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To analyze differences in the variables associated with severity of suicidal intent and in the main factors associated with intent when comparing younger and older adults. Observational, descriptive cross-sectional study. Four general hospitals in Madrid, Spain. Eight hundred seventy suicide attempts by 793 subjects split into two groups: 18–54 year olds and subjects older than 55 years. The authors tested the factorial latent structure of suicidal intent through multigroup confirmatory factor analysis for categorical outcomes and performed statistical tests of invariance across age groups using the DIFFTEST procedure. Then, they tested a multiple indicators-multiple causes (MIMIC) model including different covariates regressed on the latent factor “intent” and performed two separate MIMIC models for younger and older adults to test for differential patterns. Older adults had higher suicidal intent than younger adults (z = 2.63, p = 0.009). The final model for the whole sample showed a relationship of intent with previous attempts, support, mood disorder, personality disorder, substance-related disorder, and schizophrenia and other psychotic disorders. The model showed an adequate fit (χ2[12] = 22.23, p = 0.035; comparative fit index = 0.986; Tucker-Lewis index = 0.980; root mean square error of approximation = 0.031; weighted root mean square residual = 0.727). All covariates had significant weights in the younger group, but in the older group, only previous attempts and mood disorders were significantly related to intent severity. The pattern of variables associated with suicidal intent varies with age. Recognition, and treatment of geriatric depression may be the most effective measure to prevent suicidal behavior in older adults.

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28-0.67, stopping self: 0.54-0.72, stigma consciousness: -0.32-0.57], as was internal consistency reliability (α = 0.74-0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

The concerns raised by Philipe de Souto Barreto can be summarised as \"Did the conclusions remain the same when all variables were fitted in the model?\" Our statistical analysis section seems to contain, in his view, two suspicious steps in the selection of the independent variables: (1) three potential explanatory variables were found to be highly correlated with three others and so were sacrificed in the regression modelling procedure; and (2) only potential explanatory variables significantly associated with the dependent variable in the univariable regression models were introduced in the multivariable one.

La autolesión no suicida, a menudo denominada autolesión, es el acto de dañarse deliberadamente el propio cuerpo, como cortarse o quemarse. Normalmente, no pretende ser un intento de suicidio. En este trabajo se presenta un sistema de detección de indicios de autolesiones no suicidas, basado en el análisis del lenguaje, sobre un conjunto anotado de informes médicos obtenidos del servicio de psiquiatría de un Hospital público madrileño. Tanto la explicabilidad como la precisión a la hora de predecir los casos positivos, son los dos principales objetivos de este trabajo. Para lograr este fin se han desarrollado dos sistemas supervisados de diferente naturaleza. Por un lado se ha llevado a cabo un proceso de extracción de diferentes rasgos centrados en el propio mundo de las autolesiones mediante técnicas de procesamiento del lenguaje natural para alimentar posteriormente un clasificador tradicional. Por otro lado, se ha implementado un sistema de aprendizaje profundo basado en varias capas de redes neuronales convolucionales, debido a su gran desempeño en tareas de clasificación de textos. El resultado es el funcionamiento de dos sistemas supervisados con un gran rendimiento, en donde destacamos el sistema basado en un clasificador tradicional debido a su mejor predicción de clases positivas y la mayor facilidad de cara a explicar sus resultados a los profesionales sanitarios.

This chapter considers the more personal aspects of leadership in its broadest sense, and how to put them into practice, while considering the crucial role of the context in which leader and workforce function. It highlights the specific requirements for leadership in the field of psychiatry and mental health. A charismatic leader is able to influence how individuals or the group identify with the goals. Competent individuals have a proven track record for getting things done. This generates confidence in a leader. The leadership style largely determines the behaviour of the group and the results of the task its members are responsible for. To achieve effective leadership, the characteristics of the group, its internal organization, a clear definition of the task of the organization, and its organizational and administrative structure must also be taken into account.

Shared leadership is a kind of situational style as opposed to formal leadership. Even highly hierarchical organizations sometimes need to be smart and clever enough to share out the leadership role. Individual leadership is typically understood as a necessary skill to be exerted within a group in our case, within an established and well‐defined clinical team, with a leader and followers performing their particular functions. But inter‐professional collaboration requires that ‘extended teams’ are put into action. An extended team would include other clinical services, relatives of patients, educators and social services staff. Psychiatrists as leaders in the field of health services may have the responsibility and the opportunity to contribute not only to the knowledge of their discipline but also to improve the mental health of society as a whole.