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4 results

  • Routine hospital management of self-harm and risk of further self-harm: propensity score analysis using record-based cohort data

  • S. Steeg, R. Emsley, M. Carr, J. Cooper, N. Kapur
  • Journal:
    Psychological Medicine / Volume 48 / Issue 2 / January 2018
    Published online by Cambridge University Press:
    22 June 2017, pp. 315-326
    • Article
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  • Background

    The care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm.

    Method

    Observational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation.

    Results

    Following PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80–0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort.

    Conclusions

    This study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.

  • Meeting standards set for non self-harm presentations to emergency departments

  • Diane Mullins, Siobhan MacHale, David Cotter
  • Journal:
    Irish Journal of Psychological Medicine / Volume 28 / Issue 4 / December 2011
    Published online by Cambridge University Press:
    13 June 2014, pp. 185-190
    Print publication:
    December 2011

  • Objectives: The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.

    Method: From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.

    Results: Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.

    Conclusions: The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.

  • 11 - Suicide and deliberate self-harm

  • from Part II - Common psychiatric problems across the general hospital
  • Edited by Geoffrey Lloyd, Priory Hospital, London, Elspeth Guthrie, University of Manchester
  • Book:
    Handbook of Liaison Psychiatry
    Published online:
    10 December 2009
    Print publication:
    24 May 2007, pp 245-269

  • Summary

    Suicide, as a term, appears easier to define, namely as a self-destructive behaviour with a fatal outcome. Deliberate self-harm (DSH) has been recognized as an increasing public health problem in many contemporary societies for some time. The link between DSH and suicide is a clear but complex one, with many of the factors associated with suicide also common to DSH. Several countries have implemented national suicide prevention strategies, including, for example, Finland, Norway, Australia, the USA and England. A key element of this strategy is the improved management of DSH patients presenting to general hospitals. This is discussed in this chapter, after consideration of the aetiology of suicide and DSH. All DSH patients should receive at least a brief psychosocial assessment, aimed at identifying those with severe mental illness, as well as those at risk of suicide or immediate repetition of DSH.