Papers by Isabela Troya
Background: Self-harm is the leading risk factor for suicide, with elevated rates reported amongs... more Background: Self-harm is the leading risk factor for suicide, with elevated rates reported amongst older populations. This study explores how older adults experience self-harm, identifying factors leading to self-harm. Methods: Semi-structured interviews with older adults (≥60 years) engaging in self-harm and support workers from third sector services in England. Older adults were invited to participate in a follow-up interview. Interviews were recorded, transcribed verbatim and data analysed thematically. Ethical approval obtained from Keele University's Ethics Review Panel. A Patient Involvement group contributed to study design, data analysis and interpretation. Outcomes: Between September 2017 to September 2018, 24 interviews were conducted involving 16 participants: nine older adults and seven support workers. Eight older adults consented to follow-up interviews. All older adults reported diagnoses of mental illness in addition to physical illness. Participants identified diverse stressors accumulating over the life-course leaving older adults particularly vulnerable to self-harm. Such stressors included adverse events, loss, interpersonal and health problems. A sense of shame and stigma amongst older people using self-harm to manage distress was also reported. Interpretation: Self-harm is often concealed due to stigma and shame, being further accentuated amongst older adults, which may result in low levels of medical help-seeking behaviour for self-harm. Self-harm occurred along a spectrum of no-suicidal intent to high-levels of intent, suggesting self-harm holds different functions to older adults. Clinicians should be aware of the existence of self-harm in this age-group, and the heightened risk amongst those with comorbidities so adequate assessment, support and/or referral is provided.
Health Expectations, 2019
Background: The contribution of involving patients and public in health research is widely report... more Background: The contribution of involving patients and public in health research is widely reported, particularly within mental health research. Less is written about such contributions to doctoral research. The research focus of this doctoral research, self‐harm in older adults, was put forward by a Patient Public Involvement Engagement (PPIE) group, who contributed to its development.
Aims: Critically reflect on the process, potential impact and identify challenges and opportunities in involving robust PPIE in a doctoral study.
Methods: Three PPIE members contributed to a systematic review (SR) and a qualitative study through a series of four workshops to meet the aims of the study. PPIE contributed to developing the SR review questions, protocol, data analysis and dissemination of findings. For the qualitative study, they helped develop research questions, protocol, public‐facing documentation, recruitment strategies and data
analysis. Involvement followed the GRIPP2‐SF reporting checklist.
Results: PPIE enhanced methodological rigour, data analysis, interpretation and dissemination of findings. Challenges included lack of ethical guidance, time‐related pressures and ensuring support for PPIE members. These were successfully managed through ongoing dialogue and regular communication.
Conclusions: PPIE can enhance the quality and depth of doctoral research, as lived experiences shared by PPIE members add to research’s components. Exposing early‐career researchers to PPIE can build research cultures sensitive to PPIE’s potential contribution and develop the expertise needed to avoid tokenistic involvement. Capturing lay perspectives is essential in mental health research to ensure research findings are accessible and that findings inform clinical practice. However, clear guidance on the ethical dimensions to PPIE is needed.
Background
Self-harm is a major public health concern. Increasing ageing populations and high ris... more Background
Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.
Aim
To systematically review characteristics of self-harm in older adults.
Methods
A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings.
Results
A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations.
Conclusions
Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.
Patientand Public Involvement and Engagement (PPIE) has been increasingly encouraged in hea... more Patientand Public Involvement and Engagement (PPIE) has been increasingly encouraged in health services and re-search over the last two decades. Particularly strong evi-dence has been presented with regard to the impact that PPIE has in certain research areas, such as mental health. Involving the public in mental health research has the poten-tial to improve the quality of research and reduce the power imbalance between researchers and participants. However, limitations can be frequent and include tokenistic involve-ment and lack of infrastructure and support. Nevertheless, PPIE has the potential to impact mental health research in the Latin American context, where existing policies already support public involvement in health research and where the burden of mental disorders is significant. There are many lessons to learn from the evidence of PPIE in other regions. Latin America now has the opportunity to tackle one of to-day’s most important issues: effective health care service de-livery for all, based on evidence from comprehensive health research.
Following the 7.8 magnitude earthquake that struck Ecuador on 16 April 2016, multiple salient pub... more Following the 7.8 magnitude earthquake that struck Ecuador on 16 April 2016, multiple salient public health concerns were raised, including the need to provide mental health and psychosocial support for individual survivors and their communities. The World Health Organization and the United Nations High Commissioner for Refugees recommend conducting a desk review to summarize existing information, specific to the affected communities, that will support timely, culturally-attuned assessment and delivery of mental health and psychosocial support shortly after the onset of a disaster or humanitarian emergency. The desk review is one component of a comprehensive toolkit designed to inform and support humanitarian actors and their responders in the field.
This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.
KEYWORDS: desk review, disaster behavioral health, earthquake, Ecuador, humanitarian crisis, mental health, mental health and psychosocial support, MHPSS, psychosocial
Esta revisión bibliográfica incluye información útil de antecedentes sobre el Ecuador y los efect... more Esta revisión bibliográfica incluye información útil de antecedentes sobre el Ecuador y los efectos del terremoto del 2016, así como información sobre cómo la salud mental y apoyo psicosocial son comprendidos y percibidos por los diferentes grupos de población dentro del país ( antes y después del terremoto ). También se incluyen tasas de prevalencia del país para ciertos trastornos de salud mental , ideas para apoyo psicosocial y de salud mental a los programas que están apoyando con el terremoto.
