Assessment Of Self-harm Research Articles

Biases in the evaluation of self-harm in patients with disability due to spinal cord injury.

Suicide is a global problem and accurate assessment of risk for self-harm is critical. Even morally principled clinicians can manifest bias when assessing self-harm in patients with physical disabilities such as spinal cord injury (SCI). Assessment of self-harm is an obligation for health care clinicians and overestimating or underestimating risk may undermine a patient's trust in their care, possibly leading to less engagement, increased apathy about having an interest in living, and less adherence to healthy treatment options. Introduces readers to three biases that can impact decision-making regarding a patient with a disability when assessing the patient's risk for self-harm: (1) ineffectual bias, (2) fragile friendliness bias, and (3) catastrophe bias. These preconceptions are derived from a mix of paternalism, projection, low expectations, pity, and infantilization. In this paper, we explain how each bias can affect clinical decision-making regarding diagnosis, treatment, prognosis, and prevention for patients with SCI within a common case scenario. Readers can employ personal reflection and potential self-application when they encounter individuals with SCI in and outside clinical settings. Unchecked biases toward the disabled and patients with SCI can undermine ethical caregiving. Biases are habits of mind and thoughtful clinical and education interventions can improve clinical practice. The literature on health care bias with other minority groups is instructive for investigating biases related to patients with disabilities, and especially for clinicians outside of rehabilitation medicine.

Emergency Department Visits Attributed to Adverse Events Involving Benzodiazepines, 2016–2017

Characterization of emergency department visits attributed to adverse events involving benzodiazepines can be used to guide preventive interventions. This study describes U.S. emergency department visits attributed to adverse events involving benzodiazepines by intent, patient characteristics, and clinical manifestations. Data from the 2016-2017 National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were analyzed in 2019 to calculate estimated annual numbers and rates of emergency department visits attributed to adverse events involving benzodiazepines, by intent of benzodiazepine use. Based on 6,148 cases, there were an estimated 212,770 (95% CI=167,163, 258,377) emergency department visits annually attributed to adverse events involving benzodiazepines. More than half were visits involving nonmedical use of benzodiazepines (119,008; 55.9%, 95% CI=50.0%, 61.9%), one third were visits involving self-harm with benzodiazepines (64,721; 30.4%, 95% CI=25.6%, 35.2%), and a smaller proportion of visits involved therapeutic use of benzodiazepines (29,041; 13.6%, 95% CI=11.4%, 15.9%). The estimated population rate of visits was highest for nonmedical use of benzodiazepines by patients aged 15-34 years (7.4 visits per 10,000 people). Among visits involving nonmedical use of benzodiazepines, 54.8% (95% CI=49.8%, 59.8%) were made by patients aged 15-34 years, 82.7% (95% CI=80.1%, 85.4%) involved concurrent use of other substances (illicit drugs, alcohol, prescription opioids, and/or other pharmaceuticals), and 24.2% (95% CI=17.7%, 30.6%) involved cardiorespiratory arrest or unresponsiveness. These findings support recommendations to assess for and address substance use disorder before initiating or continuing benzodiazepines and reinforce the need for validated self-harm risk assessment tools for clinicians.

Incidence and general hospital costs of self-harm across England: estimates based on the multicentre study of self-harm.

The aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England. We used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England. There were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40-49 years (30%) for men and 19-29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8-140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results. The results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm.

Adolescent self-harm: think before prescribing.

SUMMARYThe assessment of self-harm in adolescence should include identifying medical complications and any underlying psychiatric conditionsChanges in the frequency, type, and severity of self-harm can signify increasing suicidality and progression towards lethal action. As 30% of adolescent self-harm involves an overdose of prescription drugs, prescribing limited quantities and having the parents hold the supply can decrease this riskIndividual psychological therapies are first line. They can be combined with school and parental involvementThere is very little evidence supporting the use of psychotropic drugs for treating adolescent self-harm

Mediating and moderating variables in the prediction of self-harm in young people: A systematic review of prospective longitudinal studies.

