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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng225er14-lrg.png" alt="Cover of Evidence reviews for supporting people to be safe after self-harm" /></a><div class="icnblk_cntnt"><h1 id="_NBK588194_"><span itemprop="name">Evidence reviews for supporting people to be safe after self-harm</span></h1><div class="subtitle">Self-harm: assessment, management and preventing recurrence</div><p><b>Evidence review N</b></p><p><i>NICE Guideline, No. 225</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Sep</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4702-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="bcms6509.s1"><h2 id="_bcms6509_s1_">Supporting people to be safe after self-harm</h2><div id="bcms6509.s1.1"><h3>Review question</h3><p>What are the most effective ways of supporting people to be safe after self-harm?</p><div id="bcms6509.s1.1.1"><h4>Introduction</h4><p>The objective of this review was to explore the most effective ways of supporting people to be safe after self-harm and to identify elements of mental health service provision which could reduce the rates of repeat self-harm in this population. The committee therefore chose to focus this review on reviewing the evidence for the effectiveness of different staffing models and physical environment designs on the safety of people who have self-harmed.</p></div><div id="bcms6509.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK588194/table/bcms6509.tab1/?report=objectonly" target="object" rid-figpopup="figbcms6509tab1" rid-ob="figobbcms6509tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><p>For further details see the review protocol in <a href="#bcms6509.appa">appendix A</a>.</p></div><div id="bcms6509.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#bcms6509.appa">appendix A</a> and the <a href="/books/NBK588194/bin/NG225_Supplement1_Methods.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="bcms6509.s1.1.4"><h4>Effectiveness evidence</h4><div id="bcms6509.s1.1.4.1"><h5>Included studies</h5><p>Five comparative observational studies were included for this review. One of these was a retrospective cohort study (<a href="#bcms6509.s1.ref2">Ford 2020</a>) and 4 were before-and-after studies (<a href="#bcms6509.s1.ref1">Bowers 2006</a>, <a href="#bcms6509.s1.ref3">Kapur 2016</a>, <a href="#bcms6509.s1.ref4">Noelck 2019</a> and <a href="#bcms6509.s1.ref5">Reen 2020</a>). One of these studies was an ecological analysis of mental health service level changes (<a href="#bcms6509.s1.ref3">Kapur 2016</a>).</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK588194/table/bcms6509.tab2/?report=objectonly" target="object" rid-figpopup="figbcms6509tab2" rid-ob="figobbcms6509tab2">Table 2</a>.</p><p>Three studies were conducted in the UK (<a href="#bcms6509.s1.ref1">Bowers 2006</a>, <a href="#bcms6509.s1.ref3">Kapur 2016</a> and <a href="#bcms6509.s1.ref5">Reen 2020</a>) and 2 in the US (<a href="#bcms6509.s1.ref2">Ford 2020</a> and <a href="#bcms6509.s1.ref4">Noelck 2019</a>).</p><p>One study included children and adolescents admitted to an inpatient setting following a suicide attempt (<a href="#bcms6509.s1.ref4">Noleck 2019</a>). The other studies did not specify previous self-harm attempts of the study participants: 2 of these studies included inpatients on psychiatric wards (<a href="#bcms6509.s1.ref1">Bowers 2006</a> and <a href="#bcms6509.s1.ref5">Reen 2020</a>), 1 included incarcerated adult males diagnosed with a mental health condition (<a href="#bcms6509.s1.ref2">Ford 2020</a>) and 1 included all individuals who died by suicide within 12 months of contact with a mental health service (<a href="#bcms6509.s1.ref3">Kapur 2016</a>).</p><p>Four studies compared complex interventions to treatment as usual (<a href="#bcms6509.s1.ref1">Bowers 2006</a>, <a href="#bcms6509.s1.ref2">Ford 2020</a>, <a href="#bcms6509.s1.ref4">Noelck 2019</a> and <a href="#bcms6509.s1.ref5">Reen 2020</a>). All of these studies included a staffing intervention component: 1 study appointed nurses with clinical expertise in acute inpatient care to change staffing attitudes and establish ward “rules and routine” (<a href="#bcms6509.s1.ref1">Bowers 2006</a>); 1 study implemented regular twilight nursing shifts in addition to a structured programme of evening activities (<a href="#bcms6509.s1.ref5">Reen 2020</a>); 1 study implemented a quality improvement intervention, including a regular staffing communication intervention in addition to a safety protocol and a full patient safety search (<a href="#bcms6509.s1.ref4">Noleck 2019</a>); the retrospective cohort study conducted in prison settings evaluated specialised mental health units, involving multidisciplinary teams, staff training in communication and patient-centered care, in addition to daily activities (<a href="#bcms6509.s1.ref2">Ford 2020</a>). One study compared several different safety interventions before and after implementation, including environmental changes (removal of ligature points) and staff training (<a href="#bcms6509.s1.ref3">Kapur 2016</a>).</p><p>See the literature search strategy in <a href="#bcms6509.appb">appendix B</a> and study selection flow chart in <a href="#bcms6509.appc">appendix C</a>.</p></div><div id="bcms6509.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#bcms6509.appk">appendix K</a>.</p></div></div><div id="bcms6509.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK588194/table/bcms6509.tab2/?report=objectonly" target="object" rid-figpopup="figbcms6509tab2" rid-ob="figobbcms6509tab2">Table 2</a>.</p><p>See the full evidence tables in <a href="#bcms6509.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#bcms6509.appe">appendix E</a>).</p><div id="bcms6509.s1.1.5.1"><h5>Summary of the evidence</h5><p>One study (<a href="#bcms6509.s1.ref1">Bowers 2006</a>) compared a nursing staff intervention to treatment as usual on 2 psychiatric inpatient wards, in which nurses with clinical expertise in acute inpatient care were appointed to change staffing attitudes and establish ward “rules and routine”. The study found a significant decrease in the mean number of self-harm events per shift and no difference in the mean number of suicide attempts per shift in the 12 month follow-up period compared to the 3 month pre-intervention period (low quality).</p><p>One study (<a href="#bcms6509.s1.ref2">Ford 2020</a>) compared specialised mental health units for prisoners diagnosed with a serious mental health disorder to standard of care single cell housing. The study did not find a significant decrease in the rate of self-injury at 30 or 60 days measured over the 38-month intervention period (low quality). Self-injury was reported as number of events per 100 person days, as multiple attempts could have been made by the same participant.</p><p>One study (<a href="#bcms6509.s1.ref3">Kapur 2016</a>) compared the implementation of national policies at the service level (removal of collapsible curtain rails, removal of low-lying ligature points, and staff training in management of suicide risk) to treatment as usual before implementation of the policy for people who died by suicide up to 12 months after contact with mental health services. The study found significant reductions in the suicide incidence rate ratio after implementation of each the 3 interventions (very low quality). The number of patients exposed to each intervention was not reported.</p><p>One study (<a href="#bcms6509.s1.ref4">Noelck 2019</a>) compared a quality improvement intervention, including a regular staffing communication intervention in addition to a safety protocol and a full patient safety search to standard care for children and adolescents who were hospitalised after a suicide attempt. The study reported a lower mean number of self-harm events per 100 patient days post-intervention compared to pre-intervention over an 18 month follow-up period (very low quality). The standard deviations of the means were not reported and not enough other data were reported to allow their calculation. The significance of the difference in means could not be determined.</p><p>One study (<a href="#bcms6509.s1.ref5">Reen 2020</a>) compared regular twilight nursing shifts and a structured programme of evening activities to standard care for adolescents on an inpatient psychiatric ward. The study reported self-harm (reported as mean proportion of patients self-harming per month and the rate of self-harm per 100 bed days per month) during evening and non-evening periods over an 18-month follow-up period. The study reported a significantly lower mean proportion of patients self-harming per month in the post-intervention period, during both evening and non-evening periods compared to the pre-intervention period (low quality). The rate of self-harm per 100 bed days per month was also significantly lower in the post-intervention period, during both evening and non-evening periods relative to the pre-intervention period (low quality).</p><p>The following outcomes were not reported by any of the studies: service user satisfaction, quality of life, engagement with services and number of people leaving without assessment being completed.</p><p>See <a href="#bcms6509.appf">appendix F</a> for full GRADE tables.</p></div></div><div id="bcms6509.s1.1.6"><h4>Economic evidence</h4><div id="bcms6509.s1.1.6.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in <a href="#bcms6509.appb">appendix B</a> and economic study selection flow chart in <a href="#bcms6509.appg">appendix G</a>.</p></div><div id="bcms6509.s1.1.6.2"><h5>Excluded studies</h5><p>Economic studies not included in the guideline economic literature review are listed, and reasons for their exclusion are provided in <a href="#bcms6509.appj">appendix J</a>.</p></div></div><div id="bcms6509.s1.1.7"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="bcms6509.s1.1.8"><h4>Evidence statements</h4><div id="bcms6509.s1.1.8.1"><h5>Economic</h5><p>No economic studies were identified which were applicable to this review question.</p></div></div><div id="bcms6509.s1.1.9"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="bcms6509.s1.1.9.1"><h5>The outcomes that matter most</h5><p>Self-harm repetition, suicide and service user satisfaction were prioritised as critical outcomes by the committee. Self-harm repetition and suicide were prioritised as critical outcomes because they are direct measures of any differential effectiveness associated with the method of initial contact and captures both fatal and non-fatal self-harm. Service user satisfaction was chosen as a critical outcome due to the importance of delivering services which are centred around the patients’ experiences and because patient satisfaction is likely to influence whether the patient engages with the intervention.</p><p>The committee agreed that quality of life, engagement with services and number of people leaving without assessment being completed should be important outcomes. Engagement with after-care was chosen as an important outcome because the first contact after discharge may influence the likelihood of whether a person who has self-harmed will attend follow-up sessions, thereby influencing whether after-care will be effective. Quality of life was chosen as an important outcome as this is a global measure of well-being and may capture aspects of effectiveness of the interventions not captured by any of the other outcome measures. Engagement with services and number of people leaving without assessment being completed were included as they are important measures of adherence and acceptability of interventions.