Lifeguard Pharmacy - A feasibility trial of a novel pharmacy-based intervention for people experiencing domestic abuse and/or suicidal ideation.

Domestic abuse and suicidal ideation are highly prevalent and often co-occur. These issues are distressing and put people in danger from themselves or others. Numerous practical and psycho-social barriers inhibit help-seeking. Community pharmacies are accessible healthcare environments that deliver various public health functions. However, no studies have yet developed and tested a robust intervention for responding to domestic abuse and suicidal ideation in community pharmacy. To co-develop a domestic abuse and suicidal ideation response service in community pharmacy; and to test whether the co-developed intervention and a future trial to evaluate it would be feasible and acceptable in community pharmacies. Service scope and resources were co-developed with 36 people (lay and professional) who participated in focus groups, interviews and/or workshops. A randomised feasibility trial tested the deliverability and feasibility of consenting clients and collecting study data, including data for a future economic evaluation. A nested process evaluation, comprising staff focus groups, customer interviews and a wider public survey, assessed the fidelity, acceptability and accessibility. A final feasibility workshop reviewed all feasibility objectives. The service was tested for 6 months in eight intervention pharmacies in Lincolnshire. Four more pharmacies acted as controls, providing usual care. In intervention pharmacies, trained staff provided triage assessment and structured signposting to those identified at risk of domestic abuse and/or suicidal ideation. Data were collected on the number and type of relevant patient contacts from intervention and control pharmacies. Staff training was evaluated using the Continuing Professional Development-Reaction questionnaire, with before-and-after data analysed via paired t-tests. Feasibility objectives were assessed in a multistakeholder workshop. Qualitative process evaluation data were thematically analysed. Co-development participants considered community pharmacies to be an ideal service setting. Their recommendations for safety, equity, empowerment and discretion were incorporated into service design. Following training, staff showed statistically significant improvements in their perceived ability and confidence in responding to people in need of help for suicidal ideation and/or domestic abuse. The public and pharmacy customers showed positive support and acceptability. During the intervention period, 24 patients needing support were identified in the intervention pharmacies compared to two in the control pharmacies. Stakeholder workshop findings confirmed community pharmacy as an appropriate setting for a staff-initiated intervention and the dual focus on domestic abuse and suicidal ideation. The findings do not support a client-initiated service at this stage due to challenges related to marketing and ensuring sufficient staffing capacity to deliver a safe, high-quality service. Limited participant diversity and significant gaps in data collection from clients due to complexities of gaining consent in a pharmacy setting for this type of intervention. A co-developed, staff-initiated response service for suicidal ideation and/or domestic abuse in community pharmacy was found to be feasible to deliver and acceptable to patients and staff. An implementation study to scale-up service roll-out, evaluate it in diverse settings and streamline operational processes across more organisations is required. Further work is needed to determine how to collect outcome and cost-effectiveness data from people receiving a rapid intervention and/or in distress. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133132.

BackgroundSuicidal thoughts and domestic abuse are major public health concerns which have enduring physical, psychological and economic impacts on the individuals affected, and their family and friends. For both issues,...

The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.

BackgroundDomestic abuse (DA) and suicidal ideation (SI) are prevalent and often co-occur. Numerous practical and psychosocial barriers inhibit help-seeking, including accessibility and confidentiality concerns. Early intervention and referral are essential for both DA and SI. Pharmacies are accessible and may be perceived as a discreet venue for a DA and SI response service. There is a growing body of literature about the role of community pharmacy teams in suicide prevention and assisting domestic abuse victims globally. Whilst there have been some interventions in UK pharmacies to support domestic abuse victims and encouragement of staff training in suicide prevention, there is currently no commissioned service for DA and/or SI in pharmacies in the UK. ObjectiveTo assess public acceptability of a novel response service in community pharmacy for people in danger from domestic abuse and/or suicidal ideation. MethodsData collection consisted of an online public survey running for 6 weeks and qualitative interviews with pharmacy customers. Descriptive statistics were used to present the survey results and interviews were audio recorded, transcribed verbatim and then analysed using the Framework Analysis method and NVivo 11. ResultsThe majority of 501 survey respondents and all 12 customer interview participants were supportive of offering a response service for DA and/or SI in community pharmacy. Participants emphasised the need for appropriate staff training and support. They considered it an ethical and accessible approach and the majority said that they would recommend such a service to family or friends, and use it themselves if needed. However, awareness of the service was low and marketing materials were considered insufficiently clear. ConclusionsThere is strong public support and acceptability for a response service covering both suicidal ideation and domestic abuse in community pharmacies. Further research is required to develop appropriate marketing materials.

