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class="bkr_bib"><h1 id="_NBK588204_"><span itemprop="name">Evidence review for assessment in specialist settings</span></h1><div class="subtitle">Self-harm: assessment, management and preventing recurrence</div><p><b>Evidence review F</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 class="bkr_clear"></div></div><div id="bcms6501.s1"><h2 id="_bcms6501_s1_">Assessment in specialist settings</h2><div id="bcms6501.s1.1"><h3>Review question</h3><p>How should assessment for people who have self-harmed be undertaken in specialist settings, such as: community mental health services, emergency departments (by specialist staff), inpatient mental health services?</p><div id="bcms6501.s1.1.1"><h4>Introduction</h4><p>People who have self-harmed frequently present to Emergency Departments (EDs) for mental and physical health assessment. People who are under the care of Community Mental Health Services and who are inpatients in psychiatric wards represent a population with high rates of self-harm. Assessment is a key factor in establishing a positive therapeutic relationship with health services and in ensuring that people receive the treatment that they need, both for their physical and mental health. The aim of this review is to identify how assessment should be undertaken in specialist settings.</p></div><div id="bcms6501.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK588204/table/bcms6501.tab1/?report=objectonly" target="object" rid-figpopup="figbcms6501tab1" rid-ob="figobbcms6501tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figbcms6501tab1"><a href="/books/NBK588204/table/bcms6501.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figbcms6501tab1" rid-ob="figobbcms6501tab1"><img class="small-thumb" src="/books/NBK588204/table/bcms6501.tab1/?report=thumb" src-large="/books/NBK588204/table/bcms6501.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="bcms6501.tab1"><a href="/books/NBK588204/table/bcms6501.tab1/?report=objectonly" target="object" rid-ob="figobbcms6501tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details, see the review protocol in <a href="#bcms6501.appa">appendix A</a>.</p></div><div id="bcms6501.s1.1.3"><h4>Methods and process</h4><p>A modified version of the GRADE approach to rate the certainty of evidence in systematic reviews was used as part of a pilot project undertaken by NICE. Instead of using predefined clinical decision/minimal important difference (MID) thresholds to assess imprecision in GRADE tables, imprecision was assessed qualitatively during committee discussions. Other than this modification, GRADE was used to assess the quality of evidence for the selected outcomes and this evidence review 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="#bcms6501.appa">appendix A</a> and the methods document (<a href="/books/NBK588204/bin/NG225_Supplement1_Methods.pdf">supplementary document 1</a>).</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="bcms6501.s1.1.4"><h4>Effectiveness evidence</h4><div id="bcms6501.s1.1.4.1"><h5>Included studies</h5><p>Three studies reported in 4 publications were included in this review. Two of these were randomised controlled trials (RCTs: <a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a>, <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>, <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>). Two of these publications reported results from the same study (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>, <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>). One study was a non-randomised prospective cohort study (<a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>).</p><p>These included studies are summarised in <a class="figpopup" href="/books/NBK588204/table/bcms6501.tab2/?report=objectonly" target="object" rid-figpopup="figbcms6501tab2" rid-ob="figobbcms6501tab2">Table 2</a>.</p><p>Two studies were conducted in a UK setting (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>, <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>, <a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>), and 1 was from the USA (<a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a>).</p><p>Two studies included individuals presenting with an episode of self-harm (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>, <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>, <a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>): 1 focused on adolescents aged 12–18 years who were not engaged with psychiatric services and who had self-harmed and been referred for a psychosocial assessment (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>, <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>), and the other study analysed presentations of self-harm to hospital (<a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>). The third study included veterans recruited from an inpatient psychiatry unit following a recent suicide attempt or for whom suicidal ideation was a presenting problem (<a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a>).</p><p>The 2 RCTs compared different types of assessment. <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin (2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013)</a> compared therapeutic assessment with assessment as usual, while <a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a> compared ‘usual assessment group therapy’ with ‘suicide status form assessment group therapy’. The cohort study (<a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>) compared assessment by a psychiatrist with assessment by a psychiatric nurse.</p><p>See the literature search strategy in <a href="#bcms6501.appb">appendix B</a> and study selection flow chart in <a href="#bcms6501.appc">appendix C</a>.</p></div><div id="bcms6501.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="#bcms6501.appj">appendix J</a>.</p></div></div><div id="bcms6501.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/NBK588204/table/bcms6501.tab2/?report=objectonly" target="object" rid-figpopup="figbcms6501tab2" rid-ob="figobbcms6501tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figbcms6501tab2"><a href="/books/NBK588204/table/bcms6501.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figbcms6501tab2" rid-ob="figobbcms6501tab2"><img class="small-thumb" src="/books/NBK588204/table/bcms6501.tab2/?report=thumb" src-large="/books/NBK588204/table/bcms6501.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="bcms6501.tab2"><a href="/books/NBK588204/table/bcms6501.tab2/?report=objectonly" target="object" rid-ob="figobbcms6501tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#bcms6501.appd">appendix D</a>.</p></div><div id="bcms6501.s1.1.6"><h4>Summary of the evidence</h4><p>One study (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013)</a> compared therapeutic assessment with assessment as usual in adolescents who had self-harmed. No significant differences in ED presentations with self-harm or total number of episodes of self-harm were identified between the groups at 24 months (low-to-moderate quality). The outcome ‘engagement with follow-up’ was reported at 1, 3, 12, and 24 months. Attendance at first follow-up (1 month) was significantly higher in the therapeutic assessment group compared with the assessment as usual group (moderate quality). Participants in the therapeutic assessment group were more likely to attend ≥4 sessions of routine community treatment in the 3 months after assessment than individuals in the assessment as usual group (moderate quality). Over the longer term (at 12 and 24 months) engagement with treatment remained higher in the therapeutic assessment group compared with assessment as usual (low quality).