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Louis Appleby

Publications and source records attributed to Louis Appleby.

At least 37 records · Page 2Linked to original sources
PubMed2005

The effects on suicide rates of an educational intervention for front-line health professionals with suicidal patients (the STORM Project).

BACKGROUND: The opportunity to study district-wide educational interventions on suicide rates is rarely available. In 1997, the authors carried out a district-wide training programme for primary care, accident and emergency, and mental health workers (47% of eligible staff trained), and demonstrated improvements in skills, attitude and confidence among the recipients of the training. METHOD: Suicide rates (including definite suicides and undetermined deaths) and population statistics were collected for a district and region of England from official sources from 1993-2001. A before-and-after (1994-1996 and 1998-2000) training intervention analysis was conducted on suicide rates. RESULTS: The suicide rate in 1994-1996 was 8.8 per 100 000 before our educational intervention and unchanged at 8.6 per 100 000 in 1998-2000 after it (p = 0.783). CONCLUSION: Brief educational interventions to improve the assessment and management of suicide for front-line health professionals in contact with suicidal patients may not be sufficient to reduce the population suicide rate.

Depression↗
PubMed2005

Suicide after deliberate self-harm: a 4-year cohort study.

OBJECTIVE: The purposes of this study were to estimate suicide rates up to 4 years after a deliberate self-harm episode, to investigate time-period effects on the suicide rate over the follow-up period, and to examine potential sociodemographic and clinical predictors of suicide within this cohort. METHOD: This prospective cohort study included 7,968 deliberate self-harm attendees at the emergency departments of four hospital trusts in the neighboring cities of Manchester and Salford, in northwest England, between September 1, 1997, and August 31, 2001. Suicide rates and standardized mortality ratios (SMRs) for the cohort were calculated. Potential risk factors were investigated by using Cox's proportional hazards models. RESULTS: Sixty suicides occurred in the cohort during the follow-up period. An approximately 30-fold increase in risk of suicide, compared with the general population, was observed for the whole cohort. The SMR was substantially higher for female patients than for male patients. Suicide rates were highest within the first 6 months after the index self-harm episode. The independent predictors of subsequent suicide were avoiding discovery at the time of self-harm, not living with a close relative, previous psychiatric treatment, self-mutilation, alcohol misuse, and physical health problems. CONCLUSIONS: The results highlight the importance in a suicide prevention strategy of early intervention after an episode of self-harm. Treatment should include attention to physical illness, alcohol problems, and living circumstances. Self-harm appears to confer a particularly high risk of suicide in female patients.

Adolescent↗
PubMed2005

Mortality in offspring of parents with psychotic disorders: a critical review and meta-analysis.

OBJECTIVE: Mortality risk in offspring of parents with psychotic disorders is a sensitive and important topic, but evidence on which to base plans for preventive services is limited. The authors synthesized evidence for mortality risk among offspring of parents with psychotic disorders and examined potential modifiers of risk such as offspring age and parental diagnosis. METHOD: Electronic reference and citation databases were searched. Secondary analyses were carried out to generate relative risk estimates and perform post hoc statistical power calculations. A meta-analysis of the association between maternal psychotic disorder and fetal death/stillbirth was conducted. RESULTS: Most of the relevant studies investigated the relationship between exposure to maternal schizophrenia and perinatal or infant mortality outcomes but were not truly population-based and lacked adequate power. Studies published since 1960 generally indicated higher than expected mortality risk in exposed offspring. Meta-analysis indicated an almost twofold higher risk of fetal death/stillbirth among offspring of women with psychoses. Notable gaps in the existing evidence include outcome beyond the first year of life, cause-specific mortality, and effects of exposure to specific parental conditions other than schizophrenia and of exposure to paternal versus maternal disorder. Etiological mechanisms are not fully understood. CONCLUSIONS: Large-scale population-based studies are needed to understand mortality risk in offspring of parents with psychoses. In the absence of etiological evidence, only general preventive measures can be taken. Prevention of offspring mortality at an early age is most likely to be achieved by identification and treatment of maternal disorder and greater provision of support to these vulnerable families.

Adolescent↗
PubMed2005

Clustering of suicides among people with mental illness.

