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Witt K, McGill K, Leckning B, Hill NTM, Davies BM, Robinson J, Carter G. Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis. BJPsych Open 2024; 10:e29. [PMID: 38205598 PMCID: PMC10790226 DOI: 10.1192/bjo.2023.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/04/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Hospital-treated self-harm is common, costly and associated with repeated self-harm and suicide. Providing a comprehensive psychosocial assessment following self-harm is recommended by professional bodies and may improve outcomes. AIMS To review the provision of psychosocial assessments after hospital-presenting self-harm and the extent to which macro-level factors indicative of service provision explain variability in these estimates. METHOD We searched five electronic databases to 3 January 2023 for studies reporting data on the proportion of patients and/or events that were provided a psychosocial assessment. Pooled weighted prevalence estimates were calculated with the random-effects model. Random-effects meta-regression was used to investigate between-study variability. RESULTS 119 publications (69 unique samples) were included. Across ages, two-thirds of patients had a psychosocial assessment (0.67, 95% CI 0.58-0.76). The proportion was higher for young people and older adults (0.75, 95% CI 0.36-0.99 and 0.83, 95% CI 0.48-1.00, respectively) compared with adults (0.64, 95% CI 0.54-0.73). For events, around half of all presentations had these assessments across the age range. No macro-level factor explained between-study heterogeneity. CONCLUSIONS There is room for improvement in the universal provision of psychosocial assessments for self-harm. This represents a missed opportunity to review and tailor aftercare supports for those at risk. Given the marked unexplained heterogeneity between studies, the person- and system-level factors that influence provision of psychosocial assessments after self-harm should be studied further.
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Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Australia; and Orygen, Parkville, Australia
| | - Katie McGill
- School of Medicine and Public Health, The University of Newcastle, Australia; and Hunter New England Local Health District, Waratah, Australia
| | - Bernard Leckning
- Menzies School of Health Research, Charles Darwin University, Australia
| | - Nicole T. M. Hill
- School of Population and Global Health, The University of Western Australia, Australia; and Telethon Kids Institute, Nedlands, Australia
| | | | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Australia; and Orygen, Parkville, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Australia
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Feng YR, Valuri GM, Morgan VA, Preen DB, O’Leary CM, Crampin E, Waterreus A. Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review. Aust N Z J Psychiatry 2023; 57:1208-1222. [PMID: 37161341 PMCID: PMC10466987 DOI: 10.1177/00048674231172116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours. METHODS A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'. RESULTS Studies in young people (n = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies (n = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%. CONCLUSION This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
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Affiliation(s)
- YR Feng
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - GM Valuri
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - DB Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Colleen M O’Leary
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - E Crampin
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Hawgood J, Kõlves K, Spence SH, Arensman E, Krysinska K, De Leo D, Ownsworth T. Long-Term Use and Application of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Following Original Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11324. [PMID: 36141597 PMCID: PMC9517291 DOI: 10.3390/ijerph191811324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Understanding the use of Systematic Tailored Assessment for Responding to Suicidality protocol (STARS-p) in practice by trained mental health practitioners over the longer- term is critical to informing further developments. The study aim was to examine practitioners' experiences of STARS-p and factors associated with its use in practice over a 12-24-month period after training. METHOD Practitioners who undertook the STARS-p training completed an online survey 12-24 months post training. The survey focused on the frequency of use of STARS-p (in full and each section) as well as perceptions about STARS-p applied in practice. Analyses included correlations, logistic regression and content analysis. RESULTS 67 participants (81% female, Mage = 43.2, SD = 10.3) were included in the analyses. A total of 80.6% of participants had used the entire STARS-p at some time-point in their practice and less than half (44.7%) frequently used the entire STARS-p (all components in one administration). Parts A, B and C were used frequently in suicide risk assessment (SRA) by 84%, 71% and 82% of participants, respectively. Use of the entire protocol and different sections was most related to male gender, perceived ease of administration and confidence in the use of the protocol. Qualitative results revealed three main themes. CONCLUSIONS STARS-p as a whole or its parts, is frequently used. Advantages of, and barriers to, using STARS-p in practice can inform further developments of STARS-p and STARS training.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD 4122, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD 4122, Australia
| | - Susan H. Spence
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD 4122, Australia
| | - Ella Arensman
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD 4122, Australia
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, T12 XF62 Cork, Ireland
- National Suicide Research Foundation, University College Cork, Western Gateway Building, T12 XF62 Cork, Ireland
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD 4122, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4222, Australia
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Rosebrock HY, Batterham PJ, Chen NA, McGillivray L, Rheinberger D, Torok MH, Shand FL. Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation. CRISIS 2021; 43:442-451. [PMID: 34547919 DOI: 10.1027/0227-5910/a000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.
