Alexandra Pitman1, Apostolos Tsiachristas2, Deborah Casey3, Galit Geulayov3, Fiona Brand4, Elizabeth Bale3, Keith Hawton4. 1. UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London W1W 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom. Electronic address: a.pitman@ucl.ac.uk. 2. Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom. 3. Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom. 4. Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom.
Abstract
BACKGROUND: There is mixed evidence for whether psychosocial assessment following hospital presentation for self-harm reduces self-harm repetition. A possible reason is the differences in professional background of assessors (primarily psychiatrists and psychiatric nurses) due to variability in training and therapist style. METHODS: Using data from the Oxford Monitoring System for Self-harm, we analysed data on patients making their first emergency department (ED) presentation for self-harm between 2000 and 2014, followed-up until 2015. Using logistic regression, we estimated the probability of repeat self-harm within 12 months, comparing: (i) patients receiving psychosocial assessment versus none, adjusting for age, gender, self-harm method, past self-harm presentation, and general hospital admission; and (ii) patients assessed by a psychiatric nurse versus those assessed by a psychiatrist, adjusting for age, self-harm method, time and year of presentation. RESULTS: The 12,652 patients who had an index ED presentation for self-harm during the study period accounted for 24,450 presentations, in 17,303 (71%) of which a psychosocial assessment was conducted; in 9318 (54%) by a psychiatric nurse and in 7692 (45%) by a psychiatrist. We found a reduced probability of repeat self-harm presentation among patients receiving psychosocial assessment versus none (adjusted odds ratio [AOR] = 0.70; 95% CI = 0.65-0.75; p < 0.001), but no differences between patients assessed by a psychiatric nurse or a psychiatrist (AOR = 1.05; 95% CI = 0.98-1.13; p = 0.129). LIMITATIONS: Findings from a single hospital may not be generalizable to other settings. CONCLUSIONS: Short-term risk of repeat self-harm after psychosocial assessment for self-harm may not differ by the assessor's professional background.
BACKGROUND: There is mixed evidence for whether psychosocial assessment following hospital presentation for self-harm reduces self-harm repetition. A possible reason is the differences in professional background of assessors (primarily psychiatrists and psychiatric nurses) due to variability in training and therapist style. METHODS: Using data from the Oxford Monitoring System for Self-harm, we analysed data on patients making their first emergency department (ED) presentation for self-harm between 2000 and 2014, followed-up until 2015. Using logistic regression, we estimated the probability of repeat self-harm within 12 months, comparing: (i) patients receiving psychosocial assessment versus none, adjusting for age, gender, self-harm method, past self-harm presentation, and general hospital admission; and (ii) patients assessed by a psychiatric nurse versus those assessed by a psychiatrist, adjusting for age, self-harm method, time and year of presentation. RESULTS: The 12,652 patients who had an index ED presentation for self-harm during the study period accounted for 24,450 presentations, in 17,303 (71%) of which a psychosocial assessment was conducted; in 9318 (54%) by a psychiatric nurse and in 7692 (45%) by a psychiatrist. We found a reduced probability of repeat self-harm presentation among patients receiving psychosocial assessment versus none (adjusted odds ratio [AOR] = 0.70; 95% CI = 0.65-0.75; p < 0.001), but no differences between patients assessed by a psychiatric nurse or a psychiatrist (AOR = 1.05; 95% CI = 0.98-1.13; p = 0.129). LIMITATIONS: Findings from a single hospital may not be generalizable to other settings. CONCLUSIONS: Short-term risk of repeat self-harm after psychosocial assessment for self-harm may not differ by the assessor's professional background.