</p></div><div id="bcms6509.s1.1.9.2"><h5>The quality of the evidence</h5><p>When assessed using GRADE methodology the evidence was found to range from low to very low quality. In all cases, the evidence was downgraded due to risk of bias as per ROBINS-I (due to unmeasured confounding variables and inability to ascertain intervention exposure and follow-up in the intervention group). In four studies, the evidence was downgraded due to indirectness because the proportion of the population that had previously self-harmed was unclear.</p></div><div id="bcms6509.s1.1.9.3"><h5>Imprecision and clinical importance of effects</h5><p>When examining the evidence from each study the committee discussed the effect sizes and 95% confidence intervals for each outcome to determine whether the results were clinically meaningful. The committee noted that for the majority of comparisons, there was no important difference or no evidence of important difference in outcomes, as either effect sizes were small and confidence intervals crossed the line of no effect or confidence intervals could not be calculated based on the available data. There was evidence of a benefit in terms of self-harm repetition for removal of low lying ligature points and removal of non-collapsible curtain rails versus no removal, and for clinical staff training in management of suicide risk versus standard training on self-harm. The committee noted that the 95% confidence intervals were small indicating that the moderate effect estimates were precise, however, they were not confident of the clinical importance of the effect estimates as the data were from an ecological level observational study with a very serious risk of bias due to unmeasured confounding and classification of intervention exposure. There was evidence of a benefit in terms of mean number of patients self-harming per month and rate of self-harm for a ward environment intervention which aimed to establish rules and routine versus standard care. The committee noted that the size of the effect estimates were moderate to large and were relatively precise based on the width of the confidence intervals, however, they were not confident in the clinical importance of the effects due to concerns of risk of bias from unmeasured confounding, missing data and deviations from the intended intervention.</p></div><div id="bcms6509.s1.1.9.4"><h5>Benefits and harms</h5><p>The recommendations were drafted on the evidence where possible, but due to concerns over the quality and paucity of evidence, they are in some parts supplemented with the committee’s own experience and expertise.</p><p>There was evidence on the benefits of a staffing intervention which established ward rules and routines in an inpatient psychiatric ward in terms of the mean number of self-harm events per shift. The committee agreed that due to the indirectness of the evidence, they could not make a strong recommendation about a specific staffing intervention, however, discussed the evidence within the wider context of continuity of care. The committee acknowledged the importance of minimising variations in care and ensuring that all staff are familiar with setting-specific layouts, policies and protocols and noted that this was particularly important in settings where consistency in staffing could not be ensured, for example where temporary bank staff were used.</p><p>The committee discussed the lack of evidence on the consistency and continuity of staffing personnel and based on their experience, they agreed that this was a fundamental aspect of supporting people to be safe after self-harm. While the committee acknowledged that continuity of care is important for all patients, they wanted to make a recommendation to highlight the benefits of minimising the number of staff that people who have self-harmed see, as this is particularly important for minimising distress in this population. Based on their experience, the committee noted that this might not be practical at all times or in all settings due to staffing constraints and staff shift patterns. The committee used the evidence presented in Evidence Report T to support these recommendations. The committee referred to guidance on ensuring continuity of care in the NICE guideline on <a href="https://www.nice.org.uk/guidance/cg138/chapter/1-Guidance#continuity-of-care-and-relationships" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">patient experience in adult NHS services</a> and the NICE guideline on <a href="https://www.nice.org.uk/guidance/ng204/chapter/Recommendations#continuity-and-coordination-of-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">babies, children and young people’s experience of healthcare</a>.</p><p>The committee discussed the limited evidence on observation for people who have self-harmed and noted that in their experience, better outcomes were expected when observation was a therapeutic interaction which engaged the patient and built rapport. The committee stressed the importance of ensuring that clinical observation is considered an element of care which has important benefits for the patient’s recovery. For these reasons, the committee agreed it is important that all staff undertaking clinical observation of people who have self-harmed be trained in clinical observation, which includes engagement of the patient and rapport building. The committee agreed that observation of people who have self-harmed should not be carried out by untrained staff such as security guards based on the principle of the parity of esteem. The committee discussed experiences where observation by non-clinical staff was intimidating and caused distress for people who had self-harmed and agreed that there was an increased risk of harm if observation was carried out by untrained staff. These discussions were also used to inform the recommendations on assessment and care in general hospital settings.</p><p>The committee discussed safety considerations for people who have self-harmed when transferring between settings. While there was no evidence identified, based on their experience and expertise, the committee agreed it was important that care plans of people who have self-harmed were accessible to staff working in both primary and secondary care settings. The committee agreed that this would help to promote continuity of care across settings and minimise distress for the patient from variations in practice.</p><p>The committee discussed the limited evidence on the benefits of ensuring staff presence during periods in inpatient settings considered high-risk for episodes of self-harm. Together with their experience, the committee agreed that staff remaining visible and accessible during handovers and busy periods would have important benefits on patient safety.</p><p>There was very low quality evidence that removing low-lying ligature points and collapsible curtain rails had the benefit of reducing suicide rates in people who had been in contact with a mental health service in the previous 12 months. the committee agreed it is important to ensure a safe physical environment for all mental health patients, but a particular focus on environmental safety for people who have self-harmed is important, so that ways of self-harming are not needlessly accessible. The committee agreed that there was a risk that stigma surrounding self-harm could result in overly restrictive measures when assessing the safety of the environment, and agreed that the least restrictive measures should always be used depending on the person’s needs and vulnerabilities in order to preserve the person’s autonomy and dignity, and improve their experience of services. The restrictions taken would also vary between and within trusts and should be considered at the ward level. The committee also agreed the removal of items that could be used to self-harm should be considered, again based on the individual’s needs and vulnerabilities. They agreed that removing every potential item that could be used to self-harm would not be practical, and that some people would not need this precaution to be taken. As a result, in order to promote person-centred care, the committee agreed the person who has self-harmed should be involved in any decision-making regarding this.</p><p>The committee discussed the benefits of staff familiarising patients to the procedures and the physical environment when people who have self-harmed present to the emergency department or are admitted to inpatient wards. In their experience, ensuring the person is comfortable and knows how to access help reduces distress and repeat self-harm in what can be a highly distressing experience for the person. Despite the lack of evidence, the committee agreed that this is an important component of supporting people to be safe and should be carried out at the earliest opportunity.</p><p>While there was limited evidence, the committee highlighted the importance of all staff working in secondary care settings knowing what to do if they have immediate concerns about somebody’s safety, for example if the person has self-harmed or the professional is worried they might be about to. The committee noted that often non-specialist or temporary staff were not clear on communication procedures or, due to the sensitivity of the situation, were uncomfortable in raising concerns. The committee agreed that communication channels should be made clear and maintained to ensure all staff are capable of promptly raising concerns to ensure patient safety in secondary care settings.</p></div><div id="bcms6509.s1.1.9.5"><h5>Cost effectiveness and resource use</h5><p>The committee noted that no relevant published economic evaluations had been identified and no additional economic analysis had been undertaken in this area. They recommended specific strategies that aimed to reduce the likely variation across the NHS in the current practice for delivering care for people who have self-harmed and ensure that current standards of care are consistently met across settings. The committee agreed that there was unlikely to be a significant resource impact from the recommendations made, as these are in line with the current practice in terms of continuity of care and staffing. Additionally, they highlighted that a substantial economic impact was unlikely as the recommendations made were marginally different from the previous NICE guidelines on self-harm.</p></div></div><div id="bcms6509.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.12.1-1.12.9 and 1.14.4.</p></div></div><div id="bcms6509.s1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="bcms6509.s1.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><div id="bcms6509.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588194/table/bcms6509.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6509.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th></tr></thead><tbody><tr><td headers="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a id="bcms6509.s1.ref1"></a>Bowers, L., Brennan, G., Flood, C.