</p><p>One study (<a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a>) compared ‘suicide status form assessment group therapy with ‘usual assessment group therapy’ in veterans discharged from an inpatient psychiatry setting. The study reported the outcomes of satisfaction, distress and engagement with follow-up. No significant differences in satisfaction were identified between groups at 3 months (very low quality). No significant differences between groups in overall symptom distress were observed at 1 month, or 3 months following assessment (very low quality). No significant differences between groups were observed in attendance of follow-up at 1 month or 3 months following assessment (very low quality).</p><p>One study (<a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>) compared assessment of individuals presenting with self-harm in ED by psychiatrists and psychiatric nurses. The study reported the outcome of self-harm repetition. No significant difference in repeat self-harm was identified between individuals assessed by a psychiatrist compared with those assessed by a psychiatric nurse (low quality). Results from unadjusted and adjusted statistical models (model 1 adjusted for: age at presentation, method of self-harm, hour of presentation, and year of presentation; model 2 adjusted for: age at presentation, method of self-harm, hour of presentation, year of presentation; and aftercare) were consistent (low quality).</p><p>None of the included studies reported the following outcomes: suicide, quality of life or initiation of safeguarding procedures.</p><p>See <a href="#bcms6501.appf">appendix F</a> for full GRADE tables.</p></div><div id="bcms6501.s1.1.7"><h4>Economic evidence</h4><div id="bcms6501.s1.1.7.1"><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="#bcms6501.appb">appendix B</a> and economic study selection flow chart in <a href="#bcms6501.appg">appendix G</a>.</p></div><div id="bcms6501.s1.1.7.2"><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="#bcms6501.appj">appendix J</a>.</p></div></div><div id="bcms6501.s1.1.8"><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="bcms6501.s1.1.9"><h4>Evidence statements</h4><div id="bcms6501.s1.1.9.1"><h5>Economic</h5><p>No economic studies were identified which were applicable to this review question.</p></div></div><div id="bcms6501.s1.1.10"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="bcms6501.s1.1.10.1"><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 types of assessment and capture 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 empowering and centred around the patient’s experiences, and because patient satisfaction is likely to influence whether the patient engages with the intervention.</p><p>Initiating safeguarding procedures, distress, engagement with after-care, and quality of life were considered important outcomes by the committee. Engagement with after-care was chosen as an important outcome because repetition of self-harm is common after initial assessment and the assessment may therefore have indicated a need for further care. However, if the type of assessment influences the likelihood of whether a person who has self-harmed both has access to and attends follow-up sessions, then this will influence whether after-care will be effective. Quality of life was chosen as an important outcome as it is a multidimensional concept encompassing health-related outcomes beyond those of repeat self-harm or survival. Distress was chosen as an important outcome as, given that self-harm is an expression of personal distress, different assessment types may affect an individual distress levels in different ways. The committee agreed that patients sometimes feel the care that is offered after an episode of self-harm can increase rather than reduce their distress, which can deter patients from seeking care in future. Initiation of safeguarding procedures following assessment was considered an important outcome because domestic violence, childhood abuse and maltreatment, and other forms of abuse and exploitation increase rates of self-harm, and self-harm may be the first indicator of abuse. Repetition of self-harm is common after initial assessment. Assessment may identify individuals for whom the initiation of safeguarding procedures may be necessary and may reduce rates of repeat self-harm.</p></div><div id="bcms6501.s1.1.10.2"><h5>The quality of the evidence</h5><p>When assessed using GRADE methodology the evidence was found to range in quality from very low to moderate quality. In all cases, the evidence was downgraded due to risk of bias as per Cochrane RoB 2.0 or ROBINS-I (for example, due to missing data or lack of blinding), and in one case it was also downgraded due to indirectness as the study was conducted in a non-UK setting.</p><p>There was no evidence identified for a number of interventions and comparisons, including: assessments including principles of active listening; comprehensive biopsychosocial assessment; culturally sensitive assessment. Additionally, no evidence was identified for the following outcomes: suicide; quality of life; initiation of safeguarding procedures.</p></div><div id="bcms6501.s1.1.10.3"><h5>Imprecision and clinical importance of effects</h5><p>The committee discussed the evidence and agreed that, as the quality of the majority of the evidence was either low or very low and found no important difference in a number of outcomes, most of the evidence presented did not allow them to make strong recommendations on the overall benefit or potential harm of specific models of assessment in specialist settings. The committee also qualitatively discussed imprecision for each of the interventions and agreed that none of the treatment effects were likely to be clinically meaningful.</p><p>One study (<a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a>) compared therapeutic group assessment using the Suicide Status Form against therapeutic group assessment using informal questions, however this study was of limited applicability as the population was veterans recently discharged from an inpatient psychiatry setting and the study was conducted in a non-UK setting. Due to the lack of applicability of the study and the very low quality of the evidence, the committee did not feel confident recommending use of the Suicide Assessment Form. One study (<a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a>) looked at whether who conducted the assessment affected outcomes, comparing assessment completed by a psychiatrist against assessment completed by a psychiatric nurse. The quality of this evidence was low and the study found no overall differences in repeat self-harm between groups, so the committee did not feel confident making recommendations relating to which professionals should carry out assessment for people who have self-harmed. Overall only 1 study (<a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013)</a> reported findings of moderate quality, and this study found no important difference in terms of A&E presentations with self-harm when comparing Therapeutic Assessment for young people with assessment as usual, but an important benefit in terms of attendance of treatment sessions at CAMHS at 1 and 3 months’ follow-up. This study also found no important difference in total recorded self-harm episodes and an important benefit in attendance of treatment sessions at CAMHS at 12 and 24 months’ follow-up, however the committee agreed during their qualitative discussion of imprecision that there was serious imprecision in the evidence regarding these outcomes, due to uncertainty around the estimates. Overall, the committee agreed that the estimated benefit in engagement with services in the short term for participants who received Therapeutic Assessment was worth taking into consideration when drafting the recommendations. The committee therefore used the moderate quality evidence from <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013</a> and their own knowledge and experience to draft the recommendations, taking into account existing concerns in current practice.