Background
What is BA?
Brief Admission in the Netherlands
Review of research on brief admission for crisis management of self-harming, suicidal, and borderline individuals
BAS objectives
Data provider | Outcome variable | Questionnaires |
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Hospital records | N of days with general admission to hospital | - |
N of visits at the psychiatric emergency department | - | |
N of days with involuntary admission to hospital as defined by LPT | - | |
N of involuntary acts as defined by LPT (Act on compulsory psychiatric care) | - | |
N of BAS | - | |
N of days with BAS | - | |
Research persons | Self-harm |
Five Self-Harm Behaviour Groupings Measure (5S–HM [34]) |
Self-harm |
The Inventory of Statements About Self-Injury (ISAS [35]) | |
Emotion regulation |
The Difficulties in Emotion Regulation Scale (DERS [36]) | |
Coping strategies |
The Brief COPE [37] | |
Health and disability |
The World Health Organization Disability Assessment Schedule II (WHODAS 2.0 [38]) | |
Developmental cognitive disabilities Alcohol consumption, and alcohol-related problems. |
Five questions [39]
The Alcohol Use Disorder Identification Test (AUDIT [40]) | |
Drug abuse and drug-related problems. |
The Drug Use Disorders Identification Test (DUDIT [41]) | |
Client satisfaction with human services |
The Client Satisfaction Questionnaire (CSQ [42]) | |
Client satisfaction with BAS |
Individual’s Experience Scale (IES [23]) | |
Clinicians | Clinician, administering BAS, satisfaction with BAS |
Clinician’s Experience Scale (CES [23]) |
Psychiatrists | Psychiatric disorders | |
Personality disorders |
Structured Clinical Interview for DSM IV Axis II disorders (SCID II [44]) | |
The severity of the patient’s illness |
Clinical Global Impression Severity (CGI-S [45]) |
Trial design
Methods: participants, interventions, and outcomes
Study setting
Participants
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Current episodes of self-harm and/or recurrent suicidality
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Fulfilling at least three criteria for a diagnosis of BPD.
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Admitted to psychiatric hospital for acute care for at least seven days or presenting to the psychiatric emergency department at least three times during the last six months.
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Age 18–60 years.
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No regular contact with outpatient psychiatric services.
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Unstable housing
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Somatic disorder or need for medication management that significantly contributes to inclusion criteria (e.g. if self-harm only occurs during episodes of hypoglycemia in a diabetic person or in someone with substance-induced psychosis).
BAS randomized controlled trial: intervention
Criteria for discontinuing or modifying allocated interventions for a given participant
Strategies to improve adherence and fidelity
Outcomes
Data category | Information |
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Primary registry and trial identifying number |
Clinicaltrials.gov NCT02985047 |
Date of registration in primary registry | November 25, 2016 |
Secondary identifying numbers | N/A |
Sources(s) of monetary or material support | Mats Paulsson Stiftelse; Swedish Research Council; Sweden’s National Self-Harm Project (NSP); Regional Research Funds; Söderström-Königska Foundation; Ellen och Henrik Sjöbrings Minnesfond; OM Persson Stiftelse; Maggie Stephens Stiftelse |
Primary Sponsor | Region Skåne Clinical Psychiatric Research Center Baravägen 1 22,185 Lund Sweden |
Secondary Sponsor | None |
Contact for public queries | Sophie Liljedahl Department of Psychology Lund University Box 213 221 85, Lund Sweden Phone: +46 0708 88 5618 Email: sophie.liljedahl@psy.lu.se |
Contact for scientific queries | Sophie Liljedahl (contact information above) Sophie Westling, M. D., Ph. D. Lund University Box 213 221 85, Lund Sweden Phone:+46 0735 62 6099 Email: sophie.westling@med.lu.se |
Public Title | Brief Admission Skåne (BAS) Brukarstyrd Inläggning (BI) – Swedish
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Scientific Title | Brief Admission Skåne Randomised Controlled Trial (BASRCT) |
Countries of recruitment | Sweden |
Health condition or problem(s) studied | Individuals with three or more symptoms of borderline personality disorder; self-harming and/or suicidal individuals receiving public mental health services in the region of Skåne (South Sweden). |
