For annually between 2010 and 2020, a median of over 6,200 folks within the UK took their very own lives (The Nationwide Confidential Inquiry into Suicide and Security in Psychological Well being, 2023). This loss could have been felt keenly by the numerous hundreds of relations, buddies and colleagues who stay. Reflecting its public and psychological well being significance, a number of Psychological Elf blogs have appeared over time specializing in up-to-date analysis within the areas of suicide and self-harm, with latest examples exploring the relationships between the therapeutic alliance, psychosis and suicide, the dangers of suicide amongst folks with extreme bodily well being issues and suicide threat amongst younger LGBTQ+ folks.
On this paper, Groves et al. (2023) got down to systematically convey collectively what is thought about suicide, self-harm and suicidal pondering in nurses and midwives, and to concurrently synthesise the proof regarding contributory elements and interventions. As they observe, a part of the context for his or her examine is a longstanding concern that the dangers of suicide amongst nurses are elevated relative each to the final inhabitants and to different occupational teams (The Nationwide Confidential Inquiry into Suicide and Security in Psychological Well being, 2020).
With the intention of bettering on earlier critiques which the authors determine as having had methodological and/or different shortcomings, on this examine the purpose was to synthesise the proof from present analysis on suicide, suicidal pondering and suicidal behaviours in nurses and midwives. The assessment additionally aimed to attract out implications for prevention, and to make suggestions for additional investigation.
Having beforehand printed their protocol on PROSPERO, the worldwide potential register of systematic critiques, Groves et al. (2023) opened with the interrogation of three databases (CINAHL, Medline and PsycINFO) within the seek for all related empirical papers, utilizing any design, printed within the English language from 1996 onwards. Detailed search methods are included in a supplementary file.
In the primary paper, info is given on the extra methods used to determine materials together with an account of how objects had been screened and the way information from included papers had been extracted. High quality evaluation concerned use of the Blended Strategies Appraisal Software (Hong et al., 2018), with a story strategy used to the synthesis of findings.
A clearly labelled PRISMA stream diagram reveals how a complete of 100 research had been lastly included within the assessment, with the bulk utilizing quantitative strategies and the one largest quantity (40) coming from North America. Examine high quality diversified, with solely a small quantity addressing interventions to cut back the dangers of suicide.
Forty-five of the 100 research from all over the world examined the prevalence of suicide. Proof from numbers of those indicated elevated dangers of suicide for nurses (and midwives, the place these had been included in research) in comparison with the final inhabitants and to another occupational teams. Proof from some included research additionally indicated that nurses taking their very own lives had been extra probably than different occupational teams and the final inhabitants to have skilled prior psychological well being issues. As within the common inhabitants, substance misuse and bodily ill-health had been additionally discovered to be threat elements for suicide, with precise or potential job loss additionally recognized as a threat consider some research.
Twenty-one research investigated the strategies utilized in suicide completion, and 36 of the included research centered on self-harm, suicidal behaviour and suicidal pondering. Continual sickness, debt and expertise of psychological well being difficulties had been amongst the elements related to nurses’ self-reporting of suicidal ideas and behaviours.
Research investigating suicidal pondering had been characterised by selection when it comes to approaches taken to measurement and the time interval for evaluation, with some proof of burnout and despair being related to suicide ideation. Along with a sequence of research explicitly analyzing suicidal ideas and behaviours within the context of the Covid-19 pandemic, solely three of the 100 included research centered on interventions to stop suicidal behaviour in nurses. These described and explored a US mannequin combining an training ingredient, threat screening, and counselling mixed with onwards referral.
Concluding their proof assessment, Groves et al. (2023) observe that:
Current analysis continues to point out that nursing professionals, particularly females, are at elevated threat of suicide, warranting additional analysis consideration.
Given the restricted variety of research included on this assessment introducing and evaluating preventative interventions to cut back the dangers of suicide in nurses and midwives makes research of this sort a urgent precedence.
Strengths and limitations
This is a crucial, well-designed and clearly written systematic assessment, which is reported with regards to PRISMA requirements. There’s readability round search methods, how information had been extracted, the standard of included research was appraised, and the way included materials was themed and synthesised.
One limitation, famous by the writer workforce, is the inclusion solely of things written within the English language. Related analysis in different languages will due to this fact not have been positioned. The looking of solely CINAHL, Medline and PsycINFO is an additional limitation. Scrutiny of further databases, past these three (e.g., Embase, and the Well being Administration Info Consortium), could have led to the identification of additional research. Searches for gray literature printed in native studies, evaluations and theses, along with journal papers, may additionally have strengthened the comprehensiveness of the assessment, as would additional looking efforts to search out unpublished research.
Implications for follow
The elevated fee of suicide amongst nurses and midwives which this systematic assessment confirms calls for pressing consideration. That is significantly so, as Groves et al. (2023) write, due to the quantity and number of elements related to this raised threat. These embody prior contact with well being (together with psychological well being) companies, earlier self-harming, substance misuse and each interpersonal and office difficulties.
Alternatives for suicide threat evaluation exist within the major and secondary care settings the place nurses and midwives obtain their very own help and remedy. Modifiable office elements instantly or not directly rising the dangers of suicide and/or suicidal behaviour and pondering current themselves as essential targets for intervention. Overload, worry of job loss and burnout all demand motion by service managers and scientific leaders with the purpose of bettering the on a regular basis follow environments wherein nurses and midwives perform their work.
Assertion of pursuits
Ben Hannigan declares no conflicts of curiosity.
Groves, S., Lascelles, Ok. & Hawton, Ok. 2023. Suicide, self-harm, and suicide ideation in nurses and midwives: A scientific assessment of prevalence, contributory elements, and interventions. J Have an effect on Disord, 331, 393-404.
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., Vedel, I. & Pluye, P. 2018. The Blended Strategies Appraisal Software (MMAT) model 2018 for info professionals and researchers. Schooling for Info, 34, 285-291.
The Nationwide Confidential Inquiry into Suicide and Security in Psychological Well being 2020. Suicide by feminine nurses: a quick report, Manchester, College of Manchester.
The Nationwide Confidential Inquiry into Suicide and Security in Psychological Well being 2023. Annual report: UK affected person and common inhabitants information, 2010-2020, Manchester, College of Manchester.