Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England.
Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England.
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DOI：
10.1371/journal.pone.0070434
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Cooper J
中科院分区：
文献类型：
--
作者：
Kapur N;Steeg S;Webb R;Haigh M;Bergen H;Hawton K;Ness J;Waters K;Cooper J
指导自我伤害临床管理的证据很少，试验招募了选定的样本，指南中建议的心理治疗在常规实践中可能无法获得。研究患者在医院接受的治疗与后续结局的关系。我们确定了10年期间（2000年至2009年）在英国三个中心（德比，曼彻斯特，牛津）出现的自残事件。我们使用已建立的数据收集系统来调查四个方面的管理（心理社会评估，医疗入院，精神病入院，转诊专家心理健康随访）和12个月内重复自残之间的关系，并根据基线人口统计学和临床特征的差异进行调整。在研究期间，35，938人出现了自我伤害。在三个中心中的两个，接受心理社会评估与40%的重复风险降低相关，风险比（95%CI）：中心A 0.99（0.90-1.09）;中心B 0.59（0.48-0.74）;中心C 0.59（0.52-0.68）。几乎没有迹象表明，明显的保护作用是通过转介和后续安排介导的。社会心理评估与减少重犯风险之间的联系在来自最贫困地区的人中似乎最不明显。这些发现增加了越来越多的证据表明，彻底的评估是自我伤害管理的核心，但需要进一步的工作来阐明可能的机制，并探讨不同临床亚组的影响。
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. To examine how the management that patients receive in hospital relates to subsequent outcome. We 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. 35,938 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. These 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.
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影响因子：
7
作者：
Kapur, N;Cooper, J;House, A
通讯作者：
House, A
DOI：
10.7326/0003-4819-127-8_part_2-199710151-00064
发表时间：
1997-10-15
影响因子：
39.2
作者：
Rubin, DB
通讯作者：
Rubin, DB
影响因子：
--
作者：
Jenkins, GR;Hale, R;Tyrer, P
通讯作者：
Tyrer, P
影响因子：
6.6
作者：
Bergen, Helen;Hawton, Keith;Kapur, Navneet
通讯作者：
Kapur, Navneet
影响因子：
10.5
作者：
Johnston, Amy;Cooper, Jayne;Kapur, Navneet
通讯作者：
Kapur, Navneet