Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study

Background: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. Methods: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Results: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. Conclusion: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

[1]  M. Krishna,et al.  Nurses attitudes and beliefs to attempted suicide in Southern India , 2015, Journal of mental health.

[2]  B. van Meijel,et al.  Nurses' attitudes towards self-harm: a literature review. , 2015, Journal of psychiatric and mental health nursing.

[3]  Mamta,et al.  Nursing students’ attitude toward suicide prevention , 2013, Industrial psychiatry journal.

[4]  K. Saunders,et al.  Attitudes and knowledge of clinical staff regarding people who self-harm: a systematic review. , 2012, Journal of affective disorders.

[5]  M. Phillips,et al.  The changing global face of suicide , 2012, The Lancet.

[6]  A. Felton,et al.  Self-harm: what's the problem? A literature review of the factors affecting attitudes towards self-harm. , 2010, Journal of psychiatric and mental health nursing.

[7]  S. Hinck,et al.  Best‐practice intervention for care of clients who self‐mutilate , 2009, Journal of the American Academy of Nurse Practitioners.

[8]  S. Billett,et al.  Working effectively with clients who self-injure using a solution focused approach. , 2008, International emergency nursing.

[9]  A. Lewis,et al.  Professional Attitudes Towards Deliberate Self-Harm in Patients With Borderline Personality Disorder , 2008, The Australian and New Zealand journal of psychiatry.

[10]  Lucy Palmer,et al.  Services for people who self-harm. , 2008, Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association.

[11]  David Gunnell,et al.  The global distribution of fatal pesticide self-poisoning: Systematic review , 2007, BMC public health.

[12]  K. Cleaver Characteristics and trends of self-harming behaviour in young people. , 2007, British journal of nursing.

[13]  J. Lönnqvist,et al.  Attitudes of general hospital emergency room personnel towards attempted suicide patients , 2007, Nordic journal of psychiatry.

[14]  F. Konradsen,et al.  Mortality rate and years of life lost from unintentional injury and suicide in South India , 2006, Tropical medicine & international health : TM & IH.

[15]  C. McDonald Self-Mutilation in Adolescents , 2006, The Journal of school nursing : the official publication of the National Association of School Nurses.

[16]  A. Mitchell,et al.  Predictors of A&E staff attitudes to self-harm patients who use self-laceration: influence of previous training and experience. , 2006, Journal of psychosomatic research.

[17]  T. McCann,et al.  Accident and emergency nurses' attitudes towards patients who self-harm. , 2006, Accident and emergency nursing.

[18]  C. Barrowclough,et al.  Accident and emergency staff's perceptions of deliberate self-harm: attributions, emotions and willingness to help. , 2005, The British journal of clinical psychology.

[19]  Ronald C Kessler,et al.  Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. , 2005, JAMA.

[20]  Martin Johnson,et al.  Countertransference and self-injury: a cognitive behavioural cycle. , 2005, Journal of advanced nursing.

[21]  D. K. Subbakrishna,et al.  Risk factors for completed suicides: a case–control study from Bangalore, India , 2004, Injury control and safety promotion.

[22]  J. Muliyil,et al.  Suicides in young people in rural southern India , 2004, The Lancet.

[23]  R. Bland,et al.  A multivariate study of predictors of repeat parasuicide , 2004, Acta psychiatrica Scandinavica.

[24]  Linda Gurrister M.S.W.,et al.  How therapists perceive and treat suicidal patients , 2004, Community Mental Health Journal.

[25]  S. Platt,et al.  A comparative investigation of health workers' attitudes towards parasuicide , 2004, Social psychiatry.

[26]  E. Simonoff,et al.  Staff knowledge and attitudes towards deliberate self-harm in adolescents. , 2003, Journal of adolescence.

[27]  P. Standen,et al.  Nurses' and doctors' perceptions of young people who engage in suicidal behaviour: a contemporary grounded theory analysis. , 2003, International journal of nursing studies.

[28]  D. Jeffery,et al.  A study of service providers' understanding of self-harm , 2002 .

[29]  M. Khan Suicide on the Indian subcontinent. , 2000, Crisis.

[30]  S Simkin,et al.  The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study , 2001, Psychological Medicine.

[31]  A. Hawkins,et al.  Staff Attitudes to Self‐harm and its Management in a Forensic Psychiatric Service , 2000 .

[32]  D. Tantam,et al.  Attitudes to self-injury within a group of mental health staff. , 2000, The British journal of medical psychology.

[33]  D. Gunnell,et al.  Are recent increases in deliberate self-harm associated with changes in socio-economic conditions? An ecological analysis of patterns of deliberate self-harm in Bristol 1972–3 and 1995–6 , 2000, Psychological Medicine.

[34]  S. Nazir,et al.  Nurses' and doctors' attitudes towards suicidal behaviour in young people. , 2000, International journal of nursing studies.

[35]  M. Anderson Nurses' attitudes towards suicidal behaviour--a comparative study of community mental health nurses and nurses working in an accidents and emergency department. , 1997, Journal of advanced nursing.

[36]  M. Åsberg,et al.  Attitudes of psychiatric nursing personnel towards patients who have attempted suicide , 1997, Acta psychiatrica Scandinavica.

[37]  C. McLaughlin Casualty nurses' attitudes to attempted suicide. , 1994, Journal of advanced nursing.

[38]  S. Bailey Critical care nurses' and doctors' attitudes to parasuicide patients. , 1994, The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation.

[39]  J. Lönnqvist,et al.  Work stress has negative effects on the attitudes of emergency personnel towards patients who attempt suicide , 1989, Acta psychiatrica Scandinavica.

[40]  K. Hawton,et al.  The attitudes of psychiatrists to deliberate self-poisoning: comparison with physicians and nurses. , 1981, The British journal of medical psychology.

[41]  A. Proudfoot ATTITUDES TO PATIENTS WHO ATTEMPT SUICIDE , 1981, The Medical journal of Australia.

[42]  A. Ghodse The attitudes of casualty staff and ambulance personnel towards patients who take drug overdoses. , 1978, Social science & medicine.

[43]  J. Bancroft,et al.  Attitudes towards Self-Poisoning among Physicians and Nurses in a General Hospital , 1975, British Journal of Psychiatry.

[44]  T. C. Welu Psychological Reactions of Emergency Room Staff to Suicide Attempters , 1972 .