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: Whereas the standard KM analysis indicated that male patients had a higher likelihood of remaining well, the alternative method revealed that both sexes were similarly likely to remain well.
Abstract: Objectives: Time to first recurrence, as analyzed by the Kaplan–Meier (KM) survival analysis, is a commonly applied statistical method in psychiatric research. However, many psychiatric disorders are characterized not by a single event, but rather by recurrent events, such as multiple affective episodes. This study aims to demonstrate a method of survival analysis that takes multiple recurrences into account.
Methods: We examined data on sex differences in a sample of 181 patients undergoing prophylactic treatment with lithium or carbamazepine (serum level assayed) for bipolar disorder (ICD-10). The classical KM method was compared with an approach developed by Pena, Strawderman and Hollander (PSH) that uses recurrent event data to estimate survival function.
Results: The results obtained with the multiple events method differed considerably from those acquired using the standard KM analysis. When taking recurrent event data into account, the probability of remaining well was lower and survival times were longer. In addition, whereas the standard KM analysis indicated that male patients had a higher likelihood of remaining well, the alternative method revealed that both sexes were similarly likely to remain well.
Conclusions: Survival analysis techniques that take recurrent events into account are potentially important instruments for the study of psychiatric conditions characterized by multiple recurrences. In many cases, the standard KM analysis appears to provide only a rough approximation of the course of illness.
11 citations