An interventional study of Brief Admission in Self-Injurious Behavior, Suicidal Ideation and Suicide, Attempted, sponsored by Region Skane. Completed at 1 site in Sweden. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2018-08-28.
Sponsored by Region Skane · Not applicable, Interventional, and Treatment
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.
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This study's enrollment of 125 is below the median of 145 across 931 interventional studies indexed under Emergencies.
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Exclusion Criteria:
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).
Other: Brief Admission
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).
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.
Also known as: Brukarstyrd Inläggning (Swedish)
Number of days with hospital admission
Number of days with Brief admission, general admission, forced (involuntary) admission
Time frame: Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively
Frequency of forced acts (e.g. restraints and forced medication)
Time frame: 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)
Time frame: 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)
Time frame: 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)
Time frame: 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)
Time frame: 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)
Time frame: Change in ratings between baseline, 6 months and 12 months prospectively.
Ability to cope effectively with life stress
The Brief COPE
Time frame: Change in ratings between baseline, 6 months and 12 months prospectively.
Ability to regulate emotions
The Difficulties in Emotion Regulation Scale
Time frame: Change in ratings between baseline, 6 months and 12 months prospectively.
Global psychiatric symptoms
Outcome from Clinical Global Impression Severity Scale
Time frame: Change in ratings between baseline, 6 months and 12 months prospectively.
Satisfaction with health care
Client Satisfaction Questionnaire (CSQ)
Time frame: Change in ratings between baseline, 6 months and 12 months prospectively.
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Plan to share: No
This study is completed, as verified in Aug 2018. You cannot join it, but the record below documents what was studied.
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Region Skane