2014 Cohort

Dr. Ailbhe Spillane, UCC 2014

The impact of suicidal behaviour on family members in Ireland: a mixed methods study

Institution: UCC, 2014 cohort

Supervisors:  Prof. Ella Arensman (UCC), Dr. Paul Corcoran (UCC), Dr. Karen Matvienko-Sikar (UCC)

 

Thesis Abstract:

Background: Suicidal behaviour is a complex and multifaceted problem encompassing individual, social and environmental components. There is a plethora of studies examining the adverse psychological health effects of suicide bereavement, but high quality research in this area is still limited. However, the physical health consequences of both suicide and self-harm on family members is lacking. There is also a paucity of research exploring the specific support needs of people bereaved by suicide and people experiencing a family member’s self-harm, regardless of severity, both in the short and long-term.

Methods: This doctoral work adopted a mixed methods approach and comprised four studies. Study 1 was a systematic review of the physical and psychosomatic health outcomes of family members bereaved by suicide. Study 2 (Inc. a published protocol) was a mixed methods examination of the physical and psychological health outcomes of family members bereaved by suicide that was conducted using qualitative interviews and quantitative scaled data. Study 3 was a qualitative study exploring how suicide-bereaved family members experienced the inquest process. Study 4 was a qualitative examination of individuals’ experiences of a family member’s high-risk self-harm.

Results: The systematic review found tentative evidence that suicide-bereaved family members have an increased risk of a number of adverse physical health outcomes, including cardiovascular disease, diabetes and hypertension, compared to people bereaved by non-suicide deaths. The qualitative component of the mixed methods study indicated that intense grief reactions, including guilt, blame, anger and shame manifested in exacerbating and prolonging physical, psychological and psychosomatic difficulties. The quantitative component of the mixed methods study demonstrated that suicide-bereaved family members have elevated depression, anxiety and stress levels. The qualitative study exploring the impact of the inquest process identified a number of distressing and challenging aspects for family members, including the timing and setting of the inquest and hearing graphic evidence about their own family member and that of other people who died by suicide. Finally, the qualitative study exploring experiences after a family member’s high-risk self-harm indicated that the health impacts of experiencing multiple high-risk self-harm acts is particularly marked compared to experiencing a single self-harm act.

Conclusion: The doctoral work presented in this thesis is innovative in examining the impact of a family member’s fatal or non-fatal suicidal behaviour from multiple research methods. The health impact of family members experiencing fatal or non-fatal suicidal behaviour are broadly similar and require proactive facilitation of support by clinicians. The inquest process was often viewed as distressing by suicide-bereaved family members. The support needs of people experiencing a family member’s suicide or high-risk self-harm are similar and both groups would benefit from a model of proactive facilitation of support by clinicians and other health professionals.

Dr. Kieran Walsh, UCC 2014

Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation

Institution: UCC, 2014 cohort

Supervisors:  Dr. Suzanne Timmons (UCC), Prof. Stephen Byrne (UCC), Prof. John Browne (UCC), Dr. Jennifer McSharry (NUIG)

Thesis Abstract:  

Introduction: Antipsychotics are commonly prescribed to people with dementia, especially in nursing homes, despite limited benefits and significant harms. There have been calls to better understand the reasons why antipsychotics continue to be inappropriately prescribed to people with dementia, and to develop sustainable interventions. Hence the overarching aim of this thesis was to develop and assess the feasibility of a theoretically-informed, evidence-based and sustainable intervention to rationalise (or optimise) antipsychotic prescribing in nursing home residents with dementia.
Methods: The overarching Medical Research Council (MRC) framework for developing and evaluating complex interventions guided our approach to this mixed-methods research. Firstly, a systematic review was undertaken to determine the effectiveness of pharmacists’ intervention in improving the appropriateness of prescribing in hospitalised older adults, with a particular focus on people with dementia. Secondly, a retrospective cross-sectional study was conducted examining prescribing differences between older adults with and without dementia, on admission to hospital. Next, a systematic review of qualitative evidence was undertaken to explore the influences on decision-making regarding antipsychotic prescribing in nursing home residents with dementia, which subsequently informed a semi-structured interview study exploring antipsychotic prescribing behaviours. The Behaviour Change Wheel (BCW) was then used to develop a complex intervention with Patient and Public Involvement (PPI) throughout. Finally, a feasibility study of the novel intervention was conducted in a nursing home setting.
Results: Despite the fact that our cross-sectional study showed that hospitalised adults with dementia were prescribed significantly more antipsychotics, our systematic review found no pharmacist intervention existed which aimed to improve the quality of prescribing in this population. Our qualitative synthesis highlighted the complexity of decision-making with regards antipsychotic prescribing to nursing home residents with dementia. The interview study identified determinants influencing prescribing behaviours. Based on these findings, we developed the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention which consisted of academic detailing with general practitioners, education and training with nursing home staff, and an assessment tool. This intervention was found to be both feasible and acceptable, however limited uptake of the assessment tool compromised intervention implementation.
Conclusion: This thesis has made a significant original contribution to knowledge, generating a much needed conceptual understanding of this complex issue and contributing towards intervention development. Further research is required to evaluate the effectiveness and sustainability of our novel intervention through larger scale evaluations.

