Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury
TL;DR: Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned, and attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.
Abstract: Background
Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.
Aims
We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.
Method
Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10 498 consecutive episodes of self-harm at six English teaching hospitals.
Results
Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning ( P <0.001). Of those who repeated, a third switched method of self-harm.
Conclusions
Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.
Citations
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TL;DR: What self-harm research can tell us about the concept of NSSI is considered and the potential pitfalls of introducing N SSI into clinical practice are examined.
Abstract: Non-suicidal self-injury (NSSI) is a term that is becoming popular especially in North America and it has been proposed as a new diagnosis in DSM-5. In this paper we consider what self-harm research can tell us about the concept of NSSI and examine the potential pitfalls of introducing NSSI into clinical practice.
322 citations
TL;DR: There was a significant treatment effect for CBT-based psychotherapy compared to TAU at final follow-up in terms of fewer participants repeating SH, but for interventions typically delivered to individuals with a history of multiple episodes of SH/probable personality disorder, group-based emotion-regulation psychotherapy and mentalisation were associated with significantly reduced repetition.
Abstract: Background: Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm.
Objectives: To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH.
Search methods: The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date).
Selection criteria: We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent (within six months) episode of SH resulting in presentation to clinical services.
Data collection and analysis: We used Cochrane's standard methodological procedures.
230 citations
TL;DR: This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH and finds that mentalisation therapy was associated with fewer adolescents scoring above the cut-off for repetition of SH based on the Risk-Taking and Self-Harm Inventory 12 months post-intervention.
Abstract: Self-harm (SH; intentional self-poisoning or self-injury) is common in children and adolescents, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for SH published in 1998 and updated in 1999. We have
215 citations
TL;DR: A substantial increase in self-injury occurred in the latter part of the study period, especially marked for self-cutting/stabbing and hanging/asphyxiation.
Abstract: Objectives Self-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000–2012. Design and setting This observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients). Participants During 2000–2012, there were 84 378 self-harm episodes (58.6% by females), involving 47 048 persons. Results Rates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, p Conclusions Trends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients still do not receive psychosocial assessment, especially those who self-injure.
180 citations
Cites result from "Hospital care and repetition follow..."
...The increase in self-cutting is also concerning given our earlier finding that the proportion of patients who receive psychosocial assessment is especially low for individuals who self-cut.(28) The increase in other methods of self-injury, especially hanging/asphyxiation, is also worrying....
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TL;DR: It is difficult to find predictors for repetition of nonfatal suicide attempts, and even more difficult to identify predictors of completed suicide.
Abstract: OBJECTIVES: This review aimed to identify the evidence for predictors of repetition of suicide attempts, and more specifically for subsequent completed suicide. METHODS: We conducted a literature search of PubMed and Embase between January 1, 1991 and December 31, 2009, and we excluded studies investigating only special populations (eg, male and female only, children and adolescents, elderly, a specific psychiatric disorder) and studies with sample size fewer than 50 patients. RESULTS: The strongest predictor of a repeated attempt is a previous attempt, followed by being a victim of sexual abuse, poor global functioning, having a psychiatric disorder, being on psychiatric treatment, depression, anxiety, and alcohol abuse or dependence. For other variables examined (Caucasian ethnicity, having a criminal record, having any mood disorders, bad family environment, and impulsivity) there are indications for a putative correlation as well. For completed suicide, the strongest predictors are older age, suicide ideation, and history of suicide attempt. Living alone, male sex, and alcohol abuse are weakly predictive with a positive correlation (but sustained by very scarce data) for poor impulsivity and a somatic diagnosis. CONCLUSION: It is difficult to find predictors for repetition of nonfatal suicide attempts, and even more difficult to identify predictors of completed suicide. Suicide ideation and alcohol or substance abuse/dependence, which are, along with depression, the most consistent predictors for initial nonfatal attempt and suicide, are not consistently reported to be very strong predictors for nonfatal repetition. Language: en
173 citations
References
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TL;DR: There was much cross over in the methods of DSH used and that cutters were not a distinguishable group, therefore, those who present to mental health services with cutting need to be treated as carrying significant risk of fatality.
Abstract: This article explores the issue of cutting among children and adolescents presenting to an outpatient child and adolescent mental health service in New Zealand. Of interest is the extent to which children and adolescents who cut themselves also carry out other forms of deliberate self-harm (DSH). This study found that there was much cross over in the methods of DSH used and that cutters were not a distinguishable group. Therefore, those who present to mental health services with cutting need to be treated as carrying significant risk of fatality.
27 citations
TL;DR: Older people who undertake self‐harm are at higher suicide risk than are younger patients and this study examines whether this greater risk is reflected in the assessment and after‐care that older patients receive when they attend accident and emergency.
Abstract: OBJECTIVE: Older people who undertake self-harm are at higher suicide risk than are younger patients. This study examines whether this greater risk is reflected in the assessment and after-care that older patients receive when they attend accident and emergency. METHOD: This cross-sectional study, set in the two accident and emergency departments in a large industrial city in Northern England, compared 141 consecutive attendances due to self-harm among older patients (aged 55 years and over) with a random sample of 125 attendances of younger people (aged 15-54) attending because of self-harm. Data were drawn from accident and emergency records and from psychiatric and general hospital casenotes. RESULTS: Compared with the younger group, older patients were significantly more likely to be admitted from accident and emergency to the general hospital, to receive a specialist assessment whilst at the hospital, and to be offered psychiatric after-care-either as a psychiatric in-patient or an out-patient. CONCLUSIONS: Fortunately, older people attending accident and emergency following self-harm seemed likely to receive psychosocial assessment from a mental health specialist, and they were much more likely than younger patients to be offered after-care. Hospitals will need to monitor accident and emergency and other records if they are to check that their services are responding to the high risks seen in older patients. Language: en
23 citations
TL;DR: The content of the new national strategy for suicide prevention in England is examined and what new contributions it may make and what revisions and updates of the national strategy should be made regularly are examined.
Abstract: Over the last decade an increasing number of countries have established national strategies for suicide prevention. In the autumn of 2002 the suicide prevention strategy for England was presented to the general public, introducing what could be called a second generation of national programs for suicide prevention. This strategy uses evidence-based criteria for its priorities more systematically than before. Furthermore, it has put an increased emphasis on goals being specific, preventive measures being practical, and the preventive potential being visible. Other guiding principles for this strategy are that suicide preventive measures and initiatives should be open to monitoring and evaluation, and that revisions and updates of the national strategy should be made regularly--thus constituting an evolving strategy. This paper examines the content of the new national strategy for suicide prevention in England and what new contributions to the field it may make.
22 citations
TL;DR: The nation’s first coordinated suicide prevention strategy, a broad public health–oriented plan that calls for increased awareness, reduced stigma associated with mental health care, and a host of new community-based programs, prominently mentions primary care and emergency medicine physicians.
Abstract: WASHINGTON—Each year, some 30000 people in the United States take their own lives and another 650 000 attempt to do so. To reduce these losses, Surgeon General David Satcher, MD, PhD, recently released the nation’s first coordinated suicide prevention strategy, a broad public health–oriented plan that calls for increased awareness, reduced stigma associated with mental health care, and a host of new community-based programs. The plan also prominently mentions primary care and emergency medicine physicians, as well as other health care professionals such as nursing home staff, recommending that they keep a more watchful eye out for symptoms that precede a suicide attempt. “The vast majority [of those who commit suicide] have a diagnosable mental health or substance abuse disorder,” said Satcher, adding that suicide screening and depression treatment need to be better integrated into primary care.
20 citations