Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
Br J Psychiatry. 2015 Mar;206(3):229-36. doi: 10.1192/bjp.bp.113.135780. Epub 2015 Jan 22.
The problem of people presenting to hospitals with self-harm is important because such presentations are common, there is a clear link to suicide and a high premature mortality. However, the best treatment for this population is unclear.
To see whether a package of measures, that included regular postcards and problem-solving therapy, improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm (the ACCESS study: trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000641291).
The design of the study was a Zelen randomised controlled trial. The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode.
There were no significant differences in the primary outcome and most of the secondary outcomes between the two groups. About half the people offered problem-solving therapy did not receive it, for various reasons.
The package as offered had little effect on the proportion of people re-presenting to hospital with self-harm. The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty engaging participants in active treatment.
人们到医院进行自残的问题很重要，因为这种情况很常见，与自杀有明确的联系，而且过早死亡率很高。然而，目前尚不清楚针对这一人群的最佳治疗方法。
评估一套措施（包括定期寄明信片和解决问题疗法）是否能改善因自残而到医院就诊的人群在 1 年内的预后，与常规护理相比（ACCESS 研究：试验注册澳大利亚和新西兰临床试验注册处 ACTRN12609000641291）。
研究设计为 Zelen 随机对照试验。主要结局是在指数发作后 12 个月内再次因自残而到医院就诊。
两组之间在主要结局和大多数次要结局上均无显著差异。出于各种原因，大约有一半接受解决问题疗法的人没有接受治疗。
所提供的方案对因自残而再次到医院就诊的人数比例影响不大。解决问题疗法的剂量可能太小，无法产生效果，而且让参与者参与积极治疗存在困难。