</p><p>The committee agreed not to prioritise this area for research recommendations despite the poor quality of the evidence as other areas of the guideline were deemed more necessary to prioritise.</p></div><div id="bcms6501.s1.1.10.4"><h5>Benefits and harms</h5><p>In advance of the discussion of recommendations, the committee agreed that there was never a scenario in which a psychosocial assessment should not be offered to the person who had self-harmed. The committee discussed that there may be a belief that withholding assessment or treatment for episodes of self-harm is therapeutic and will reduce the frequency of self-harm; this belief is based on a mistaken understanding of behavioural change theory and contingency management.</p><p>The committee made recommendations in part split according to setting specialty, and in part split according to staff speciality. This was because both specialist and non-specialist staff work in some settings, such as EDs, making it difficult to define these settings as either specialist or non-specialist. The committee agreed that in these situations, staff with different levels of responsibility would provide different assessments for people who have self-harmed, regardless of setting type.</p><p>The committee agreed that it is a commonly accepted principle that a psychosocial assessment must be offered to all people presenting for self-harm. The committee discussed existing concerns around assessments that were conducted remotely, without contact with the person who had self-harmed, for example by reviewing case notes or from discussions between clinicians. The committee agreed that the person should always be involved in their own assessment in order to avoid incorrect assumptions being made, or inaccuracies in case notes being replicated, potentially leading to inappropriate care planning and the provision of care and support not based on the individual’s needs. The committee discussed whether assessments should always be held face-to-face but ultimately agreed that this may not always be appropriate or possible, and that the key point to emphasise is therefore that an assessment should always include direct communication with the person, whichever way is most appropriate. The committee agreed that the assessment should have the aims of understanding and engaging people who have self-harmed, with the goal of initiating a therapeutic relationship. However, the committee felt that a psychosocial assessment should also have other key aims. The committee agreed based on their expertise that assessments should be undertaken with the aim of understanding why the person has self-harmed and facilitating the person’s access to care, to ensure they receive appropriate treatment and support and to provide information to the person who had self-harmed and their family members or carers. This recommendation was also based on qualitative evidence from the review on specialist staff skills (evidence report P), which showed that staff and people who had self-harmed though ti was important that staff took the time to explore the person’s reasons for self-harming. Evidence also showed that a model of assessment that provided information to family members had a positive effect on engagement with follow-up services. The committee felt that these recommendations would reduce the chance of future self-harm, encourage help seeking and improve service user satisfaction. The committee agreed that patient factors are often cited as a barrier to engagement with care for people who self-harm, but clinician attitudes and systemic barriers to access are equally important.</p><p>The committee agreed that assessments should not be delayed until after treatment for the physical consequences of self-harm was complete, and that it was important to emphasise the necessity of prioritising a psychosocial assessment. The committee agreed that the best approach would usually be for psychosocial assessment to be carried out concurrently with medical assessment, as this could lead to improved service user satisfaction and supports the provision of appropriate mental and physical health care. In the emergency department, this means that specialist mental health professionals should arrive promptly and should work alongside physical health colleagues during the initial assessment and treatment process.</p><p>The committee agreed, based on their knowledge and experience that a psychosocial assessment is essential after an episode of self-harm, and that delaying an assessment for someone who had self-harmed for any reason was a cause for concern, as this could result in inappropriate treatment being given at all later stages in the person’s care. The committee discussed their concerns regarding the potential for staff to use intoxication as an excuse not to give a psychosocial assessment, and agreed that there are scenarios where a mildly intoxicated person may still be capable of providing accurate answers to assessment. However, they also discussed the fact that it may be unethical to do an assessment if the person is severely intoxicated, as they might be more likely to provide inaccurate or incorrect answers, or say something they may later regret. As a result, the committee agreed that specialist staff should review whether the person is able to meaningfully engage with the assessment in collaboration with the person. They agreed, based on their knowledge and experience, that this would prevent staff members from automatically refusing assessment on the grounds of intoxication, but encourage staff to consult with the patient and use their professional judgment to decide when performing an assessment would be unethical at that moment. The committee agreed that psychosocial assessments are still a priority in these situations and that delays can be problematic, and therefore recommended that patients should be regularly reviewed so that an assessment can take place as soon as appropriate.</p><p>The recommendation about breath and blood levels was based on the committee’s knowledge that breathalysers and blood alcohol tests did not accurately assess the ability of a person to meaningfully engage with an assessment, and therefore could be used to wrongly deny someone an assessment. In their experience, the committee agreed that breathalysers and blood alcohol tests could cause harm to someone who has self-harmed by delaying assessment.</p><p>The recommendation that an assessment should follow any existing care management plan was based on the committee’s experience and expertise. The committee discussed the fact that people who self-harmed frequently sometimes had care plans in place and that there was a risk that a full in-depth assessment might not be appropriate, especially for someone who had already had one that day, for example. The committee agreed that such plans had usually been agreed in collaboration with the person who had self-harmed, and therefore existing plans should be incorporated into assessment in order to improve service user satisfaction. However, the committee agreed that this did not override the importance of offering psychosocial assessment for each episode of self-harm: the decision to limit the extent of assessment and to follow an existing care plan should be made jointly between clinicians and the person themselves.