期刊
PLOS ONE
卷 11, 期 2, 页码 -出版社
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0149713
关键词
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资金
- Department of Health (England) as part of the Multi-Centre Study of Self-harm
- Manchester Mental Health and Social Care Trust
- NIHR
- Medical Research Council
- University of Bristol [MC_UU_12013/9]
- Economics and Social Research Council (ESRC) [ES/N000757/1]
- MRC [MC_UU_12013/9, MC_UU_12013/1] Funding Source: UKRI
- Medical Research Council [MC_UU_12013/1, MC_UU_12013/9] Funding Source: researchfish
- National Institute for Health Research [DRF-2012-05-189, NF-SI-0512-10068] Funding Source: researchfish
- National Institutes of Health Research (NIHR) [DRF-2012-05-189] Funding Source: National Institutes of Health Research (NIHR)
Background Clinical guidelines have recommended psychosocial assessment of self-harm patients for years, yet estimates of its impact on the risk of repeat self-harm vary. Assessing the association of psychosocial assessment with risk of repeat self-harm is challenging due to the effects of confounding by indication. Methods We analysed data from a cohort study of 15,113 patients presenting to the emergency departments of three UK hospitals to investigate the association of psychosocial assessment with risk of repeat hospital presentation for self-harm. Time of day of hospital presentation was used as an instrument for psychosocial assessment, attempting to control for confounding by indication. Results Conventional regression analysis suggested psychosocial assessment was not associated with risk of repeat self-harm within 12 months (Risk Difference (RD) 0.00 95% confidence interval (95% CI) -0.01 to 0.02). In contrast, IV analysis suggested risk of repeat self-harm was reduced by 18% (RD -0.18, 95% CI -0.32 to -0.03) in those patients receiving a psychosocial assessment. However, the instrument of time of day did not remove all potential effects of confounding by indication, suggesting the IV effect estimate may be biased. Conclusions We found that psychosocial assessments reduce risk of repeat self-harm. This is in-line with other non-randomised studies based on populations in which allocation to assessment was less subject to confounding by indication. However, as our instrument did not fully balance important confounders across time of day, the IV effect estimate should be interpreted with caution.
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