Gardner Kathryn Jane, Bickley Harriet, Turnbull Pauline, Kapur Nav, Taylor Peter, Clements Caroline
Kathryn Jane Gardner, School of Psychology, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
J Affect Disord. 2020 Apr 1;266:603-609. doi: 10.1016/j.jad.2020.01.093. Epub 2020 Jan 21.
Self-cutting in young people is associated with high risk of repetition and suicide. It is important, therefore, to identify characteristics of self-cutting that might impact on repetition and aspects of care by staff. This study aimed to explore differences in clinical (e.g., previous self-harm) and psychological characteristics (intent, mental state, precipitants) of self-cutting in young people based on whether site of cut was visible or concealed.
Data were from a large prospective self-harm monitoring database that collected data on hospital emergency department presentations for self-harm in the City of Manchester, UK, between 2005 and 2011. Clinical and psychological characteristics, as well as onward referral/clinical management from the emergency department, of 799 young people (totalling 1,196 episodes) age 15-24 who self-cut in visible or concealed areas were compared using logistic regression.
During the study period 500 (40%) episodes were in a concealed location. Concealed self-cutting was more likely to be precipitated by specific self-reported precipitants such as abuse and characterised by the following: previous self-harm, current psychiatric treatment, premeditation, and greater risk of repetition within the study period. Receiving a psychosocial assessment and referral to psychiatric services from the emergency department were less likely, however. Repetition and referral to psychiatric treatment were not significantly associated with site of injury when adjusting for other factors.
There are meaningful differences in characteristics associated with location of cut. We recommend that all young people who present to hospital following self-harm receive a psychosocial assessment, in line with NICE guidance.
青少年自我切割行为与重复自我伤害及自杀的高风险相关。因此，识别可能影响重复自我伤害行为及医护人员护理工作的自我切割行为特征至关重要。本研究旨在探讨基于切割部位是可见还是隐蔽的青少年自我切割行为在临床（如既往自我伤害史）和心理特征（意图、精神状态、诱发因素）方面的差异。
数据来自一个大型前瞻性自我伤害监测数据库，该数据库收集了2005年至2011年期间英国曼彻斯特市医院急诊科因自我伤害就诊的数据。对799名年龄在15 - 24岁之间、在可见或隐蔽部位进行自我切割的青少年（共1196次发作）的临床和心理特征，以及急诊科的后续转诊/临床管理情况进行逻辑回归分析比较。
在研究期间，500次（40%）发作发生在隐蔽部位。隐蔽性自我切割行为更有可能由特定的自我报告诱发因素（如虐待）引发，其特征如下：既往自我伤害史、当前接受精神科治疗、有预谋，以及在研究期间重复自我伤害的风险更高。然而，从急诊科接受社会心理评估并转诊至精神科服务的可能性较小。在调整其他因素后，重复自我伤害行为和转诊至精神科治疗与受伤部位无显著关联。
与切割部位相关的特征存在显著差异。我们建议，按照英国国家卫生与临床优化研究所（NICE）的指导意见，所有因自我伤害而到医院就诊的青少年都应接受社会心理评估。