Self-harm is widespread amongst young people. A growing body of research has explored factors that predict self-harm in young people, however, a systematic review of mediators and moderators of those factors has not yet been offered. This review aims to fill this gap by synthesising research about mediators and moderators of factors that prospectively predict self-harm in young people. A systematic review of research trials published up until 2018 was undertaken. Electronic databases Scopus (Elsevier), CINAHL, PsychINFO (EBSCO) and Medline were searched. Included studies utilised prospective longitudinal designs with participants aged 25 years or younger and self-harm outcome measures with published or reported psychometric properties. The aim of the review was to identify mediators and moderators of factors that predict self-harm in young people. Of the 25 studies that met inclusion criteria, 22 reported at least one positive finding of a mediator or moderator. Specifically, 15 significant mediators and 20 significant moderators were identified in relation to a broad range of predictors of self-harm. Predictors were classified as adverse childhood experiences and parenting factors, psychological and psychiatric factors, social factors and intrapersonal factors. A number of potentially modifiable mediators and moderators were identified including interpersonal difficulties, impulsivity, self-esteem and self-compassion. Gender was the most commonly reported moderator. Included studies were assessed as limited by the heterogeneity of the mediators and moderators assessed, and by methodological factors including study durations, population characteristics, and the definition and assessment of self-harm. In addition, replication research was limited. Therefore it was difficult to integrate results and draw firm conclusions. This review allowed us to explore diverse relationships between factors predictive of self-harm in young people and to identify a number of potentially modifiable mediators and moderators. Our findings have important implications for future research and treatment efforts as the identification of mediators and moderators is demonstrated to assist in identifying high risk individuals as well informing potential targets for treatment.

Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review.

There are increasing numbers of children presenting to paediatric hospital settings in mental health crisis. Typically, non-mental health professionals are responsible for the initial assessment of these children and are required to identify immediate physical and emotional health needs. To ensure the safety of these children, immediate risk of suicide and self-harm should be assessed. However, no standardized assessment tool is used in clinical practice, and for those tools that are used, their validity and reliability is unclear. A scoping review was conducted to identify the existing assessment tools of immediate self-harm and suicide risk. Searches of electronic databases and relevant reference lists were undertaken. Twenty-two tools were identified and most assessed acute risk of suicide with only four tools incorporating a self-harm assessment. The tools varied in number of items (4-146), subscales (0-11) and total scores (16-192). Half incorporated Likert-type scales, and most were completed via self-report. Many tools were subject to limited psychometric testing, and no single tool was valid or reliable for use with children presenting in mental health crisis to non-mental health settings. As such, a clinically appropriate, valid and reliable tool that assesses immediate risk of self-harm and suicide in paediatric settings should be developed.

Do scores on the HCR-20 and FAM predict frequency of self-harm in females within a secure psychiatric hospital?

The Historical, Clinical, and Risk Management scales (HCR-20) and the Female Additional Manual (FAM) are violence risk assessment tools. This study aimed to examine whether scores on the HCR-20 and FAM are related to frequency of self-harm. HCR-20 Version 3 and FAM scores and frequency of self-harm across the following year were examined for 89 female patients within a secure psychiatric hospital. The results showed that higher mean total scores on the HCR-20, and also on the Historical and Clinical scales were associated with more frequent self-harm, both with and without the FAM items. The Risk Management scale was not associated. Eight individual items were positively associated with self-harm, and one was negatively associated. The final risk judgement for self-destructive behaviour was also positively associated with self-harm. The HCR-20 and FAM are useful tools for assessing risk of self-harm, particularly the Historical and Clinical scales. However, not all items are independently associated with more frequent self-harm. Final risk judgements are also an accurate indicator of frequency of self-harm, and therefore the process of completing the HCR-20 and FAM may aid accurate self-harm risk assessment.

Systematic Review and Quality Appraisal of Practice Guidelines for Self-Harm in Children and Adolescents.

This study aimed to systematically identify and appraise clinical practice guidelines (CPGs) relating to the assessment and management of suicide risk and self-harm in children and adolescents. Our research question is as follows: For young people (under 18years old) presenting to clinical care with suicide ideation or a history of self-harm, what is the quality of up-to-date CPGs? Using the PRISMA format, we systematically identified CPGs meeting our inclusion and exclusion criteria. Subsequently, two independent raters conducted appraisals of the eligible CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. CPGs were then classified as "poor quality," "minimum quality," and "high quality" using operationally defined criteria developed a priori. We identified 10 eligible CPGs published or renewed between 2005 and May 2017. Only the long-term management of self-harm CPGs produced by the National Institute for Health and Care Excellence met "high-quality" criteria. Despite multiple options of CPGs published to choose from, only one was identified as "high quality," where bias is adequately minimized. Clinicians are advised to direct resources to implementing the "high-quality" CPG.

Children and Young People-Mental Health Safety Assessment Tool (CYP-MH SAT) study: Protocol for the development and psychometric evaluation of an assessment tool to identify immediate risk of self-harm and suicide in children and young people (10–19 years) in acute paediatric hospital settings

IntroductionCurrently, no standardised, evidence-based assessment tool for assessing immediate self-harm and suicide in acute paediatric inpatient settings exists.AimThe aim of this study is to develop and test the psychometric properties...

