On Refugee Agency, Bio-Politics, and a New World

This short intervention starts by discussing Giorgio Agamben’s theoretical formulation of ‘bare life,’ popular in refugee studies. Thinking with the case study of Palestinian refugee camps, particularly in the West Bank, it argues that there are clear limitations to the discourse of and bare life. I argue that ‘bare life’ neither accounts for the multilayered relations of power, particularly colonialism, slavery, and indigenous genocide, that systemically make certain populations more susceptible to its power than others. Nor does it account for the modes of of those who are systemically relegated to its sphere. I conclude by working through some of the theoretical formulations around body politics from the field of Black studies, particularly Alexander Weheliye's 2014 concept of the flesh, in order to explore new directions they may point us towards in refugee studies.

A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

Background Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. Methods This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. Discussion This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. Trials registration ClinicalTrials.govNCT04072666. Registered on 28 August 2019

De rol van mobiele crisisteams in de behandeling van suïcidepogers: het 'Attempted Suicide Short Intervention Program'

The role of intensive home treatment teams in the treatment of suicidality and suicide attempters: a novel therapy Suicide is preventable and the World Health Organization (WHO) has made suicide prevention a priority as a global goal. Suicide attempters deserve extra attention as a prior suicide attempt is the main risk factor for a completed one. Suicidality is an important reason for referrals by general practitioners to psychiatric crisis services, including intensive home treatment teams (IHTTs). Suicide attempters, however, find it difficult to link up with regular care. IHTTs are more accessible than residential crisis care and are often more quickly available than regular outpatient care. IHTTs can therefore play an important role in the treatment of suicidality and should offer specific treatment. Various methods have been developed in recent years to effectively treat suicidality. The ‘Attempted Suicide Short Intervention Program’ (ASSIP) can be used within an IHTT. The methodology and available literature are discussed.

Efficacy of metamizole versus ibuprofen and a short educational intervention versus standard care in acute and subacute low back pain: a study protocol of a randomised, multicentre, factorial trial (EMISI trial)

IntroductionLow back pain (LBP) is among the top three most common diseases worldwide, resulting in a life with pain-related disability. To date, no study has assessed the efficacy of metamizole (dipyrone), a non-opioid analgesic and antipyretic prodrug compared with the conventional non-steroidal anti-inflammatory drug ibuprofen, in patients with an acute LBP episode. Further, it is unclear, whether a short educational intervention is superior to usual care alone.ObjectivesThe objective of this study is to assess first, whether metamizole is non-inferior to ibuprofen in a new episode of acute or subacute LBP. Second, we aim to assess whether a short educational intervention including evidence-based patient information on the nature of LBP is superior to usual care alone.Methods and analysisAn investigator-initiated multicentre, randomised, double blind trial using a factorial design will be performed. A total of 120 participants with a new episode of LBP will be recruited from GP practices, outpatient clinics and from emergency departments, and randomised into four different treatment groups: ibuprofen alone, ibuprofen and short intervention, metamizole alone, metamizole and short intervention. The primary endpoint for the medical treatment will be change in pain assessed on an 11-point Numeric Rating Scale after 14 days. The primary outcome for the short intervention will be change in the Core Outcome Measures Index assessed after 42 days.Ethics, dissemination and fundingThis study has been approved by the responsible Ethics Board (Ethikkommission Bern/2018-01986) and the Swiss Agency for Therapeutic Products (Swissmedic/2019DR4002). Results will be published in open access policy peer-reviewed journals. The study is funded by the Swiss National Science Foundation (grant number 32 003B-179346).Trial registration numberNCT04111315

Problem-solving skills groups for female Syrian refugees in Lebanon: a study of a mental health intervention

Since the outbreak of the Syrian civil war in 2011, Lebanon has witnessed an influx of over one million refugees. This has placed a serious strain on Lebanon’s mental healthcare system, creating the need for an efficient intervention for refugees. Health workers were recruited from various centres and trained to deliver a module of 12 sessions in problem-solving skills in group format. Then, they recruited female Syrian refugees and Lebanese women to form groups and deliver the intervention in the host communities. Results showed that levels of anxiety and depression, as reported by the Hopkins Symptom Checklist screening tool, seemed to decrease significantly after the intervention. An additional outcome was that most of the participants felt supported by other women. These results demonstrated that a direct and short intervention with female refugees can lead to measurable improvements in their mental1 health and was perceived by participants as highly beneficial.

A dismantling study on imaginal retraining in overweight or obese women

Imaginal retraining is a variant of approach bias modification and transfers the method into one’s own mind. As the technique contains multiple elements, this pilot study aimed to dismantle which of its components is most efficient in reducing craving for high-calorie food. A total of 113 women were randomly allocated to one out of six conditions containing a short intervention to mentally manipulate a picture displaying high-calorie foods. Four of the interventions involved different combinations of elements of the imaginal retraining technique, while the remaining two conditions comprised thought suppression or merely observing a picture. Participants rated their level of craving, as well as three pictures containing healthy and unhealthy foods regarding their pleasantness before and after the interventions took place. Within-group changes were assessed with paired t-tests (in case of non-normal data Wilcoxon paired t-tests) and between-group differences with one-way ANOVAs (non-parametric Kruskal–Wallis tests). A trend level reduction in craving was found in the imaginal retraining condition with and without a movement. A post hoc analysis of both conditions joint together showed a statistically significant reduction in craving. In addition, positive picture appraisal for unhealthy foods was significantly reduced in both imaginal retraining conditions (with and without movement) with medium to large effect sizes. This study demonstrated that imaginal retraining with an arm movement can reduce craving and picture appraisal for high-calorie foods significantly in a one-time application. It is a promising technique to reduce appraisal for unhealthy high-calorie foods. Future studies should repeat the experiment in situations of high craving and allow for a personalized selection of stimuli.

Effectiveness of Counselling on Diet Quality and Physical Activity with Cognitive Counselling for Overweight and Obese Women-A Randomized Clinical Trial

Various treatments for obesity exist that actually work, however, a great deal of them face the issue of weight regain. Hence, there is this desire to focus on health measures that can be predictors of weight maintenance. This study explores whether four sessions of group-based cognitive counselling can lead to superior results compared to counselling on diet and physical activity only, in terms of eating behavior, calorie intake, diet quality, weight, and physical activity. We conducted a randomized trial for this purpose. Our findings suggest that a short intervention of cognitive counselling can lead to improved emotional eating and uncontrolled eating. Both conditions showed significant improvement in diet quality, cognitive restraint on eating, weight, BMI, calorie intake, and physical activity, while between group differences remained non-significant. Further studies are needed to assess the impact of brief cognitive counselling on measures of weight maintenance in long term.

A Lived Experience Co-Designed Study Protocol for a Randomised Control Trial: The Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as Additional Interventions After a Suicide Attempt Compared to a Standard Suicide Prevention Pathway (SPP).

Background Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently there are limited treatment options with limited underpinning research for those who present to Emergency Departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves outcomes for consumers presenting to a Mental Health Service with a suicide attempt. Methods This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP) and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospital with suicide attempt and/or suicidal ideations. Death by suicide rates will also be examined. Self-reported level of suicidality, depression, anxiety, stress, resilience, problem-solving skills, self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, 6,12, and 24 months. Discussion This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. Trials registration : NCT04072666 - Registered on 28th August 2019 on Clinical Trials US Gov (https://www.clinicaltrials.gov/ct2/show/NCT04072666?term=NCT04072666&draw=2&rank=1) and ANZCTR (https://www.anzctr.org.au/TrialSearch.aspx)