BJPsych Kaleidoscope September 2020

magazine-coverRisk prediction in mental health is notoriously difficult: self-harm is relatively common, compared with which, suicide is ‘rare’. So what to do?

Whilst research continues to show that risk prediction models and tools have huge false positive rates – emphasising the primacy of clinical expertise and good note-keeping – it is a different question to ask if suicide-prevention interventions are of value.

September’s Kaleidoscope reports on a paper that meta-analysed brief, single-encounter interventions across fourteen different studies. It found they did work, reducing subsequent suicide attempts with a pooled odds ratio of 0.69: in old money that’s 78 fewer suicide attempts in 2,241 people.

They were also linked with improved engagement with professional services. The interventions varied in exactly what they did, but some factors were common across them: care coordination, safety planning, short-term follow-up contacts and a brief therapeutic intervention. The findings are heartening: whilst risk prediction of the future remains an enormous challenge, the work that you can do on a daily basis is effective, and specific targeted interventions are of particular value.

What was the deal with all the toilet roll hoarding at the start of COVID-19? (And all the egg and flour buying: how much sponge can you bake?)

Hand sanitiser purchasing was perhaps more reasoned – there was a need to sterilise – but, y’know, there’s only so much business even the most enthusiastic of us can do with toilet roll. Scientists have been exploring the underlying human behaviour, proposing two main behavioural theories*.

The first is that people are just selfish, and stockpiled anything they thought might run out, ignoring social solidarity. The second is that the presence of disease taps into a deep sensitivity to feelings of disgust, and toilet roll symbolises cleanliness to us: think of how you feel when you step in a nice big pile of dog poo – even reading that makes you feel queasy, right?

An international study crossing 35 countries explored what happened, including the personalities and purchasing behaviours of over a thousand adults. Those who self-rated a high perceived threat from COVID-19 and scored ‘high emotionality’ drove the buying, with more frequent shops and bigger purchases. Nothing else impacted in any country: not age, gender, work, or political alignment.

This matters: it is important to understand this if and when we face future epidemics, and it is not to blame those who stockpiled**. It tells us that governmental and scientific messaging to the public about risks is a key factor in keeping supply chains going and social cohesion high.

*There’s also a Freudian perspective on anal retentiveness, but I don’t feel inclined to go there.

**But enough with the eggs and flour – at least share the baked cakes next time.

 

Quiz

All questions true or false. Full answers – and source material – will be in September’s Kaleidoscope column in the BJPsych.

  1. The first large twin/adoption study in borderline personality disorder has affirmed that early environment is far stronger modifier than genetic transmission.
  2. Renal dialysis for psychosis had a minor vogue in the 70s and 80s following an influential case series. A re-analysis of that data, in light of contemporary understanding of inflammatory factors, confirms it actually has promise.
  3. Insulin modulates a range of brain processes, from dentritic spine formation to clearance of amyloid beta. The first randomised controlled trial of an intranasal variant has shown some promise in halting progress of mild cognitive impairment and early Alzheimer’s disease.
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