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Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

OBJECTIVE: To investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. DESIGN:...

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Autores principales: Quinlivan, L, Cooper, J, Steeg, S, Davies, L, Hawton, K, Gunnell, D, Kapur, N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025469/
https://www.ncbi.nlm.nih.gov/pubmed/24793255
http://dx.doi.org/10.1136/bmjopen-2013-004732
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author Quinlivan, L
Cooper, J
Steeg, S
Davies, L
Hawton, K
Gunnell, D
Kapur, N
author_facet Quinlivan, L
Cooper, J
Steeg, S
Davies, L
Hawton, K
Gunnell, D
Kapur, N
author_sort Quinlivan, L
collection PubMed
description OBJECTIVE: To investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. DESIGN: Observational study. SETTING: A stratified random sample of 32 hospitals in England. PARTICIPANTS: 6442 individuals presenting with self-harm to 32 hospital services during a 3-month period between 2010 and 2011. OUTCOMES: 21-item measure of service quality, repeat self-harm within 6 months. RESULTS: A variety of different risk assessment tools were in use. Unvalidated locally developed proformas were the most commonly used instruments (reported in n=22 (68.8%) mental health services). Risk assessment scales were used in one-third of services, with the SAD PERSONS being the single most commonly used scale. There were no differences in service quality score between hospitals which did and did not use scales as a component of risk assessment (median service quality score (IQR): 14.5 (12.8, 16.4) vs 14.5 (11.4, 16.0), U=121.0, p=0.90), but hospitals which used scales had a lower median rate of repeat self-harm within 6 months (median repeat rate (IQR): 18.5% vs 22.7%, p=0.008, IRR (95% CI) 1.18 (1.00 to 1.37). When adjusted for differences in casemix, this association was attenuated (IRR=1.13, 95% CI (0.98 to 1.3)). CONCLUSIONS: There is little consensus over the best instruments for risk assessment following self-harm. Further research to evaluate the impact of scales following an episode of self-harm is warranted using prospective designs. Until then, it is likely that the indiscriminant use of risk scales in clinical services will continue.
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spelling pubmed-40254692014-05-21 Scales for predicting risk following self-harm: an observational study in 32 hospitals in England Quinlivan, L Cooper, J Steeg, S Davies, L Hawton, K Gunnell, D Kapur, N BMJ Open Health Services Research OBJECTIVE: To investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. DESIGN: Observational study. SETTING: A stratified random sample of 32 hospitals in England. PARTICIPANTS: 6442 individuals presenting with self-harm to 32 hospital services during a 3-month period between 2010 and 2011. OUTCOMES: 21-item measure of service quality, repeat self-harm within 6 months. RESULTS: A variety of different risk assessment tools were in use. Unvalidated locally developed proformas were the most commonly used instruments (reported in n=22 (68.8%) mental health services). Risk assessment scales were used in one-third of services, with the SAD PERSONS being the single most commonly used scale. There were no differences in service quality score between hospitals which did and did not use scales as a component of risk assessment (median service quality score (IQR): 14.5 (12.8, 16.4) vs 14.5 (11.4, 16.0), U=121.0, p=0.90), but hospitals which used scales had a lower median rate of repeat self-harm within 6 months (median repeat rate (IQR): 18.5% vs 22.7%, p=0.008, IRR (95% CI) 1.18 (1.00 to 1.37). When adjusted for differences in casemix, this association was attenuated (IRR=1.13, 95% CI (0.98 to 1.3)). CONCLUSIONS: There is little consensus over the best instruments for risk assessment following self-harm. Further research to evaluate the impact of scales following an episode of self-harm is warranted using prospective designs. Until then, it is likely that the indiscriminant use of risk scales in clinical services will continue. BMJ Publishing Group 2014-04-30 /pmc/articles/PMC4025469/ /pubmed/24793255 http://dx.doi.org/10.1136/bmjopen-2013-004732 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
spellingShingle Health Services Research
Quinlivan, L
Cooper, J
Steeg, S
Davies, L
Hawton, K
Gunnell, D
Kapur, N
Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title_full Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title_fullStr Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title_full_unstemmed Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title_short Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
title_sort scales for predicting risk following self-harm: an observational study in 32 hospitals in england
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025469/
https://www.ncbi.nlm.nih.gov/pubmed/24793255
http://dx.doi.org/10.1136/bmjopen-2013-004732
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