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Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data

BACKGROUND: Observational studies are suited to examining links between the routine hospital management of self-harm and future suicide and all-cause mortality due to their large scale. However, care must be taken when attempting to infer causal associations in non-experimental settings. METHODS: Da...

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Autores principales: Steeg, Sarah, Carr, Matthew, Emsley, Richard, Hawton, Keith, Waters, Keith, Bickley, Harriet, Ness, Jennifer, Geulayov, Galit, Kapur, Nav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161837/
https://www.ncbi.nlm.nih.gov/pubmed/30261030
http://dx.doi.org/10.1371/journal.pone.0204670
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author Steeg, Sarah
Carr, Matthew
Emsley, Richard
Hawton, Keith
Waters, Keith
Bickley, Harriet
Ness, Jennifer
Geulayov, Galit
Kapur, Nav
author_facet Steeg, Sarah
Carr, Matthew
Emsley, Richard
Hawton, Keith
Waters, Keith
Bickley, Harriet
Ness, Jennifer
Geulayov, Galit
Kapur, Nav
author_sort Steeg, Sarah
collection PubMed
description BACKGROUND: Observational studies are suited to examining links between the routine hospital management of self-harm and future suicide and all-cause mortality due to their large scale. However, care must be taken when attempting to infer causal associations in non-experimental settings. METHODS: Data from the Multicentre Study of Self-Harm in England were used to examine associations between four types of hospital management (specialist psychosocial assessment, general hospital admission, psychiatric outpatient referral and psychiatric admission) following self-harm and risks of suicide and all-cause mortality in the subsequent 12 months. Missing data were handled by multiple imputation and propensity score (PS) methods were used to address observed differences between patients at baseline. Unadjusted, PS stratified and PS matched risk ratios (RRs) were calculated. RESULTS: The PSs balanced the majority of baseline differences between treatment groups. Unadjusted RRs showed that all four treatment types were associated with either increased risks or no change in risks of suicide and all-cause mortality within a year. None of the four types of hospital management were associated with lowered risks of suicide or all-cause mortality following propensity score stratification (psychosocial assessment and medical admission) and propensity score matching (psychiatric outpatient referral and psychiatric admission), though there was no longer an increased risk among people admitted to a psychiatric bed. Individuals who self-cut were at an increased risk of death from any cause following psychosocial assessment and medical admission. Medical admission appeared to be associated with reduced risk of suicide in individuals already receiving outpatient or GP treatment for a psychiatric disorder. CONCLUSIONS: More intensive forms of hospital management following self-harm appeared to be appropriately allocated to individuals with highest risks of suicide and all-cause mortality. PS adjustment appeared to attenuate only some of the observed increased risks, suggesting that either differences between treatment groups remained, or that some treatments had little impact on reducing subsequent suicide or all-cause mortality risk. These findings are in contrast to some previous studies that have suggested psychosocial assessment by a mental health specialist reduces risk of repeat self-harm. Future observational self-harm studies should consider increasing the number of potential confounding variables collected.
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spelling pubmed-61618372018-10-19 Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data Steeg, Sarah Carr, Matthew Emsley, Richard Hawton, Keith Waters, Keith Bickley, Harriet Ness, Jennifer Geulayov, Galit Kapur, Nav PLoS One Research Article BACKGROUND: Observational studies are suited to examining links between the routine hospital management of self-harm and future suicide and all-cause mortality due to their large scale. However, care must be taken when attempting to infer causal associations in non-experimental settings. METHODS: Data from the Multicentre Study of Self-Harm in England were used to examine associations between four types of hospital management (specialist psychosocial assessment, general hospital admission, psychiatric outpatient referral and psychiatric admission) following self-harm and risks of suicide and all-cause mortality in the subsequent 12 months. Missing data were handled by multiple imputation and propensity score (PS) methods were used to address observed differences between patients at baseline. Unadjusted, PS stratified and PS matched risk ratios (RRs) were calculated. RESULTS: The PSs balanced the majority of baseline differences between treatment groups. Unadjusted RRs showed that all four treatment types were associated with either increased risks or no change in risks of suicide and all-cause mortality within a year. None of the four types of hospital management were associated with lowered risks of suicide or all-cause mortality following propensity score stratification (psychosocial assessment and medical admission) and propensity score matching (psychiatric outpatient referral and psychiatric admission), though there was no longer an increased risk among people admitted to a psychiatric bed. Individuals who self-cut were at an increased risk of death from any cause following psychosocial assessment and medical admission. Medical admission appeared to be associated with reduced risk of suicide in individuals already receiving outpatient or GP treatment for a psychiatric disorder. CONCLUSIONS: More intensive forms of hospital management following self-harm appeared to be appropriately allocated to individuals with highest risks of suicide and all-cause mortality. PS adjustment appeared to attenuate only some of the observed increased risks, suggesting that either differences between treatment groups remained, or that some treatments had little impact on reducing subsequent suicide or all-cause mortality risk. These findings are in contrast to some previous studies that have suggested psychosocial assessment by a mental health specialist reduces risk of repeat self-harm. Future observational self-harm studies should consider increasing the number of potential confounding variables collected. Public Library of Science 2018-09-27 /pmc/articles/PMC6161837/ /pubmed/30261030 http://dx.doi.org/10.1371/journal.pone.0204670 Text en © 2018 Steeg et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Steeg, Sarah
Carr, Matthew
Emsley, Richard
Hawton, Keith
Waters, Keith
Bickley, Harriet
Ness, Jennifer
Geulayov, Galit
Kapur, Nav
Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title_full Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title_fullStr Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title_full_unstemmed Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title_short Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data
title_sort suicide and all-cause mortality following routine hospital management of self-harm: propensity score analysis using multicentre cohort data
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161837/
https://www.ncbi.nlm.nih.gov/pubmed/30261030
http://dx.doi.org/10.1371/journal.pone.0204670
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