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et al. (2006) Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: City Nurses. Journal of Psychiatric and Mental Health Nursing
|
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13: 165–172 [<a href="https://pubmed.ncbi.nlm.nih.gov/16608471" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16608471</span></a>]
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</td></tr><tr><td headers="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a id="bcms6509.s1.ref2"></a>Ford, E. B., Silverman, K. D., Solimo, A.
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|
et al. (2020) Clinical outcomes of specialized treatment units for patients with serious mental illness in the New York City jail system. Psychiatric Services
|
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71: 547–554 [<a href="https://pubmed.ncbi.nlm.nih.gov/32041509" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32041509</span></a>]
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</td></tr><tr><td headers="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a id="bcms6509.s1.ref3"></a>Kapur, N., Ibrahim, S., While, D.
|
|
et al. (2016) Mental health service changes, organisational factors, and patient suicide in England in 1997-2012: A before-and-after study. The Lancet Psychiatry
|
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3: 526–534 [<a href="https://pubmed.ncbi.nlm.nih.gov/27107805" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27107805</span></a>]
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</td></tr><tr><td headers="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a id="bcms6509.s1.ref4"></a>Noelck, M.; Velazquez-Campbell, M.; Austin, J. P. (2019) A quality improvement initiative to reduce safety events among adolescents hospitalized after a suicide attempt. Hospital Pediatrics
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9: 365–372 [<a href="https://pubmed.ncbi.nlm.nih.gov/30952690" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30952690</span></a>]
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</td></tr><tr><td headers="hd_h_bcms6509.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a id="bcms6509.s1.ref5"></a>Reen, G. K., Bailey, J., McGuigan, L.
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et al. (2020) Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis. European Child and Adolescent Psychiatry [<a href="/pmc/articles/PMC8310847/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8310847</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32719945" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32719945</span></a>]
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</td></tr></tbody></table></div></div></ul></div><div id="bcms6509.s1.rl.r1.2"><h4>Economic</h4><ul class="simple-list"><p>No studies were identified that met the inclusion criteria.</p></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="bcms6509.appa"><h3>Appendix A. Review protocols</h3><p id="bcms6509.appa.et1"><a href="/books/NBK588194/bin/bcms6509-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 203K)</span></p></div><div id="bcms6509.appb"><h3>Appendix B. Literature search strategies</h3><p id="bcms6509.appb.et1"><a href="/books/NBK588194/bin/bcms6509-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 269K)</span></p></div><div id="bcms6509.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="bcms6509.appc.et1"><a href="/books/NBK588194/bin/bcms6509-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 198K)</span></p></div><div id="bcms6509.appd"><h3>Appendix D. Evidence tables</h3><p id="bcms6509.appd.et1"><a href="/books/NBK588194/bin/bcms6509-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 234K)</span></p></div><div id="bcms6509.appe"><h3>Appendix E. Forest plots</h3><div id="bcms6509.appe.s1"><h4>Forest plots for review question: What are the most effective ways of supporting people to be safe after self-harm?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="bcms6509.appf"><h3>Appendix F. Modified GRADE tables</h3><p id="bcms6509.appf.et1"><a href="/books/NBK588194/bin/bcms6509-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Modified GRADE tables for review question: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 191K)</span></p></div><div id="bcms6509.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="bcms6509.appg.et1"><a href="/books/NBK588194/bin/bcms6509-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What are the most effective ways of supporting people to be safe after self-harm?</a><span class="small"> (PDF, 164K)</span></p></div><div id="bcms6509.apph"><h3>Appendix H. Economic evidence tables</h3><div id="bcms6509.apph.s1"><h4>Economic evidence tables for review question: What are the most effective ways of supporting people to be safe after self-harm?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="bcms6509.appi"><h3>Appendix I. Economic model</h3><div id="bcms6509.appi.s1"><h4>Economic model for review question: What are the most effective ways of supporting people to be safe after self-harm?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="bcms6509.appj"><h3>Appendix J. Excluded studies</h3><div id="bcms6509.appj.s1"><h4>Excluded studies for review question: What are the most effective ways of supporting people to be safe after self-harm?</h4></div><div id="bcms6509.appj.s2"><h4>Excluded effectiveness studies</h4><div id="bcms6509.appj.tab1" class="table"><h3><span class="label">Table 12</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588194/table/bcms6509.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6509.appj.tab1_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Atkinson, J. A., Page, A., Heffernan, M.
|
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et al. (2019) The impact of strengthening mental health services to prevent suicidal behaviour. Australian and New Zealand Journal of Psychiatry
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53: 642–650 [<a href="https://pubmed.ncbi.nlm.nih.gov/30541332" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30541332</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Comparison not in PICO</p>
|
|
<p>Study examines through modelling analyses the effect of different mental health or hospital service level variables on forecast incidence of suicidal behaviour. Actual data input into the model also unclear</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Atkinson, J. A., Page, A., Skinner, A.
|
|
et al. (2019) The impact of reducing psychiatric beds on suicide rates. Frontiers in Psychiatry
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10: 448 [<a href="/pmc/articles/PMC6615492/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6615492</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31333513" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31333513</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>Study examines through modelling analyses the effect of different mental health or hospital service level variables on forecast incidence of suicidal behaviour. Actual data input into the model also unclear</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bowers, L., Allan, T., Simpson, A.
|
|
et al. (2007) Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: The Tompkins acute ward study. International Journal of Social Psychiatry
|
|
53: 75–84 [<a href="https://pubmed.ncbi.nlm.nih.gov/17333953" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17333953</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- unclear how many of the population had previously self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Bowers, L. and Crowder, M. (2012) Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards-A cross sectional time series Poisson regression study. International Journal of Nursing Studies
|
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49: 15–20 [<a href="https://pubmed.ncbi.nlm.nih.gov/21813126" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21813126</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Bowers, L., Whittington, R., Nolan, P.
|
|
et al. (2008) Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study. British Journal of Psychiatry
|
|
193: 395–401 [<a href="https://pubmed.ncbi.nlm.nih.gov/18978321" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18978321</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- unclear how many of the population had previously self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Bryan, C. J., Mintz, J., Clemans, T. A.
|
|
et al. (2017) Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of Affective Disorders
|
|
212: 64–72 [<a href="https://pubmed.ncbi.nlm.nih.gov/28142085" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28142085</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Intervention not in PICO</p>
|
|
<p>Crisis response plan vs enhanced crisis response plan vs treatment as usual (in people with suicidal ideation and/ or lifetime history of suicide attempt)</p>
|
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Cailhol, L., Allen, M., Moncany, A. H.