Assessment and Management of Self Harm in Emergency Departments in Ireland: The National Clinical Programme

In 2014, more than 11,000 people came to Irish general hospital Emergency Departments following self-harm. It is known that up to 15% of patients who present following self-harm leave the Emergency Department (ED) without a bio-psycho-social (BPS) assessment of risk and need, and 17% will repeat their self-harm act within 3 months.Self-harm is the single biggest risk factor for completed suicide, increasing the risk of suicide 40-fold, as compared to the general population. Suicide is now the commonest cause of death for young men (aged 15-24 years) and middle aged men (45-54 years). Alcohol consumption is implicated in more than 37% of cases of self-harm and half of those who die by suicide have had a history of alcohol abuse in the final year of their lives.Diversity with regard to assessment procedures and management in health settings, as well as feedback from families bereaved by suicide, have led to repeated calls for the development and resourcing of an effective response for people who present to health services having engaged in self-harm.The aim of this National Clinical Care Programme (NCP) for the Assessment and Management of Patients Presenting to Emergency Departments following Self-harm is to develop a standardised and effective process for the assessment and management of individuals of all age ranges, including children, adolescents, adults and older adults, who present with self-harm to ED.It refers to the mental health/bio-psycho-social assessment and initial management of both risk and need following self-harm, in the acute hospital Emergency Department, from time of presentation to discharge.This NCP requires that all patients presenting to ED with self-harm (including suicidal ideation and intent) receive standardised triage, bio-psycho-social assessment and assertive follow up by skilled clinicians.Family/carers will be included in the assessment and follow up process. The quality of the programme will be monitored through a set of key metrics.The objectives of this programme are to:- Improve the assessment and management of all individuals who present to ED with self-harm- Improve access to appropriate interventions at times of personal crisis- Ensure rapid and timely linkage to appropriate follow-up care- Optimise the experience of families and carers in trying to support those who present with self-harm.The Clinical Programme started in December 2014 and has now been implemented in 16 of the targeted 21 hospitals in Ireland with 24 hour EDs. This was done by the deployment of Mental Health Clinical Nurse Specialists to the Emergency Departments. As well as assessment, their role has included on-site training for non-mental health ED staff to improve integrated care. Data reflecting the objectives of the Clinical Programme has been collected and will be presented and discussed.

Rating scale item assessment of self-harm in postpartum women: a cross-sectional analysis.

We examined the utility of screening instruments to identify risk factors for suicidal ideation (SI) in a population of women with neuropsychiatric illnesses at high risk for postpartum depression. Pregnant women with neuropsychiatric illness enrolled prior to 20weeks of gestation. Follow-up visits at 4-8-week intervals through 13weeks postpartum included assessment of depressive symptoms with both clinician and self-rated scales. A total of 842 women were included in the study. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period.

P141 Management of sexual assault in a nurse-delivered sexual health service

IntroductionComparing April 2014 to March 2015 with the same period in 2013–14, has seen an increase of 32% in the number of serious sexual offences reported to Police in our county.We audited management of complainants of sexual assault attending our nurse-delivered sexual health service against BASHH auditable outcome measures (guidelines 2011) and other factors relevant to improving the quality of sexual assault aftercare offered.MethodsRetrospective study November 2014 to November 2015.50 case notes were identified from two sites within our service – 23 from Site1 and 27 Site2. In addition to BASHH auditable outcomes, we included data such as: Time from assault to attendance, History of previous assault, Disclosure at time of attendance, Police report at attendance & Attitude to reporting at end of consultation, documentation of follow up plan re medical and psychosocial support/referrals.Results33/50 (66%) complainants were <25 years. Nearly 40% attended within the first 7 days, half of these within 3 days, 35/50 (70%) within 6 weeks of assault. Compliance with BASHH outcomes reached 100% in baseline STI screening and documentation of child protection needs, 84-92% for essential history components, 90% Hepatitis B offer, 79% Emergency contraception, 74% FME and 70% PEP offer. Self-harm assessment 76%. Documentation of physical injury 20% and offer of prophylactic antibiotics 2%.DiscussionWe have re-designed our proforma to more readily capture poorly documented information. A review use of skill mix, training updates regarding forensic time scales/pathways for early intervention were undertaken, with algorithms included in updated proforma.

Oral Ketamine in Treatment-Resistant Depression: A Clinical Effectiveness Case Series.

