Larkin Celine, Di Blasi Zelda, Arensman Ella
National Suicide Research Foundation, Cork, Ireland.
School of Applied Psychology, University College Cork, Cork, Ireland.
PLoS One. 2014 Jan 20;9(1):e84282. doi: 10.1371/journal.pone.0084282. eCollection 2014.
Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition.
This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent.
PubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form.
A total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity.
Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode. The current review will enhance prediction of self-harm and assist in the efficient allocation of intervention resources.
自残行为在自杀风险、发病率和医疗支出方面给个人和社会带来了高昂代价。重复自残会带来更高的自杀风险，对自残患者的风险评估是自残患者医疗管理的关键组成部分。迄今为止，尚未发表过系统综述来综合有关重复自残风险因素的大量证据。
本综述旨在确定首次自残事件后自残行为再次发生的风险因素，无论有无自杀意图。
使用PubMed、PsychInfo和Scirus搜索相关出版物。我们纳入了队列研究，这些研究考察了在急诊科出现自残行为的人群中与再次发生自残行为相关的因素。考虑截至2012年6月以任何语言发表的期刊文章、摘要、信件和论文。对研究进行质量评估并以叙述形式进行综合。
共有129项研究，包括329,001名参与者，符合我们的纳入标准。一些因素得到了广泛研究，发现与再次发生自残行为存在一致关联。这些因素包括既往自残史、人格障碍、绝望感、精神科治疗史、精神分裂症、酒精滥用/依赖、药物滥用/依赖以及独居。然而，这些测量方法的敏感性值在不同研究中差异很大。心理风险因素和保护因素的研究相对较少，但显示出与再次发生自残行为的新关联。综合风险量表往往敏感性高但特异性差。
许多自残行为再次发生的风险因素与自残行为开始的风险因素相匹配，但再次发生自残行为风险增加的最一致证据来自长期存在的心理社会脆弱性，而非首次发作的特征。当前的综述将加强对自残行为的预测，并有助于有效分配干预资源。
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