</p><p>The recommendation that an assessment should take place in a private area was based on the committee’s experience that when assessments took place in a public space or in a screened-off space where the assessment could be overheard, it was likely that the person who had self-harmed would feel self-conscious or as though they were not being taken seriously, and would feel unable to talk candidly about confidential and sensitive topics. The committee agreed that an area should be designated for assessment purposes and that this area should be appropriate for discussing private matters where other people cannot walk through or overhear. Evidence from the qualitative review on the information and support needs of people who have self-harmed (see Evidence Report A) also showed that people valued privacy as well as having a safe and trusted environment in which they can feel comfortable discussing self-harm.</p><p>The committee discussed their experience that people who had self-harmed often had preferences about how they wanted to receive an assessment, including whether they wanted their assessment to be completed by a man or a woman, which would allow them to feel more comfortable and therefore more likely to engage with services. The committee agreed based on their experience that it was important to consider the person’s preferences and accommodate them where possible, as this could have the important benefit of increasing patient satisfaction. The committee agreed that appropriate adaptations to assessments should also be made for people with a learning disability or physical, mental health or neurodevelopmental conditions based on their experience that psychosocial assessments could be intimidating or disruptive for some people. The committee also discussed the fact that people may have specific communication needs in order for an assessment to be adequately conducted (including people for whom English is not a first language) and therefore agreed that these needs should be taken into account in order to improve accessibility and allow for a higher quality of care that was tailored to the needs of the individual.</p><p>The committee discussed the elements of the Therapeutic Assessment model employed in <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013</a> and agreed that certain features of the assessment model should be included in a psychosocial assessment in specialist settings. The evidence showed an assessment model including identification of the functions of self-harm, including the target problem, resulted in better engagement with follow-up. The committee therefore discussed whether it was useful to assess the motivation behind each individual incident for people who repeat self-harm and felt there were benefits to doing so, including improved patient satisfaction and better engagement with services as a result of a more tailored assessment. The committee identified the fact that repeating this part of an assessment may be unnecessary for people who presented multiple times. However, the consensus was that it was important to identify the functions of self-harm for the person at each assessment, as the same person could have different motivations for each episode of self-harm and it could pose a risk to assume previous assessments were still relevant. The committee agreed that investigation of the person’s values and wishes should always be prioritised, to ensure assessment will lead to person-centred care. They also agreed that an assessment should allow for staff members to exercise their own clinical judgment regarding the person’s need for specific elements of care such as interventions, support, and referral to other services including social care and rehabilitation, for example. Consideration of these factors should be supplemented by the person’s preferences, based on the committee’s experience that doing so could result in improved quality of care and encourage better engagement with services. The committee agreed this would facilitate addressing both the psychological and the social aspects contributing to a person’s reason for self-harming. The committee additionally discussed the need to consider the intersection between self-harm and coexisting conditions such as learning disability, neurodevelopmental conditions, or mental health problems, as this can also inform care planning further down the care pathway. The involvement of family and carers in the assessment should be considered, as other qualitative evidence from the review on involving family and carers (Evidence report D) showed that people who had self-harmed and their family members and carers perceived an improvement in the quality of care when they were involved in the person’s care.</p><p>The committee agreed that any psychosocial assessment should include an assessment of the individual’s strengths, vulnerabilities, and needs, including interpersonal factors, social characteristics, life difficulties (such as financial problems), and healthcare history, which could be triggers for self-harm or linked to higher rates of self-harm. The recommendations about what factors a comprehensive psychosocial assessment should explore were based primarily on the committee’s experience and expertise, supplemented by the moderate quality evidence from this review. The committee considered the evidence from the <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a>/ <a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">2013</a> study, which showed that Therapeutic Assessment that included consideration and enhancement of motivation for change, as well as an exploration of ways of breaking identified ‘vicious cycles’ resulted in better engagement with follow-up. The committee agreed that an assessment should look at the skills and strengths of the person who has 17 self-harmed as well as potential existing strategies they use to cope, as these could have the important benefit of helping the person to develop ways to manage the urge to self-harm, or support the development of existing coping strategies to be more effective. The committee also discussed whether a diagnostic element that considered underlying psychiatric conditions such as depression or obsessive-compulsive disorder should remain part of the assessment, and considered the possible risk that this could undermine the importance of focusing on self-harm as a phenomenon in its own right. However, the committee felt that self-harm should not be seen as a homogenous expression of distress and that there were a number of benefits to considering potential psychiatric diagnoses during assessment, such as facilitating the provision of important evidence-based interventions for these conditions. The committee also felt that it was important not to overlook the fact that people with undiagnosed neurodevelopmental conditions who require specific care and support may present with self-harm. The evidence showed that an assessment model that featured consideration of ‘reciprocal roles’ (internal working models of relationships), core pain and maladaptive procedures (ways of coping that ultimately increase distress) had the important benefit of increasing engagement with follow-up. The committee agreed based on their expertise that assessments should take into account a history of trauma so that any treatment plan could be informed by it, as trauma can often be a causal factor for self-harm. The committee agreed it is important to support the person to disclose a history of trauma, but clinicians should also be sensitive to how much the person might be willing to discuss details of trauma during a crisis. Other factors the committee considered important included safeguarding risks, which the committee agreed could exist for people of all ages, and therefore consideration for safeguarding issues, including domestic violence, should be included in assessments for all people who had self-harmed. Additionally, the committee agreed based on their experience that it is important to consider the person’s ongoing access to means of self-harm in order to reduce rates of repeat self-harm. This discussion should be carried out collaboratively in order to reach a shared plan to reduce access to means. The committee also agreed based on their knowledge and experience that intoxication can have significant