Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK.
Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK.
Eur Child Adolesc Psychiatry. 2021 Aug;30(8):1173-1186. doi: 10.1007/s00787-020-01607-3. Epub 2020 Jul 27.
Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.
现有的减少青少年在精神科病房内自残的干预措施通常侧重于个体的心理治疗。然而，治疗发生的病房环境是治疗成功的一个重要因素，也会影响自残行为发生的可能性。本研究旨在评估对精神科病房环境的改变对青少年自残发生率的影响。在一家儿童和青少年精神病病房进行了一项准实验性中断时间序列研究。与工作人员和患者一起制定了一项干预措施，以解决该病房在工作日晚上自残发生率高的问题。干预措施包括为护理人员增加一个常规的黄昏班（下午 3 点至晚上 11 点），并在病房内引入一个结构化的晚间活动计划。对中断时间序列的分段回归分析发现，每 100 个床位日的自残率在基线时已经在下降，并在干预后继续下降，但下降幅度没有统计学意义（p=0.415）。然而，在基线时自残的患者比例在增加，且在干预后显著减少（p=0.001），且与白天的其他时间相比，夜间的减少幅度显著更大（p=0.004，p=0.09）。针对精神科病房环境的定制干预措施有助于减少病房内青少年自残的比例。对于随着时间的推移对卫生系统进行改变的未来干预措施，应考虑使用中断时间序列分析。
