Brief Admission for Adolescents Who Self-harm

Brief Admission by Self-referral for Adolescents Who Self-harm, at Risk for Suicide. A Qualitative Study to Optimise and Standardise the Intervention

There is still no consensus on how to manage suicidal behavior in youth with recurrent self-harm at times when the risk for suicide is imminent (1). Brief Admission (BA) has evolved as a promising crisis intervention for adults with self-harm (2). The characteristics of BA is different from other types of admission, being focused on prevention through increased autonomy and self-care, based on structured and voluntary brief self-referrals to hospital (3). As a result of a randomized controlled trial, BA is since January 2019, continuously offered to adults with self-harm at risk for suicide in Skåne (4). Parallel to this clinical trial, the method has been adapted to work in a psychiatric setting for adolescents. At present 24 adolescents have access to the method in Skåne. Clinical experiences from staff are promising, however, the lived experiences have not been collected in a standardized way.

The aim of the present study is to gather information on how BA in its present, standardized form works for adolescents, their loved ones and staff working at the ward providing BA. This will be done through semi-structured interviews with:

1. Adolescents using BA and their loved ones
2. Staff working at the ward providing BA. Data will be analyzed with qualitative analysis (5, 6). The ultimate aim is to use these results to optimize the current standardized version of BA for adolescents in order to test in a randomized clinical trial.

Study Overview

• Status: Completed
• Conditions: Suicide, Attempted; Self-Harm, Deliberate; Non-Suicidal Self Injury; Suicidal
• Intervention / Treatment: Other: Semi-structured interviews

• Study Type: Observational
• Enrollment (Actual): 59

Contacts and Locations

Study Locations

• Sweden
  • Skåne
    • Lund, Skåne, Sweden, 22185
      • Psykiatri och habilitering, Region Skåne

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 100 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Adolescents with an active BA contract, their loved ones who have given informed consent to participate and psychiatric staff working with the adolescents.

Description

Sample 1:

Inclusion Criteria:

• Adolescents with an active BA contract
• At least 13 years of age.
• Able to consent to study participation through written and oral information.
• Consent from caregivers
• Given consent to participate

Exclusion Criteria:

• Below the age of 13.

Sample 2:

Inclusion Criteria:

• Parents to adolescents with an active BA contract
• At least 18 years of age.
• Able to consent to study participation through written and oral information.
• Given consent to participate

Exclusion Criteria:

• None

Sample 3:

Inclusion Criteria:

• Staff working with adolescents with an active BA contract
• At least 18 years of age.
• Able to consent to study participation through written and oral information.
• Given consent to participate

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Adolescents; Adolescents with a contract for Brief admission by self-referral	Other: Semi-structured interviews; Each participant will attend a 30-60 minute semi-structured interview conducted by the CI
Parents; Parents to adolescents with a contract for Brief admission by self-referral	Other: Semi-structured interviews; Each participant will attend a 30-60 minute semi-structured interview conducted by the CI
Staff; Health care providers who work with adolescents with a contract for Brief admission by self-referral	Other: Semi-structured interviews; Each participant will attend a 30-60 minute semi-structured interview conducted by the CI

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived effective components of Brief Admission for adolescents	Qualitative data from interviews	60mins
Potential adaptations of the method to better fit adolescents	Qualitative data from interviews	60mins
Areas where Brief Admission have the most prominent perceived effects in adolescents	Qualitative data from interviews	60mins

Collaborators and Investigators

• Sponsor: Region Skane
• Collaborators: Lund University

Publications and helpful links

General Publications

• Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105-12. doi: 10.1016/j.nedt.2003.10.001.
• Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: A systematic review. Nord J Psychiatry. 2015;69(8):574-86. doi: 10.3109/08039488.2015.1025835. Epub 2015 Apr 2.
• Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci. 2004 Jun;18(2):145-53. doi: 10.1111/j.1471-6712.2004.00258.x.
• Helleman M, Lundh LG, Liljedahl SI, Daukantaite D, Westling S. Individuals' experiences with brief admission during the implementation of the brief admission skane RCT, a qualitative study. Nord J Psychiatry. 2018 Jul;72(5):380-386. doi: 10.1080/08039488.2018.1467966. Epub 2018 Apr 27.
• Lindkvist RM, Landgren K, Liljedahl SI, Daukantaite D, Helleman M, Westling S. Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care. Issues Ment Health Nurs. 2019 Jul;40(7):548-556. doi: 10.1080/01612840.2019.1585497. Epub 2019 May 17.
• Lindkvist RM, Westling S, Liljedahl SI, Landgren K. A Brief Breathing Space: Experiences of Brief Admission by Self-Referral for Self-Harming and Suicidal Individuals with a History of Extensive Psychiatric Inpatient Care. Issues Ment Health Nurs. 2021 Feb;42(2):172-182. doi: 10.1080/01612840.2020.1789787. Epub 2020 Aug 7.
• Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin A, Flyckt L, Helleman M. Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide: A Randomized Clinical Trial. JAMA Netw Open. 2019 Jun 5;2(6):e195463. doi: 10.1001/jamanetworkopen.2019.5463.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2020
• Primary Completion (Actual): June 30, 2025
• Study Completion (Actual): June 30, 2025

Study Registration Dates

• First Submitted: July 4, 2021
• First Submitted That Met QC Criteria: July 13, 2021
• First Posted (Actual): July 15, 2021

Study Record Updates

• Last Update Posted (Actual): August 6, 2025
• Last Update Submitted That Met QC Criteria: August 1, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Suicide; Self-Injurious Behavior; Suicide, Attempted
• Other Study ID Numbers: 2020-01840

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data is qualitative, transcriptions from interviews. Even if personal identifiers are removed, it is difficult to ensure enough secrecy/privacy for the participants.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No