Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Lund University | OTHER |
| Radboud University Medical Center | OTHER |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The purpose of the study is to test a standardized version of brief admission (BA) through randomized controlled trial (RCT). The main objective is to evaluate if BA can serve as a crisis management model for individuals with recurrent self-harm, including suicide attempts and at least three symptoms of Borderline Personality disorder. Participants will be allocated to BA + Treatment as Usual (TAU) or TAU.
When individuals with recurrent self-harm and suicidal behaviour seek acute admission to hospital due to a crisis and associated increased suicidal ideation, recommendations for clinical care are still conflicting. The risk for iatrogenic effects of inpatient care are considerable, and long hospital admissions without a clear treatment structure may predict decompensation in functioning. This has resulted in a clinical practice of avoiding admission for individuals diagnosed with Borderline Personality Disorder (BPD).
Brief admission (BA) as an intervention has a longstanding history in the delivery of mental health services in the Netherlands. The core elements of brief admission were determined through consultation with Dutch researchers, interviews with individuals with experience, Dutch clinicians familiar with Brief Admission, and local guidelines from hospitals familiar with implementing this crisis management intervention. Core elements of the intervention were standardized into a protocol, and an educational manual was developed to train clinicians involved in the trial. An objectively rated fidelity measure was developed in order to ensure adherence.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Brief Admission | Experimental | Participants randomised to Brief admission (BA) will have the possibility of admitting themselves to hospital for a maximum duration of three consecutive days at a maximum frequency of three times per month. Apart from BA they have access to all psychiatric care that they would have if they had not participated in the study (including general admission to hospital). |
|
| Control | No Intervention | Participants randomized to Treatment as Usual will receive no intervention from the study protocol, except the baseline assessments and repeated assessments administered on the same schedule as described above for the treatment group. They will not be given the evaluation measures that are specific to the intervention. Participants have access to all psychiatric care that they would have if they had not participated in the study (including general admission to hospital). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Brief Admission | Other | Participants randomised to Brief admission (BA) will participate in a negotiation together with their out-patient clinician and a representative from the ward. The aim of the negotiation is to form an individualised contract defining how BA will work for them. After signing the contract, will have the possibility to admit themselves to hospital according to the procedure stated in the contract. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of days with hospital admission | Number of days with Brief admission, general admission, forced (involuntary) admission | Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of forced acts (e.g. restraints and forced medication) | Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively | |
| Individuals' Experiences of the intervention | Outcome from the questionnaires developed for the method: Individual's Experience Scale (IES) |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Sofie Westling, MD PhD | Region Skane | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Division of Psychiatry, Region SkĂĄne | Lund | SkĂĄne County | 22185 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33884617 | Derived | Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2021 Apr 22;4(4):CD013668. doi: 10.1002/14651858.CD013668.pub2. | |
| 32368793 | Derived | Storebo OJ, Stoffers-Winterling JM, Vollm BA, Kongerslev MT, Mattivi JT, Jorgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5(5):CD012955. doi: 10.1002/14651858.CD012955.pub2. |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 23, 2018 |
Not provided
Not provided
Not provided
Not provided
Not provided
|
|
| Data collected at each Brief Admission during a period of 140 weeks. A Brief Admission is defined as a hospital admission according to the procedure defined in the Brief Admission Skane Standardised Protocol. |
| Clinicians' Experiences of the intervention | Outcome from the questionnaires developed for the method: Clinician's Experience Scale (CES) | Data collected at each Brief Admission during a period of 140 weeks. A Brief Admission is defined as a hospital admission according to the procedure defined in the Brief Admission Skane Standardised Protocol. |
| Frequency of all self-harming behaviours including suicide attempts | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) | Change in frequency between baseline, 6 months and 12 months prospectively. |
| Severity of self-harming behaviours | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) | Change in severity between baseline, 6 months and 12 months prospectively. |
| Level of functioning in activities of daily life | The World Health Organization Disability Assessment Schedule II (WHODAS 2.0) | Change in ratings between baseline, 6 months and 12 months prospectively. |
| Ability to cope effectively with life stress | The Brief COPE | Change in ratings between baseline, 6 months and 12 months prospectively. |
| Ability to regulate emotions | The Difficulties in Emotion Regulation Scale | Change in ratings between baseline, 6 months and 12 months prospectively. |
| Global psychiatric symptoms | Outcome from Clinical Global Impression Severity Scale | Change in ratings between baseline, 6 months and 12 months prospectively. |
| Satisfaction with health care | Client Satisfaction Questionnaire (CSQ) | Change in ratings between baseline, 6 months and 12 months prospectively. |
| 31173128 | Derived | Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin A, Flyckt L, Helleman M. Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide: A Randomized Clinical Trial. JAMA Netw Open. 2019 Jun 5;2(6):e195463. doi: 10.1001/jamanetworkopen.2019.5463. |
| 29703119 | Derived | Helleman M, Lundh LG, Liljedahl SI, Daukantaite D, Westling S. Individuals' experiences with brief admission during the implementation of the brief admission skane RCT, a qualitative study. Nord J Psychiatry. 2018 Jul;72(5):380-386. doi: 10.1080/08039488.2018.1467966. Epub 2018 Apr 27. |
| 28619050 | Derived | Liljedahl SI, Helleman M, Daukantaite D, Westrin A, Westling S. A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skane randomized controlled trial protocol (BASRCT). BMC Psychiatry. 2017 Jun 15;17(1):220. doi: 10.1186/s12888-017-1371-6. |
| Aug 10, 2018 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D016728 | Self-Injurious Behavior |
| D059020 | Suicidal Ideation |
| D013406 | Suicide, Attempted |
| D001883 | Borderline Personality Disorder |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D013405 | Suicide |
| D010554 | Personality Disorders |
| D001523 | Mental Disorders |
Not provided
Not provided