PurposeThe aim of the study was to assess the effectiveness, tolerability, and safety of oral ketamine as an antidepressant treatment in adults with treatment-resistant depression.MethodsWe reviewed retrospective data on 22 patients with treatment-resistant depression, who failed at least 3 adequate antidepressant treatment trials and 1 adequate trial of repetitive transcranial magnetic stimulation; subsequently, they received open-label treatment with oral ketamine, commenced at a dose of 50 mg every 3 days, titrated up by 25 mg every 3 days, according to response and tolerability. The primary outcome measure was the Beck Depression Inventory II, which was used to rate subjective mood improvement at baseline and then at each follow-up visit. Data about adverse effects related to ketamine and a self-harm risk assessment were also obtained.FindingsOver the course of treatment, 18% of the patients showed greater than 50% reduction in the Beck Depression Inventory II scores, 14% reported partial improvement in mood symptoms, while 45% had no response to ketamine and 23% showed a mild worsening in their depressive symptoms. The most frequent adverse effects were acute dissociation, dizziness, blurred vision, numbness and sedation. Neither serious adverse effects, nor any cases of abuse or dependence were observed.ConclusionsAlthough this case series found oral ketamine to be safe and well tolerated, the findings also showed rather modest effectiveness of oral ketamine in treatment-resistant depression, with only approximately 30% reporting some benefit and approximately 70% reporting no change or worsening of mood. However, bearing in mind the limitations of this small, open-label case series, further exploration of the effectiveness of oral ketamine is warranted.

Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study.

Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances. Baseline surveys with 1309 adults within 6weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression. During 4691 person-years of follow-up (median 3.86years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances. Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.

Sleep problems among adolescents: is there a relation with deliberate self-harm and aggression?

Background Adequate sleep during adolescence is important for healthy development and proper daytime functioning. Sleep problems are commonly reported in adolescents, with an estimated prevalence between 17 and 45%. Besides, adolescence period is usually associated with various behavioral problems such as aggression and self-harm. Aims The aim of this study was to evaluate sleep habits and the presence of sleep problems in an Egyptian adolescent sample. Moreover, this study aimed to examine the presence of a relationship between sleep problems and the development of aggression and self-harm among those adolescents. Patients and methods A total of 117 adolescents in the preparatory stage participated in this study. Three self-report questionnaires were used, Child and Adolescent Sleep Checklist, the Deliberate Self-Harm Inventory, and the Aggression Scale, for students for assessment of sleep problems, deliberate self-harm (DSH), and aggression, respectively, among those adolescents. Results A total of 117 adolescents, 51 (43.6%) male and 66 (56.4%) female, participated in this study; their mean age was 13.85±0.81 years. Bedtime problems and daytime problems are more common among adolescents, with higher scores (8.10±3.99 and 6.56±3.61, respectively). Of those, 36 (30.8%) adolescents had a score of 18 or more, and so they were considered to have sleep problems. The participated adolescents had score ranging from 3 to 38 in the Aggression Scale, with a mean±SD of 12.36±8.32. A total of 24 (20.5%) adolescents had engaged in self-harm according to the Deliberate Self-Harm Inventory. Moreover, a significant positive correlation (P Conclusion Bedtime problems and daytime problems were common among the participated adolescents. Moreover, DSH and aggressive behaviors were reported. This study provides evidence that there is a strong relationship between sleep problems and both DSH and aggressive behaviors among those adolescents. Early detection, diagnosis, and treatment of sleep problems and promoting sleep hygiene will, undoubtedly, improve adolescents’ daily functioning and will have good impact on controlling these annoying behavioral problems.

Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study.

Background:There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm.Methods:A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773).Results:Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors.Conclusion:There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

Suicide and self-harm related internet use in patients presenting to hospital with self-harm: a cross-sectional study