To test a brief intervention for preventing statin nonadherence among community pharmacy patrons. Prospective, cluster-randomized, controlled trial (the Community Pharmacists Assisting in Total Cardiovascular Health [CPATCH] trial). Thirty community pharmacies in Saskatchewan, Canada. Participating pharmacies were randomized to 15 intervention pharmacies where a brief statin adherence intervention was delivered by pharmacists (intervention group [907 patients]) or 15 usual care pharmacies where no statin adherence intervention was delivered (usual care group [999 patients]) to new users of statins (defined as less than 1 yr of statin therapy). Staff (pharmacy managers, staff pharmacists, and technicians) from intervention pharmacies attended a 2.5-hour workshop on the CPATCH program that prepared pharmacists to deal with the adherence barriers most likely associated with statin use (e.g., safety, cost, patient-provider relationship, and tolerability). Intervention pharmacists screened for new statin users and assessed these adherence barriers. Pharmacists were then instructed to tailor their follow-up plan based on the individual patient's situation. Investigators contacted the intervention pharmacies monthly to assess their compliance with the protocol and to offer additional support to motivate ongoing participation. The primary outcome was mean difference in statin adherence between the intervention and usual care groups. Adherence was measured by the proportion of days covered (PDC) between 6 and 12 months following the original prescription fill date. General estimating equations were used to evaluate the difference in mean adherence between groups. Secondary outcomes included the percentage of new statin users exhibiting optimal adherence (defined as PDC of 80% or higher) and the percentage exhibiting nonpersistence (defined as the cessation of all statin dispensations within 3 mo of the first dispensation). Among 1906 eligible patients, no significant differences in mean adherence were observed between those receiving the intervention and those receiving usual care (71.6% vs 70.9%, p=0.64), the percentage of patients achieving optimal adherence (57.3% vs 55.9%, p=0.51), or the percentage exhibiting nonpersistence (9.4% vs 8.3%, p=0.41). However, compliance to the study protocol was extremely low in several intervention pharmacies. In a post hoc analysis, a higher level of protocol compliance among intervention pharmacies was significantly associated with higher adherence (p<0.01 for trend). Pharmacies falling in the highest tertile of compliance to the study protocol exhibited higher mean adherence among their patients compared with those in the usual care group (β = 0.056, 95% confidence interval [CI] 0.010-0.101, p=0.01), and a significantly higher percentage of patients achieving optimal adherence (odds ratio 1.32, 95% CI 1.08-1.61; p<0.01); however, nonpersistence did not significantly differ between the two groups (5.5% vs 8.3%, p=0.27). The CPATCH intervention was ineffective for improving patient adherence to statin therapy in community pharmacies. However, poor effectiveness may have resulted from a failure to deliver the protocol consistently in several intervention pharmacies.

To evaluate the effects of a community pharmacy-based fall prevention intervention (STEADI-Rx) on the risk of falling and use of medications associated with an increased risk of falling. Randomized controlled trial. A total of 65 community pharmacies in North Carolina (NC). Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565). Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist-conducted medication review, with recommendations sent to patients' healthcare providers following the review. At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high-risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls. Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication-related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre- to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre- to postintervention period or differ between groups (P = .58). We successfully implemented STEADI-Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778-1786, 2020.

