessary modifications required within inpatient settings. The findings will inform a larger, definitive trial.

Trial registration

15 March 2012, PB-PG-1111-26026, NIHR ISRCTN17890126.
Appendix
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Literature
1.
go back to reference National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Annual report: England, Northern Ireland, Scotland and Wales. July 2015. Manchester: University of Manchester; 2015. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Annual report: England, Northern Ireland, Scotland and Wales. July 2015. Manchester: University of Manchester; 2015.
2.
go back to reference Office for National Statistics. Suicides in the United Kingdom, 2013 Registrations. London: Office for National Statistics; 2015. Office for National Statistics. Suicides in the United Kingdom, 2013 Registrations. London: Office for National Statistics; 2015.
3.
go back to reference Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Brit Med Bull. 2011;100:101.CrossRefPubMed Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Brit Med Bull. 2011;100:101.CrossRefPubMed
4.
go back to reference National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Suicide in primary care in England: 2002–2011. Manchester: University of Manchester; 2014. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Suicide in primary care in England: 2002–2011. Manchester: University of Manchester; 2014.
5.
go back to reference Hunt IM, Kapur N, Webb R, Robinson J, Burns J, Turnbull P, et al. Suicide in current psychiatric in-patients: a case-control study. Psychol Med. 2007;37:831–37.CrossRefPubMed Hunt IM, Kapur N, Webb R, Robinson J, Burns J, Turnbull P, et al. Suicide in current psychiatric in-patients: a case-control study. Psychol Med. 2007;37:831–37.CrossRefPubMed
6.
go back to reference Bickley H, Hunt IM, Windfuhr K, Shaw J, Appleby L, Kapur N. Suicide within two weeks of discharge from psychiatric inpatient care: a case-control study. Psych Serv. 2013;64:653–59.CrossRef Bickley H, Hunt IM, Windfuhr K, Shaw J, Appleby L, Kapur N. Suicide within two weeks of discharge from psychiatric inpatient care: a case-control study. Psych Serv. 2013;64:653–59.CrossRef
7.
go back to reference Knapp M, McDaid D, Personage M. Mental health promotion and prevention: the economic case. A report by Personal Social Services Research Unit, London School of Economics and Political Science, Department of Health. 2011. Knapp M, McDaid D, Personage M. Mental health promotion and prevention: the economic case. A report by Personal Social Services Research Unit, London School of Economics and Political Science, Department of Health. 2011.
8.
go back to reference Health & Social Care Information Centre. Mental health bulletin: annual report from MHMDS Returns 2013–14. November 2014. Health & Social Care Information Centre. Mental health bulletin: annual report from MHMDS Returns 2013–14. November 2014.
9.
go back to reference Haw C, Bergen H, Casey D, Hawton K. Repetition of deliberate self‐harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suic Life-Threat Behav. 2007;37:379–96.CrossRef Haw C, Bergen H, Casey D, Hawton K. Repetition of deliberate self‐harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suic Life-Threat Behav. 2007;37:379–96.CrossRef
10.
go back to reference Kapur N, Cooper J, King-Hele S, Webb R, Lawlor M, Rodway C, et al. The repetition of suicidal behaviour: a multicenter cohort study. J Clin Psychiatr. 2006;67:1599–609.CrossRef Kapur N, Cooper J, King-Hele S, Webb R, Lawlor M, Rodway C, et al. The repetition of suicidal behaviour: a multicenter cohort study. J Clin Psychiatr. 2006;67:1599–609.CrossRef
11.
go back to reference Royal College of Psychiatrists. Second round of the National Audit of Psychological Therapies for Anxiety and Depression (NAPT). 2013. Royal College of Psychiatrists. Second round of the National Audit of Psychological Therapies for Anxiety and Depression (NAPT). 2013.
12.
go back to reference Care Quality Commission. Right here, right now: people’s experiences of help, care and support during a mental health crisis. London: Care Quality Commission; 2015. Care Quality Commission. Right here, right now: people’s experiences of help, care and support during a mental health crisis. London: Care Quality Commission; 2015.
13.
go back to reference The Schizophrenia Commission. The abandoned illness: a report from the Schizophrenia Commission. London: Rethink Mental Illness; 2012. The Schizophrenia Commission. The abandoned illness: a report from the Schizophrenia Commission. London: Rethink Mental Illness; 2012.
14.
go back to reference Johnson S, Paul SW, Osborn D, Wearn E, Lloyd-Evans B, Totman J, et al. Inpatient mental health staff morale: a national investigation. London: NIHR Service Delivery and Organisation programme; 2011. Johnson S, Paul SW, Osborn D, Wearn E, Lloyd-Evans B, Totman J, et al. Inpatient mental health staff morale: a national investigation. London: NIHR Service Delivery and Organisation programme; 2011.
15.
go back to reference National Institute for Health and Clinical Excellence (NICE). Self-harm. Longer term management. London: CG133; 2011. National Institute for Health and Clinical Excellence (NICE). Self-harm. Longer term management. London: CG133; 2011.