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et al. (2007) Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention. General Hospital Psychiatry
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29: 42–44 [<a href="https://pubmed.ncbi.nlm.nih.gov/17189744" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17189744</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Outcome not in PICO</p>
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<p>Aggregated outcome of violent behaviour (suicidal ideation, self-harming behaviors, refusing psychiatric care or violence towards people or furniture)</p>
|
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Cardell, R.; Bratcher, K. S.; Quinnett, P. (2009) Revisiting “suicide proofing” an inpatient unit through environmental safeguards: A review. Perspectives in Psychiatric Care
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45: 36–44 [<a href="https://pubmed.ncbi.nlm.nih.gov/19154238" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19154238</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Catalan, J.; Keating, D.; Williams, E. R. L. (2003) Clinical audit of suicides in a general psychiatric service. Archives of Suicide Research
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7: 183–188
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Data collected pre-2000</p>
|
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<p>Data collected between 1995 and 1997</p>
|
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Changchien, T. C., Yen, Y. C., Wang, Y. J.
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|
et al. (2019) Establishment of a comprehensive inpatient suicide prevention network by using health care failure mode and effect analysis. Psychiatric Services
|
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70: 518–521 [<a href="https://pubmed.ncbi.nlm.nih.gov/30947637" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30947637</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Population not in PICO</p>
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<p>Mixed population (hospital-wide initiative)- not clear how many participants had self-harmed</p>
|
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Clarke, T., Baker, P., Watts, C. J.
|
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et al. (2002) Self-harm in adults: A randomised controlled trial of nurse-led case management versus routine care only. Journal of Mental Health
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11: 167–176
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Intervention not in PICO</p>
|
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<p>Case management</p>
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Corser, R. and Ebanks, L. (2004) Introducing a nurse-led clinic for patients who self-harm. Journal of wound care
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13: 167–170 [<a href="https://pubmed.ncbi.nlm.nih.gov/15160568" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15160568</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Case study</p>
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<p>n=1</p>
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Donovan, A. L., Aaronson, E. L., Black, L.
|
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et al. (2021) Keeping Patients at Risk for Self-Harm Safe in the Emergency Department: A Protocolized Approach. Joint Commission Journal on Quality and Patient Safety
|
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47: 23–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/32962905" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32962905</span></a>]
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Population not in PICO</p>
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<p>≤ 27% of the population had self-harmed</p>
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Doupnik, S. K., Rudd, B., Schmutte, T.
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et al. (2020) Association of Suicide Prevention Interventions with Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis. JAMA Psychiatry
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77: 1021–1030 [<a href="/pmc/articles/PMC7301305/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7301305</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32584936" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32584936</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Intervention not in PICO</p>
|
|
<p>The study includes brief suicide prevention interventions (psychosocial assessments, brief contact interventions, safety planning and followup interventions)</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Drew, B. L. (2001) Self-harm behavior and no-suicide contracting in psychiatric inpatient settings. Archives of psychiatric nursing
|
|
15: 99–106 [<a href="https://pubmed.ncbi.nlm.nih.gov/11413501" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11413501</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Data collected pre-2000</p>
|
|
<p>Study used patient medical records from January 1996 to mid-July 1997</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ferguson, M. S., Reis, J. A., Rabbetts, L.
|
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et al. (2018) The Effectiveness of Suicide Prevention Education Programs for Nurses. Crisis
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39: 96–109 [<a href="https://pubmed.ncbi.nlm.nih.gov/28990823" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28990823</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Population not in PICO</p>
|
|
<p>Study population is nurses</p>
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</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Fletcher, E. and Stevenson, C. (2001) Launching the Tidal Model in an adult mental health programme. Nursing standard (Royal College of Nursing (Great Britain) : 1987)
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15: 33–36 [<a href="https://pubmed.ncbi.nlm.nih.gov/12214392" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12214392</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed patient population- not clear how many participants had self-harmed (also preliminary results, not fully reported)</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Flynn, S., Nyathi, T., Tham, S. G.
|
|
et al. (2017) Suicide by mental health in-patients under observation. Psychological medicine
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47: 2238–2245 [<a href="https://pubmed.ncbi.nlm.nih.gov/28397618" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28397618</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Non-comparative study</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Furuno, T., Nakagawa, M., Hino, K.
|
|
et al. (2018) Effectiveness of assertive case management on repeat self-harm in patients admitted for suicide attempt: Findings from ACTION-J study. Journal of Affective Disorders
|
|
225: 460–465 [<a href="https://pubmed.ncbi.nlm.nih.gov/28863298" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28863298</span></a>]
|
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</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Intervention not in PICO</p>
|
|
<p>Assertive case management</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Ghahramanlou-Holloway, M., Brown, G. K., Currier, G. W.
|
|
et al. (2014) Safety planning for military (SAFE MIL): Rationale, design, and safety considerations of a randomized controlled trial to reduce suicide risk among psychiatric inpatients. Contemporary Clinical Trials
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39: 113–123 [<a href="https://pubmed.ncbi.nlm.nih.gov/25020008" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25020008</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study protocol</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Harrington, A., Darke, H., Ennis, G.
|
|
et al. (2019) Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit. International journal of mental health nursing
|
|
28: 1099–1109 [<a href="https://pubmed.ncbi.nlm.nih.gov/31206989" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31206989</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed patient population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hochstrasser, L., Frohlich, D., Schneeberger, A. R.
|
|
et al. (2018) Long-term reduction of seclusion and forced medication on a hospital-wide level: Implementation of an open-door policy over 6 years. European Psychiatry
|
|
48: 51–57 [<a href="https://pubmed.ncbi.nlm.nih.gov/29331599" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29331599</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Huber, C. G., Schneeberger, A. R., Kowalinski, E.
|
|
et al. (2016) Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year, observational study. The Lancet Psychiatry
|
|
3: 842–849 [<a href="https://pubmed.ncbi.nlm.nih.gov/27477886" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27477886</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p><10% participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Katz, I. R., Kemp, J. E., Blow, F. C.
|
|
et al. (2013) Changes in suicide rates and in mental health staffing in the veterans health administration, 2005-2009. Psychiatric Services
|
|
64: 620–625 [<a href="https://pubmed.ncbi.nlm.nih.gov/23494171" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23494171</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kroll, D. S., Stanghellini, E., DesRoches, S. L.
|
|
et al. (2020) Virtual monitoring of suicide risk in the general hospital and emergency department. General Hospital Psychiatry
|
|
63: 33–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/30665667" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30665667</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Non-comparative study</p>
|
|
<p>Single-arm intervention (virtual monitoring not compared to standard care)</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Links, P. S. and Hoffman, B. (2005) Preventing suicidal behaviour in a general hospital psychiatric service: Priorities for programming. Canadian Journal of Psychiatry
|
|
50: 490–496 [<a href="https://pubmed.ncbi.nlm.nih.gov/16127967" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16127967</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review</p>
|
|
<p>Included studies checked for relevance</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Loveridge, S. M. (2013) Use of a safe kit to decrease self-injury among adolescent inpatients: a pilot study. Journal of psychosocial nursing and mental health services
|
|
51: 32–36 [<a href="https://pubmed.ncbi.nlm.nih.gov/23786242" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23786242</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Non-comparative study</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lynch, M. A., Howard, P. B., El-Mallakh, P.
|
|
et al. (2008) Assessment and management of hospitalized suicidal patients. Journal of Psychosocial Nursing and Mental Health Services
|
|
46: 45–52 [<a href="https://pubmed.ncbi.nlm.nih.gov/18686596" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18686596</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
McCue, R. E., Urcuyo, L., Lilu, Y.