BackgroundSuicidal ideation is an indicator of psychological distress and a proportion of people reporting suicidal ideation attempt or commits suicide. Mental illness of any type is strongly associated with suicidal ideation. Furthermore, the links between exposure to domestic violence and mental health problems are well established. Furthermore, a number of studies have reported an association between domestic violence and suicidal ideation.AimsTo study the link between domestic violence, mental health and suicidal ideation.MethodUsing data from a group of 650 Pakistani women, we explored the putative predictors of suicidal ideation using univariate and multiple logistic regression. Significant predictors were then entered into a path analysis in order to evaluate both the direct and indirect effects of domestic violence on the odds of a study participant reporting suicidal ideation.ResultsMental disorders were observed to significantly predict suicidal ideation. Ability to negotiate conflict between couples appeared to both directly and indirectly, via mitigation against mental disorder, protect against suicidal ideation.ConclusionsThe effect of verbal aggression on suicidal ideation appeared to be mostly mediated via its impact on mental health.

Aims: Suicide among adolescents is a rising public health concern, particularly in Nigeria, where cultural stigma and under-reporting make the true burden difficult to estimate. This study examined the association between child abuse, domestic violence and suicidality among secondary school students in Osun State, Southwestern Nigeria, and explored the contribution of selected sociodemographic variables to suicidal ideation in this population. Study Design: Using a cross-sectional research design, the study investigated how experiences of child abuse and domestic violence are related to levels of suicidality in a school-based sample of adolescents. Place and Duration of Study: The study was conducted in selected public and private secondary schools in Osun State, Nigeria, and coordinated by the Department of Psychology, Redeemer’s University, between August 2024 and February 2025. Methodology: Data was collected from 300 students, [male 143(47.7%) and females 157(52.3%)], Data were collected from 300 students [143 males (47.7%) and 157 females (52.3%)] whose ages ranged between 10 and 20 years (Mean age = 14.1 ± 1.5 years). A multi-stage sampling procedure was used to select four secondary schools, from which participants were drawn using proportionate sampling. Self-administered questionnaires were used to obtain information on suicidality, child abuse and domestic violence, including the Suicidal Ideation Scale and the Childhood Trauma Questionnaire. Results: A substantial proportion of students reported clinically concerning levels of suicidality, with nearly half falling in the moderate-to-high risk categories. Child abuse and domestic violence were both positively associated with suicidality, and together they significantly predicted suicidal ideation in the regression model, explaining a large proportion of the variance (R² ≈ 0.68). Child abuse showed a stronger association with suicidality (β ≈ 0.59, p &lt; .01) than domestic violence (β ≈ 0.30, p &lt; .01). In contrast, most sociodemographic variables made only modest additional contributions, and the correlation between age and suicidal ideation was not significant. Conclusion: The findings indicate that experiences of child abuse and domestic violence are strongly associated with higher levels of suicidality among secondary school students in Osun State. These results underscore the urgent need for school- and community-based interventions that prevent child maltreatment and domestic violence, improve early identification of at-risk adolescents, and enhance access to age-appropriate mental health support and counselling services in order to protect young people and promote their psychological well-being.

