Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England.
BACKGROUND
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.


OBJECTIVE
To examine how the management that patients receive in hospital relates to subsequent outcome.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Centre for Mental Health and Risk, Centre for Suicide Prevention, University of Manchester, Manchester, United Kingdom. nav.kapur@manchester.ac.uk
Nav
N
Kapur
Sarah
S
Steeg
Roger
R
Webb
Matthew
M
Haigh
Helen
H
Bergen
Keith
K
Hawton
Jennifer
J
Ness
Keith
K
Waters
Jayne
J
Cooper
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010343:Patient Admission; D010346:Patient Care Management; D012017:Referral and Consultation; D012306:Risk; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult