The inter-relationships between stigma, severe mental health problems, substance use and suicidal thoughts and acts.

自杀的想法和行为是一个严重的全球健康问题，并在有严重精神健康问题的人中显着升高，例如精神分裂症谱系的精神健康问题。有这些问题的人使用酒精和药物进一步提高了自杀想法、行为和企图的频率和强度。来自他人（外部）和自我（内部）的耻辱往往与严重的心理健康问题和物质使用有关。需要研究内部和外部耻辱感，心理健康问题和药物使用之间的相互作用，以及这种相互作用影响自杀想法，计划和行为的方式。这个博士学位提案的主要目的是调查严重的心理健康问题，内部和外部的耻辱感和物质使用之间的相互作用，这些相互作用使用收敛的定性，定量和混合方法，设计和分析，为自杀想法，计划和尝试提供心理机制。提出了四个实证研究。第一项和第二项研究将采用定性方法和分析，即扎根理论，调查内部和外部的耻辱，心理健康问题，物质使用和自杀的经验。第一项研究将招募生活在社区中有精神健康问题的成年人，特别是精神分裂症。第二项研究将从NHS心理健康服务和心理健康慈善机构招募心理健康专业人员。第三项研究将使用经验抽样来跟踪七天内全天与耻辱、药物使用、心理健康问题和自杀有关的想法、感受和行为。将使用多层次模型对这些数据进行分析。第四项研究将使用每日日记，从有精神健康问题的人和精神健康专业人员那里收集与耻辱感、精神健康问题和自杀有关的免费答复。将使用定性和定量反应相结合的混合方法分析数据。研究中使用的方法多种多样，例如，定性，定量和混合的方法，因此，提供优秀的研究生培训和博士后奖学金申请的准备。该项目还涉及高级临床心理学技能的培训，即进行结构化临床访谈（例如，PANSS;精神分裂症阳性和阴性症状量表）。病人和公众参与是这个博士学位提案的核心，一开始将成立一个服务用户参考小组，从细化研究问题到传播研究结果，该小组将参与工作的各个阶段。

Suicidal thoughts and acts are a severe global health concern, and are significantly elevated in people with severe mental health problems, such as, mental health problems on the schizophrenia spectrum. The use of alcohol and drugs by those with such problems further elevates the frequency and intensity of suicidal thoughts, behaviours and attempts. Stigma from others (external) and the self (internal) is often associated with both severe mental health problems and substance use. Research is needed which examines the interplay between internal and external stigma, mental health problems and substance use, and the ways in which this interplay affects suicidal thoughts, plans and acts. The over-arching objective of this PhD proposal is to investigate the interactions between severe mental health problems, internal and external stigma, and substance use which feed into the psychological mechanisms underlying suicidal thoughts, plans and attempts using convergent qualitative, quantitative, and mixed methods, designs and analyses. Four empirical studies are proposed. The first and second study will use qualitative methods and analyses, namely grounded theory, to investigate experiences of internal and external stigma, mental health problems, substance use and suicidality. The first study will recruit adults living in the community with mental health problems, specifically schizophrenia. The second study will recruit mental health professionals from NHS mental health services and mental health charities. The third study will use experience sampling to track in the moment thoughts, feelings and behaviours relating to stigma, substance use, mental health problems and suicidality throughout the day for seven days. This data will be analysed using multi-level modelling. The fourth study will use a daily diary to collect free responses relating to stigma, mental health problems and suicidality from both people with mental health problems and from mental health professionals. The data will be analysed using mixed methods in which qualitative and quantitative responses converge. The methods used across the studies are diverse, e.g., qualitative, quantitative, and mixed methods and, therefore, provide excellent post-graduate training and preparation for post-doctoral fellowship applications. The project also involves training in advanced clinical psychology skills, namely, administering structured clinical interviews (e.g., the PANSS; Positive and Negative Syndrome Scale for Schizophrenia). Patient and Public Involvement is central to this PhD proposal and a service-user reference group will be set up at the outset which will feed into all stages of the work from refining the research questions to disseminating the findings.