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

To review and evaluate research on pharmaceutical services in community and ambulatory care pharmacy settings, specifically study designs and patient outcome measures, and to provide recommendations to improve future research on pharmaceutical services in community and ambulatory care pharmacy settings. English-language articles were identified by searching MEDLINE (1966-December 1998) and International Pharmaceutical Abstracts (1970-December 1998), using a combination of search terms: pharmacist services, pharmacist interventions, community pharmacy, ambulatory care, primary care, and patient outcomes. Relevant studies were selected based on article abstracts. From each relevant study, we extracted the study objectives, sample size, study period, study design, major tasks performed by pharmacists, and economic, clinical, and humanistic outcomes (ECHO). Results were tabulated separately for research on community pharmacy and ambulatory care pharmacy settings. We identified 95 relevant studies. Of these, 21 studies were conducted in community pharmacy settings and 74 in ambulatory care settings. Ten community pharmacy studies used prospective, single group, pretest/posttest, or posttest only designs; seven used prospective two or more group comparison designs; and four used randomized, controlled designs. Nine studies on community pharmacies measured clinical outcomes, two measured humanistic outcomes, and five measured economic outcomes. Four studies measured both clinical and humanistic outcomes and one measured humanistic and economic outcomes. No study measured all three ECHO variables. Twenty-three studies in ambulatory care settings used prospective or retrospective, single group, pretest/posttest or posttest only designs; 21 used prospective or retrospective two-or-more group comparison designs; and 30 used randomized, controlled designs. Thirty-six measured clinical outcomes, five measured humanistic outcomes, and 15 measured economic outcomes. Fifteen studies measured clinical and economic outcomes and three measured clinical and humanistic outcomes. Only 21 of 95 selected studies were conducted in community pharmacy settings and measured the impact of pharmaceutical services on patient outcomes. Few studies employed adequate research designs to control threats to internal and external validity. In order to obtain a comprehensive and accurate picture of the impact of pharmaceutical services on patient outcomes, an attempt must be made to measure all three ECHO variables while employing adequate research design.

Purpose The purpose of this study is to examine the impact on suicidal ideation (SI) of having experienced spousal physical abuse and the possible effects of protective factors on the relationship between depressive symptoms and SI among community-dwelling older adults. Methods Using Wisconsin Longitudinal Study data (N = 6,125), a path analysis was conducted to examine the impact of spousal physical abuse on SI and test the possible effects of protective factors. Results First, the experience of spousal physical abuse had a significant impact on both depressive symptoms and SI. Second, problem-focused coping, social support, and having a family confidant reduced depressive symptoms directly and mitigated SI indirectly. Third, emotional-focused coping had both direct and indirect effects on depressive symptoms and SI, leading to increases in both. Fourth, although the practical significance may be small, emotional-focused coping worked as a moderator between depressive symptoms and SI. Conclusions Interventions are necessary to increase protective factors and decrease risk factors of depressive symptoms and SI among older adults. In addition, regular screening tests of Intimate Partner Violence, depressive symptoms and SI are recommended.

Background and Aim: It seems that education and awareness of families about domestic violence and its consequences and ways to cope with it can increase mental health in the family and society. The present study aimed to determine the prediction of suicide ideation and psychological helplessness based on domestic violence in women. Methods: The present study was descriptive and correlational and its statistical population consisted of all female victims of domestic violence in Shiraz in 2020. Among the statistical population, we selected and studied 110 women who visited health-medical centers, social emergencies, and family courts using the convenience method. To collect data, we used the Depression, Anxiety and Stress Scale- 21 Items (DASS-21), Beck Scale for Suicide Ideation (1961), and Domestic Violence against Women Scale by Tabrizi et al. (2012). After collecting and extracting data, we analyzed the participants' scores using univariate and multivariate regression analysis. Results: The results indicated that there was a significant positive correlation between domestic violence and suicide ideation and psychological helplessness in women (P= 0.01). The results of multivariate regression indicated that domestic violence could predict suicide ideation and psychological helplessness in women (P=0.01). Conclusion: The present study indicated the psychological consequences of spousal abuse and violence against women and confirmed the damage to women's mental health due to violence. According to the results, providing supportive factors to reduce domestic violence could be effective in increasing women's mental health

