Pitman, A; Tsiachristas, A; Casey, D; Geulayov, G; Brand, F; Bale, E; Hawton, K; (2020) Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital: cohort study. Journal of Affective Disorders , 272 pp. 158-165. 10.1016/j.jad.2020.03.180.

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Abstract

Background: There is mixed evidence for whether psychosocial assessment following hospital presentation for self-harm reduces self-harm repetition. A possible reason is the differences in professional background of assessors (primarily psychiatrists and psychiatric nurses) due to variability in training and therapist style. / Methods: Using data from the Oxford Monitoring System for Self-harm, we analysed data on patients making their first emergency department (ED) presentation for self-harm between 2000 and 2014, followed-up until 2015. Using logistic regression, we estimated the probability of repeat self-harm within 12 months, comparing: i) patients receiving psychosocial assessment versus none, adjusting for age, gender, self-harm method, past self-harm presentation, and medical admission; and ii) patients assessed by a psychiatric nurse versus those assessed by a psychiatrist, adjusting for age, self-harm method, time and year of presentation. / Results: The 12,652 patients who had an index ED presentation for self-harm during the study period accounted for 24,450 presentations, in 17,303 (71%) of which a psychosocial assessment was conducted; in 9,318 (54%) by a psychiatric nurse and in 7,692 (45%) by a psychiatrist. We found a reduced probability of repeat self-harm presentation among patients receiving psychosocial assessment versus none (adjusted odds ratio [AOR]=0.70; 95% CI=0.65-0.75; p<0.001), but no differences between patients assessed by a psychiatric nurse or a psychiatrist (AOR=1.05; 95% CI=0.98-1.13; p=0.129). / Limitations: Findings from a single hospital may not be generalizable to other settings. / Conclusions: Short-term risk of repeat self-harm after psychosocial assessment for self-harm may not differ by the assessor's professional background.

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