The desk review includes useful background information on Ecuador and the effects of the earthqua... more The desk review includes useful background information on Ecuador and the effects of the earthquake, information on how mental health and psychosocial support is understood and perceived by different population groups within the country (before and after the earthquake), known prevalence rates for certain MH disorders, ideas for MHPSS programming related to the earthquake and importantly also programming ideas for the Zika virus outbreak response too.
Thesis Chapters by Isabela Troya
The number of people encountering a humanitarian crisis around the world is the highest since the... more The number of people encountering a humanitarian crisis around the world is the highest since the Second World War, with over 76 million people in need of assistance (1). Amongst these, millions have a mental disorder, which in most cases, is left without treatment. The Andean
country of Ecuador has encountered several natural disasters and armed conflict during the last decades due to its geographic location (See Appendix 1). Despite the adverse effects and consequences of mental disorders in humanitarian contexts in Ecuador, there is an unclear standing on how to respond with regards to mental health within these settings. The present policy reports wishes to provide evidence-based advice to policy-makers of Ecuador through comprehensive information and policy recommendations for achieving culturally appropriate
guidelines for Humanitarian Response in the mental health and psychosocial support context in Ecuador.
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Papers by Isabela Troya
Aims: Critically reflect on the process, potential impact and identify challenges and opportunities in involving robust PPIE in a doctoral study.
Methods: Three PPIE members contributed to a systematic review (SR) and a qualitative study through a series of four workshops to meet the aims of the study. PPIE contributed to developing the SR review questions, protocol, data analysis and dissemination of findings. For the qualitative study, they helped develop research questions, protocol, public‐facing documentation, recruitment strategies and data
analysis. Involvement followed the GRIPP2‐SF reporting checklist.
Results: PPIE enhanced methodological rigour, data analysis, interpretation and dissemination of findings. Challenges included lack of ethical guidance, time‐related pressures and ensuring support for PPIE members. These were successfully managed through ongoing dialogue and regular communication.
Conclusions: PPIE can enhance the quality and depth of doctoral research, as lived experiences shared by PPIE members add to research’s components. Exposing early‐career researchers to PPIE can build research cultures sensitive to PPIE’s potential contribution and develop the expertise needed to avoid tokenistic involvement. Capturing lay perspectives is essential in mental health research to ensure research findings are accessible and that findings inform clinical practice. However, clear guidance on the ethical dimensions to PPIE is needed.
Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.
Aim
To systematically review characteristics of self-harm in older adults.
Methods
A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings.
Results
A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations.
Conclusions
Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.
This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.
KEYWORDS: desk review, disaster behavioral health, earthquake, Ecuador, humanitarian crisis, mental health, mental health and psychosocial support, MHPSS, psychosocial
Thesis Chapters by Isabela Troya
country of Ecuador has encountered several natural disasters and armed conflict during the last decades due to its geographic location (See Appendix 1). Despite the adverse effects and consequences of mental disorders in humanitarian contexts in Ecuador, there is an unclear standing on how to respond with regards to mental health within these settings. The present policy reports wishes to provide evidence-based advice to policy-makers of Ecuador through comprehensive information and policy recommendations for achieving culturally appropriate
guidelines for Humanitarian Response in the mental health and psychosocial support context in Ecuador.
Aims: Critically reflect on the process, potential impact and identify challenges and opportunities in involving robust PPIE in a doctoral study.
Methods: Three PPIE members contributed to a systematic review (SR) and a qualitative study through a series of four workshops to meet the aims of the study. PPIE contributed to developing the SR review questions, protocol, data analysis and dissemination of findings. For the qualitative study, they helped develop research questions, protocol, public‐facing documentation, recruitment strategies and data
analysis. Involvement followed the GRIPP2‐SF reporting checklist.
Results: PPIE enhanced methodological rigour, data analysis, interpretation and dissemination of findings. Challenges included lack of ethical guidance, time‐related pressures and ensuring support for PPIE members. These were successfully managed through ongoing dialogue and regular communication.
Conclusions: PPIE can enhance the quality and depth of doctoral research, as lived experiences shared by PPIE members add to research’s components. Exposing early‐career researchers to PPIE can build research cultures sensitive to PPIE’s potential contribution and develop the expertise needed to avoid tokenistic involvement. Capturing lay perspectives is essential in mental health research to ensure research findings are accessible and that findings inform clinical practice. However, clear guidance on the ethical dimensions to PPIE is needed.
Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.
Aim
To systematically review characteristics of self-harm in older adults.
Methods
A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings.
Results
A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations.
Conclusions
Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.
This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.
KEYWORDS: desk review, disaster behavioral health, earthquake, Ecuador, humanitarian crisis, mental health, mental health and psychosocial support, MHPSS, psychosocial
country of Ecuador has encountered several natural disasters and armed conflict during the last decades due to its geographic location (See Appendix 1). Despite the adverse effects and consequences of mental disorders in humanitarian contexts in Ecuador, there is an unclear standing on how to respond with regards to mental health within these settings. The present policy reports wishes to provide evidence-based advice to policy-makers of Ecuador through comprehensive information and policy recommendations for achieving culturally appropriate
guidelines for Humanitarian Response in the mental health and psychosocial support context in Ecuador.