BackgroundSuicide remains a critical public health issue worldwide. In Iran, particularly in the western province of Kermanshah, forced marriage and domestic violence are prevalent social problems that may contribute to suicidal ideation among married individuals. This study aimed to examine the association between forced marriage, physical intimate partner violence (IPV), and suicidal ideation, while exploring the protective roles of social support and resilience.MethodsA cross-sectional population-based study was conducted in 2024 with 369 married adults aged 18–59 years from Kermanshah city. Participants were selected through multi-stage sampling from diverse socioeconomic areas. Data were collected using validated questionnaires including Beck Scale for Suicidal Ideation, Multidimensional Perceived Social Support Scale, Connor-Davidson Resilience Scale, and a demographic checklist. Logistic regression was used to identify predictors of suicidal ideation.ResultsIn this study, 24.1% of people reported suicidal ideation, 33.9% experienced forced marriage, and 22.2% experienced physical IPV. Suicidal ideation was significantly higher among those exposed to forced marriage (OR = 2.47, 95% CI: 1.32–4.61, P < 0.01), physical IPV (OR = 2.33, 95% CI: 1.24–4.74, P < 0.01), history of attempted suicide (OR = 2.31, 95% CI: 1.01–6.22, P < 0.05), suicide attempts in the family (OR = 2.22, 95% CI: 1.07–4.60, P < 0.05), history of mental disorders (OR = 2.13, 95% CI: 1.04–4.38, P < 0.05), female gender (OR = 2.13, 95% CI: 1.01–4.11, P < 0.05), and suicide attempt in friends (OR = 2.02, 95% CI: 1.06–3.84, P < 0.05). Conversely, higher social support (OR = 0.93, 95% CI: 0.88–0.98, P < 0.05) and resilience (OR = 0.96, 95% CI: 0.94–0.99, P < 0.01) were significantly protective against suicidal ideation. The model explained up to 41% of the variance in suicidal ideation.ConclusionForced marriage and domestic violence are significant risk factors for suicidal ideation among married individuals in Kermanshah, while social support and resilience serve as protective factors. These findings highlight the urgent need for culturally sensitive interventions targeting harmful social practices and strengthening psychosocial resources to reduce suicide risk in this population.

Suicide is one of the leading causes of death, and the rates of suicidal ideation are higher among unwed mothers compared to their counterparts in the Republic of Korea. Adverse childhood experiences (ACEs) have been associated with negative health and behavior outcomes, including suicidal ideation. However, the impact of ACEs on suicidal ideation among Korean unwed mothers remains underexplored. The purpose of this study is to examine the relationships between ACEs and suicidal ideation in adulthood within a sample of 255 Korean unwed mothers. Logistic regression was used to examine the impact of both cumulative and specific ACEs on suicidal ideation in adulthood. The results showed that 34.1% of mothers reported suicidal ideation, 79.8% experienced at least one ACE, and 44.7% reported experiencing four or more ACEs, highlighting a significant level of risk. The number of ACEs was associated with increased odds of having suicidal ideation. Distinct effects of specific types and combinations of ACEs were also identified. Unwed mothers exposed to physical neglect, emotional neglect, or domestic violence were at heightened risk of suicidal ideation. These findings suggest that neglect and domestic violence are critical factors in identifying unwed mothers at risk for suicidal ideation and underscore the necessity of implementing trauma-informed practices to mitigate suicide risk.

Domestic violence (DV) against women is a multidimensional public health problem that has both psychologically and socially devastating consequences, especially in patriarchal societies. The aim of this study was to investigate the mediating role of self-perception and somatoform dissociation in the relationship between DV and suicidal ideation in women living in Turkey. The sociodemographic data form, Severity of Violence Against Women Scale, Somatoform Dissociation Questionnaire, Social Comparison Scale, and Suicidal Ideation Scale were administered to 102 participants. In addition to descriptive statistics, linear and mediation regression analyses were performed. DV scores were significantly negatively correlated with self-perception and positively correlated with somatoform dissociation scores. While negative self-perception and increased somatoform dissociation were partial mediators in the relationship of threat and sexual violence with suicidal ideation and full mediators in the relationship of physical violence with suicidal ideation. Negative self-perception and increased somatoform dissociation were critical mediators in relation to DV and suicidal ideation in women. Psychotherapeutic approaches focused on self-perception and somatoform symptoms may reduce the risk of suicide in women who have been exposed to DV. Long-term clinical studies are needed to investigate the factors mediating suicidal ideation in women who have been exposed to DV.