|
|
et al. (2004) Reducing Restraint Use in a Public Psychiatric Inpatient Service. Journal of Behavioral Health Services and Research
|
|
31: 217–224 [<a href="https://pubmed.ncbi.nlm.nih.gov/15255229" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15255229</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Miller, I. W., Camargo, C. A., Arias, S. A.
|
|
et al. (2017) Suicide prevention in an emergency department population: The ED-safe study. JAMA Psychiatry
|
|
74: 563–570 [<a href="/pmc/articles/PMC5539839/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5539839</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28456130" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28456130</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>Universal screening vs universal screening, secondary risk assessment and telephone-based follow-up for 52 weeks vs treatment as usual</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mohl, A., Stulz, N., Martin, A.
|
|
et al. (2012) The “Suicide Guard Rail”: a minimal structural intervention in hospitals reduces suicide jumps. BMC research notes
|
|
5: 408 [<a href="/pmc/articles/PMC3439295/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3439295</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22862804" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22862804</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed population (hospital-wide initiative)- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Riley, D., Meehan, C., Whittington, R.
|
|
et al. (2006) Patient restraint positions in a psychiatric inpatient service. Nursing times
|
|
102: 42–45 [<a href="https://pubmed.ncbi.nlm.nih.gov/16440977" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16440977</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Robst, J. (2015) Suicide Attempts After Emergency Room Visits: The Effect of Patient Safety Goals. Psychiatric Quarterly
|
|
86: 497–504 [<a href="https://pubmed.ncbi.nlm.nih.gov/25631155" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25631155</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>Risk assessment</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rotheram-Borus, M. J., Piacentini, J., Cantwell, C.
|
|
et al. (2000) The 18-month impact of an emergency room intervention for adolescent female suicide attempters. Journal of consulting and clinical psychology
|
|
68: 1081–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/11142542" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11142542</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Data collected pre-2000</p>
|
|
<p>Data collected from suicidal youths admitted to an emergency department between March 1991 to February 1994</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Russell, G. and Owens, D. (2010) Psychosocial assessment following self-harm: Repetition of nonfatal self-harm after assessment by psychiatrists or mental health nurses. Crisis
|
|
31: 211–216 [<a href="https://pubmed.ncbi.nlm.nih.gov/20801751" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20801751</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>Psychosocial assessment</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sarchiapone, M., Mandelli, L., Iosue, M.
|
|
et al. (2011) Controlling access to suicide means. International Journal of Environmental Research and Public Health
|
|
8: 4550–4562 [<a href="/pmc/articles/PMC3290984/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3290984</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22408588" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22408588</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sivak, K. (2012) Implementation of comfort rooms to reduce seclusion, restraint use, and acting-out behaviors. Journal of Psychosocial Nursing and Mental Health Services
|
|
50: 24–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/22439145" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22439145</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Smith, T., Clark, A., Dodd, E.
|
|
et al. (2018) Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults. International journal of mental health nursing
|
|
27: 756–764 [<a href="https://pubmed.ncbi.nlm.nih.gov/28681424" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28681424</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stanley, B., Brown, G. K., Brenner, L. A.
|
|
et al. (2018) Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry
|
|
75: 894–900 [<a href="/pmc/articles/PMC6142908/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6142908</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29998307" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29998307</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>Follow-up intervention</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stewart, D.; Bowers, L.; Warburton, F. (2009) Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis. General Hospital Psychiatry
|
|
31: 523–530 [<a href="https://pubmed.ncbi.nlm.nih.gov/19892210" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19892210</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sullivan, A. M., Barron, C. T., Bezmen, J.
|
|
et al. (2005) The safe treatment of the suicidal patient in an adult inpatient setting: A proactive preventive approach. Psychiatric Quarterly
|
|
76: 67–83 [<a href="https://pubmed.ncbi.nlm.nih.gov/15757237" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15757237</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>Mixed psychiatric population- not clear how many participants had self-harmed</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tyler, N.; Wright, N.; Waring, J. (2019) Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. BMC health services research
|
|
19: 883 [<a href="/pmc/articles/PMC6876082/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6876082</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31760955" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31760955</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>Follow-up interventions</p>
|
|
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
While, D., Bickley, H., Roscoe, A.
|
|
et al. (2012) Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: A cross-sectional and before-and-after observational study. The Lancet
|
|
379: 1005–1012 [<a href="https://pubmed.ncbi.nlm.nih.gov/22305767" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22305767</span></a>]
|
|
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Other</p>
|
|
<p>Earlier version of <a href="#bcms6509.s1.ref3">Kapur 2016</a> which is included</p>
|
|
</td></tr></tbody></table></div></div></div><div id="bcms6509.appj.s3"><h4>Excluded economic studies</h4><div id="bcms6509.appj.tab2" class="table"><h3><span class="label">Table 10</span><span class="title">Excluded studies from the guideline economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588194/table/bcms6509.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6509.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Adrian, M., Lyon, A. R., Nicodimos, S., Pullmann, M. D., McCauley, E., Enhanced “Train and Hope” for Scalable, Cost-Effective Professional Development in Youth Suicide Prevention, Crisis, 39, 235–246, 2018 [<a href="https://pubmed.ncbi.nlm.nih.gov/29183240" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29183240</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline - this study examined the impact of an educational training ongoing intervention, and the effect of the post-training reminder system, on mental health practitioners’ knowledge, attitudes, and behaviour surrounding suicide assessment and intervention. As well, this study was not a full health economic evaluation.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Borschmann
|
|
R, Barrett
|
|
B, Hellier
|
|
JM, et al. Joint crisis plans for people with borderline personality disorder: feasibility and outcomes in a randomised controlled trial. Br J Psychiatry. 2013;202(5):357–364. [<a href="https://pubmed.ncbi.nlm.nih.gov/23637110" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23637110</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline - this study examined the feasibility of recruiting and retaining adults with borderline personality disorder to a pilot randomised controlled trial investigating the potential efficacy and cost-effectiveness of using a joint crisis plan.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bustamante Madsen, L., Eddleston, M., Schultz Hansen, K., Konradsen, F., Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions, Crisis, 39, 82–95, 2018 [<a href="https://pubmed.ncbi.nlm.nih.gov/28914094" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28914094</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design - this review of health economics studies has been excluded for this guideline, but its references have been hand-searched for any relevant health economic study.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Byford, S., Barrett, B., Aglan, A., Harrington, V., Burroughs, H., Kerfoot, M., Harrington, R. C., Lifetime and current costs of supporting young adults who deliberately poisoned themselves in childhood and adolescence, Journal of Mental Health, 18, 297–306, 2009
