• A Cross-Sectional Study Investigating the Relationship Between Alexithymia and Suicide, Violence, and Dual Harm in Male Prisoners

      Hemming, Laura; Shaw, Jennifer; Haddock, Gillian; Carter, Lesley-Anne; Pratt, Daniel; email: daniel.pratt@manchester.ac.uk (Frontiers Media S.A., 2021-04-29)
      Background: Suicide and violence are common within male prisoners. One suggested risk factor for both behaviors is alexithymia. Alexithymia describes a deficit in identifying and describing feelings and is also related to externally oriented thinking. This study aimed to explore the relationship between alexithymia, suicide, violence and dual harm in male prisoners. Methods: Eighty male prisoners were recruited from three prisons. Participants were asked to complete a battery of questionnaires including measures of alexithymia (TAS-20), suicide ideation (ASIQ), suicide behavior, violence ideation (SIV), violence behavior, depression (BDI-II), hopelessness (BHS), impulsivity (DII) and anger (NAS-PI). Regression analyses and ANOVAS were conducted to assess the association between alexithymia (and its subcomponents) with six outcomes; suicide ideation, suicide behavior, violence ideation, violence behavior, dual harm ideation and dual harm behavior. Results: Alexithymia was a univariate predictor of suicide ideation, though was not a significant predictor when considered in a multivariate model. Alexithymia was a significant multivariate predictor of suicide behavior. Alexithymia was not a significant multivariate predictor of violence ideation or behavior. There were no significant differences in alexithymia or subscales between those with suicide ideation/behavior alone, violence ideation/behavior alone and those with dual harm ideation/behavior. Conclusion: In male prisoners, alexithymia appears an important univariate predictor of suicide and violence, though the current study suggests no significant contribution above other well-known correlates of suicide and violence.
    • A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol

      Gooding, Patricia A.; orcid: 0000-0002-7458-4462; email: patricia.gooding@manchester.ac.uk; Pratt, Daniel; Awenat, Yvonne; Drake, Richard; Elliott, Rachel; Emsley, Richard; Huggett, Charlotte; Jones, Steven; Kapur, Navneet; Lobban, Fiona; et al. (BioMed Central, 2020-06-16)
      Abstract: Background: Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. Methods: The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders. Discussion: This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious. Trial registration: ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
    • Involving an individual with lived‐experience in a co‐analysis of qualitative data

      Hemming, Laura; orcid: 0000-0001-8818-9802; Pratt, Daniel; email: daniel.pratt@manchester.ac.uk; Bhatti, Peer; Shaw, Jennifer; Haddock, Gillian (2021-03-31)
      Abstract: Background: People with lived‐experience of the phenomenon under investigation are seldom involved in the analysis of qualitative data, and there exists little guidance for those wishing to involve contributors at this stage of research. Aims: To critically reflect on the process of involving people with lived‐experience in a thematic analysis and to offer direction to other researchers. Methods: An individual with lived‐experience of residing in prison contributed to a co‐analysis of qualitative data using thematic analysis. This paper reports on involvement at each stage of a thematic analysis and follows an established reporting checklist. Results: A number of challenges and benefits were encountered in the process of co‐analysing the data. These are discussed in relation to previous research and how to overcome the challenges encountered. Conclusions: The paper concludes by giving recommendations and guidance for future researchers wishing to involve people with lived‐experience in qualitative data analysis.
    • Male prisoners’ experiences of taking part in research about suicide and violence: a mixed methods study