BACKGROUND: Most previous investigations of imitative suicide have reported suicide clustering in the general population, either temporal clustering following media reporting of suicide or case studies of geographically localised clusters. AIMS: To determine whether space - time and space-time-method clustering occur in a national case register of those who had recent contact with mental health services and had died by suicide and to estimate the suicide imitation rate in this population. METHOD: Knox tests were used for space-time and space-time-method clustering. Model simulations were used to estimate effect size. RESULTS: Highly significant space-time and space-time-method clustering was found in a sample of 2741 people who died by suicide over 4 years who had had recent contact with one of 105 mental health trusts. Model simulations with an imitation rate of 10.1% (CI 4-17) reproduced the observed space-time-method clustering. CONCLUSIONS: This study provides indirect evidence that imitative suicide occurs among people with mental illnesses and may account for about 10% of suicides by current and recent patients.

Cause of Death↗
PubMed2005

Prevalence and predictors of parenting outcomes in a cohort of mothers with schizophrenia admitted for joint mother and baby psychiatric care in England.

OBJECTIVES: Most women with schizophrenia have children. Schizophrenia has been identified as an independent predictor of poor parenting outcome following joint mother and baby psychiatric admission. We aimed to describe the characteristics of these women postnatally and to estimate the prevalence of, and identify independent predictors of, parenting outcomes. METHOD: Clinical and psychosocial data from consecutive joint psychiatric admissions of mothers and infants between September 1996 and September 2002 were collected. Diagnoses were based on ICD-10 criteria (N = 239 schizophrenia; N = 693 affective disorders). The prevalence of each parenting outcome at discharge, assessed according to social services intervention and staff-rated measures of parenting ability, was estimated. Factors associated with poor parenting outcomes and independent predictors were identified using "modified" Poisson regression, and prevalence of these parenting outcomes was estimated in subgroups of mothers stratified by combinations of protective/risk factors. RESULTS: Mothers with schizophrenia were characterized as having more complex clinical and psychosocial problems and were considerably more likely to experience all types of poor parenting outcomes, compared to mothers with affective disorders. Mothers with schizophrenia reporting supportive marital and other relationships, those whose partners were well, and those of higher social class showed the best parenting outcomes. CONCLUSIONS: Mothers with schizophrenia who experience better parenting outcomes may be protected by certain factors. Successful parenting is related, partly, to stability within the family and access to financial and social resources. The nature of the relationship between identified predictors and parenting outcomes in this group is unclear but may suggest that parenting outcome varies with clinical outcome in schizophrenia. Future research and service development should focus on potential protective factors that may encourage successful parenting outcomes in this vulnerable group.

Adult↗
PubMed2005

Half way there.

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Financing, Government↗
PubMed2004

The psychosocial outcome of pregnancy in women with psychotic disorders.

OBJECTIVE: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. METHOD: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls). RESULTS: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. CONCLUSIONS: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.

Adolescent↗
PubMed2004

Mental illness in people who kill strangers: longitudinal study and national clinical survey.

OBJECTIVES: To establish changes over time in the frequency of homicides committed by strangers, and to describe the personal and clinical characteristics of perpetrators of stranger homicides. DESIGN: Longitudinal study and national clinical survey. PARTICIPANTS: People convicted of homicide in England and Wales between 1996 and 1999 and whether the victim was known to the perpetrator. SETTING: England and Wales. MAIN OUTCOME MEASURE: Characteristics of perpetrators of homicides according to whether victims were strangers or not. RESULTS: Stranger homicides increased between 1967 and 1997, both in number and as a proportion of all homicides. No increase was found, however, in the number of perpetrators placed under a hospital order after homicide, whether all homicides or stranger homicides only. 358 of 1594 (22%) homicides were stranger homicides. In these cases the perpetrator was more likely to be male and young. The method of killing was more likely to be by hitting, kicking, or pushing (36% (130 of 358) for victims who were strangers to the perpetrator compared with 14% (145 of 1074) for victims who were known). Perpetrators were less likely to have a history of mental disorder (34%, n = 80 nu 50%, n = 142), a history of contact with mental health services (16%, 37 of 234 nu 24%, 200 of 824), and psychiatric symptoms at the time of the offence (6%, n = 14 nu 18%, n = 143). They were more likely to have a history of drug misuse (47%, n = 93 nu 37%, n = 272); alcohol (56%, n = 94 nu 41%, n = 285) or drugs (24% n = 44 nu 12%, n = 86) were more likely to have contributed to the offence. CONCLUSIONS: Stranger homicides have increased, but the increase is not the result of homicides by mentally ill people and therefore the "care in the community" policy. Stranger homicides are more likely to be related to alcohol or drug misuse by young men.

