Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK.
Crisis. 2010;31(4):211-6. doi: 10.1027/0027-5910/a000022.
Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists.
To compare psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm: comparing assessments carried out by trainee psychiatrists, allocated to the task alongside other duties on a roster, or by mental health nurses with a designated role in self-harm services.
Arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city were compared, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses.
Compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help - such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2).
Despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.
因自残而住院的患者在出院前应接受心理社会评估。在实践中，英国和其他地方的许多此类评估都是由受训者而不是专科精神科医生进行的。
比较在自残后被收入普通医院的患者的心理社会评估、后续护理和非致命性重复模式：比较由受训精神科医生进行的评估，这些医生在轮班中与其他任务一起分配任务，或由在自残服务中具有指定角色的心理健康护士进行的评估。
根据评估是由受训精神科医生还是心理健康护士进行，比较了在英国一个大城市的 787 例连续心理社会评估中的后续护理安排和非致命性自残重复率。
与护士相比，精神科医生更有可能安排精神科住院或门诊随访。护士更常将人们指向志愿部门的帮助，如药物、酒精或关系咨询。由护士或精神科医生评估的患者自残重复率同样常见（33%；危险比 0.93，95%置信区间 0.71 至 1.2）。
尽管心理健康护士进行的后续护理安排较少涉及法定精神卫生服务，但对自残重复的影响没有迹象表明其有害。
