Strengthening Reporting of Observational Studies

Question: Discuss about the Strengthening Reporting of Observational Studies. Answer: Introduction: Borderline personality disorder (BPD) is a set of abnormal behavior is observed in an individual characterized by unstable mood, behavior, emotion and functioning. There is extreme feeling of depression, anxiety, self-harm and suicidal thinking among people with BPD. The rate of suicide and suicidal behavior is high in people with borderline personality disorder. There are argument regarding the values of hospitalization on patients with BPD and one research suggests that hospitalization can produce negative effects for patients. This is because of the chronic suicidality characteristics of BPD. The management of chronic suicidality characteristic is based on specific treatment, which should not be restricted to hospital setting. Hospital should be reserved for specific treatment such a neuroleptic therapy for psychotic patients which cannot be delivered outside the hospital. Hence, suicidal prevention in hospital leads to more regression in patients (Paris, 2004). Another study just ifies in-patient treatment for such patients to promote safety, however the suicidal precaution steps used in hospital setting reinforce suicidal thinking in patients. People continue to have suicidal intention even after suicide (Bateman Fonagy, 2010). Hence, the purpose of hospitalization for these patients is not met. People with BPD are often hospitalized for continuous psychotic episodes, serious suicide attempts and self-mutilation. This has been found of no value for recovery of patient and lead to negative effects in patients. Some of the prolonged impact of extended inpatient hospitalization includes continued risk of assaultive behavior, poor physical and social functioning, eating disorder and non-adherence to treatment. It is also an additional expense in terms of cost. Hence, psychiatric admissions are often opposed by mental health professionals due to adverse effect of regression and iatrogenic dependency (Koekkoek et al., 2010). Apart from this negative impact of hospitalization on patients, the negative attitude of psychiatric staffs on treatment of patients BPD also creates risk for patient. Negative attitude and lack of empathy towards patients further increased the burden and cost of treatment (Bodner et al., 2015). The analysis of literature revealed that there is lack of studies regarding the long-term impact of prolonged hospitalization on people with BPD. Although studies present reinforcement of suicidal tendency despite hospital, researchers have not yet explored the long-term impact of hospitalization on mental health of BPD patients. Objective of the study The purpose of this research is to analyse and evaluate the long-term impact of prolonged hospitalization on patients with BPD and identify the strategies or approach by which the impact can be reduced. The research question for the study includes the following: How does prolonged hospitalization affect patients with BPD? What are the long-term impact of hospitalization on patients with BPD? What strategies or interventions are needed to reduce the adverse impact of hospitalization? Research approach The review of research presents several contrasting viewpoint for hospitalization in BPD patients. Short-term hospitalization is effective in severe crisis situation and for the diagnosis of BPD. Short-term hospitalization is also supported to provide temporary relief from acute stressful episodes and self-destructive behavior. However, there is doubt regarding prolonged hospitalization for this group of patients as most of the symptoms of BPD can be managed by structured outpatient program like individual therapy and medication. Hence, due to the lack of study regarding the adverse effect of prolonged hospitalization in this patient, this research is important to widen the knowledge regarding adverse effect of hospitalization and find alternative ways to reduce the harm in patients. Grounded theory approach to qualitative research will be done to conduct this research. This methodology of research is used to construct theory through the analysis of data relevant to the purpose of study. It is an inductive way of research in which specific research question guides the future course of investigation. The data collected for the study is reviewed repeatedly with separate repeated idea and categorize data into different codes. This codes can be further developed into a concept and consequently specific categories (Charmaz, 2014). Conventional research is based on a theoretical framework on the basis of which data is collected to show prove whether the theory applies to the phenomenon under study or not. In contrast, grounded theory research method offers explanation related to the phenomenon of study which results in the development of theory. Apart from generation of theories from data, this research methodology also helps in the discovery of emerging patterns in the data. By this means, several social patterns of society can be easily conceptualized (Kelle, 2010). The methodological strategies of grounded theory by means of extensive data analysis lead to the development of middle level theories. The final result has credibility as it is made on the basis of strong empirical foundation. Reflexivity in grounded theory can contribute to validity of the research by