Global prevalence of psychiatric in- and out-patient treatment following hospital-presenting self-harm: a systematic review and meta-analysis

Witt, Katrina; McGill, Katie; Leckning, Bernard; Hill, Nicole T.M.; Davies, Benjamin M.; Robinson, Jo; Carter, Gregory

doi:10.1016/j.eclinm.2023.102295

Cited by 4 publications

(1 citation statement)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to a recent meta-analysis encompassing 131 distinct studies, roughly two-thirds of these patients receive referrals for either in- or outpatient care, with considerable variability in the factors influencing the allocation of treatment. Importantly, only about one in five effectively receive the recommended treatment [ 21 ] and non-attendance among those referred is a strong predictor for subsequent death by suicide [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project

Mortier,

Amigo,

Bhargav

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

Background Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. Methods PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS’ practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. Discussion Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.

show abstract

Section: Introductionmentioning

confidence: 99%

Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project

Mortier,

Amigo,

Bhargav

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

show abstract

Self-harm and suicidal behaviors in children: perspectives of mental health clinicians

Townsend,

Barr,

Miller

et al. 2024

Journal of Pediatric Psychology

View full text Add to dashboard Cite

Objective Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children. Methods 26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis. Results Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child’s behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem. Conclusions Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.

show abstract

Practitioner Review: Treatments for young people who self‐harm – challenges and recommendations for research and clinical practice

Witt,

Stewart,

Hawton

2024

Child Psychology Psychiatry

View full text Add to dashboard Cite

BackgroundSelf‐harm is very common in young people and is associated with suicide. Rates of both self‐harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self‐harm.MethodWe significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self‐harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world.ResultsCurrently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT‐A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self‐harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry‐based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals.ConclusionsRecommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT‐A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural‐based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self‐harm in a person‐centred and compassionate manner.

show abstract

Global prevalence of psychiatric in- and out-patient treatment following hospital-presenting self-harm: a systematic review and meta-analysis

Cited by 4 publications

References 34 publications

Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project

Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project

Self-harm and suicidal behaviors in children: perspectives of mental health clinicians

Practitioner Review: Treatments for young people who self‐harm – challenges and recommendations for research and clinical practice

Contact Info

Product

Resources

About