Mental Health Group, Division of Clinical Neurosciences, Department of Psychiatry, Royal South Hants Hospital, University of Southampton, Brintons Terrace, Southampton, SO14 0YG, UK.
Soc Psychiatry Psychiatr Epidemiol. 2011 Apr;46(4):263-71. doi: 10.1007/s00127-010-0183-5. Epub 2010 Feb 21.
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.
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.
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.
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.
有过自伤行为的患者在广泛的健康结果方面发病率增加，但他们的健康和社会服务使用模式及其与自伤行为重复的关系尚无证据。先前的研究表明，短期医院管理中自伤行为的资源使用和成本与某些患者和服务特征有关，但尚未证明其在长期内的影响。本研究旨在检验健康和社会保健成本变化水平与进一步自伤行为之间的关联，并确定与之相关的临床和社会因素。
这是一项对来自自伤患者队列中的患者样本的成本分析发生率研究，这些患者在随访过程中仍在一个地区内。从他们的第一次自伤事件（有些情况下可以追溯到 20 世纪 70 年代）开始，回顾性地观察资源使用情况，并应用成本。使用面板数据分析来确定与随时间观察到的成本相关的因素。
有五次或更多次自伤行为的患者的资源成本最高。自上次自伤行为以来，健康和社会保健成本随时间减少。在第一次自伤行为后的一年中，精神科护理占平均资源成本的 69%，精神药物处方占 1%。
自伤的管理发生在一个复杂的健康和社会保健系统中。主要的自伤重复者对系统造成最大的成本负担。更好地了解风险评估模型的影响和随之而来的服务提供对临床结果的影响，可能有助于为这一患者群体设计有效的服务。