means of analysis and interpretation of different phases of research (Gentles et al. 2014). This methodology has been chosen for the current study because there is lack of studies regarding the harmful long-term impact of hospitalization in BPD patients. Short-term impact has been discussed, however there is lack of theory regarding long-term potential impact of prolonged hospitalization. Hence, study with this group of people through grounded theory approach will help to evaluate the long-term impact and develop theory regarding potential ill-effect. It will help in better understanding of the phenomenon related to adverse impact of prolonged exposure to hospitalization (Creswell, 2012). Other advantage of using this methodology in current study is that it will sequentially guide the research process and offer specific strategies for handling the research data. It will promote conceptual understanding and enhance the legitimacy of the qualitative research (Kolb, 2012). Data collection The data collection for this research will be based on the data collection technique of participant observation to generate data for the grounded theory and research question. It will help to gain familiarity with the study participants a specific environment for a certain period of time (Bryman, 2015). As the aim of the research is to develop understanding about long-term hospitalization process on people with BPD, the research will be conducted for extended time period. Participant for the study will be recruited from the outpatient unit of the Department of Psychiatry in the regional hospital of Australia. The inclusion criteria for the participation included diagnosis of BPD within 1 year and absence of other chronic disease. They should also have past history of at least one suicidal attempt in the past one year. This criteria is important because if participants with other chronic illness are include in the study, it might give biased and invalid results. The participants will be assessed for inclusion by means of assessment carried out by experienced clinician. They will confirm the diagnosis of BPD on the basis of criteria listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) classification system and clinical history of participants (Sellbom et al., 2014). As this group of participants will be kept in hospital for about 3 months period, their clinical assessment will be done before and after hospitalization. After provi ding the same treatment protocol to all patients during the hospitalization, their health status and symptom will be assessed quarterly followed by one-year follow-up to evaluate any long-term impact of hospitalization. After the hospitalization phase, the severity of the symptoms will be assessed by means of Hamilton Rating Scale for depression and Anxiety. Secondly, suicidal behavior questionnaire will be distributed to each participant and they will be asked to give their response. This will help to observe suicide ideation post-hospitalization (Linehan et al., 2015). Ethics of research The ethical requirement in conducting the research will be met by taking ethical approval for the research from the Australian Institute of Applied Psychology Human Research Ethics Committee. This approval will reflects that the research process will follow the standards of ethical conduct as mentioned in the Australian Code for Responsible Conduct of Research. The permission or approval of research depicts that research process has been assessed on all level such as quality, safety, ethical responsibility, risk management and financial management (ACAP Research Ethics ACAP, 2017). Secondly, during the recruitment phase of research, participants will be included in the study only after taking written informed consent for the participants. This will mean informing participant about the purpose of study, any risk during the process, concealment of identity of participants and method of dissemination of study finding. The detail regarding the treatment protocol and interventions will a lso be provided to participants while taking informed consent. This will ensure that participants will voluntarily participate in the research based on relevant risk and benefits of the research for them. The main information given to participant will include purpose of research, expected duration, right to decline, reasonable foreseeable risk factors and limits of confidentiality (Kass et al., 2015). Steps taken to strengthen the credibility and generelisability of the findings The research is mainly concerned with identifying the long-term adverse impact of hospitalization on patients with BPD. Analysis of recent literature on the topic has propose little value of hospitalization on suicide ideation and depression in patients with BPD. Research studies have analyzed the impact of certain interventions in hospital setting, however there is lack of studies regarding the impact of hospitalization in people with BPD. To gain insight into the issues faced by patient after prolonged hospitalization and plan strategies to reduce the effect, the participant observation and clinical assessment is considered important for this research study. Furthermore, the credibility of the research will be enhanced by means of appropriate tool to assess the level of anxiety and suicide ideation among participants post-hospitalization period (Noble Smith, 2015). In this study, Hamilton Anxiety Rating Scale (HAM-A) will be used to measure the severity of anxiety level in participants post-hospitalization. This will enhance the credibility of the research data and findings as it is validated tool used to assess response of patient following an intervention or treatment. The score obtained from the HAM-A will help to evaluate the potential bad or good effect of prolonged hospitalization on management of symptoms of BPD (Thompson, 2015). This means of clinical assessment and collection of data related to anxiety and suicide ideation will enhance the richness of the data collected. Furthermore, the trustworthiness of the data will be increased by analyzing data through the data triangulation method. By this technique, the validation of the data will be enhanced through cross verification from two or more sources. In this research, the two approaches for understanding the phenomenon (adverse impact of hospitalization) include use of anxiety and su icide ideation tool as well as completing the Suicidal behavior questionnaire. By this multiple technique of assessment, the study finding can be cross-verified and any biasness or confounding factors in research can be readily identified. This technique will help to overcome the limitations of research, which is based on single-observation technique (Hussein, 2015). The credibility of the finding is also enhanced by maintaining consistency in research findings so that it can be readily understood and replicated by others. All this is dependent on method of inquiry, analysis and presentation of research finding. Integrity in this research will be maintained by recruitment of experienced clinical staff involved in dealing with BPD patients and other psychological disorder. This involvement of experienced staff in research will establish control over the data collection, data analysis and reporting of the research finding. As this research used observation method for data collection, the guidelines for reporting observational studies will be followed. It helped in reporting of data transparently so that readers and reviewers can easily follow the research process, study finding and the final conclusion of the research. The study finding will also be compared with other relevant research to analyze consistency level. This form of critical assessment and comparison with other research article will help to identify strength and weakness in study design and analysis. The use of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement checklist of items required for reporting observational studies will enhance the reporting process of studies (Von Elm et al., 2014). Grounded theory methodology is chosen for this research study to develop theory or approach regarding impact of hospitalization on BPD patients. The rigour in the grounded theory research can be developed by special consideration regarding this in the data collection phase. For this research study, the rigour and validity of the research is dependent on scores obtained for each participant in the Hamilton Anxiety Scale and the Hamilton Suicide Ideation Scale. Furthermore, the response that will be obtained from the Suicide Ideation Questionnaire will first be code and categorized into different concepts. Secondly, the emerging concepts obtained from participants response will be cross-checked by the score obtain from the clinical assessment tool for the study. Other research experts will be consulted for to make sampling and analytical decisions. This step will reflect the rigour in research as well as strengthen the credibility of the research study. This inductive-deductive process will lead to theory generation specific to the objective of the research (Cooney, 2011). Another aim of this research is to reduce the impact of hospitalization on BPD by suggestive effective inpatient intervention for this group. This is highly dependent on the level of severity found in participants post- hospitalization. To address the negative impact of hospitalization on BPD patient, it is suggested to include partial hospitalization in patients with severe psychotic symptoms and self-harm attempts. Furthermore, BPD patients can be provided therapy in residential setting. One example of an intervention that can be given outside the hospital include the Dialectical behavior therapy. This treatment consists of multiple components such as individual therapy, skills training and coping skills to achieve positive outcome for patients. The efficacy of this intervention for treatment of risk behavior in BPD has been proved by various research studies and it has revealed reduced rate of suicidal and self-injurious behavior in treatment groups. This intervention is increasin gly provided in community setting where patients are not restricted to the limits of the hospital and gets chance to do other activities. This promotes well-being and better results post the intervention (Linehan et al., 2015). The utility of dialectical behavior therapy in patient treatment of BPD patients has also been analysed by Bloom et al., (2012) and the researcher showed that it is effective in reducing symptoms related to BPD in inpatient setting. However, this involved variation in certain strategies of the intervention such as phone consultation was removed from treatment schedule. Secondly, duration of the treatment was changes according to the convenience of patient. 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