Adolescent↗
PubMed2004

The production and interpretation of disease mapsA methodological case-study.

BACKGROUND: The study of the spatial variation in disease incidence is a vital component of descriptive epidemiology. The production of attractive and informative disease maps complements any formal statistical analyses of spatial variations and often their visual impact will influence the recipient of the information much more than the accompanying statistics. Like any other graphical display, however, a map can both inform and mislead. METHODS: We describe methodological alternatives and pitfalls for the production of disease maps using data on recent suicides in England and Wales as an illustrative example. RESULTS: Decisions concerning the methods of mapping of suicide rates, including smoothing, choice of grouping criteria and colouring scheme dramatically influence the resulting map and how it might be interpreted by the reader. CONCLUSIONS: This study provides clinicians and other non-specialist research workers an insight into the methodological pitfalls of disease mapping and atlas production and should also act as a methodological framework for a critical appraisal of published maps and atlases.

Cause of Death↗
PubMed2004

"Near-fatal" deliberate self-harm: characteristics, prevention and implications for the prevention of suicide.

BACKGROUND: There have been few studies of the most serious cases of deliberate self-harm (DSH). These cases represent an important clinical problem. They may also be suitable as a "proxy" for suicide in research studies. METHODS: We developed a definition of "near-fatal" deliberate self-harm (NFDSH) and identified all cases attending accident and emergency departments in an urban area during an 18-month period. We compared them to less severe DSH on social and clinical characteristics, and examined their initial clinical management. We compared their age and gender profile with that of completed suicides. NFDSH cases who agreed to be interviewed were asked about their experiences of seeking help and their views on prevention of suicide. RESULTS: 158 cases were identified, 8% of all DSH. The most common method of self-harm was self-poisoning. The most common psychiatric diagnosis was depression. Compared to less severe DSH, near-fatal cases had higher rates of several social and clinical risk factors for suicide and showed evidence of greater suicidal intent. Forty-one percent were allowed home following assessment. Most admissions lasted 2 days or less. The age and gender profile was closer to that of suicide than in DSH generally. Few subjects agreed to be interviewed; those who did described poor previous experiences of services. LIMITATIONS: We did not assess each case of DSH individually but applied a workable definition of NFDSH. Firm conclusions cannot be drawn from the qualitative part of the study because of the low rate of agreement to interview. CONCLUSIONS: NFDSH is an important clinical phenomenon associated with indicators of high suicide risk. This high risk is frequently not reflected in clinical management. Further studies of NFDSH could contribute to what is known about suicide prevention but the reluctance of NFDSH subjects to be interviewed may be a difficulty for future research.

Adult↗
PubMed2004

Suicide by prisoners. National clinical survey.

BACKGROUND: The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides. AIMS: To describe the clinical and social circumstances of self-inflicted deaths among prisoners. METHOD: A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff. RESULTS: There were 172 self-inflicted deaths: 85 (49%; 95% CI 42-57) were of prisoners on remand; 55 (32%; 95% CI 25-39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88-96). A total of 110 (72%; 95% CI 65-79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20-35). Eighty-nine (57%; 95% CI 49-64) had symptoms suggestive of mental disorder at reception into prison. CONCLUSIONS: Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.

Adolescent↗
PubMed2004

Mind the gap.

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Emergency Service, Hospital↗
PubMed2003

Predictors of social services supervision of babies of mothers with mental illness after admission to a psychiatric mother and baby unit.

BACKGROUND: There is insufficient information on the predictors of parenting difficulties in mothers with severe mental illness. Using data from mother and baby units in the UK we aimed to examine the social and clinical characteristics of mothers whose babies were supervised by social services on discharge. METHOD: A case-control study was carried out using data from mother and baby units and facilities entered onto the Marce database. RESULTS: Of 1197 mothers, 23% were discharged with their babies under some form of social services supervision. Factors independently associated with an increased risk of supervision included social class (OR 3.16, 95% CI 1.99-5.03), single marital status (OR 2.10, 95% CI 1.38-3.20), behavioural disturbance (OR 1.69, 95% CI 1.08-2.65) and psychiatric illness in the partner (OR 2.67, 95% CI 1.59-4.49). The diagnostic groups independently associated with the highest risk of having a supervised baby were schizophrenia (OR 5.16, 95% CI 2.61-10.21) and personality disorder (OR 9.29, 95% CI 3.46-24.91). CONCLUSIONS: Mothers with schizophrenia are at particularly high risk of having their baby supervised by social services. Preventative interventions should be targeted at socio-economic difficulties, early detection of psychiatric disorders postpartum and treatment of perinatal mental illness in the context of the whole family.