interactions with self-harm, that new triggers and vulnerabilities can arise due to withdrawal where the person who had self-harmed was dependent on drugs or alcohol, and that it is important to inquire about drugs and alcohol in terms of access to further means of self-harm. The committee therefore agreed that substance misuse should be included in the assessment. In addition, the committee discussed their experience that not infrequently, people who have self-harmed present under the influence of drugs or alcohol, and felt that while psychosocial assessment should never be unnecessarily delayed, special consideration should be given to the timing of assessment in people who are intoxicated. Another factor the committee considered important to investigate in a psychosocial assessment were the needs of dependent children, and they discussed the fact that often people had dependents who were not children. The recommendation that cultural considerations should be included in an assessment was based on the committee’s knowledge that cultural sensitivity could provide a benefit of more tailored care and improve the person’s engagement with services, as well as qualitative evidence from the review on specialist staff skills which confirmed that some people who had self-harmed wanted the impact of cultural, social and demographic factors on self-harm to be considered during their care. The committee also discussed further considerations for people from protected or marginalised groups, based on their experience that methods of self-harm might differ for people in protected groups and that assessment would need to be respectful of these factors. The committee agreed that it was important to include the impact of discrimination in a psychosocial assessment based on their understanding that discrimination was often a key factor in trauma and could be a causal factor for self-harm. Finally, based on their expertise, the committee discussed the fact that social media usage could have both positive and negative effects on risk of self-harm, due to the accessibility of both self-help resources and peer support, as well as potentially distressing content. They agreed that social media was often viewed more negatively by healthcare professionals but that it was important to acknowledge the potential positive effect of it on people who have self-harmed as well. The committee agreed this factor should not just be investigated for children and young people, due to the widespread use of social media and smartphones by people of all ages. The committee agreed that the individual’s perspective on their ability to manage their own distress was also important to consider, because a lack of hope or belief in their own emotional capacity and abilities could lead to repeat self-harm. The committee agreed that considering these factors would result in a more accurate assessment that would thereby improve care planning.</p><p>Based on the above discussions, the committee agreed on the importance of a number of specific factors that should be considered when providing an assessment, but stressed this is not an exhaustive list and that clinicians should exercise their professional judgment when considering which factors should be prioritised for investigation depending on the person’s individual circumstances:
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<ul><li class="half_rhythm"><div>historic factors, including but not limited to:
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<ul><li class="half_rhythm"><div>vulnerabilities, including those related to age, race, religion, gender identity, sexual orientation, linguistic and cultural factors</div></li><li class="half_rhythm"><div>past self-harm and/or suicidal behaviours</div></li><li class="half_rhythm"><div>adverse childhood events</div></li><li class="half_rhythm"><div>history of trauma, if the person feels able to discuss this in the acute context</div></li><li class="half_rhythm"><div>family history of suicide</div></li><li class="half_rhythm"><div>any mental health and/or neurodevelopmental condition and its relationship to self-harm</div></li><li class="half_rhythm"><div>treatments</div></li></ul></div></li><li class="half_rhythm"><div>changeable and current factors, including but not limited to:
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<ul><li class="half_rhythm"><div>recent and current life difficulties</div></li><li class="half_rhythm"><div>recent or ongoing trauma</div></li><li class="half_rhythm"><div>ability to engage in work or educational activities</div></li><li class="half_rhythm"><div>methods and frequency of current self-harm, including their ongoing access to methods of self-harm</div></li><li class="half_rhythm"><div>prescribed medicines</div></li><li class="half_rhythm"><div>current suicidal thoughts and behaviours</div></li><li class="half_rhythm"><div>significant relationships and changes to them</div></li><li class="half_rhythm"><div>threats of abuse or harm (see Evidence report C on consent, confidentiality and safeguarding)</div></li><li class="half_rhythm"><div>the needs of any dependents and any safeguarding issues</div></li><li class="half_rhythm"><div>harmful or hazardous use of alcohol or recreational drugs</div></li><li class="half_rhythm"><div>any personal, financial, social or other factors preceding self-harm, such as emotional distress</div></li><li class="half_rhythm"><div>the benefits and harms of social media and internet resources</div></li></ul></div></li><li class="half_rhythm"><div>future factors, including specific upcoming events or circumstances</div></li><li class="half_rhythm"><div>protective or mitigating factors, including but not limited to:
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<ul><li class="half_rhythm"><div>coping strategies (social, psychological, pharmacological) that the person has used to:
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<ul><li class="half_rhythm"><div>limit or avert self-harm <b>or</b></div></li><li class="half_rhythm"><div>minimise the impact of personal, social or other factors preceding episodes of self-harm</div></li></ul></div></li><li class="half_rhythm"><div>supportive personal and family relationships</div></li><li class="half_rhythm"><div>support from statutory or third sector services</div></li><li class="half_rhythm"><div>the person’s and their family and carers’ (as appropriate) perspective about their ability to manage their distress.</div></li></ul></div></li></ul></p><p>The committee agreed that psychosocial assessments of children and young people, and older people who have self-harmed need to be age-appropriate and factor in the circumstances that are unique to these populations. They therefore recommended that the mental health professional carrying out the psychosocial assessment needs to be experienced in assessing children and young people who self-harm. The committee agreed to emphasise the need to assess the social, peer group, education and home situations of children and young people because these factors are particularly likely to impact the functions of self-harm in this population. They acknowledged that having caring responsibilities could factor into self-harm for people of all ages, but that it was particularly important to consider how these responsibilities might affect a child or young person. Similarly, while people of all ages use social media and the internet, children and young people were noted by the committee to be a particularly vulnerable group with regards to how the use of social media and the internet could impact their mental health and wellbeing, in both positive and negative ways. For example, the committee agreed that it is common for children and young people to seek connection with peers, and this could have the benefit of peer support, as well as posing a number of safeguarding risks. Additionally, specific consideration should be given to children and young people regarding child protection or safeguarding issues, because this population is particularly vulnerable to abuse, violence and exploitation. The committee agreed that paying additional attention to these factors for children and young people who had self-harmed would reduce the potential for inappropriate interventions or follow-up to be offered because of an incomplete assessment.