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Byford, S., Leese, M., Knapp, M., Seivewright, H., Cameron, S., Jones, V., Davidson, K., Tyrer, P., Comparison of alternative methods of collection of service use data for the economic evaluation health care interventions, Health Economics, 16, 531–536, 2007 [<a href="https://pubmed.ncbi.nlm.nih.gov/17001749" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17001749</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Byford, Sarah, Barber, Julie A., Harrington, Richard, Barber, Baruch Beautrais Blough Brent Brodie Byford Carlson Chernoff Collett Fergusson Garland Goldberg Harman Harrington Hawton Huber Kazdin Kazdin Kerfoot Kerfoot Kerfoot Knapp Lindsey McCullagh Miller Netten Reynolds Sadowski Shaffer Simms Wu, Factors that influence the cost of deliberate self-poisoning in children and adolescents, Journal of Mental Health Policy and Economics, 4, 113–121, 2001 [<a href="https://pubmed.ncbi.nlm.nih.gov/11967471" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11967471</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Denchev, P., Pearson, J. L., Allen, M. H., Claassen, C. A., Currier, G. W., Zatzick, D. F., Schoenbaum, M., Modeling the cost-effectiveness of interventions to reduce suicide risk among hospital emergency department patients, Psychiatric Services, 69, 23–31, 2018 [<a href="/pmc/articles/PMC5750130/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5750130</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28945181" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28945181</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline - this study estimated the cost-effectiveness of outpatient interventions (i.e. Postcards, Telephone outreach, Cognitive Behaviour Therapy) to reduce suicide risk among patients presenting to general hospital emergency departments.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Dunlap, L. J., Orme, S., Zarkin, G. A., Arias, S. A., Miller, I. W., Camargo, C. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., Manton, A. P., Clark, R., Boudreaux, E. D., Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions, Psychiatric services (Washington, D.C.), appips201800445, 2019 [<a href="https://pubmed.ncbi.nlm.nih.gov/31451063" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31451063</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline - this study estimated the cost-effectiveness of suicide screening followed by an intervention to identify suicidal individuals and prevent recurring self-harm.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Fernando, S. M., Reardon, P. M., Ball, I. M., van Katwyk, S., Thavorn, K., Tanuseputro, P., Rosenberg, E., Kyeremanteng, K., Outcomes and Costs of Patients Admitted to the Intensive Care Unit Due to Accidental or Intentional Poisoning, Journal of Intensive Care Medicine, 35, 386–393, 2020 [<a href="https://pubmed.ncbi.nlm.nih.gov/29357777" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29357777</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Flood, C., Bowers, L., Parkin, D., Estimating the costs of conflict and containment on adult acute inpatient psychiatric wards, Nursing economic$, 26, 325–330, 324, 2008 [<a href="https://pubmed.ncbi.nlm.nih.gov/18979699" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18979699</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fortune, Z., Barrett, B., Armstrong, D., Coid, J., Crawford, M., Mudd, D., Rose, D., Slade, M., Spence, R., Tyrer, P., Moran, P., Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders, International Review of Psychiatry, 23, 61–9, 2011 [<a href="https://pubmed.ncbi.nlm.nih.gov/21338300" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21338300</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
George, S., Javed, M., Hemington-Gorse, S., Wilson-Jones, N., Epidemiology and financial implications of self-inflicted burns, Burns, 42, 196–201, 2016 [<a href="https://pubmed.ncbi.nlm.nih.gov/26670160" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26670160</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Gunnell, D., Shepherd, M., Evans, M., Are recent increases in deliberate self-harm associated with changes in socio-economic conditions? An ecological analysis of patterns of deliberate self-harm in Bristol 1972-3 and 1995-6, Psychological medicine, 30, 1197–1203, 2000 [<a href="https://pubmed.ncbi.nlm.nih.gov/12027054" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12027054</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design - cost-of-illness study.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Kapur, N., House, A., Dodgson, K., Chris, M., Marshall, S., Tomenson, B., Creed, F., Management and costs of deliberate self-poisoning in the general hospital: A multi-centre study, Journal of Mental Health, 11, 223–230, 2002
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Kapur, N., House, A., May, C., Creed, F., Service provision and outcome for deliberate self-poisoning in adults - Results from a six centre descriptive study, Social Psychiatry and Psychiatric Epidemiology, 38, 390–395, 2003 [<a href="https://pubmed.ncbi.nlm.nih.gov/12861446" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12861446</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Kinchin, I., Russell, A. M. T., Byrnes, J., McCalman, J., Doran, C. M., Hunter, E., The cost of hospitalisation for youth self-harm: differences across age groups, sex, Indigenous and non-Indigenous populations, Social Psychiatry and Psychiatric Epidemiology, 55, 425–434, 2020 [<a href="https://pubmed.ncbi.nlm.nih.gov/31732765" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31732765</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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O’Leary, F. M., Lo, M. C. I., Schreuder, F. B., “Cuts are costly”: A review of deliberate self-harm admissions to a district general hospital plastic surgery department over a 12-month period, Journal of Plastic, Reconstructive and Aesthetic Surgery, 67, e109–e110, 2014 [<a href="https://pubmed.ncbi.nlm.nih.gov/24183058" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24183058</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Olfson, M., Gameroff, M. J., Marcus, S. C., Greenberg, T., Shaffer, D., National trends in hospitalization of youth with intentional self-inflicted injuries, American Journal of Psychiatry, 162, 1328–1335, 2005 [<a href="https://pubmed.ncbi.nlm.nih.gov/15994716" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15994716</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Ostertag, L., Golay, P., Dorogi, Y., Brovelli, S., Cromec, I., Edan, A., Barbe, R., Saillant, S., Michaud, L., Self-harm in French-speaking Switzerland: A socio-economic analysis (7316), Swiss Archives of Neurology, Psychiatry and Psychotherapy, 70 (Supplement 8), 48S, 2019
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Ougrin, D., Corrigall, R., Poole, J., Zundel, T., Sarhane, M., Slater, V., Stahl, D., Reavey, P., Byford, S., Heslin, M., Ivens, J., Crommelin, M., Abdulla, Z., Hayes, D., Middleton, K., Nnadi, B., Taylor, E., Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial, The Lancet Psychiatry, 5, 477–485, 2018 [<a href="/pmc/articles/PMC5994473/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5994473</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29731412" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29731412</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not self-harm. In addition, the interventions evaluated in this economic analysis (i.e.: a supported discharge service provided by an intensive community treatment team compared to usual care) were not relevant to any review questions.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Palmer, S., Davidson, K., Tyrer, P., Gumley, A., Tata, P., Norrie, J., Murray, H., Seivewright, H., The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial, Journal of Personality Disorders, 20, 466–481, 2006 [<a href="/pmc/articles/PMC1852260/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1852260</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17032159" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17032159</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not self-harm.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Quinlivan
|
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L, Steeg
|
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S, Elvidge
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J, et al. Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis. J Affect Disord. 2019;249:208–215. [<a href="https://pubmed.ncbi.nlm.nih.gov/30772749" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30772749</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not relevant to any of the review questions in the guideline - this study estimated the cost-effectiveness of of risk assessment scales versus clinical assessment for adults attending an emergency department following self-harm.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Richardson
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JS, Mark
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TL, McKeon
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R. The return on investment of postdischarge follow-up calls for suicidal ideation or deliberate self-harm. Psychiatr Serv. 2014;65(8):1012–1019. [<a href="https://pubmed.ncbi.nlm.nih.gov/24788454" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24788454</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not enough data reporting on cost-effectiveness findings.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Smits, M. L., Feenstra, D. J., Eeren, H. V., Bales, D. L., Laurenssen, E. M. P., Blankers, M., Soons, M. B. J., Dekker, J. J. M., Lucas, Z., Verheul, R., Luyten, P., Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: Multicentre randomised clinical trial, British Journal of Psychiatry, 216, 79–84, 2020 [<a href="https://pubmed.ncbi.nlm.nih.gov/30791963" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30791963</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not self-harm.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Tsiachristas, A., Geulayov, G., Casey, D., Ness, J., Waters, K., Clements, C., Kapur, N., McDaid, D., Brand, F., Hawton, K., Incidence and general hospital costs of self-harm across England: estimates based on the multicentre study of self-harm, Epidemiology & Psychiatric Science, 29, e108, 2020 [<a href="/pmc/articles/PMC7214546/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7214546</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32160934" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32160934</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Tsiachristas, A., McDaid, D., Casey, D., Brand, F., Leal, J., Park, A. L., Geulayov, G., Hawton, K., General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis, The Lancet Psychiatry, 4, 759–767, 2017 [<a href="/pmc/articles/PMC5614771/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5614771</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28890321" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28890321</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design – no comparative cost analysis.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Tubeuf, S., Saloniki, E. C., Cottrell, D., Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England, PharmacoEconomics, 37, 513–530, 2019 [<a href="https://pubmed.ncbi.nlm.nih.gov/30294758" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30294758</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study is not a separate study from one already included in the guideline for topic 5.2 (Cottrel 2018). This secondary analysis presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents of (Cottrel 2018), and discusses the practical limitations of those methods.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Tyrer, P., Thompson, S., Schmidt, U., Jones, V., Knapp, M., Davidson, K., Catalan, J., Airlie, J., Baxter, S., Byford, S., Byrne, G., Cameron, S., Caplan, R., Cooper, S., Ferguson, B., Freeman, C., Frost, S., Godley, J., Greenshields, J., Henderson, J., Holden, N., Keech, P., Kim, L., Logan, K., Manley, C., MacLeod, A., Murphy, R., Patience, L., Ramsay, L., De Munroz, S., Scott, J., Seivewright, H., Sivakumar, K., Tata, P., Thornton, S., Ukoumunne, O. C., Wessely, S., Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study, Psychological medicine, 33, 969–976, 2003 [<a href="https://pubmed.ncbi.nlm.nih.gov/12946081" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12946081</span></a>]