16.
go back to reference Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behav Modif. 2008;32:77–108.CrossRefPubMed Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behav Modif. 2008;32:77–108.CrossRefPubMed
17.
go back to reference Tarrier N, Kelly J, Maqsood S, Snelson N, Maxwell J, Law H, et al. The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophr Res. 2014;156:204–10.CrossRefPubMed Tarrier N, Kelly J, Maqsood S, Snelson N, Maxwell J, Law H, et al. The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophr Res. 2014;156:204–10.CrossRefPubMed
18.
go back to reference Chang NA, Stanley B, Brown GK, Cunningham A. Treating the suicidal patient: cognitive therapy and dialectical behaviour therapy. In: O’Connor RC, Platt S, Gordon J, editors. International handbook of suicide prevention: research, policy and practice. Chichester: Wiley; 2011. Chang NA, Stanley B, Brown GK, Cunningham A. Treating the suicidal patient: cognitive therapy and dialectical behaviour therapy. In: O’Connor RC, Platt S, Gordon J, editors. International handbook of suicide prevention: research, policy and practice. Chichester: Wiley; 2011.
19.
go back to reference Tarrier N, Gooding P, Pratt D, Kelly J, Awenat Y, Maxwell J. Cognitive behavioural prevention of suicide in psychosis: a treatment manual. London: Routledge; 2013. Tarrier N, Gooding P, Pratt D, Kelly J, Awenat Y, Maxwell J. Cognitive behavioural prevention of suicide in psychosis: a treatment manual. London: Routledge; 2013.
20.
21.
go back to reference Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol Psychother Theory Res Pract. 2008;81:55–77.CrossRef Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol Psychother Theory Res Pract. 2008;81:55–77.CrossRef
23.
go back to reference Haddock G, Devane S, Bradshaw TJ, McGovern J, Tarrier N, Kinderman P, et al. An investigation into the psychometric properties of the cognitive therapy scale of psychosis (CTS-Psy). Behav Cog Psychother. 2001;29:221–33.CrossRef Haddock G, Devane S, Bradshaw TJ, McGovern J, Tarrier N, Kinderman P, et al. An investigation into the psychometric properties of the cognitive therapy scale of psychosis (CTS-Psy). Behav Cog Psychother. 2001;29:221–33.CrossRef
24.
go back to reference Beck A, Kovacs M, Weissman A. Assessment of suicidal intention: The Scale of Suicide Ideation. J Consult Clin Psychol. 1979;47:343.CrossRefPubMed Beck A, Kovacs M, Weissman A. Assessment of suicidal intention: The Scale of Suicide Ideation. J Consult Clin Psychol. 1979;47:343.CrossRefPubMed
25.
go back to reference Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment. 2001;8:443–54.CrossRefPubMed Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment. 2001;8:443–54.CrossRefPubMed
26.
go back to reference Cull J, Gill W. Suicide probability scale. Western Psychological Services, Los Angeles. CA The Suicide Probability Scale is a proprietary instrument published by Western Psychological Services. 1982;12031:1997–2005. Cull J, Gill W. Suicide probability scale. Western Psychological Services, Los Angeles. CA The Suicide Probability Scale is a proprietary instrument published by Western Psychological Services. 1982;12031:1997–2005.
27.
go back to reference Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: The Hopelessness Scale. J Consult Clinl Psychol. 1974;42:861.CrossRef Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: The Hopelessness Scale. J Consult Clinl Psychol. 1974;42:861.CrossRef
28.
go back to reference Steed L. Further validity and reliability evidence for Beck Hopelessness Scale scores in a nonclinical sample. Edu Psychol Measur. 2001;61:303–16.CrossRef Steed L. Further validity and reliability evidence for Beck Hopelessness Scale scores in a nonclinical sample. Edu Psychol Measur. 2001;61:303–16.CrossRef
29.
go back to reference Kay SR, Flszbein A, Opfer LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261.CrossRefPubMed Kay SR, Flszbein A, Opfer LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261.CrossRefPubMed
30.
go back to reference Peralta V, Cuesta MJ. Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia. Psychiatr Res. 1994;53:31–40.CrossRef Peralta V, Cuesta MJ. Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia. Psychiatr Res. 1994;53:31–40.CrossRef
31.
go back to reference Haddock G, McCarron J, Tarrier N, Faragher E, Tarrier N. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med. 1999;29:879–89.CrossRefPubMed Haddock G, McCarron J, Tarrier N, Faragher E, Tarrier N. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med. 1999;29:879–89.CrossRefPubMed
32.
go back to reference Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res. 1990;3:247–51.CrossRefPubMed Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res. 1990;3:247–51.CrossRefPubMed
33.
