title: Healthcare and social services resource use and costs of self-harm patients.
abstract: BACKGROUND
  Patients who have self-harmed have increased morbidity across a wide range of health outcomes, but there is no evidence on their pattern of health and social service use, and its relationship with repetition of self-harm. Previous studies have shown that resource use and costs in the short-term hospital management of self-harm is associated with certain patient and service characteristics but their impact in the longer term has not been demonstrated. The aim of this study is to test the association between changing levels of costs of health and social care with further episodes of self-harm and to identify the clinical and social factors associated with this.
  
  
  METHODS
  This was a cost-analysis incidence study of a sample of patients from a cohort of self-harm patients who remained within one region over the course of their follow-up. Resource use was retrospectively observed from their first episode of self-harm (dating back on some occasions to the 1970's), and costs applied. Panel data analyses were used to identify factors associated with observed costs over time.
  
  
  RESULTS
  Patients with five or more episodes of self-harm had the highest levels of resource costs. Health and social care costs reduced with time from last episode of self-harm. In the year following the first episode of self-harm, psychiatric care accounted for 69% and psychotropic drug prescriptions 1% of the mean resource costs.
  
  
  CONCLUSIONS
  The management of self-harm occurs within a complex system of health and social care. Major self-harm repeaters place the greatest cost burden on the system. Better understanding of the impact of risk assessment models and consequent service provision on clinical outcome may help in the design of effective services for this patient group.
authors.affiliation: Mental Health Group, Division of Clinical Neurosciences, Department of Psychiatry, Royal South Hants Hospital, University of Southampton, Brintons Terrace, Southampton, SO14 0YG, UK. julia.sinclair@soton.ac.uk
authors.forename: Julia M A
authors.initials: JM
authors.lastname: Sinclair
authors.forename: Alastair
authors.initials: A
authors.lastname: Gray
authors.forename: Oliver
authors.initials: O
authors.lastname: Rivero-Arias
authors.forename: Kate E A
authors.initials: KE
authors.lastname: Saunders
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D015337:Multicenter Studies as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D012947:Social Work / Q000191:economics* / Q000706:statistics & numerical data; D055815:Young Adult