|
|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design - no economic evaluation.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Van Roijen, L. H., Sinnaeve, R., Bouwmans, C., Van Den Bosch, L., Cost-effectiveness and Cost-utility of Shortterm Inpatient Dialectical Behavior Therapy for Chronically Parasuicidal BPD (Young) Adults, Journal of Mental Health Policy and Economics, 18, S19–S20, 2015
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract.</td></tr><tr><td headers="hd_h_bcms6509.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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van Spijker, B. A., Majo, M. C., Smit, F., van Straten, A., Kerkhof, A. J., Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help, Journal of medical Internet research, 14, e141, 2012 [<a href="/pmc/articles/PMC3517339/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3517339</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23103835" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23103835</span></a>]
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|
</td><td headers="hd_h_bcms6509.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not self-harm.</td></tr></tbody></table></div></div></div></div><div id="bcms6509.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="bcms6509.appk.s1"><h4>Research recommendations for review question: What are the most effective ways of supporting people to be safe after self-harm?</h4><p>No research recommendations were made for this review question.</p></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="bcms6509.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588194/table/bcms6509.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6509.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_bcms6509.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_bcms6509.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Inclusion:</b>
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|
<ul><li class="half_rhythm"><div>All people who have self-harmed, including those with a mental health problem, neurodevelopmental disorder or a learning disability</div></li></ul>
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<b>Exclusion</b>:
|
|
<ul><li class="half_rhythm"><div>People displaying repetitive stereotypical self-injurious behaviour, for example head-banging in people with a significant learning disability</div></li></ul></td></tr><tr><th id="hd_b_bcms6509.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_bcms6509.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ol><li class="half_rhythm"><div>Staffing model (e.g., number, expertise, skills mix of staff on duty, observation schedules, location of staff)</div></li><li class="half_rhythm"><div>Physical environment design (e.g., physically safe environment [e.g., ligature points])</div></li></ol></td></tr><tr><th id="hd_b_bcms6509.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_bcms6509.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ol><li class="half_rhythm"><div>Different staffing models</div></li><li class="half_rhythm"><div>Different designs</div></li></ol></td></tr><tr><th id="hd_b_bcms6509.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_bcms6509.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Critical:
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|
<ul><li class="half_rhythm"><div>Self-harm repetition (for example, self-poisoning or self-cutting)</div></li><li class="half_rhythm"><div>Suicide</div></li><li class="half_rhythm"><div>Service user satisfaction</div></li></ul>
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Important:
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<ul><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Engagement with services</div></li><li class="half_rhythm"><div>Number of people leaving without assessment being completed</div></li></ul></td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="bcms6509.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588194/table/bcms6509.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6509.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a href="#bcms6509.s1.ref1">Bowers 2006</a>
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</p>
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<p>Before-and-after study</p>
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<p>UK</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N= not reported</p>
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<p>Inpatients of two acute psychiatric wards during the study period. The ward managers applied to participate in the study.</p>
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<p>Patient characteristics not reported</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">‘City Nurses’ staffing intervention, designed to reduce conflict and containment, involving:
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<ul><li class="half_rhythm"><div>action-research (intervention co-designed with ward staff and periodic feedback on outcomes from the wards)</div></li><li class="half_rhythm"><div>a ‘City Nurse’ with clinical expertise in acute inpatient care appointed to each ward for 3 days a week</div></li><li class="half_rhythm"><div>staffing attitude: “positive appreciation of patients by staff; the ability of the staff to regulate their own natural emotional reactions to patients; and the creation of an effective structure (rules and routine) for ward life” (p. 166)</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment as usual provided (not otherwise specified; assume standard of care for acute psychiatric ward)</td><td headers="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Self-harm (over 12 months)</div></li><li class="half_rhythm"><div>Suicide attempts (over 12 months)</div></li></ul></td></tr><tr><td headers="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a href="#bcms6509.s1.ref2">Ford 2020</a>
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</p>
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<p>Retrospective cohort study</p>
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<p>US</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N= 602</p>
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<p>Incarcerated male adults (aged ≥18 years), diagnosed with a serious mental illness and in the jail census for 14 days or more during the study period.</p>
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<p><b>Intervention:</b>
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<ul><li class="half_rhythm"><div>n= 302</div></li><li class="half_rhythm"><div>Age median: 36</div></li><li class="half_rhythm"><div>Female/ male n: 0/ 302</div></li><li class="half_rhythm"><div>Ethnicity: Hispanic 82; non-Hispanic white 33; non-Hispanic Black 165; non-Hispanic Asian 11; other or missing 11</div></li><li class="half_rhythm"><div>Comorbidities: bipolar and related disorders 23; depression and depressive disorders 12; neurodevelopmental disorder 24; personality disorder 37; PTSD, trauma and stress related disorders 13; schizophrenia and psychotic disorders 244; substance abuse 202</div></li><li class="half_rhythm"><div>Duration/ history of self-harm: not reported</div></li><li class="half_rhythm"><div>Previous self-harm: not reported</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: Clozapine 24; Lithium 40; Antipsychotic injection 101; Quetiapine 32; Haloperidol 67; Risperidone 116; Olanzapine 78; Aripiprazole 54; Valproic acid 106</div></li><li class="half_rhythm"><div>Assessment setting: prisons; specialised treatment units</div></li></ul>
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<b>Control:</b>
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<ul><li class="half_rhythm"><div>n= 302</div></li><li class="half_rhythm"><div>Age median: 36</div></li><li class="half_rhythm"><div>Female/ male n: 0/ 302</div></li><li class="half_rhythm"><div>Ethnicity: Hispanic 76; non-Hispanic white 38; non-Hispanic Black 163; non-Hispanic Asian 15; other or missing 10</div></li><li class="half_rhythm"><div>Comorbidities: bipolar and related disorders 25; depression and depressive disorders 17; neurodevelopmental disorder 24; personality disorder 38; PTSD, trauma and stress related disorders 17; schizophrenia and psychotic disorders 238; substance abuse 202</div></li><li class="half_rhythm"><div>Duration/ history of self-harm: not reported</div></li><li class="half_rhythm"><div>Previous self-harm: not reported</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: Clozapine 3; Lithium 32; Antipsychotic injection 87; Quetiapine 26; Haloperidol 61; Risperidone 121; Olanzapine 84; Aripiprazole 51; Valproic acid 90</div></li></ul>
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Setting: prisons; single-cell housing</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PACE (program for accelerating clinical effectiveness) units in prisons, involving:
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<ul><li class="half_rhythm"><div>physical components: large open spaces; natural light; confidential interview rooms; sufficient space for protected group activities</div></li><li class="half_rhythm"><div>staffing: multidisciplinary mental health treatment teams (including a psychologist, psychiatric providers, nurses, counsellers, treatment aides, art therapists)</div></li><li class="half_rhythm"><div>training: correctional officers received specialised mental health training; staff communication mechanisms established</div></li><li class="half_rhythm"><div>activities: daily activities, including community meetings, creative arts therapy, discussion groups</div></li><li class="half_rhythm"><div>patient-centered crisis-deesaclation; incentives program to emphasize positive reinforcement over punishment;</div></li><li class="half_rhythm"><div>treatment: patient engagement in medication over coercion</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Single cell housing (mental observation units), including:
