Understanding predictors of change in a day treatment setting for non‐suicidal self‐injury

Abstract

Objectives. To examine change in non-suicidal self-injury (NSSI) frequency, quality of life, and functional impairment from admission to discharge in patients enrolled in partial hospitalization and intensive outpatient programmes (PHP/IOP) designed to treat NSSI. Demographic, clinical, and treatment-related predictors of changes were also examined.Design. Data were collected as part of routine clinical assessment procedures at admission and discharge from patients enrolled in a PHP/IOP programme designed to treat NSSI. The clinical assessment included measures examining quality of life, functional impairment, and NSSI behaviour.Methods. Paired t-tests were used to examine change in NSSI frequency, quality of life, and functional impairment. Reliable clinical change analyses were used to identify clinically significant change in quality of life and functional impairment. Multilevel mixed-effects regression was used to examine predictors of change for quality of life and functional impairment. Negative binomial regression was used to examine predictors of change for NSSI frequency.Results. From admission to discharge, NSSI frequency significantly decreased and quality of life and functional impairment evidenced clinically significant change. Age, race/ ethnicity, and insurance type predicted change in functional impairment, while gender predicted change in quality of life. Urge to self-injure predicted change in NSSI frequency. Borderline symptoms predicted change across all outcome variables. Conclusions.Patients who completed a day treatment programme for NSSI evidenced significant change in NSSI frequency, functional impairment, and quality of life at discharge; however, several demographic and clinical variables were associated with change. Practitioner pointsPatients who engage in NSSI show significant change from admission to discharge in a day treatment programme dedicated to the treatment of NSSI. Quality of life and functional impairment are important outcome variables to consider and evaluate in higher levels of care. It is important to consider demographic and clinical variables when creating a treatment plan for NSSI.

Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

“…These findings contrast with previous research comparing telehealth IOP outcomes by insurance type that found disparities in outcomes for adults [10] as well as disparities in in-person IOP outcomes for children [32], youths [28], and young adults [35]. In studies addressing youths and young adults, these different findings may be explained by the handling of dropout as these studies appear to have included all clients who initiated treatment [28,35]. It may be that there are higher dropout levels among clients on public insurance and that the resulting effect on outcomes from a smaller dose of treatment is inadequate for symptom improvement.…”

“…In the only study identified that collected data from multiple reporters, adolescents in an IOP treating self-harm reported no differences by insurance type, but parents of youths with private insurance reported significantly greater behavior improvement than parents of youths with public insurance [28]. A recent study of an IOP for self-harm examined treatment differences by insurance type with the largest sample to date (n=1327 [35]), finding a significantly greater increase in functioning for youths and young adults on private insurance than for those on public insurance. In each of these cases, the authors note that time and the financial commitments of the intensive program may cause greater stressors for youths and families on public insurance than for those on private insurance.…”

Development and validation of a prediction nomogram for non-suicidal self-injury in female patients with mood disorder

“…In addition to the factor above, we also found that patients with fewer hospitalizations were more likely to have self-injury behaviors, indicating that hospitalization can improve the patient’s condition and prevent the recurrence of NSSI. In a day treatment setting for non-suicidal self-injury, NSSI frequency significantly decreased after hospitalization, while quality of life and functional impairment significantly improved at the same time ( 46 ). Therefore, our lower incidence of NSSI may also be related to inpatients.…”

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

“…Based on our data, NSSI prevention strategies should involve the routine assessment of QoL in adolescents, especially in clinical settings. QoL could, therefore, be an important outcome variable to assess the efficiency of NSSI treatment [115].…”