go back to reference Addington J, Shah H, Liu L, Addington D. Reliability and validity of the Calgary Depression Scale for Schizophrenia (CDSS) in youth at clinical high risk for psychosis. Schizophr Res. 2014;153:64–7.PubMedCentralCrossRefPubMed Addington J, Shah H, Liu L, Addington D. Reliability and validity of the Calgary Depression Scale for Schizophrenia (CDSS) in youth at clinical high risk for psychosis. Schizophr Res. 2014;153:64–7.PubMedCentralCrossRefPubMed
34.
go back to reference Espie C, Kyle S, Hames P, Gardani M, Fleming L, Cape J. The Sleep Condition Indicator (SCI): a practical clinical screening tool to evaluate DSM-5 insomnia disorder. Sleep. 2013;36(Suppl):A193–4. Espie C, Kyle S, Hames P, Gardani M, Fleming L, Cape J. The Sleep Condition Indicator (SCI): a practical clinical screening tool to evaluate DSM-5 insomnia disorder. Sleep. 2013;36(Suppl):A193–4.
35.
go back to reference Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101:323–29.PubMed Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101:323–29.PubMed
36.
go back to reference Kawaka AK, Ravicki DA. Psychometric properties of the Personal and Social Performance scale (PSP) among individuals with schizophrenia living in the community. Qual Life Res. 2008;17:1247–56.CrossRef Kawaka AK, Ravicki DA. Psychometric properties of the Personal and Social Performance scale (PSP) among individuals with schizophrenia living in the community. Qual Life Res. 2008;17:1247–56.CrossRef
37.
go back to reference Group W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.CrossRef Group W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.CrossRef
38.
go back to reference Skevington SM, Lotfy M, O’Connel KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res. 2004;13:299–310.CrossRefPubMed Skevington SM, Lotfy M, O’Connel KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res. 2004;13:299–310.CrossRefPubMed
39.
go back to reference Gilbert P, Allan S. The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view. Psychol Med. 1998;28:585–98.CrossRefPubMed Gilbert P, Allan S. The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view. Psychol Med. 1998;28:585–98.CrossRefPubMed
40.
go back to reference Robson P. Development of a new self-report questionnaire to measure self esteem. Psychol Med. 1989;19:513–18.CrossRefPubMed Robson P. Development of a new self-report questionnaire to measure self esteem. Psychol Med. 1989;19:513–18.CrossRefPubMed
41.
go back to reference Ghaderi A. Psychometric properties of the self-concept questionnaire. Eur J Psychol Assess. 2005;21:139–46.CrossRef Ghaderi A. Psychometric properties of the self-concept questionnaire. Eur J Psychol Assess. 2005;21:139–46.CrossRef
42.
go back to reference Endler N, Parker J. Coping Inventory for Stressful Situations (CISS): manual. Toronto: Multi-Health Systems; 1990. Endler N, Parker J. Coping Inventory for Stressful Situations (CISS): manual. Toronto: Multi-Health Systems; 1990.
43.
go back to reference McWilliams LA, Cox BJ, Enns MW. Use of the coping inventory for stressful situations in a clinically depressed sample: factor structure, personality correlates, and prediction of distress. J Clin Psych. 2003;59:423–37.CrossRef McWilliams LA, Cox BJ, Enns MW. Use of the coping inventory for stressful situations in a clinically depressed sample: factor structure, personality correlates, and prediction of distress. J Clin Psych. 2003;59:423–37.CrossRef
44.
go back to reference Evans J, Rose D, Flach C, Csipke E, Glossop H, McCrone P, et al. VOICE: developing a new measure of service users’ perceptions of inpatient care, using a participatory methodology. J Ment Health. 2012;21:57–71.PubMedCentralCrossRefPubMed Evans J, Rose D, Flach C, Csipke E, Glossop H, McCrone P, et al. VOICE: developing a new measure of service users’ perceptions of inpatient care, using a participatory methodology. J Ment Health. 2012;21:57–71.PubMedCentralCrossRefPubMed
45.
go back to reference Laker C, Rose D, Flach C, Csipke E, McCrone P, Craig T, et al. Views of the Therapeutic Environment (VOTE): stakeholder involvement in measuring staff perceptions of acute in-patient care. Internat J Nurs Stud. 2012;49:1403–10.CrossRef Laker C, Rose D, Flach C, Csipke E, McCrone P, Craig T, et al. Views of the Therapeutic Environment (VOTE): stakeholder involvement in measuring staff perceptions of acute in-patient care. Internat J Nurs Stud. 2012;49:1403–10.CrossRef
47.
go back to reference Dolan P, Gudex C, Kind P, Williams A. A social tariff for EuroQol: results from a UK general population survey. UK: Centre for Health Economics University of York; 1995. Dolan P, Gudex C, Kind P, Williams A. A social tariff for EuroQol: results from a UK general population survey. UK: Centre for Health Economics University of York; 1995.
48.
go back to reference Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. J Couns Psychol. 1989;36:223–33.CrossRef Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. J Couns Psychol. 1989;36:223–33.CrossRef
49.
50.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
Metadata
Title
Investigating the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards (the ‘INSITE’ trial): study protocol for a randomised controlled trial
Publication date
01-12-2016
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1192-9

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