Clinical trial NCT06406972: Brief Admission by Self-referral for Individuals With Self-harm: Effects on Compulsory Care
Official title: Brief Admission by Self-referral for Individuals With Self-harm: Effects on Compulsory Care
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Self-injury
Suicide
Suicide, Attempted
Self-harm
Borderline Personality Disorder
Emergency Psychiatric
Hospitalizations Psychiatric
Keywords: Brief Admission by self-referral
self-harm
traits of borderline personality disorder
compulsory care
Lead sponsor: Region Skane
Sponsor class: OTHER
Collaborators: name: Lund University
name: Linkoeping University
First posted: 2024-05-09
Enrollment: 7000
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: OTHER
Sampling method: PROBABILITY_SAMPLE
Study population: Individuals with repeated self-harm and traits of Borderline personality disorder

Brief summary: Brief Admission by self-referral (BA) is a standardized treatment model, providing patient-controlled and person-centered care. It was developed to reduce self-harm and compulsory care by promoting autonomy. Randomized clinical trials have not yielded significant between group differences with respect to inpatient care, including compulsory care. The major difficulty in evaluating BA is preventing the control group from cross-contamination, as in the implementation process of BA, all physicians, all inpatient and outpatient staff as well as managers need to be informed and undergo basic education regarding the intervention. As BA addresses a prevalent and frustrating issue in psychiatric health care, there is considerable risk that the approach leaks to the control group, reducing the possibility to detect between-group differences. In the current study this will be addressed through a register-based approach, comparing similar clinics, implementing BA at different timepoints over time. Individuals with traits of borderline personality disorder will be included and comparisons will be made with respect to compulsory care, voluntary inpatient care and mortality.


Eligibility criteria: Inclusion Criteria:

* Living in the uptake area of Lund, Linköping, Helsingborg or Norrköping
* Age 18-65 years at the time of inclusion
* Admitted to hospital either diagnosed with ICD-10 diagnosis BPD F60.3, or admitted at least twice with Intentional self-harm X60-83 in combination with one of more of the following diagnoses ADHD (F90.0-F90.X), Bipolar disorder type 2, (F31.8W, F318A-F, F31.0, F31.8-9, F31.8W) or Autism, Atypical autism, Aspergers syndrome (F84.0, F84.1, F84.5) or Mild intellectual disability (F70.0-F70.9).

Exclusion Criteria:

* not fulfilling inclusion criteria

Primary outcomes:
measure: Days with compulsory admission
timeFrame: 2010-09-15 - 2025-09-14
Secondary outcomes:
measure: Days with voluntary psychiatric admission
timeFrame: 2010-09-15 - 2025-09-14
measure: Duration of free intervals between admissions
timeFrame: 2010-09-15 - 2025-09-14
measure: Mortality
timeFrame: 2010-09-15 - 2025-09-14
measure: Number of compulsory admissions
timeFrame: 2010-09-15 - 2025-09-14
measure: Number of voluntary psychiatric admissions (admissions/year)
timeFrame: 2010-09-15 - 2025-09-14
measure: Number of compulsory acts/year
timeFrame: 2010-09-15 - 2025-09-14
Other outcomes:
measure: Gender distribution
timeFrame: 2010-09-15 - 2025-09-14
measure: Number of admissions with Brief admission by self-referral (BA)
timeFrame: 2010-09-15 - 2025-09-14
measure: Compulsory admission - median length
timeFrame: 2010-09-15 - 2025-09-14
measure: Voluntary psychiatric admissions - median length
timeFrame: 2010-09-15 - 2025-09-14
measure: Number of voluntary psychiatric admissions
timeFrame: 2010-09-15 - 2025-09-14
Locations:
city: Lund
country: Sweden
facility: Division of Psychiatry, Region Skåne
state: Skåne
city: Linköping
country: Sweden
facility: Region Östergötland
city: Solna
country: Sweden
facility: Statistiska centralbyrån
city: Stockholm
country: Sweden
facility: Socialstyrelsen
Study officials:
affiliation: Lund University
name: Sofie Sofie, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Warrender D. Borderline personality disorder and the ethics of risk management: The action/consequence model. Nurs Ethics. 2018 Nov;25(7):918-927. doi: 10.1177/0969733016679467. Epub 2017 Jan 19.
citation: Coyle TN, Shaver JA, Linehan MM. On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder. J Consult Clin Psychol. 2018 Feb;86(2):116-124. doi: 10.1037/ccp0000275.
citation: Liljedahl SI, Helleman M, Daukantaite D, Westrin A, Westling S. A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skane randomized controlled trial protocol (BASRCT). BMC Psychiatry. 2017 Jun 15;17(1):220. doi: 10.1186/s12888-017-1371-6.
citation: Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: A systematic review. Nord J Psychiatry. 2015;69(8):574-86. doi: 10.3109/08039488.2015.1025835. Epub 2015 Apr 2.
citation: Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin A, Flyckt L, Helleman M. Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide: A Randomized Clinical Trial. JAMA Netw Open. 2019 Jun 5;2(6):e195463. doi: 10.1001/jamanetworkopen.2019.5463.
citation: Lindkvist RM, Landgren K, Liljedahl SI, Daukantaite D, Helleman M, Westling S. Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care. Issues Ment Health Nurs. 2019 Jul;40(7):548-556. doi: 10.1080/01612840.2019.1585497. Epub 2019 May 17.
citation: Sigrunarson V, Moljord IE, Steinsbekk A, Eriksen L, Morken G. A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders. Nord J Psychiatry. 2017 Feb;71(2):120-125. doi: 10.1080/08039488.2016.1240231. Epub 2016 Oct 14.
citation: Thomsen CT, Benros ME, Maltesen T, Hastrup LH, Andersen PK, Giacco D, Nordentoft M. Patient-controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study. Acta Psychiatr Scand. 2018 Apr;137(4):355-363. doi: 10.1111/acps.12868. Epub 2018 Mar 4.