Psycho-social intervention following attempted suicide: is there a case for better services?

House, Allan; Owens, David; Storer, David

doi:10.3109/09540269209066298

Cited by 40 publications

(23 citation statements)

References 31 publications

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“…Our findings may reflect a high risk approach to intervention or a lack of consensus on the psychiatric management of self poisoning 5. We believe they probably reflect the low medical and psychiatric priority given to patients who have taken an overdose.…”

Section: Commentmentioning

confidence: 78%

Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study

Kapur

House

Creed

et al. 1998

BMJ

142

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Our relapse rate is similar to that in a trial of nicotine patches (37% between years 1 and 3) 3 and in a study using supportive counselling and nicotine gum for 5 years (40% between years 1 and 5). 4 High relapse rates after 1 year are also common in those not attending for treatment. A large general population survey estimated a relapse rate of 35% from non-validated self reports of the duration of abstinence. 5Success rates after 1 year or less of follow up substantially overestimate lifelong cessation after a single treatment episode.Contributors: MAHR, GS, and JAS designed the original study, which GS conducted. JAS and GS designed the long term follow up phase, which GS conducted. JAS analysed the data and wrote the text of the paper. JAS and GS will act as guarantors for the paper. 2 Good services to manage deliberate self poisoning in general hospitals might therefore help to achieve the targets set out by the Health of the Nation strategy to reduce suicide rates. Existing services have not been planned coherently; the care provided by hospitals varying greatly, even in the same region. 3 We assessed the management of self poisoning in four teaching hospitals in England by using standardised methods of notification. Subjects, methods, and resultsWe prospectively identified all patients over 16 years of age who attended four teaching hospitals in Leeds, Leicester, Manchester, and Nottingham for deliberate self poisoning during 4 weeks (November to December 1996). We obtained data by examining computerised databases on wards and in the accident and emergency department, referral ledgers, accident and emergency notes, and copies of specialist assessments of deliberate self poisoning. We checked all inpatient data retrospectively against information on admission and discharge for deliberate self poisoning that we obtained from the patient administration system in each hospital. We collected demographic details of patients, along with details of substance dependence, previous overdoses, and contact with psychiatric services. We also recorded information on the management of the current episode of self poisoning.During the study period 458 patients accounted for 477 hospital attendances for deliberate self poisoning; 223 (49%) of these were women. The mean age of the patients was 30.9 years (SD 11.8 years); 65 (14%) were dependent on alcohol or drugs, 177 (39%) had taken a previous overdose, and 119 (26%) were in contact with psychiatric services. These percentages and the substances ingested were similar across study centres. By contrast, there were striking variations in the management of episodes between study centres, with a fourfold difference in discharge rates from accident and emergency departments, and almost a twofold difference in the proportion of subjects receiving a specialist psychosocial assessment (table). In 220 out of 477 hospital attendances (46%) the patient had no psychosocial assessment at any time during their hospital contact.

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Section: Commentmentioning

confidence: 78%

Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study

Kapur

House

Creed

et al. 1998

BMJ

142

View full text Add to dashboard Cite

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“…Alcohol consumption has been found to precede 48% of self harm episodes (House, Owens & Storer, 1992). The contribution of an inebriated state to a suicide attempt, however, is not well understood.…”

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confidence: 99%

Gambling Problems and Attempted Suicide: Part II—Alcohol Abuse Increases Suicide Risk

Penfold¹,

Hatcher

Sullivan³

et al. 2006

Int J Ment Health Addiction

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Alcohol misuse is commonly associated with problem gambling and suicide attempts. This study included seventy patients admitted to an Auckland (New Zealand) hospital immediately following a suicide attempt. The first paper in the study identified 12 (17.1%) patients from the sample as being positive on the Eight Gambling Screen. Of these individuals, 75% were also positive on the CAGE alcohol screen. Problem gambling patients who had attempted suicide were also more likely to be Maori (indigenous New Zealanders). The severity of the suicide attempt between patients screened as problem gamblers and those who were not did not differ.

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“…Self-poisoning has potentially serious consequences: follow-up studies have found between 3% and 10% of self-harm patients eventually kill themselves 34 Unfortunately, services for this important problem have generally been badly planned and incoherently delivered 5. In an effort to improve this situation, the Royal College of Psychiatrists produced a consensus statement which set standards for service provision 6.…”

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confidence: 99%

General hospital services for deliberate self-poisoning: an expensive road to nowhere?

Kapur

House

Creed

et al. 1999

Postgraduate Medical Journal

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SummaryThis study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current selfharm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be oVered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and aftercare. This state of aVairs cannot be justified on financial or clinical grounds.

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Psycho-social intervention following attempted suicide: is there a case for better services?

Cited by 40 publications

References 31 publications

Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study

Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study

Gambling Problems and Attempted Suicide: Part II—Alcohol Abuse Increases Suicide Risk

General hospital services for deliberate self-poisoning: an expensive road to nowhere?

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