BackgroundEvidence that the internet might be being used in planning suicidal acts, promoting suicidal behaviour, and accessing help, adds a new dimension to suicide prevention. Yet research into the frequency and type of internet use before suicide is lacking. We investigated self-harm related to internet use among patients who presented to hospital with self-harm. MethodsData on self-harm presentations to the emergency departments of an adult hospital (Jan 1, 2013, to Dec 31, 2015) and a children's hospital (Sept 1, 2013, to Nov 30, 2015) in a large city in the South West of England were obtained from a local self-harm surveillance register. Patients who had psychosocial assessments (65% of adult and 82% of children's hospital presentations) were asked during the assessment about internet use associated with their presentation. Beck Suicide Intent (BSI) scale was used to assess suicidal intent. Multivariable logistic regression models were performed to investigate the association between internet use and sociodemographic characteristics, clinical characteristics, and repeat presentation within 6 months. The self-harm register has ethics approval. Findings1192 first presentations to the adult hospital (mean age 35 years, SD 14·7) and 312 to the children's hospital (14, 1·1) had data recorded about internet use, age, and sex. Prevalence of self-harm related to internet use was 8·4% (n=100) among adult presentations (8·9% men, 8·0% women) and 26·0% (n=81) among children's presentations (26·3% boys, 25·9% girls). In both samples, self-harm related to internet use was associated with high intent (BSI >8) (odds ratio for adults 2·6, 95% CI 1·6–4·4; children 2·0, 0·9–4·3) but not repeat presentation (0·9, 0·5–1·8; 0·6, 0·2–1·3). InterpretationThe findings indicate that self-harm related to internet use is likely to become increasingly relevant as the internet-native generation matures and might be a proxy marker for intent. The inclusion of questions about internet use in clinical self-harm assessments could provide an alternative means by which to explore complex issues. More generally, assessments may require updating in light of technological advancements. However, further research, which differentiates between types of internet use and explores the impact of asking about internet use, is necessary. FundingNone.

P148 An audit on management of aftercare for victims of sexual assault attending a dedicated aftercare clinic

Background/introduction A dedicated sexual assault aftercare clinic was set up at the integrated sexual health service to provide care for the victims of sexual assault. British Association for Sexual Health and HIV (BASHH) guidelines provide auditable measures to compare standard of care provided by services. We wanted to assess and improve the service offered to victims by the dedicated clinic. Aim(s)/objectives To evaluate current clinical practice in the management of victims of sexual assault against the auditable outcome measures in the guidelines and improve the quality of care provided by communicating the findings, recommendations and action plans to team members. Methods Retrospective review of all victims who attended the clinic between January 2015 and 31st September 2015 was performed. Cases were identified from coding used in the clinic. A standard data collection sheet developed on the basis of the BASHH guidelines was used. Results Of the 53 victims identified, 96% were women, 83% were white, 13% were alcohol/drug related and 25% were under 18 years of age. 57% were referred by the sexual assault referral centre.96% reported one assailant and 55% were known to the victim. 100% had HIV risk assessment and were offered PEPSE if indicated. 98% were offered forensic examination if applicable, 93% emergency contraception if needed. Offer of prophylaxis against sexually transmitted infections: chlamydia 74%, gonorrhoea 62%, Trichomonas 49%. Offer of baseline testing for chlamydia 98%, gonorrhoea 100%, trichomonas 64%, syphilis HIV and hepatitis B & C 100%. Documentation of a plan for repeat STI testing 93%, documentation of offer of vaccination against hepatitis B 94% and assessment of child protection needs if under 18 years 77%. Discussion/conclusion Areas to improve: documentation of a self-harm risk assessment, offer of emergency contraception, recording of a discussion of need for pregnancy test in 3 weeks after emergency contraception, documentation of offer of prophylactic treatment for chlamydia, gonorrhoea and trichomonas and documentation of an assessment of child protection needs if the victim was under 18 years of age. This will be re-audited in 6 months.

Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy

ObjectivesThe aims of this review were to calculate the diagnostic accuracy statistics of risk scales following self-harm and consider which might be the most useful scales in clinical practice.DesignSystematic review.MethodsWe...

General Practitioners' Accounts of Patients Who Have Self-Harmed: A Qualitative, Observational Study.

. Background: The relationship between self-harm and suicide is contested. Self-harm is simultaneously understood to be largely nonsuicidal but to increase risk of future suicide. Little is known about how self-harm is conceptualized by general practitioners (GPs) and particularly how they assess the suicide risk of patients who have self-harmed. Aims: The study aimed to explore how GPs respond to patients who had self-harmed. In this paper we analyze GPs’ accounts of the relationship between self-harm, suicide, and suicide risk assessment. Method: Thirty semi-structured interviews were held with GPs working in different areas of Scotland. Verbatim transcripts were analyzed thematically. Results: GPs provided diverse accounts of the relationship between self-harm and suicide. Some maintained that self-harm and suicide were distinct and that risk assessment was a matter of asking the right questions. Others suggested a complex inter-relationship between self-harm and suicide; for these GPs, assessment was seen as more subjective. In part, these differences appeared to reflect the socioeconomic contexts in which the GPs worked. Conclusion: There are different conceptualizations of the relationship between self-harm, suicide, and the assessment of suicide risk among GPs. These need to be taken into account when planning training and service development.