      Hemming, Laura; Pratt, Daniel; email: daniel.pratt@manchester.ac.uk; Haddock, Gillian; Bhatti, Peer; Shaw, Jennifer (BioMed Central, 2021-09-14)
      Abstract: Background: There is an apparent reluctance to engage ‘vulnerable’ participants in conversation about sensitive topics such as suicide and violence and this can often lead to a paucity of research in these areas. This study aimed to explore the experiences of male prisoners taking part in quantitative and qualitative research on suicide and violence. Methods: Participants at four male prisons completed a visual analogue scale of mood before and after data collection for both a cross-sectional study and also a qualitative interview. Participants were also asked to give three words to describe their experience of participation. A paired samples T-test was conducted to explore the difference in pre- and post-mood ratings, and content analysis was conducted to explore the positive and negative comments on participants’ experiences. Results: Overall, participants’ mood significantly improved after participating in a cross-sectional study about suicide and violence (from 4.8 out of 10 to 5.3, p = 0.016), and there was no significant change in mood following participation in a related qualitative study (5.1 to 5.0, p = 0.793). Participants primarily described their experiences as positive, stating that the process had been satisfying, calming, interesting, enlightening and beneficial. A smaller number of participants described their experiences as stressful, challenging, saddening, uncomfortable and bizarre. Conclusions: This study has found that researching sensitive topics such as suicide and violence with male prisoners did not have a negative impact on mood, rather that participants largely enjoyed the experience. These findings dispel the myth that research about sensitive topics with prisoners is too risky and could inform how future researchers assess levels of risk to participants.
    • “Sex isn’t everything”: views of people with experience of psychosis on intimate relationships and implications for mental health services

      White, Rebecca; email: rebecca.white@manchester.ac.uk; Haddock, Gillian; Varese, Filippo; Haarmans, Maria (BioMed Central, 2021-06-14)
      Abstract: Background: The experience of psychosis and associated discrimination can be a barrier to forming and maintaining romantic relationships. Sexual health interventions within mental health services often focus on contraception and reducing risk. There are no known studies that seek to understand what support, if any, people who experience psychosis want regarding psychosocial aspects of intimate relationships. Methods: To address this gap in the literature, qualitative data was collected to investigate how people with experience of psychosis conceptualise romantic relationships and what support they would like in this area of their lives. Semi-structured interviews were conducted with 10 mental health service users (four women, six men) with experience of psychosis. Interviews were analysed from a critical realist social constructionism perspective using thematic analysis. Results: Stigma was a prominent theme, described as impacting numerous aspects of romantic relationships. Power imbalance within services meant participants were wary of having conversations about relationships with professionals and identified a therapeutic alliance as a prerequisite. However, abusive relationships were highlighted as a needed area for support by services. Conclusion: Services should be trauma-informed and help those in abusive relationships. The power and autonomy of people with experience of psychosis should be maintained in any discussions or interventions regarding intimate relationships. A strong therapeutic alliance is essential for any work in this area.
    • Therapeutic alliance in psychological therapy for posttraumatic stress disorder: A systematic review and meta‐analysis

      Howard, Ruth; orcid: 0000-0002-1021-6046; email: ruth.howard@postgrad.manchester.ac.uk; Berry, Katherine; orcid: 0000-0002-7399-5462; Haddock, Gillian (2021-07-21)
      Abstract: Background: Therapeutic alliance is a key element of successful therapy. Despite being particularly relevant in people with posttraumatic stress disorder (PTSD), due to fear, mistrust and avoidance, there has not yet been a comprehensive systematic review of therapeutic alliance in this population. This review explored (a) variables which may predict alliance and (b) whether alliance predicts PTSD outcomes. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, the review identified 34 eligible studies. Studies were subjected to a quality assessment. Predictors of alliance were considered in a narrative synthesis. Twelve studies were entered into a meta‐analysis of the association between therapeutic alliance and PTSD outcomes. Results: There was some evidence for individual variables including attachment, coping styles and psychophysiological variables predicting the alliance. Therapy variables did not predict alliance. The therapeutic alliance was found to significantly predict PTSD outcomes, with an aggregated effect size of r = −.34, across both in‐person and remote therapies. Limitations: Included studies were restricted to peer‐reviewed, English language studies. Quality of included studies was mostly rated weak to moderate, primarily reflecting issues with selection bias in this area of research. Conclusions: This is the first review to demonstrate that therapeutic alliance is a consistent predictor of PTSD outcomes, in both in‐person and remote therapies, and the effect appears at least as strong as in other populations. This is of relevance to clinicians working with traumatized populations. The review identified a need for further research to determine variables predicting alliance in therapy for PTSD.