Eimear Galvin - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature
Title: Identifying factors which facilitate and impede disclosure or non-disclosure of suicidal ideation: a systematic review.
Background: As identifying suicide risk relies on individuals choosing to disclose their suicidal ideation to others, non-disclosure of suicidal ideation acts as a significant barrier to effective suicide risk assessment and management. We aimed to review the predictors of suicidal ideation disclosure as well as the factors which separate disclosers from non-disclosers, to develop a wider understanding of barriers and facilitators to disclosure, and thereby inform risk assessment and management protocols.
Methods: For this systematic review, we reviewed Embase, PsycINFO, Ovid, Scopus and Web of Science in November 2021. All studies which explored predictors of suicidal ideation disclosure or non-disclosure in adults, or the factors which separated adult disclosers and non-disclosers were included without date restriction. A narrative synthesis was conducted. This study is registered on Prospero, number: CRD42021262056.
Findings: Of 7448 papers, 26 were eligible for synthesis, where risk of bias was low overall. No individual characteristics (i.e. demographics, mental or physical health or suicidality) conclusively predicted suicidal ideation disclosure or non-disclosure. Tentative links were associated with being female, being of younger age, having a history of psychiatric symptoms and having a history of suicide attempt and disclosure of suicidal ideation. In a small number of studies, individuals’ motivations for (non-)disclosure, as well as their relationships with both personal and professional confidants were more consistently identified as being predictive of disclosure.
Interpretation: Theoretical conceptualisations of suicidal ideation disclosure, as well as clinical risk assessment and management protocols should consider the inclusion of relationship dynamics between the individual experiencing suicidal ideation and their confidants, in addition to individual characteristics and external contextual factors.

Service Improvement Project
Title: Developing integrated mental health care for people experiencing homelessness: an exploration of barriers and facilitators.
Research highlights the need for integrated mental health provision for people experiencing homelessness. Examples of such services are currently limited in the UK, and the implementation of current services have encountered several obstacles. Utilising interpretative phenomenological analysis, this project aimed to explore staff perspectives on the barriers and facilitators to integrated mental health provision for homeless people in Berkshire. Semi-structured interviews were conducted with 6 participants from a range of professional backgrounds. Super- and subordinate themes about understanding, clarity, service demands vs. individual needs, and the benefits and challenges of working in homelessness emerged. Recommendations for service development based on these findings were outlined.

Theory Driven Research Project
Title: The roles of cognitive appraisals and self-compassion as predictors of post-traumatic stress symptoms following first episode psychosis.
Individuals who experience first episode psychosis (FEP) often develop symptoms of post-psychotic trauma symptoms (PPTS) as a result of their distressing experiences. Although systematic reviews have called for further understanding of the risk factors for PPTS, few studies have examined the psychological underpinnings. This study examined the role of post-traumatic cognitions (negative cognitions about the self and the world, and self-blame) in PPTS, and examined whether self-compassion contributed to this relationship. A quantitative prospective methodology was employed. 34 participants under the care of Early Intervention in Psychosis teams completed measures of post-traumatic cognitions, post-traumatic stress symptoms, depression, symptoms of psychosis, self-compassion and history of trauma. Follow-up measures of post-traumatic stress symptoms, depression and psychosis symptoms were also completed. The study identified that post-traumatic cognitions, and particularly negative cognitions about the self are associated with symptoms of PTSD, and individuals with PPTS experienced significantly greater post-traumatic cognitions than those without. Aside from self-blame, post-traumatic cognitions were not found to be predictive of PPTS over time. No relationship was identified between self-compassion, post-traumatic cognitions and PPTS. Limitations and implications for clinical practice are discussed.

Keywords: mental health
appraisals
suicidal ideation
IPA
homelessness
self-compassion
risk assessment
psychosis
disclosure
PTSD
Advisor: Johns, L