</p><p>The committee also recommended that any mental health professional carrying out a psychosocial assessment for an older person who has self-harmed needs to be experienced in doing so for this population. The committee agreed that older people who have self-harmed should have potential coexisting conditions taken into particular consideration, based on their knowledge that older people tend to be at higher risk for poor physical or mental health. They agreed that additional consideration should be given to older peoples’ social and home situation, as well the fact that people in this age group experienced higher rates of loneliness, isolation, and suicide. The committee agreed that paying additional attention to these factors for older people who had self-harmed would reduce the potential for inappropriate interventions or follow-up to be offered because of an incomplete assessment.</p><p>The committee agreed that people with a learning disability who have self-harmed have particular needs that require the person providing their assessment to be experienced in assessing this population. The committee agreed this would improve the quality of care provided and ensure appropriate adaptions can be facilitated as needed.</p><p>The <a href="https://www.hsib.org.uk/investigations-and-reports/provision-mental-health-care-patients-presenting-emergency-department/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Healthcare Safety Information Branch (HSIB) report on investigation into the provision of mental health care to patients presenting at the emergency department (2018)</a> informed the recommendation that the immediate safety concerns and any mental health problems of people who wish to leave before treatment is complete should be assessed. The committee agreed this would ensure patients who leave who are most in need of urgent follow-up can be identified, allowing staff to prioritise the delivery of initial aftercare to this population, and potentially reducing rates of repeat self-harm or suicide soon after the person has left.</p><p>The committee agreed that a psychosocial assessment should be used to develop a care plan, or, where the person already had one, to review it. In addition, the recommendation that family and carers should be included in the development of a care plan when appropriate was consistent with qualitative evidence from the review on involving family and carers, which showed that some people who had self-harmed and their family members and carers wanted family members and carers to be involved in the person’s care.</p><p>The committee agreed that providing the person with a copy of their care plan would increase transparency, improving trust between service user and provider, based on the committee’s experience. Additionally, the committee agreed that providing any other relevant healthcare professionals with the care management plan would ensure all staff are up-to-date regarding the wants and needs of the person, improving the quality of their care and their transition between services.</p><p>There was insufficient evidence for the committee to define how frequent attendance for self-harm would have to be to trigger a multidisciplinary review. However, the committee agreed that this recommendation was still important based on their knowledge that the individual circumstances of the person, including whether they are continuing to self-harm, should be assessed to evaluate whether a multidisciplinary review is necessary. The committee agreed that a multidisciplinary review should enable staff to reconsider current care, finding the most suitable care approach for the person and therefore preventing further repeat self-harm.</p></div><div id="bcms6501.s1.1.10.5"><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 drafted recommendations aimed to reduce variation across the NHS specialist mental health services in delivering psychosocial assessments after self-harm. The committee acknowledged the costs associated with psychosocial assessment but advised that this is essential after an episode of self-harm and potentially harmful if delayed. They expressed the view that psychosocial assessment which incorporates therapeutic elements such as identification of the target problem, takes into account the preferences of the person who has self-harmed, and involves family members and carers, as appropriate, is likely to improve quality of care, facilitate access to care, and enhance service user satisfaction and engagement. The committee also expressed the opinion that, although special considerations, provisions and adjustments for children and young people as well as older adults in order to carry out the psychosocial assessment might increase the cost of the assessment (for example, use of specially designated private areas to carry out the assessment, giving a choice of a male or female health professional, availability of specialist staff experienced in assessing older people), these would promote safeguarding for children and young people and improve outcomes for protected groups resulting from a more tailored assessment for the individual. The committee expressed the view that the majority of recommendations are based on existing recommended practice and that the additional recommended approaches for carrying out psychosocial assessments by mental health professionals should have a minimal effect on costs and not result in a significant resource impact, depending on how services currently assess people who self-harmed.</p></div></div><div id="bcms6501.s1.1.11"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.5.1 – 1.5.17. Other evidence supporting these recommendations can be found in the evidence reviews on specialist and non-specialist staff skills (Evidence reports P and R).</p></div></div><div id="bcms6501.s1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="bcms6501.s1.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><p>Study</p><li class="half_rhythm"><p><div class="bk_ref" id="bcms6501.s1.ref1">Johnson, L. L., O’Connor, S. S., Kaminer, B.
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et al (2018) Evaluation of Structured Assessment and Mediating Factors of Suicide-Focused Group Therapy for Veterans Recently Discharged from Inpatient Psychiatry. Archives of Suicide Research: 1–19 [<a href="https://pubmed.ncbi.nlm.nih.gov/29220609" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29220609</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="bcms6501.s1.ref2">Ougrin, D., Boege, I., Stahl, D.
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et al (2013) Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up. Archives of Disease in Childhood
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98: 772–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/23709314" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23709314</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="bcms6501.s1.ref3">Ougrin, D., Zundel, T., Ng, A.
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et al (2011) Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm. Archives of Disease in Childhood
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96: 148–53 [<a href="https://pubmed.ncbi.nlm.nih.gov/21030367" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21030367</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="bcms6501.s1.ref4">Pitman, A., Tsiachristas, A., Casey, D.
