BackgroundEvidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice.AimsTo examine how the management that patients receive in hospital relates to subsequent outcome.MethodsWe identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford) over a 10 year period (2000 to 2009). We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up) and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics.Results35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs): Centre A 0.99 (0.90–1.09); Centre B 0.59 (0.48–0.74); Centre C 0.59 (0.52–0.68). There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas.ConclusionThese findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups.

The Cognitive Reflection Test (CRT) is a hugely influential problem solving task that measures individual differences in the propensity to reflect on and override intuitive (but incorrect) solutions. The validity of this three-item measure depends on participants being naïve to its materials and objectives. Evidence from 142 volunteers recruited online suggests this is often not the case. Over half of the sample had previously seen at least one of the problems, predominantly through research participation or the media. These participants produced substantially higher CRT scores than those without prior exposure (2.36 vs. 1.48), with the majority scoring at ceiling level. Participants that had previously seen a specific problem (e.g., the bat and ball problem) nearly always solved that problem correctly. These data suggest the CRT may have been widely invalidated. As a minimum, researchers must control for prior exposure to the three problems and begin to consider alternative, extended measures of cognitive reflection.

The ability to represent conditional information is central to human cognition. In two self-paced reading experiments we investigated how readers process counterfactual conditionals (e.g., If Darren had been athletic, he could probably have played on the rugby team) and indicative conditionals (e.g., If Darren is athletic, he probably plays on the rugby team). In Experiment 1 we focused on how readers process counterfactual conditional sentences. We found that processing of the antecedent of counterfactual conditionals was rapidly constrained by prior context (i.e., knowing whether Darren was or was not athletic). A reading-time penalty was observed for the critical region of text comprising the last word of the antecedent and the first word of the consequent when the information in the antecedent did not fit with prior context. In Experiment 2 we contrasted counterfactual conditionals with indicative conditionals. For counterfactual conditionals we found the same effect on the critical region as we found in Experiment 1. In contrast, however, we found no evidence that processing of the antecedent of indicative conditionals was constrained by prior context. For indicative conditionals (but not for counterfactual conditionals), the results we report are consistent with the suppositional account of conditionals. We propose that current theories of conditionals need to be able to account for online processing differences between indicative and counterfactual conditionals.

Conditionals can implicitly convey a range of speech acts including promises, tips, threats and warnings. These are traditionally divided into the broader categories of advice (tips and warnings) and inducements (promises and threats). One consequence of this distinction is that speech acts from within the same category should be harder to differentiate than those from different categories. We examined this in two self-paced reading experiments. Experiment 1 revealed a rapid processing penalty when inducements (promises) and advice (tips) were anaphorically referenced using a mismatching speech act. In Experiment 2 a delayed penalty was observed when a speech act (promise or threat) was referenced by a mismatching speech act from the same category of inducements. This suggests that speech acts from the same category are harder to discriminate than those from different categories. Our findings support a semantic distinction between speech act categories, but also reveal pragmatic differences within categories.