Previous research has found that subjective cognitive decline corresponds with assessed memory impairment and could even be predictive of neurocognitive impairment. The purpose of this study was to investigate whether a single self-report item of subjective cognitive decline corresponds with the results of a performance-based measure of episodic memory.

Older adults (n = 100; age 60-90) were given the single item measure of subjective cognitive decline developed by Verfaille et al. (2018).

Those who endorsed subjective cognitive decline (n = 68) had lower scores on the CVLT-II long delay free recall than those who did not endorse such a decline (n = 32). Additionally, older adults with a neurocognitive diagnosis believed their memory was becoming worse at a higher proportion than those without.

While a single item of subjective cognitive decline should not be substituted for a comprehensive evaluation of memory, the results suggest that it may have utility as a screening item.

We used data from Domestic Homicide Reviews (DHRs) to describe the patterns of mental health service use by perpetrators of domestic homicide in England and Wales. In 186 DHR reports we compared the characteristics of perpetrators who accessed mental health services with those of perpetrators who did not. Separate analyses were conducted for perpetrators of intimate partner homicide (IPH) and family homicide.

Over two-thirds (64.5%, n = 120) of the perpetrators had accessed mental healthcare before the homicide. Perpetrators of IPH who had used mental health services compared with those who had not were more likely to have a history of substance misuse, contact with the criminal justice system and a history of self-harm or suicide attempts.

Our findings support the need for health services, particularly mental health, addictions and primary care, to take an assertive role in the prevention of domestic violence and abuse by identifying patients who are potential perpetrators of domestic violence and abuse.

Primary care referrals received by secondary care services are vetted or triaged to pathways best suited for patients’ needs. If knowledge-based triaging is used by vetting clinicians, accuracy is required to avoid incorrect decisions being made. With limited evidence to support best practice, we aimed to evaluate consistency across vetting clinicians’ decisions and their agreement with a criterion decision.

Twenty-nine trained vetting clinicians (18 female) representative of pay grades independently triaged five musculoskeletal physiotherapy referral cases into one of 10 decisions using an internally developed triage tool. Agreement across clinicians’ decisions between and within cases was assessed using Fleiss’s kappa overall and within pay grade. Proportions of triage decisions consistent with criterion decisions were assessed using Cochran’s Q test.

Clinician agreement was fair for all cases (κ = 0.385) irrespective of pay grade but varied within clinical cases (κ = −0.014–0.786). Proportions of correct triage decisions were significantly different across cases [Q(4) = 33.80, P < 0.001] ranging from 17% to 83%.

Agreement and consistency in decisions were variable using the tool. Ensuring referrer information is accurate is vital, as is developing, automating and auditing standards for certain referrals with clear pathways. But we argue that variable vetting outcomes might represent healthy pathway abundance and should not simply be automated in response to perceived inefficiencies.

To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period.

Population-based study using data from the National Self-Harm Registry Ireland.

National hospital EDs.

Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019.

ED self-harm presentations.

Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60–69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007–2012), self-harm presentations were 7% higher compared to 2013–2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02–1.13, p = 0.01).

Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007–2012) had significantly higher rates of self-harm compared to subsequent years.

Studies consistently show that patients with prescription opioid use disorder (OUD) respond to buprenorphine treatment. Few studies have followed these patients in the long-term. Our longitudinal research has shown opioid abstinence to be associated most strongly with opioid agonist/partial agonist treatment. We also found that many patients used agonist treatment inconsistently; questions remain about the benefits of intermittent opioid agonist treatment.

We examined patients during the 3.5 years following their entry into a 3-month trial of treatment for prescription OUD. The current analysis compared opioid use outcomes among patients who reported receipt of agonist treatment consistently, inconsistently, or never.

This secondary analysis (N=309) of a U.S. multi-site randomized controlled trial of treatment for prescription OUD assessed variability in receiving opioid agonist treatment during the 3.5-year follow-up period, and the association between agonist treatment and opioid abstinence. Assessments were collected at months 18, 30, and 42 following treatment entry; patients were asked if they were currently taking agonist treatment and whether they had used other opioids in the previous month. Patients with only one follow-up assessment (n=29) were excluded from this analysis.

Most patients reported current opioid abstinence on at least one follow-up visit: 38% were always abstinent, 41% sometimes, and 21% never. Twenty-three percent always reported currently using agonist treatment, 26% sometimes, and 51% never. Patients consistently reporting agonist use were most likely to always be opioid-abstinent in the past month (69%), with 25% sometimes and 6% never abstinent. Patients who never reported agonist use were equally likely to be abstinent never (32%), sometimes (35%), and always (32%). Patients who sometimes reported receiving agonists were most likely to report abstinence sometimes (65%); 14% never reported abstinence, and 21% always did.

Those consistently receiving agonist treatment were more likely to always be opioid-abstinent (69%) than those sometimes (21%) or never (32%) receiving agonists. Those never receiving agonist treatment were more likely to never report opioid abstinence (32%) than were those sometimes (14%) or always (6%) receiving agonists. Interestingly, those who sometimes received agonists were more likely to be abstinent than those who never received agonists: those who sometimes received agonists were more likely to be abstinent sometimes than those who never received agonists (65% vs. 35%) and less likely to never be abstinent than were those who never received agonists (14% vs. 32%).

Receiving opioid agonist treatment has been shown to be associated with opioid abstinence during long-term follow-up. This study shows that even those who only inconsistently receive agonists are also likely to benefit.

R. Weiss Consultant of: Alkermes, M. Griffin: None Declared

Recovery from substance use disorder requires sustained effort and perseverance. Grit is a resilience factor that may be important for people in recovery. Little research has been conducted on grit in patients with substance use disorder, especially in a large and varied sample.

To examine the Short Grit Scale (Grit-S) in patients with substance use disorder, our aims were to analyze its psychometric properties and use demographic and clinical characteristics to predict variance in Grit-S scores.

In this study of patients in treatment for substance use disorder, participants completed the Grit-S and other self-report measures. The psychometric properties of the Grit-S were assessed in outpatients (N=94) and a hierarchical regression was used to predict Grit-S variance in inpatients (N=1238).

The Grit-S demonstrated good internal consistency (α=.75) and strong test-retest reliability (unadjusted r=.81, adjusted r=.79, p values<.001). The mean Grit-S score was 3.15, which was lower than other clinical samples reported in the literature. Regression modeling indicated a moderate, statistically significant association between demographic and clinical characteristics and Grit-S scores (R2=15.5%, p<.001).

Of particular interest, the positive factor of recovery protection showed the strongest association with grit of all the variables assessed. Hence the positive construct of grit was correlated with other positive constructs, as well as with risks. Longitudinal assessment of grit and substance use could measure the stability and clinical significance of grit throughout recovery.

M. Griffin: None Declared, R. Weiss Consultant of: Analgesic Solutions, WCG, & Alkermes, C. Trinh: None Declared