Dr. Caragh Flannery, UCC 2014

Developing a behavior change intervention for physical activity during pregnancy

Institution: NUIG, 2014 cohort

Supervisors:  Prof. Molly Byrne (NUIG), Prof. Patricia Kearney (UCC) , Prof. Fionnuala McAuliffe (UCD)

 

Thesis Abstract: 

Background: Although the benefits of physical activity during pregnancy are well documented in the literature, women’s activity levels often reduce or cease during pregnancy. Moreover, adherence to physical activity guidelines is particularly low for pregnant women with a Body Mass Index (BMI) ≥25kg/m². Aim: The aim of this PhD is to enhance our understanding of physical activity during pregnancy with the view to inform the development of a theoretically based behaviour change intervention to improve physical activity levels for pregnant women with overweight and obesity. Methods: Following the guidelines of the UK Medical Research Council Framework for developing complex interventions, four studies were conducted to address the three steps in the development phase of this framework. In the first study a cross-sectional analysis using the Screening for Pregnancy Endpoints (SCOPE) data was conducted. This study examined the impact of other health behaviours (fruit and veg consumption, fish consumption, smoking and alcohol) and psychological well-being (perceived stress scale, behavioural responses to pregnancy, state trait anxiety inventory, depression scale, and postnatal depression score) on physical activity levels during early pregnancy. Two qualitative studies were conducted, the first with pregnant women with overweight and obesity to identify enablers and barriers to physical activity using the theoretical domains framework and COM-B model (capability, opportunity, motivation and behaviour). And secondly with health care professional to understand how obstetricians, GPs and midwives engage with women with overweight and obesity during pregnancy. In the final study a systematic review and meta-analysis was conducted to identify and summarise the effectiveness of existing physical activity interventions for pregnant women with overweight and obesity with a specific emphasis on the behaviour change techniques employed. Findings: Results from the cross-sectional analysis found that having more than 12 years of schooling and a higher socioeconomic status was related to moderate physical activity compared to low physical activity. From the qualitative interviews with pregnant women with overweight and obesity, knowledge was identified as a barrier to physical activity, as women lacked information on safe activities during pregnancy and described the information they received from their midwife as ‘limited’. Social support was identified as a key enabler to physical activity; women are more likely to be physically activity if they received support from their family and friends. Health care professionals, described using a “softly-softly approach” to weight management in order to strike a balance between being woman-centred and empathetic and medicalising the conversation. Findings from the systematic review and meta-analysis, suggest that physical activity interventions are to some extent effective at increasing physical activity levels for pregnant women with overweight and obesity. The behaviour change technique ‘social support’ was identified for pregnant women with overweight and obesity within the included interventions. Additionally, ‘self-monitoring of behaviour’ (using items such as diaries, workbooks and pedometers to monitor physical activity) emerged as one of the most frequently used BCTs within the included interventions. Conclusion: The findings of this research contribute to a clearer understanding of physical activity, providing an in-depth exploration of the barriers, enablers and determinants of physical activity for pregnant women, providing important insights into this high-risk population and a thorough foundation for intervention development. Following the MRC framework and utilising frameworks from behavioural science, this research revealed factors such as ‘social support’, ‘goal setting’ and ‘self-monitoring of behaviour’ as important behavioural components that may have a positive impact on improving physical activity in future interventions. Future interventions should include women’s ‘social support’ networks and provide some form of ‘self-monitoring’ such as pedometers so that women can set goals and monitor their progress.

Dr. Amelia Smith, TCD 2014

Epidemiological studies in breast cancer: the association of commonly used medicines and specific biomarkers with patient outcomes

Supervisors: Prof. Kathleen Bennett (TCD), Dr. Ian Barron (TCD), Laura Murphy

 

Thesis Abstract: 

*not available yet*

Dr. Alan Maddock, MU 2014

A mixed methods study examining individual differences in well-being and symptom reduction, and the effectiveness of mindfulness based interventions in psoriasis patient treatment through the lens of the Buddhist Psychological Model (BPM)

Institution: TCD, 2014 cohort

Supervisors:  Prof. David Hevey (TCD), Dr. Paul D’Alton (St Vincent’s University Hospital, Dublin)

Abstract: 

*not available yet*