Adult↗
PubMed2003

The treatment of postnatal depression by health visitors: impact of brief training on skills and clinical practice.

BACKGROUND: Postnatal depression can be effectively treated by cognitive behavioural counselling (CBC), a simple intervention designed to be delivered by non-specialists in mental health. METHODS: Health visitors were trained in CBC and post-training changes in counselling skills, clinical practice and costs were assessed. RESULTS: Following training health visitors showed improved counselling skills, and they carried out more mental health assessments, recorded mental symptoms more often and treated more women themselves. However, their mean number of contacts with depressed women did not change; and the number of urgent contacts diminished. Referrals to general practitioners did not increase but there was an increase in referrals to mental health services. Costs to health visitor practice did not increase. LIMITATIONS: Assessment of clinical practice was based on health visitor records. The study uses a 'before and after' design rather than randomisation of subjects. CONCLUSIONS: Training health visitors in CBC leads to improved counselling skills and corresponding changes in clinical practice, without increasing the costs of health visitor practice.

Adult↗
PubMed2003

Clinical and parenting skills outcomes following joint mother-baby psychiatric admission.

OBJECTIVE: To examine maternal clinical and parenting outcomes as a function of diagnosis following joint mother-baby admission; to identify the associations of poor outcome. METHOD: Demographic and clinical information was collected on 1081 joint mother-baby admissions, including 224 women with schizophrenia, 155 with bipolar disorder and 409 with non-psychotic depression. Information was based on clinical judgements of senior staff in participating units using the Marcé checklist. Predictors of poor maternal clinical outcome, practical problems in baby care, poor emotional responsiveness to infant and perceived risk of harm to baby were identified by logistic regression. RESULTS: Good clinical outcome was reported in 848 (78%) cases. On each parenting outcome, good outcome was reported in at least 80%. The predictors of poor outcome were similar for all four outcomes. These were a diagnosis of schizophrenia, behavioural disturbance, low social class and either psychiatric illness in the woman's partner or a poor relationship with the partner. Of those with poor outcome on all four variables, 66% suffered with schizophrenia. Women with schizophrenia showed more behavioural disturbance, were more likely to experience hallucinations and delusions, and were more likely to be of low social class. They were also less likely to have a partner and more likely to have a partner with a psychiatric illness. CONCLUSIONS: Clinical and parenting outcomes, as reported by clinical staff, are usually good following joint mother-baby admission. Women with schizophrenia may need particular measures to improve their parenting. A marital approach to treatment, directed at the woman's relationship with her partner or the latter's own mental health may improve outcome.

Adolescent↗
PubMed2003

Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.

OBJECTIVES: To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. METHODS: The Manchester and Salford Self-Harm project is a multi-centre deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments. RESULTS: A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk. CONCLUSION: In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.

Adolescent↗
PubMed2003

Suicides in ethnic minorities within 12 months of contact with mental health services. National clinical survey.

BACKGROUND: Information on suicide by psychiatric patients from ethnic minority groups is scarce. AIMS: To establish the number of patients from ethnic minorities who kill themselves; to describe their suicide methods, and their social and clinical characteristics. METHOD: A national clinical survey was based on a 4-year sample of suicides in England and Wales. Detailed data were collected on those who had been in contact with mental health services in the year before death. RESULTS: In total 282 patients from ethnic minorities died by suicide--6% of all patient suicides. The most common method of suicide was hanging; violent methods were more common than in White patient suicides. Schizophrenia was the most common diagnosis. Ethnic minority patients were more likely to have been unemployed than White patients and to have had a history of violence and recent non-compliance. In around half, this was the first episode of self-harm. Black Caribbean patients had the highest rates of schizophrenia (74%), unemployment, living alone, previous violence and drug misuse. CONCLUSIONS: In order to reduce the number of suicides by ethnic minority patients, services should address the complex health and social needs of people with severe mental illness.

Adolescent↗