Does Clinical Management Improve Outcomes following Self-Harm? Results from the Multicentre Study of Self-Harm in England

Nav Kapur,Roger Webb,Helen Bergen,Jayne Cooper,Sarah Steeg,Matthew Haigh,Keith Hawton,Keith Waters,Jennifer Ness,Jerson Laks

doi:10.1371/journal.pone.0070434

Abstract

BackgroundEvidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice.AimsTo examine how the management that patients receive in hospital relates to subsequent outcome.MethodsWe identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford) over a 10 year period (2000 to 2009). We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up) and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics.Results35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs): Centre A 0.99 (0.90–1.09); Centre B 0.59 (0.48–0.74); Centre C 0.59 (0.52–0.68). There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas.ConclusionThese findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups.

Highlights

Self-harm is a major health problem internationally and a common cause of presentation to hospital [1]
Overall 21,099 (58.7%) index episodes resulted in a psychosocial assessment, 1,861 (5.2%) in admission to a psychiatric bed, and 8,912 (24.8%) in a referral for specialist mental health follow up
We found that in two centres (B and C), receiving a psychosocial assessment was associated with a 40% lower risk of repetition relative to non-assessment

Summary

Introduction

Self-harm is a major health problem internationally and a common cause of presentation to hospital [1]. A number of clinical guidelines have been published [2,3,4] the evidence-base to guide management is sparse. Levels of recruitment have been variable and research findings may not be generalisable to the whole population of individuals who come to the attention of services following self-harm. The treatments which hold some promise - for example, cognitive behavioural therapy, problem solving therapy and dialectic behaviour therapy [5] - are not widely available to individuals in routine healthcare settings [3]. Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice

Methods

Results

Conclusion