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<ul><li class="half_rhythm"><div>physical components: little natural light, loud and crowded spaces</div></li><li class="half_rhythm"><div>treatment: limited continuity of care</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Self-harm (at 30 and 60 days)</div></li></ul></td></tr><tr><td headers="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a href="#bcms6509.s1.ref3">Kapur 2016</a>
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</p>
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<p>Before-and-after ecological study</p>
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<p>UK</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N= 19248</p>
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<p>Individuals aged ≥10 years in England who died during the study period because of suicide, defined as a death that received a suicide or open verdict at Coroner’s inquest (ICD-10 Codes X60–X84; Y10–Y34, Y87.0, and Y87.2, excluding Y33.9), and had contact with mental health services within 12 months of death</p>
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<p>Patient characteristics not reported</p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ward-safety service changes:
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<ul><li class="half_rhythm"><div>removal of non-collapsible curtain rails</div></li><li class="half_rhythm"><div>removal of low lying ligature points</div></li></ul>
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Staff-training service changes:
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<ul><li class="half_rhythm"><div>Clinical staff receive training in the management of suicide risk</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment as usual (dependent on mental health service provider).</td><td headers="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul><li class="half_rhythm"><div>Suicide (at 12 months)</div></li></ul></td></tr><tr><td headers="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
|
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<a href="#bcms6509.s1.ref4">Noelck 2019</a>
|
|
</p>
|
|
<p>Before-and-after study</p>
|
|
<p>US</p>
|
|
</td><td headers="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N= 224</p>
|
|
<p>Children and adolescents admitted for medical stabilization after a suicide attempt in the Paediatric Intensive Care Unit (PICU) and the Paediatric Acute-Care Medical unit (PACM) units at a 150 bed tertiary-care paediatric academic medical centre</p>
|
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<p><b>Pre-intervention:</b>
|
|
<ul><li class="half_rhythm"><div>n= 53</div></li><li class="half_rhythm"><div>Age mean (SD): 15.1 (1.7)</div></li><li class="half_rhythm"><div>Female/ male n: 43/ 10</div></li><li class="half_rhythm"><div>Ethnicity: Non-Hispanic white 33; Non-Hispanic African American 1; Hispanic 6; Other 13</div></li><li class="half_rhythm"><div>Comorbidities: not reported</div></li><li class="half_rhythm"><div>Duration/ history of self-harm: not reported</div></li><li class="half_rhythm"><div>Previous self-harm: suicide attempt (all participants)</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: not reported</div></li><li class="half_rhythm"><div>Assessment setting: pediatric intensive care unit and pediatric acute-care medical</div></li></ul>
|
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<b>Post-intervention:</b>
|
|
<ul><li class="half_rhythm"><div>n= 171</div></li><li class="half_rhythm"><div>Age mean (SD): 15.0 (1.5)</div></li><li class="half_rhythm"><div>Female/ male n: 131/ 40</div></li><li class="half_rhythm"><div>Ethnicity: Non-Hispanic white 120; Non-Hispanic African American 5; Hispanic 30; Other 16</div></li><li class="half_rhythm"><div>Comorbidities: not reported</div></li><li class="half_rhythm"><div>Duration/ history of self-harm: not reported</div></li><li class="half_rhythm"><div>Previous self-harm: suicide attempt (all participants)</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: not reported</div></li><li class="half_rhythm"><div>Assessment setting: paediatric intensive care unit and the paediatric acute-care medical</div></li></ul></p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality Improvement (QI) intervention, co-designed by multidisciplinary care team, including:
|
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<ul><li class="half_rhythm"><div>Paediatric Behavioural Health Safety Protocol as standard of care (consent process, document patients’ characteristics, set expectations for patients’ behaviour)</div></li><li class="half_rhythm"><div>Full patient safety search (by two nurses within 2 hours of arrival; details recorded)</div></li><li class="half_rhythm"><div>Shared mental model/development of communication process (Safety Huddle between care team members, within 24 hours of patient admission and for patients with ongoing concerns)</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment as usual. No standardised approach to care, with the exception of:
|
|
<ul><li class="half_rhythm"><div>full-time patient safety attendant (equivalent to a certified nursing assistant) placed within the patient’s room</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul><li class="half_rhythm"><div>Self-harm (over 8- 17 months)</div></li></ul></td></tr><tr><td headers="hd_h_bcms6509.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>
|
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<a href="#bcms6509.s1.ref5">Reen 2020</a>
|
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</p>
|
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<p>Before-and-after study</p>
|
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<p>UK</p>
|
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=205</p>
|
|
<p>Adolescents inpatients of a child and adolescent psychiatry ward during the study period aged 12 to 18 years</p>
|
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<p><b>Pre-intervention:</b>
|
|
<ul><li class="half_rhythm"><div>n=124</div></li><li class="half_rhythm"><div>Age mean (SD): 15.81 (1.41)</div></li><li class="half_rhythm"><div>Female/ male n: 107/ 17</div></li><li class="half_rhythm"><div>Ethnicity: not reported</div></li><li class="half_rhythm"><div>Comorbidities: adjustment and dissociative disorder 6; anxiety 11; developmental disorder 5; eating disorder 46; mood disorder 19; obsessive compulsive disorder 1; other 9; personality disorder 8; phobias 1; schizophrenia and psychosis 9; stress-related 2; substance abuse 3; unknown 5</div></li><li class="half_rhythm"><div>Duration/ history of self-harm: not reported</div></li><li class="half_rhythm"><div>Previous self-harm: not reported</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: not reported</div></li><li class="half_rhythm"><div>Assessment setting: inpatient psychiatric ward</div></li></ul>
|
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<b>Post-intervention:</b>
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<ul><li class="half_rhythm"><div>n=80</div></li><li class="half_rhythm"><div>Age mean (SD): 15.35 (1.60)</div></li><li class="half_rhythm"><div>Female/ male n: 62/ 8</div></li><li class="half_rhythm"><div>Ethnicity: not reported</div></li><li class="half_rhythm"><div>Comorbidities: adjustment and dissociative disorder 2; anxiety 7; developmental disorder 2; eating disorder 35; mood disorder 9; obsessive compulsive disorder 1; other 5; personality disorder 4; phobias 0; schizophrenia and psychosis 2; stressrelated 1; substance abuse 1; unknown 1</div></li><li class="half_rhythm"><div>Duration/ history of self-harm:</div></li><li class="half_rhythm"><div>Previous self-harm: not reported</div></li><li class="half_rhythm"><div>Mean number of suicide attempts (SD): not reported</div></li><li class="half_rhythm"><div>Method: not reported</div></li><li class="half_rhythm"><div>Current psychiatric treatment: not reported</div></li><li class="half_rhythm"><div>Assessment setting: inpatient psychiatric ward</div></li></ul></p>
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</td><td headers="hd_h_bcms6509.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Co-designed with clinical ward staff and with input from patients and consisted of the first 3 control group interventions along with:
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<ul><li class="half_rhythm"><div>regular twilight nursing shifts (3pm- 11pm, Sunday -Thursday) to increase availability of regular nursing staff on the ward during a vulnerable time, rather than employing expensive temporary agency staff</div></li><li class="half_rhythm"><div>structured programme of evening activities that the inpatients were encouraged to participant in and could suggest, e.g., games and drama workshop, visit from therapy dog, mindfulness podcast groups and coping skills workshop conducted by activity workers or occupational therapists on the ward</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment as usual:
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<ul><li class="half_rhythm"><div>Group therapy sessions (2-3pm, daily)</div></li><li class="half_rhythm"><div>Individual treatment sessions (nurse-led, weekly)</div></li><li class="half_rhythm"><div>Medication provided on clinical need</div></li><li class="half_rhythm"><div>Occasional evening activities</div></li><li class="half_rhythm"><div>Ad-hoc twilight shift (3-11pm), covered by temporary nursing staff</div></li></ul></td><td headers="hd_h_bcms6509.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Self-harm (over 18-24 months)</div></li></ul></td></tr></tbody></table></div></div></div></div><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.12.1 to 1.12.9 and 1.14.4. in the NICE guideline</p><p>National Institute for Health and Care Excellence</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK588194</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36595598" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36595598</a></span></div></div></div>
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