The development and feasibility evaluation of a low-intensity intervention for reducing self-harm and suicidal behaviour

自杀是一个全球性问题。在英国，每年有超过5000人结束自己的生命。尽管如此，很少有有效的干预措施被证明能显著降低自杀念头和企图的频率或严重程度。由于精神卫生服务的负担处于历史最高水平，特别是在2019冠状病毒病大流行之后，需要采取低强度、可获得的干预措施。拟议的项目旨在通过开发一种自我驱动、低强度、积极关注的干预措施来解决这一差距，该干预措施针对自杀行为的已知机制。自杀理论认为，由需求受挫和绝望引起的心理痛苦会导致自杀念头，而与他人联系减少或生活缺乏意义的结合会导致自杀企图。让个体接触积极的、鼓舞人心的信息已被证明可以减少自杀的结果。该项目将提供一种新的干预措施，以希望和参与有意义的行为为目标，旨在增加幸福感，减少自杀念头和行为。通过混合方法设计，新的干预措施将通过深入了解先前的文献并与经验丰富的专家一起工作而发展。该项目的第一阶段将涉及针对感兴趣的机制进行积极干预的文献综述。随后，将根据既定的合作生产框架共同设计新的干预措施（例如护理点基金会的EBCD）。这种方法将包括最初的共同设计活动，与较小的PPI贡献者小组进行的研讨会和最终审查活动。最后，一项着眼于新干预的可接受性和可行性的试点研究将在等待更强烈治疗支持的NHS服务用户中进行。最后阶段将评估干预前和干预后的临床结果，并通过分析招募、保留和依从性数据来确定可行性。在试点研究中，将有一个过程评估，根据实施科学，从参与者的角度对新干预的可接受性进行评估。这项研究将有助于目前有关有效干预自残行为的知识。这种干预措施将有助于那些等待更强烈心理治疗的人，帮助他们将症状和痛苦控制到使更强烈的治疗更有效的程度，甚至解决他们对进一步支持的需求，从而可能减轻服务负担并释放资源。

Suicide is a global problem. In the UK, more than 5000 individuals end their own life every year. Despite this, there are few effective interventions proven to significantly reduce the frequency or severity of suicidal thoughts and attempts. With the burden on mental health services being at an all-time high, especially following the Covid-19 pandemic, there is a need for low intensity, accessible interventions.The proposed project aims to address this gap by developing a self-driven, low-intensity, positively-focused intervention which targets known mechanisms underlying suicidal behaviour. Theories of suicide posit that psychological pain, caused by thwarted needs and hopelessness, can lead to suicidal ideation and that a combination of reduced connectedness to others or a meaningful life can lead to a suicide attempt. Exposing individuals to positive, inspiring messages has been shown to reduce suicidal outcomes. This project will offer a new intervention that targets hopefulness and engagement in meaningful behaviour with the aim of increasing wellbeing and reducing suicidal thoughts and behaviour.Through a mixed method design, the new intervention will develop through an in-depth knowledge of the prior literature and working alongside experts-by-experience. The first stage of the project will involve conducting a literature review of positive interventions targeting the mechanisms of interest. Subsequently, a new intervention will be co-designed in accord with an established framework for co-production (e.g. EBCD by Point of Care Foundation). This approach will comprise of initial co-design events, ongoing workshops with a smaller group of PPI contributors and a final review event. Finally, a pilot study looking at the acceptability and feasibility of the new intervention will be conducted with NHS service users who have been waitlisted for more intense therapeutic support. This final stage will assess pre- and post-intervention clinical outcomes, as well as determine feasibility through an analysis of recruitment, retention, and adherence data. Nested within the pilot study will be a process evaluation, informed by implementation science, of the acceptability of the new intervention from the participants' perspectives.This research will contribute to current knowledge around effective interventions for self-harm behaviour. Such an intervention will be of use to those awaiting more intense psychological therapy, either by helping them manage their symptoms and distress to a level that will make more intense therapy more effective or even to address their need for further support, potentially alleviating the burden on services and freeing up resources.