| Summary: | Background: Research into the psychological effects of stroke has developed into understanding the fluidity of psychological adjustment rather than distinct diagnostic categories of mental health conditions. Research indicates the role of identity change after stroke, however this is yet to be explored in-depth. A handful of empirical studies also highlight the role social groups and identity in adjustment and quality of life after stroke. Purpose To synthesise qualitative studies on identity after stroke, from stroke survivors’ and caregivers’ perspectives. To develop the understanding of the role of social identity in post-stroke psychological adjustment. Methods A systematic search of qualitative studies in peer reviewed journals from January 2000 to March 2016 was undertaken. The CASP (Critical Appraisal Skills Programme) was used to appraise the quality of selected studies. A synthesis was conducted using a meta-ethnographic approach (Noblit & Hare, 1988). Themes relating to identity and self were analysed in the synthesis. Results 25 studies were included in the meta-ethnography. The results of these papers fell into two themes; Relationships with Self, and Social Relationships. The relationship between the themes was considered using Social Identity Theory, developing a new post-stroke self as an adjustment process. Conclusions This synthesis indicates the relationship between the self, social relationships and social identity post-stroke and highlights the role of these factors in adjustment to life and the ‘new self’ after stroke. This presents a new direction for research into identity after stroke, and needs further exploration to apply this knowledge to interventions after stroke. Main Research Project Abstract Background Recent research indicates the role of intrusive images in Bipolar Disorder (BP). It is hypothesised that imagery is an important internal state in BP (Holmes et al, 2008). This has not yet been compared to a non-clinical population. However, it is also thought that the type of internal state (whether imagery, verbal thoughts, heart rate) does not matter, but the extreme, conflicting appraisals attached to the internal state (Mansell et al, 2006) which results in difficulties in mood regulation in BP through using maladaptive emotional regulation strategies (e.g., rumination, suppression). Aims To investigate whether people with BP have more images in a positive mood state than non-clinical controls, and whether people with BP make extreme and conflicting appraisals of these images. To explore whether people with BP use more emotional regulation strategies in response to images. Methods A semi-structured interview was administered to 19 euthymic BP participants and compared to 17 non-clinical controls, requiring them to report intrusive images from a previous positive mood state, followed by questionnaires. Results BP participants experience significantly more intrusive images in a positive mood state than non-clinical controls, which was not explained by being a more ‘imagery based’ sample as there were no differences in trait use of imagery. BP participants make more extreme positive and negative appraisals of images than non-clinical controls. There were few differences in emotional regulation strategies between the groups, suggesting people with BP did not apply unhelpful emotional regulation strategies to these images. Conclusions These results further support both Holmes’ (2008) hypothesis that imagery is a key internal state in BP, and Mansell et al’s (2006) hypothesis that people with BP appraise the same internal state in conflicting ways. Future research should compare imagery to other internal states in BP to understand their relative importance. Service Improvement Project Abstract The aim of this study was to investigate current practice in managing suicidal ideation and prevention suicide attempts in older people’s services, and to consider ways of improving practice. This is in the light of an ageing population and differential presentations of risk between older and younger adults, although there are no known guidelines in the UK to specifically manage risk in older adults. Psychologists and Community Psychiatric Nurses with at least five years experience of working with older adults in mental health services contributed to focus groups. A thematic analysis was conducted, revealing a number of factors which influence risk management in older adults; sharing the burden, using a formulation driven approach, and clinician characteristics. A number of barriers were also highlighted. The findings informed recommendations, including ways to improve team management of high risk older adults, at a time of working in ageless services.
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