Intervention(s) | Brief Admission + Treatment As Usual OR Treatment As Ususal (BA + TAU OR TAU) |
Key inclusion and exclusion criteria | Ages eligible: ≥ 18 years to 60 years. Sexes eligible: Individuals or any sex or gender Accepts healthy volunteers: no Inclusion criteria: adult patient (≥ 18 years to age 60), individuals receiving public mental health services in the region of Skåne, currently engages in self-harm and/or recurrent suicidal behavior, fulfills at least three criteria for a diagnosis of BPD, admitted to psychiatric hospital for acute care for at least 7 days or presenting to the psychiatric emergency department at least 3 times during the last 6 months. Exclusion criteria: No regular contact with outpatient psychiatric services, unstable housing, somatic disorder that significantly contributes to inclusion criteria |
Study type | Interventional Allocation: randomized Masked: single blind Primary purpose: self-harm and suicide crisis and risk management |
Date of first enrolment | October 2015 |
Target sample size | 124 |
Recruitment status | Recruiting |
Primary outcome(s) | 1. Number of days with hospital admission Time frame: Change between the period from 12 months retrospectively to baseline and the period from baseline to 12 months prospectively. 2. Number of days with Brief Admission, general psychiatric admission, forced (involuntary) admission |
Secondary outcome(s) | 1. Frequency of forced acts (e.g. restraints and forced medication). Time frame: Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively. 2. Individuals’ Experiences of the intervention. Time frame: Data collected at each Brief Admission during a period of 140 weeks. Outcome: Scores from the questionnaires developed for the method: Individual’s Experience Scale (IES).
3. Clinicians’ experiences of the intervention. Time frame: Data collected at each Brief Admission during a period of 140 weeks. Outcome: Scores from the questionnaires developed for the method: Clinician’s Experience Scale (CES)
4. Frequency of all self-harming behaviours including suicide attempts. Time frame: Change in frequency between baseline, 6 months and 12 months prospectively. Outcome: Scores from the Five Self-Harm Behaviour Groupings Measure (5S–HM)
5. Severity of self-harming behaviours Time frame: Change in severity between baseline, 6 months and 12 months prospectively. Outcome: Scores from the Five Self-Harm Behaviour Groupings Measure (5S–HM)
6. Level of functioning in activities of daily life. Time frame: Change in ratings between baseline, 6 months and 12 months prospectively. Outcome: Scores from the World Health Organization Disability Assessment Schedule II (WHODAS 2.0)
7. Ability to cope effectively with life stress. Time frame: Change in ratings between baseline, 6 months and 12 months prospectively. Outcome: Scores from The Brief COPE 8. Ability to regulate emotions Time frame: Change in ratings between baseline, 6 months and 12 months prospectively. Outcome: Scores on the Difficulties in Emotion Regulation Scale (DERS)
9. Global psychiatric symptoms. Time frame: Change in ratings between baseline, 6 months and 12 months prospectively. Outcome: Scores from the Clinical Global Impression Severity Scale (CGISS)
10. Satisfaction with health care Time frame: Change in ratings between baseline, 6 months and 12 months prospectively. Outcome: Scores on the Client Satisfaction Questionnaire (CSQ)
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Participant timeline
Sample size
Recruitment
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The contract was revised after feedback from participants and clinicians.
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Minor linguistic changes were made in the IES and CES after feedback from clinicians and participants.
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The procedure administering the IES and CES was revised in order to facilitate prompt evaluation.
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The BASFM [23] was revised over the course of the pilot phase. The most significant change was to evaluate only what could be objectively rated by video-tape, which was the negotiation process. Other changes occurred with phrasing and scoring of BASFM, to reduce cultural differences between interpretations of clinician warmth, and to give partial scores for items on the BASFM where some component of the item was present but other required components were missing.