Self-harm behavior and no-suicide contracting in psychiatric inpatient settings.
Although negotiation of no-suicide contracts is common practice, research regarding the outcomes of contracting is inadequate. The purpose of this retrospective review of medical records was to examine how no-suicide contracting affected the likelihood of self-harm behavior in psychiatric inpatient settings. Thirty-one patients (4.8%) engaged in self-harm behaviors representing 2.64% of all patients admitted to both study settings during the 6 (1/2)-month period from which data were collected. Approximately half of those patients expressed suicidal intent. Logistic regression analysis suggested that patients with no-suicide contracts and with higher levels of restriction had a significantly higher likelihood of self-harm behavior (OR = 7.43 and 2.47, respectively, p = .005). Consistency of nursing assignment is likely associated with a lower probability of self-harm (OR = .07) but p.068 when this variable was included in the model. Prevention of self-harm behaviors by the use of no-suicide contracting is not shown. Negotiation of a contract is likely a reflection of staff assessment that the patient was at high risk for suicide. These findings confirm the need for thorough, ongoing assessment of suicidal risk, whether or not a patient has agreed to a no-suicide contract.
Drew
B L
BL
College of Nursing, Kent State University, Kent, OH, USA. bdrew@kent.edu
D005260:Female; D006757:Hospital Units; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D017008:Negotiating / Q000379:methods*; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D011568:Psychiatric Nursing / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D000092864:Suicide Prevention