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

自杀想法和行为是一个严重的全球健康问题，在有严重精神健康问题的人中显著增加，例如精神分裂症谱系中的精神健康问题。有这种问题的人使用酒精和毒品进一步增加了自杀念头、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精神健康问题和药物使用有关。需要进行研究，研究内部和外部污名、精神健康问题和药物使用之间的相互作用，以及这种相互作用如何影响自杀想法、计划和行为。这一博士提案的总体目标是调查严重的精神健康问题、内部和外部污名以及物质使用之间的相互作用，这些因素通过采用趋同的定性、定量和混合方法、设计和分析，形成自杀念头、计划和企图的心理机制。本文提出了四项实证研究。第一项和第二项研究将使用定性方法和分析，即扎根理论，调查内外耻辱、精神健康问题、药物使用和自杀的经历。第一项研究将招募居住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精神健康服务和精神健康慈善机构招募精神健康专业人员。第三项研究将使用经验抽样，在七天的时间里跟踪与污名、药物使用、心理健康问题和自杀有关的瞬间想法、感觉和行为。这些数据将使用多层次模型进行分析。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污名、精神健康问题和自杀有关的免费回复。这些数据将使用定性和定量答复相结合的混合方法进行分析。研究中使用的方法多种多样，例如，定性、定量和混合方法，因此，为博士后奖学金申请提供了出色的研究生培训和准备。该项目还涉及高级临床心理学技能的培训，即进行有组织的临床访谈(例如，PANSS；精神分裂症阳性和阴性症状量表)。患者和公众的参与是这项博士提案的核心，将在一开始就建立一个服务用户参考小组，该小组将纳入工作的所有阶段，从完善研究问题到传播研究结果。

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.