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

自杀是一个全球性的问题。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自杀企图的频率或严重性。随着精神卫生服务的负担达到历史最高水平，特别是在新冠肺炎大流行之后，需要低强度、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弥补这一缺口，该干预措施针对自杀行为的已知机制。自杀理论认为，需求受挫和绝望导致的心理痛苦会导致自杀念头，而与他人联系减少或过上有意义的生活可能会导致自杀企图。事实证明，让个人接触到积极、鼓舞人心的信息可以减少自杀的结果。这个项目将提供一种新的干预措施，目标是希望和参与有意义的行为，目的是增加幸福感和减少自杀想法和行为。通过混合方法设计，新的干预措施将通过对先前文献的深入了解和与专家经验的合作而发展。该项目的第一阶段将涉及对针对利益机制的积极干预措施进行文献审查。随后，将根据共同制作的既定框架(例如，关注点基金会的EBCD)共同设计一项新的干预措施。这一办法将包括最初的共同设计活动、与一小群PPI贡献者举行的持续讲习班和最后审查活动。最后，将对等待更密集治疗支持的NHS服务用户进行一项试验性研究，以考察新干预措施的可接受性和可行性。这个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。在试点研究中将嵌套一个过程评估，通过实施科学，从参与者的角度了解新干预措施的可接受性。这项研究将有助于了解有关自我伤害行为的有效干预措施的现有知识。这种干预对那些等待更密集心理治疗的人是有用的，要么帮助他们控制自己的症状和痛苦，使其更有效，要么甚至满足他们对进一步支持的需求，潜在地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.