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ANNEX J: GLOSSARY
Glossary of terms used in the review
Attempted suicide
As reviewers we have little choice but to assume that authors of research papers will take the term 'attempted suicide' to refer to any intentional act of self-harm or self-injury where the individual had a strong subjective intent to end their own life. However, in practice the term may have been used in a number of ways by different authors and, except in the rare instances where authors have defined their terminology more closely, we are ultimately reliant on their subjective interpretation of the term as it is used in their writings.
Boolean search
Boolean searching enables the researcher to narrow down a search by using special terms (called logical operators) before keywords. Examples of these terms are OR, AND and NOT. Boolean logic defines a logical relationship among search terms which means that a more specific search can be conducted that is likely to produce more relevant results.
Cognitive Behaviour Therapy ( CBT)
Cognitive behaviour therapy ( CBT) is a combination of psychotherapy and behavioural therapy. It includes several related approaches which are all aimed at solving life problems. CBT has been applied to a wide variety of problems, from anxiety and depression to relationship difficulties and substance abuse. By focusing on an individual's cognitive processes (such as their thoughts, images, beliefs and attitudes) and the way these relate to behaviour, CBT helps people to change their attitudes and behaviour and so deal more effectively with emotional problems.
Cohort study
This refers to a study in which patients with a specific condition or characteristic or who receive a particular treatment, are followed-up over a period of time and (usually) compared with another group who do not have the condition, characteristic or treatment. A prospective cohort study defines the groups before the study is conducted whereas a retrospective cohort design makes the grouping after data collection.
Cost-neutral
An intervention that costs no more than 'treatment as usual' is taken to be cost neutral.
Dialectical behaviour therapy ( DBT)
DBT is a modification of Cognitive Behaviour Therapy ( CBT), having both behavioural and cognitive therapy elements. It was developed by Marsha M. Linehan specifically to treat individuals with borderline personality disorder who were prone to self-harm, though it has been used for people with other diagnoses as well. It includes a strong emphasis on acceptance of the person as they are, combined with the expectation that current behaviours need to change. The tension that arises between this need for both acceptance and change is known as a dialectical tension, dialectics referring to finding the middle ground between two opposites.
Effectiveness and efficacy
It is common to distinguish between the efficacy and the effectiveness of an intervention. The debate about efficacy and effectiveness concerns the discrepancy between the results of randomised controlled clinical trials and the more pragmatic evaluation of treatment and practice as they occur in the clinical setting. Efficacy trials are intended to determine whether an intervention produces the expected result under ideal circumstances, whereas effectiveness studies measure the degree of beneficial effect under 'real world' clinical settings. Efficacy is high on internal validity but low on generalisability, whereas effectiveness is high on external validity but low on careful controls. The point at issue in this debate is what constitutes the best evidence for clinical decisions. Although effective health care delivery should be based on the highest level of proof of efficacy for every therapy, we may be denying patients the benefit of potentially valuable and cost-effective treatments if we ignore effectiveness.
Intention to treat analysis
In the analysis of randomised controlled trials intention to treat ( ITT) analysis is based on the initial treatment intent, not on the actual treatment administered. So, as in real life, some patients will not receive their full treatment even though that was the initial intention. Nevertheless, all patients who have been randomly assigned to one of the treatment arms will be included in the analysis, regardless of whether or not they completed or received that treatment. Why the patient did not receive the treatment is of no relevance to ITT.
Manual-assisted CBT
Cognitive behaviour therapy is frequently delivered through one-to-one sessions with a therapist. However, use of a self-help treatment manual instead of this person-to-person approach has become more common in recent years and is known as manual-assisted CBT. A development from this is use of interactive CD-Rom programmes and other self-help software packages, which may be preferred by some. These approaches are likely to be more cost-effective than therapist-based CBT though research is yet to demonstrate how effective they are.