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et al (2020) Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital: Cohort study. Journal of affective disorders
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272: 158–165 [<a href="https://pubmed.ncbi.nlm.nih.gov/32379609" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32379609</span></a>]</div></p></li></ul></div><div id="bcms6501.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="bcms6501.appa"><h3>Appendix A. Review protocols</h3><p id="bcms6501.appa.et1"><a href="/books/NBK588204/bin/bcms6501-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 174K)</span></p></div><div id="bcms6501.appb"><h3>Appendix B. Literature search strategies</h3><p id="bcms6501.appb.et1"><a href="/books/NBK588204/bin/bcms6501-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 607K)</span></p></div><div id="bcms6501.appc"><h3>Appendix C. Clinical evidence study selection</h3><p id="bcms6501.appc.et1"><a href="/books/NBK588204/bin/bcms6501-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 90K)</span></p></div><div id="bcms6501.appd"><h3>Appendix D. Evidence tables</h3><p id="bcms6501.appd.et1"><a href="/books/NBK588204/bin/bcms6501-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 378K)</span></p></div><div id="bcms6501.appe"><h3>Appendix E. Forest plots</h3><div id="bcms6501.appe.s1"><h4>Forest plots for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</h4><p>There are no forest plots for this review as no meta-analyses were conducted.</p></div></div><div id="bcms6501.appf"><h3>Appendix F. Modified GRADE tables</h3><p id="bcms6501.appf.et1"><a href="/books/NBK588204/bin/bcms6501-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Modified GRADE tables for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 169K)</span></p></div><div id="bcms6501.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="bcms6501.appg.et1"><a href="/books/NBK588204/bin/bcms6501-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</a><span class="small"> (PDF, 23K)</span></p></div><div id="bcms6501.apph"><h3>Appendix H. Economic evidence tables</h3><div id="bcms6501.apph.s1"><h4>Economic evidence tables for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="bcms6501.appi"><h3>Appendix I. Economic model</h3><div id="bcms6501.appi.s1"><h4>Economic model for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="bcms6501.appj"><h3>Appendix J. Excluded studies</h3><div id="bcms6501.appj.s1"><h4>Excluded studies for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</h4><div id="bcms6501.appj.s1.1"><h5>Excluded effectiveness studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figbcms6501appjtab1"><a href="/books/NBK588204/table/bcms6501.appj.tab1/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figbcms6501appjtab1" rid-ob="figobbcms6501appjtab1"><img class="small-thumb" src="/books/NBK588204/table/bcms6501.appj.tab1/?report=thumb" src-large="/books/NBK588204/table/bcms6501.appj.tab1/?report=previmg" alt="Table 8. Excluded studies and reasons for their exclusion." /></a><div class="icnblk_cntnt"><h4 id="bcms6501.appj.tab1"><a href="/books/NBK588204/table/bcms6501.appj.tab1/?report=objectonly" target="object" rid-ob="figobbcms6501appjtab1">Table 8</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="bcms6501.appj.s1.2"><h5>Excluded economic studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figbcms6501appjtab2"><a href="/books/NBK588204/table/bcms6501.appj.tab2/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figbcms6501appjtab2" rid-ob="figobbcms6501appjtab2"><img class="small-thumb" src="/books/NBK588204/table/bcms6501.appj.tab2/?report=thumb" src-large="/books/NBK588204/table/bcms6501.appj.tab2/?report=previmg" alt="Table 9. Excluded studies from the guideline economic review." /></a><div class="icnblk_cntnt"><h4 id="bcms6501.appj.tab2"><a href="/books/NBK588204/table/bcms6501.appj.tab2/?report=objectonly" target="object" rid-ob="figobbcms6501appjtab2">Table 9</a></h4><p class="float-caption no_bottom_margin">Excluded studies from the guideline economic review. </p></div></div></div></div></div><div id="bcms6501.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="bcms6501.appk.s1"><h4>Research recommendations for review question: How should assessment for people who have self-harmed be undertaken in specialist settings?</h4><p>No research recommendations were made for this review question.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.5.1 to 1.5.17 in the NICE guideline</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 class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK588204</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36595593" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36595593</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobbcms6501tab1"><div id="bcms6501.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/NBK588204/table/bcms6501.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6501.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_bcms6501.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_bcms6501.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Inclusion:</p><p>All people who have self-harmed, including those with a mental health problem, neurodevelopmental disorder or a learning disability, who have presented to a specialist mental health services.</p>
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<p>Exclusion:
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<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><li class="half_rhythm"><div>People who have self-harmed who have presented to non-specialist settings</div></li></ul></p></td></tr><tr><th id="hd_b_bcms6501.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_bcms6501.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Model of assessment A, for example,
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<ul><li class="half_rhythm"><div>assessment including principles of active listening,</div></li><li class="half_rhythm"><div>therapeutic assessment,</div></li><li class="half_rhythm"><div>comprehensive biopsychosocial assessment,</div></li><li class="half_rhythm"><div>assessment performed by different professions [such as psychiatric nurses],</div></li><li class="half_rhythm"><div>culturally sensitive assessment</div></li></ul></td></tr><tr><th id="hd_b_bcms6501.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><td headers="hd_b_bcms6501.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Model of assessment B, for example,
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<ul><li class="half_rhythm"><div>assessment not including principles of active listening,</div></li><li class="half_rhythm"><div>triage assessment,</div></li><li class="half_rhythm"><div>assessment performed by different professions [such as doctors],</div></li><li class="half_rhythm"><div>uniform assessment (that is, not taking culture into account)</div></li></ul></td></tr><tr><th id="hd_b_bcms6501.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_bcms6501.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b>
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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>Service user satisfaction (dignity, compassion and respect)</div></li><li class="half_rhythm"><div>Suicide</div></li></ul></p>
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<p><b>Important</b>
