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J Affect Disord. 2014 Oct;168:476-83. doi: 10.1016/j.jad.2014.06.027. Epub 2014 Jun 21.

Hospital management of self-harm patients and risk of repetition: systematic review and meta-analysis.

Author information

1
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Electronic address: Robert.Carroll@Bristol.ac.uk.
2
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.

Abstract

BACKGROUND:

Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking.

METHODS:

We undertook a systematic review to investigate whether between study differences in reported clinical management of self-harm patients were associated with the risk of repeat self-harm and suicide.

RESULTS:

Altogether 64 prospective studies were identified that described the clinical care of self-harm patients and the incidence of repeat self-harm and suicide. The proportion of a cohort psychosocially assessed was not associated with the recorded incidence of repeat self-harm or suicide; the incidence of repeat self-harm was 16.7% (95% CI 13.8-20.1) in studies in the lowest tertile of assessment levels and 19.0% (95% CI 15.7-23.0) in the highest tertile. There was no association of repeat self-harm with differing levels of hospital admission (n=47 studies) or receiving specialist follow-up (n=12 studies). In studies reporting on levels of hospital admission and suicide (n=5), cohorts where a higher proportion of patients were admitted to a hospital bed reported a lower incidence of subsequent suicide (0.6%, 95% CI 0.5-0.8) compared to cohorts with lower levels of admission (1.9%, 95% CI 1.1-3.2).

LIMITATIONS:

In some analyses power was limited due to the small number of studies reporting the exposures of interest. Case mix and aspects of care are likely to vary between studies.

DISCUSSION:

There is little clear evidence to suggest routine aspects of self-harm patient care, including psychosocial assessment, reduce the risk of subsequent suicide and repeat self-harm.

KEYWORDS:

Mental health; Meta-analysis; Meta-regression; Repetition; Self-harm; Suicide

PMID:
25128754
DOI:
10.1016/j.jad.2014.06.027
[Indexed for MEDLINE]

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