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Affiliation(s)
- Hannah Y Rosebrock
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Nicola A Chen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Demee Rheinberger
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michelle H Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Fiona L Shand
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Hawgood J, Ownsworth T, Kõlves K, Spence SH, Arensman E, De Leo D. Impact of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Training on Mental Health Professionals' Attitudes, Perceived Capabilities, Knowledge, and Reluctance to Intervene. Front Psychiatry 2021; 12:827060. [PMID: 35211039 PMCID: PMC8861433 DOI: 10.3389/fpsyt.2021.827060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Systematic Tailored Assessment for Responding to Suicidality (STARS) protocol and associated training were developed with the key objectives of supporting clinicians to conduct a suicide enquiry, obtaining a comprehensive account of psycho-social factors contributing to suicidality, and collaboratively developing a safety plan with clients. STARS training aims to address knowledge, attitudes and capabilities that influence intervention behavior/skills. This study aimed to examine associations between clinician characteristics and pre-training competencies in suicide risk assessment (SRA), as well as the impact of STARS training workshop on clinician competencies; and to determine the predictors of SRA training outcomes. METHOD Australian mental health professionals working with suicidal persons who undertook the STARS 2-day face-to-face workshop between 2018 and 2020 completed an online survey at pre- and post-training. Of the 222 participants who completed the pre-training questionnaire, 144 (64.9%) also completed the post-training questionnaire. Participants were mostly female (75.7%), had completed a university degree (86.4%), had <10 years of experience in suicide prevention (71.7%), and were allied and mental health professionals (78.1%). We used linear mixed-effects regression for statistical analyses. RESULTS STARS participants who reported higher perceived capability at baseline had significantly greater formal and informal training, more years of experience in suicide prevention, and were more likely to have experienced client suicide and/or suicide attempt and to report fewer SRA related fears. We found overall significant positive impacts of STARS training on clinician competencies (attitudes, perceived capability, declarative knowledge) from pre- to post-training. The most distinct changes following STARS training were for perceived capability and declarative knowledge. Participants who had more positive attitudes after training were significantly more likely to have had less prior supervision/mentoring. Reluctance to intervene was not found to significantly change after training. CONCLUSIONS We found evidence that attitudes, perceived capability and declarative knowledge changed positively from pre- to post-STARS training among mental health professionals. Underpinned by the minimum standardized SRA competencies, STARS training may be critical for informing evidence-based knowledge and skills in SRA and safety planning.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute of Queensland, The Hopkins Centre, Griffith University, Queensland, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland.,Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
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Boffin N, Van Casteren V, De Ridder K. Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices. BMJ Open 2019; 9:e028546. [PMID: 31061060 PMCID: PMC6501981 DOI: 10.1136/bmjopen-2018-028546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES First, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs. SETTING 105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013-2016. PARTICIPANTS 245 suicide attempts by regular patients. OUTCOMES MEASURES Ten care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time. RESULTS As for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP-patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP-patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant. CONCLUSIONS GPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.
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Affiliation(s)
- Nicole Boffin
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Karin De Ridder
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Bridge JA, Olfson M, Fontanella CA, Marcus SC. Emergency Department Recognition of Mental Disorders and Short-Term Risk of Repeat Self-Harm Among Young People Enrolled in Medicaid. Suicide Life Threat Behav 2018; 48:652-660. [PMID: 28833340 DOI: 10.1111/sltb.12377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
Previous studies of adults have shown protective associations between clinical recognition of a mental disorder in the emergency department and short-term risk of repeat self-harm. Similar studies of young self-harm patients are lacking. We conducted a retrospective longitudinal cohort analysis of national Medicaid claims data in patients aged 10-19 years with self-harm who were discharged from emergency departments to the community (N = 2,703). Emergency department mental disorder recognition was not associated with a significant change in repeat self-harm visits during the 30-day follow-up period. Future studies should assess whether other aspects of emergency care influence short-term risk of repeat self-harm.
