Carroll R, Metcalfe C, Gunnell D
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
J Affect Disord. 2014 Oct;168:476-83. doi: 10.1016/j.jad.2014.06.027. Epub 2014 Jun 21.
Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking.
We undertook a systematic review to investigate whether between study differences in reported clinical management of self-harm patients were associated with the risk of repeat self-harm and suicide.
Altogether 64 prospective studies were identified that described the clinical care of self-harm patients and the incidence of repeat self-harm and suicide. The proportion of a cohort psychosocially assessed was not associated with the recorded incidence of repeat self-harm or suicide; the incidence of repeat self-harm was 16.7% (95% CI 13.8-20.1) in studies in the lowest tertile of assessment levels and 19.0% (95% CI 15.7-23.0) in the highest tertile. There was no association of repeat self-harm with differing levels of hospital admission (n=47 studies) or receiving specialist follow-up (n=12 studies). In studies reporting on levels of hospital admission and suicide (n=5), cohorts where a higher proportion of patients were admitted to a hospital bed reported a lower incidence of subsequent suicide (0.6%, 95% CI 0.5-0.8) compared to cohorts with lower levels of admission (1.9%, 95% CI 1.1-3.2).
In some analyses power was limited due to the small number of studies reporting the exposures of interest. Case mix and aspects of care are likely to vary between studies.
There is little clear evidence to suggest routine aspects of self-harm patient care, including psychosocial assessment, reduce the risk of subsequent suicide and repeat self-harm.
自我伤害是患者就医的常见原因；然而，目前缺乏指导这些患者临床管理以降低其再次自我伤害和自杀风险的证据。
我们进行了一项系统评价，以调查自我伤害患者报告的临床管理方面的研究差异是否与再次自我伤害和自杀风险相关。
共确定了64项前瞻性研究，这些研究描述了自我伤害患者的临床护理以及再次自我伤害和自杀的发生率。接受社会心理评估的队列比例与再次自我伤害或自杀的记录发生率无关；在评估水平最低三分位数的研究中，再次自我伤害的发生率为16.7%（95%置信区间13.8 - 20.1），在最高三分位数的研究中为19.0%（95%置信区间15.7 - 23.0）。再次自我伤害与不同程度的住院治疗（n = 47项研究）或接受专科随访（n = 12项研究）无关。在报告住院治疗水平和自杀情况的研究中（n = 5），与住院水平较低的队列（1.9%，95%置信区间1.1 - 3.2）相比，患者住院比例较高的队列报告的后续自杀发生率较低（0.6%，95%置信区间0.5 - 0.8）。
在一些分析中，由于报告感兴趣暴露因素的研究数量较少，效能有限。不同研究之间的病例组合和护理方面可能存在差异。
几乎没有明确证据表明自我伤害患者护理的常规方面，包括社会心理评估，能降低后续自杀和再次自我伤害的风险。
