Division of Psychology and Mental Health,Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK.
Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK.
Psychol Med. 2018 Jan;48(2):315-326. doi: 10.1017/S0033291717001702. Epub 2017 Jun 22.
The care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm.
Observational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation.
Following PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80-0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort.
This study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.
接受自伤后到医院就诊的人群所接受的护理各不相同，尚不清楚不同类型的治疗如何影响再次自伤的风险。
英国曼彻斯特自伤项目的观察性队列数据纳入了 2003 年至 2011 年期间因自伤到急诊科就诊的 16456 例个体。对这些个体进行了 12 个月的随访。我们还使用了在 2010/2011 年 3 个月期间于英格兰 31 家医院就诊的个体的较小队列数据进行了 6 个月的随访。采用倾向评分（PS）方法解决观察性混杂问题。使用多重插补法处理缺失数据。
经过 PS 分层后，与未接受评估的个体相比，接受心理社会评估的个体再次因自伤而到医院就诊的风险较低[比值比（RR）0.87，95%置信区间（CI）0.80-0.95]。在不太可能接受评估的人群中，风险降低幅度最大。经过 PS 匹配后，我们发现再次自伤的风险与住院治疗、转介至门诊精神病学或转至精神病学病床之间无关联。在 31 个中心队列中，我们未发现心理社会评估与再次自伤之间存在关系。
本研究显示了在大型精神卫生数据集中使用新型统计技术来估计治疗效果的潜力。我们发现，专科心理社会评估可能降低再次自伤的风险。这种常规护理应该提供给所有因自伤后到医院就诊的个体，无论其风险如何。
