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Mixed models analyses were conducted to examine changes in distress and quality of life measures across the three time points.
When the overall test for change over time was significant, post hoc comparisons were performed to compare changes in distress or quality of life between time points.
To examine the time-course of changes in distress, it was important to ensure that the first time all patients expressed suicidal ideation was matched.
In addition, other unmeasured factors, such as personality characteristics or new traumatic experiences, could be driving the joint and bi-directional changes in distress and alcohol use.
Further, patients were only chosen if they had a minimum length of stay of seven days, in order to examine changes in distress over several consecutive days.
Our first objective was to examine any differences between the two triage groups in changes in distress, anxiety, depression, pain and fatigue over time.
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Secondary: total days off work, percentage that resumed work after 6 and 12 weeks, change in distress score and change in remaining SF36 dimensions after 6 and 12 weeks.
We were unable to measure any short term change in distress due to the limitations of the trial protocol and by measuring distress at 12 months we missed any possible short term increase.
Since this study aimed to estimate risk of deliberate self-harm in the presence of suicidal ideation and based on early change in distress during treatment; those individuals were excluded from analyses predicting deliberate self-harm.
This is consistent with previous research which found that sub-groups of inpatients changing in reported suicidal ideation at different rates were at different risks of engaging in deliberate self-harm [ 29], and that early change in distress results in more positive outcomes for individuals undergoing psychological treatment [ 25, 26].
Indeed, identifying sub-groups of individuals who change in distress at different rates led to superior predictions in risk of deliberate self-harm than distress scores on day 1 suggesting that continuously monitoring psychological distress amongst inpatients at this psychiatric hospital provided an innovative and useful avenue for risk prediction, and potentially prevention.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com