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Affiliation(s)
- Jeffrey A Bridge
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Mark Olfson
- New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
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Collins C, O’Shea MT, Cunniffe J, Finegan P. Health system changes needed to support people consulting general practice out of hours services in Ireland. Int J Ment Health Syst 2018; 12:56. [PMID: 30344620 PMCID: PMC6186104 DOI: 10.1186/s13033-018-0235-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. AIM To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. DESIGN AND SETTING Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). METHODS An anonymous extraction of retrospective data from 1 year of the out of hours' electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care. RESULTS Over a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend. CONCLUSIONS There are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.
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Affiliation(s)
- C. Collins
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | - M. T. O’Shea
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | | | - P. Finegan
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
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Abstract
OBJECTIVES Improving the care that patients receive after a suicide attempt will reduce the risk of a subsequent suicide attempt. We described how care for these patients can be improved and identified the available guidelines. METHODS We reviewed the literature on crisis and aftercare, psychosocial assessment, risk assessment, brief contact interventions, and brief interventions. RESULTS People who have made a suicide attempt are at increased risk of suicide, and the period immediately after discharge from hospital is particularly risky. Patients require an empathic response at their first point of contact, comprehensive psychosocial assessment, effective discharge planning, rapid and assertive follow-up, and coordinated care in the subsequent months. CONCLUSIONS Empathic and effective care that begins in the emergency department and extends through to community care is imperative. Enough is known about the risks of inadequate care and the key ingredients of effective care to proceed with changes to Australia's healthcare response to a suicide attempt.
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Affiliation(s)
- Fiona Shand
- LifeSpan Research Director, Senior Research Fellow, Black Dog Institute, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Laura Vogl
- Research Fellow, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Jo Robinson
- Senior Research Fellow and Head, Suicide Prevention Research, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
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Grimholt TK, Jacobsen D, Haavet OR, Sandvik L, Jorgensen T, Norheim AB, Ekeberg O. Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial. BMC Psychiatry 2015; 15:245. [PMID: 26467530 PMCID: PMC4604741 DOI: 10.1186/s12888-015-0635-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/05/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments. METHODS This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale. RESULTS Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1% vs. 59.4% (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5% vs. 54. 8% (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79% vs. 51% (p = 0.026)). CONCLUSIONS Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.
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Affiliation(s)
- TK Grimholt
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway ,Regional Centre of Violence, Traumatic Stress and Suicide Prevention, Eastern Norway, Norway
| | - D. Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway
| | - OR Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - L. Sandvik
- Department of Biostatistics Oslo University Hospital, Oslo, Norway
| | - T. Jorgensen
- Psychiatric Consultation Team, Akershus University Hospital, Akershus, Norway
| | - AB Norheim
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention, Eastern Norway, Norway ,Diakonhjemmet Hospital, Oslo, Norway
| | - O. Ekeberg
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway ,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences. Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Bridge JA, Marcus SC, Olfson M. Outpatient care of young people after emergency treatment of deliberate self-harm. J Am Acad Child Adolesc Psychiatry 2012; 51:213-222.e1. [PMID: 22265367 DOI: 10.1016/j.jaac.2011.11.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/03/2011] [Accepted: 11/10/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm. METHOD A retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed. RESULTS Most patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63-0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27-2.94) and inpatient (ARR 1.33, 99% CI 1.14-1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64-0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73-0.97). CONCLUSIONS A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care.
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Affiliation(s)
- Jeffrey A Bridge
- Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, The Ohio State University, USA
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Buykx P, Ritter A, Loxley W, Dietze P. Patients Who Attend the Emergency Department Following Medication Overdose: Self-reported Mental Health History and Intended Outcomes of Overdose. Int J Ment Health Addict 2011. [DOI: 10.1007/s11469-011-9338-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Suicide attempters presenting for hospital treatment is a major public health challenge in most countries. Their tendency of dropping out of treatments and their high risk of repeat suicidal behavior call for systematic assessments, in-hospital management, treatment engagement and follow-up treatments after discharge from hospital. However, hospital services provided for suicide attempters and follow-up care may have highly variable quality and favorable care programs may deteriorate over time for various reasons. Effective and sustainable treatments and interventions to create cohesive chains of care are needed to release the substantial suicide prevention potential that exist in this population.
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