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    Presentations of self-harm and suicide-related ideation among the Irish Traveller indigenous population to hospital emergency departments: evidence from the National Clinical Programme for self-harm.
    (Springer Nature Switzerland AG, 2023-02-17T00:00:00Z) Kavalidou, Katerina; Daly, Caroline; McTernan, Niall; Corcoran, Paul
    Purpose: Previous research has examined the suicide risk of the Irish Traveller population, but less is known about self-harm and suicidal ideation among this ethnic minority group, which are established risk factors for suicide. The aim of the current study was to compare the presentation-based self-harm and suicide-related ideation of Traveller to non-Traveller patients and describe any ethnic disparities in the aftercare of their presentation. Methods: Data were obtained from the service improvement database of an Irish dedicated national programme for the assessment of those presenting to emergency departments (EDs) due to self-harm and suicide-related ideation. Presentation data from 24 EDs were analysed and Poisson regression was used to assess the age–sex-adjusted relative risk of hospital-presenting self-harm and suicide-related ideation. Results: 24,473 presentations were recorded with 3% of the presentations made by Irish Travellers. Female Traveller patients had 3·04 (95% CI 2·51–3·68) higher risk for suicide-related ideation and 3·85 (95% CI 3·37–4·41) for self-harm, compared to white Irish female patients. Male Traveller patients had 4·46 (95% CI 3·86–5·16) higher risk for suicide-related ideation and 5·43 (95% CI 4·75–6·21) higher rates for self-harm. The highest rate ratios for self-harm were observed among older Traveller patients [male: 9·23 (95% CI 5·93–14·39); female: 6·79 (95% CI 4·37–10·57)]. A higher proportion of Traveller patients requested no next of kin involvement, compared to other ethnicities. Conclusions: Given that Irish Travellers are at higher risk of self-harm and suicide-related ideation presentations compared to other ethnic groups, EDs should be viewed as an important suicide intervention point.
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    Profile of people attending emergency departments with thoughts of self-harm and suicide: A descriptive study of a nurse-led programme in Ireland
    (John Wiley & Sons, Inc., 2023-03-29T00:00:00Z) Kavalidou, Katerina; Zortea, Tiago C.; Griffin, Eve; Troya, M. Isabela; Irish Research Council
    Increasing research has been conducted on individuals presenting with self-harm at emergency departments (EDs). However, less is known about individuals presenting to EDs with only self-harm ideation. We aimed to describe the characteristics of those attending Irish hospitals with self-harm ideation and investigate any differences in comparison to those presenting with suicide ideation. A prospective cohort study was conducted on Irish ED presentations due to suicidal and self-harm ideation. Data were obtained from the service improvement data set of a dedicated nurse-led National Clinical programme for the assessment of those presenting to Irish emergency departments due to Self-harm and Suicide-related Ideation (NCPSHI). A total of 10 602 anonymized presentation data were analysed from 1 January 2018 to 31 December 2019. Descriptive analysis was conducted to compare those with suicidal and self-harm ideation on sociodemographic and care interventions. Being female and aged <29 were more prevalent among the self-harm ideation presentations. Compared to the self-harm ideation group, a higher proportion of those with suicidal thoughts received an emergency care plan (63% vs 58%, p = 0.002) and General Practitioner letter sent within 24 h of presentation (75% vs 69%, p = 0.045). Little variation was found between hospitals for self-harm ideation in both years. Our study suggests that females and younger populations are more prevalent in hospital presentations due self-harm ideation, while presentations related to suicidal ideation are more often made by males and involving substance use. Attention should be given to the relationship between clinicians' attitudes towards care provision and the content of suicide-related ideation ED disclosure.
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    Iran's national suicide prevention program
    (Hogrefe, 2022-05-27) Rezaeian, Mohsen; Platt, Stephen; Arensman, Ella
    Background and Aims: Iran is one of the few countries in the Eastern Mediterranean Region (EMR) to have developed a national suicide prevention program (NSPP). This report introduces Iran's NSPP to policy planners and researchers working in suicide prevention, and is intended to encourage other low- and middle-income countries to develop, implement, and evaluate their own NSPPs. Method: This was a case study of a NSPP in one country, integrating quantitative and qualitative data. Bibliographic searches were conducted using both international and national databases, supplemented by other documents. The study benefited from the experiential evidence provided by the senior author. Results: While the national incidence of suicide is low, there are higher rates among young adults, particularly women, in western regions. In 2010, Iran's NSPP was integrated into primary health care. A rigorous evaluation of Iran's suicide prevention program concluded that Iran has the potential to take a leadership role in suicide prevention within the EMR, although several challenges were identified. Limitation: The findings of this case study cannot be generalized to other contexts. Conclusion: Given Iran's unstable situation, the NSPP needs to be monitored, evaluated, and adjusted according to evidence and ongoing changing national and local needs.
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    What do the narratives tell us? Exploring the implementation of the Athena SWAN Ireland Charter
    (Frontiers Media, 2022) O'Mullane, Monica; Horizon 2020
    Due to the systemic inequalities enduring in career progression pathways in the Irish higher education sector, the Athena SWAN Ireland Charter (ASIC), a gender equality accreditation program, is being implemented. Using a theoretical approach, blending insights from feminist institutionalism with literature on the role of narratives in policy implementation, this article reveals the complex nature of subjective engagement with policy implementation processes. This article discusses an empirical study of Athena SWAN Ireland Charter implementation across three purposively chosen Irish universities, interviewing 26 key institutional actors tasked with implementing the ASIC locally. Narrative themes emerging as dominant from the data include a lack of operational knowledge, desire for a nationally contextualized program, ambiguity, championing, "happy talk," and identifying points of resistance. Literature on the role of narrative accounts highlighting a diversity of perceptions in policy and program implementation is strengthened by this study's findings. A feminist institutionalist lens highlight the gendered nature of the operationalization of the Charter work and the vague and detached "happy talk" engaged predominantly by senior men leaders. Findings from this empirical study highlight the importance of exploring the narrative accounts of key actors in order to gain a holistic understanding of the nuanced implementation process, beyond the normative assumptions inherent in the Charter implementation.
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    Suicide and self-harm risk assessment: A systematic review of prospective research
    (Taylor & Francis, 2021-07-01) Saab, Mohamad M.; Murphy, Margaret; Meehan, Elaine; Dillon, Christina B.; O'Connell, Selena; Hegarty, Josephine; Heffernan, Sinead; Greaney, Sonya; Kilty, Caroline; Goodwin, John; Hartigan, Irene; O'Brien, Maidy; Chambers, Derek; Twomey, Una; O'Donovan, Aine; Health Service Executive
    Objective: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Method: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Results: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. Conclusions: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.