Meta-analysis
Meta-analysis is widely used in epidemiology and evidence-based medicine today. It is a form of quantitative systematic review, a statistical technique for combining the findings of several independent studies that address a set of related research hypotheses. The approach is frequently used to assess the clinical effectiveness of healthcare interventions by combining data from two or more randomised controlled trials. It provides an averaged estimate of treatment effect, weighting the role of individual studies in the analysis according to their sample size and other design characteristics.
Non-directive therapy
Client-centred Rogerian therapy is a form of non-directive therapy. The non-directive approach starts from the individual client and the therapist does not structure the session or direct the client. Instead, the therapist waits to see whatever emerges, reflecting back to the client what they say and sometimes restating the client's comments.
Non-interventionist approaches
An approach that involves no proactive intervention can be said to be non-interventionist. It refers to a situation where a purposefully non-directive, solely listening, stance is adopted by the therapist or counsellor.
Randomised controlled trial ( RCT)
Randomised controlled trials are generally considered to be the most rigorous method of determining whether a causal relationship exists between a given treatment and a specific outcome. These studies are experimental. The researcher randomly assigns subjects or other units of study, such as hospital wards or clinics, into groups. These groups should be identical except for the fact that they either receive or do not receive the intervention(s) under consideration. Where it is feasible and appropriate the study is designed so that patients and researchers remain unaware of which treatment was given to which individual subject until the study is completed - a procedure known as double blinding. The results are analysed by comparing outcomes in the groups, regardless of whether they experienced the intended intervention (known as intention to treat analysis).
Rogerian therapy
Rogerian therapy is also known as Person-Centred Therapy and Client-centred therapy. It was developed by the humanist psychologist Carl Rogers in the 1940s and 1950s and is founded on empathy, which he viewed as healing in itself. The client is encouraged to express their feelings within an environment of empathy, unconditional positive regard and acceptance. The therapist does not suggest how the person might wish to change, but by listening and then mirroring back what the client reveals to them, helps them to explore and understand their feelings for themselves. They are then able to decide what kind of changes they would like to make and can achieve personal growth.
Self-harm
As with the term 'attempted suicide', as reviewers we have little choice but to assume that authors of research papers will have some shared element of meaning around this term referring to self-poisoning or self-injury, irrespective of the apparent purpose of the act. However, in practice the term may have been used in a number of ways by different authors and, except in the rare instances where authors have defined their terminology more closely, we are ultimately reliant on their subjective interpretation of the term as it is used in their writings.
Sensitivity and specificity
Sensitivity and specificity are the most widely-used statistics to describe a medical diagnostic test. When a test is imperfect, a balance is sought between sensitivity and specificity, where sensitivity refers to the proportion of people with a disease who have a positive test result and specificity refers to the proportion of people without disease who have a negative test result. This idea has been borrowed by systematic reviewers so, in the context of citation searching in a systematic review, a restriction term string is developed to identify material relating specifically to the characteristic of interest which, in the present case, is interventions to prevent suicide. The aim is to increase the sensitivity of the full search term without reducing the specificity of the search in identifying relevant material.
Suicidal behaviour
This term applies to any behaviour that could in principle lead to completed suicide, regardless of whether this is the intention of the individual. This includes behaviours that could be considered to be acts of attempted suicide as well as any behaviour that contains an element of self-harm or self-injury. Suicidal behaviour therefore relates not only to actions where the individual intentionally self-injured with the aim of completing suicide, but also to other self-injurious acts not intended to result in death. The actual death or survival of the person concerned is not the point at issue.
Suicidal ideation
Any thoughts an individual may have of taking their own life are considered to be suicidal ideation. This remains true whether or not the thoughts include a plan to complete suicide.
Treatment-as-usual
Often referred to by the shortened form ' TAU', treatment that would usually be given in an everyday non-research clinical context is known as treatment-as-usual. TAU is commonly compared with treatment or procedures that have been specifically given as part of an experimental research study.
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