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<ul><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Initiation of safeguarding procedures</div></li><li class="half_rhythm"><div>Distress</div></li><li class="half_rhythm"><div>Engagement with after-care</div></li></ul></p></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobbcms6501tab2"><div id="bcms6501.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/NBK588204/table/bcms6501.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6501.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_bcms6501.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_bcms6501.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_bcms6501.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_bcms6501.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_bcms6501.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_bcms6501.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b><a class="bibr" href="#bcms6501.s1.ref1" rid="bcms6501.s1.ref1">Johnson 2018</a></b></p>
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<p>Randomised controlled trial</p>
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<p>USA</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>N=134 veterans recruited from an inpatient psychiatry unit following a recent suicide attempt or for whom suicidal ideation was a presenting problem</p>
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<p>•</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Suicide status form assessment group therapy (SSF-AGT)</b>
|
|
<ul><li class="half_rhythm"><div>n=65 Co-led by 2 therapists (licensed clinical psychologist and a licensed clinical social worker)*, and comprised up to 12 participants;</div></li><li class="half_rhythm"><div>group co-leader worked with the individual to complete sections A and B of the SSF initial session form (concerned with overall risk assessment).</div></li><li class="half_rhythm"><div>Individual completion of Section A of the SSF tracking form, which asked patients to: (1) rate their current levels of psychological pain, stress, agitation, hopelessness, self-hate, and overall risk of suicide using a 1–5 rating scale; and (2) report the presence of suicidal thoughts, ability to manage suicidal urges, and suicide behaviours <b>since the last session</b>.</div></li><li class="half_rhythm"><div>Each group member then reported on their scores and replies to the questions on the form.</div></li><li class="half_rhythm"><div>Group discussion.</div></li><li class="half_rhythm"><div>Groups were held weekly up to 12 sessions.</div></li><li class="half_rhythm"><div>Upon discharge from inpatient treatment, each participant was scheduled into the next session of his/her treatment group</div></li></ul></p>
|
|
<p>*The same therapists led both groups</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Usual assessment group therapy (UAGT)</b>
|
|
<ul><li class="half_rhythm"><div>n=69</div></li></ul></p>
|
|
<p>:</p>
|
|
<ul><li class="half_rhythm"><div>Co-led by 2 therapists (licensed clinical psychologist and a licensed clinical social worker)*, and comprised up to 12 participants.</div></li><li class="half_rhythm"><div>co-leaders applied informal risk assessment techniques, specifically, asking each group member at the outset of group, “How have you been doing in the past week with suicidal thoughts, plans, intent,” and so on</div></li><li class="half_rhythm"><div>Group discussion would then follow from whatever was identified in the check-in.</div></li><li class="half_rhythm"><div>Groups were held weekly up to 12 sessions.</div></li><li class="half_rhythm"><div>Upon discharge from inpatient treatment, each participant was scheduled into the next session of his/her treatment group.</div></li></ul></td><td headers="hd_h_bcms6501.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>Satisfaction (3 months after assessment)</div></li></ul></p>
|
|
<p><b>Important</b>
|
|
<ul><li class="half_rhythm"><div>Overall symptom distress (1 and 3 months after assessment)</div></li><li class="half_rhythm"><div>Number of sessions of follow-up attended (1 and 3 months after assessment)</div></li></ul></p></td></tr><tr><td headers="hd_h_bcms6501.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b><a class="bibr" href="#bcms6501.s1.ref2" rid="bcms6501.s1.ref2">Ougrin 2013</a>; <a class="bibr" href="#bcms6501.s1.ref3" rid="bcms6501.s1.ref3">Ougrin 2011</a></b></p>
|
|
<p>Randomised controlled trial</p>
|
|
<p>UK</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>N=70 adolescents aged 12–18 years who were not engaged with psychiatric services and who had self-harmed and been referred for a psychosocial assessment.</p>
|
|
<p>•</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Therapeutic assessment:
|
|
<ul><li class="half_rhythm"><div>n=35</div></li><li class="half_rhythm"><div>standard psychosocial history and risk assessment (1 hour);</div></li><li class="half_rhythm"><div>joint construction of diagram consisting of reciprocal roles, core pain and maladaptive procedures;</div></li><li class="half_rhythm"><div>identification of target problem;</div></li><li class="half_rhythm"><div>considering and enhancing motivation for change;</div></li><li class="half_rhythm"><div>exploring potential ‘exits’ (ways of breaking the vicious cycles identified);</div></li><li class="half_rhythm"><div>describing the diagram and exits in an understanding letter to the family alongside usual assessment letter</div></li></ul></td><td headers="hd_h_bcms6501.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment as usual:
|
|
<ul><li class="half_rhythm"><div>n=35</div></li><li class="half_rhythm"><div>standard psychosocial history and risk assessment per NICE Guidelines</div></li><li class="half_rhythm"><div>assessment letter to community team and copy to family</div></li></ul></td><td headers="hd_h_bcms6501.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>Presentation to A&E with self-harm (24 months after assessment)</div></li><li class="half_rhythm"><div>Repeat self-harm (24 months after assessment)</div></li></ul></p>
|
|
<p><b>Important</b>
|
|
<ul><li class="half_rhythm"><div>Attendance of treatment sessions in CAMHS (1, 3, 12, and 24 months after assessment)</div></li></ul></p></td></tr><tr><td headers="hd_h_bcms6501.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b><a class="bibr" href="#bcms6501.s1.ref4" rid="bcms6501.s1.ref4">Pitman 2020</a></b></p>
|
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<p>Prospective non-randomised cohort</p>
|
|
<p>UK</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>N=9644 individuals presenting to hospital following self-harm</p>
|
|
<p>•</p></td><td headers="hd_h_bcms6501.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Psychosocial assessment by psychiatrist:
|
|
<ul><li class="half_rhythm"><div>n=4159</div></li></ul></td><td headers="hd_h_bcms6501.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Psychosocial assessment by psychiatric nurse:
|
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<ul><li class="half_rhythm"><div>n=5485</div></li></ul></td><td headers="hd_h_bcms6501.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b>
|
|
<ul><li class="half_rhythm"><div>Repeat hospital presentation for self-harm within 12 months</div></li></ul></p>
|
|
<p><b>Important</b>
|
|
<ul><li class="half_rhythm"><div>None</div></li></ul></p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">A&E: accident and emergency; CAMHS: Community and Mental Health Services; SD: standard deviation; SSF-AGT: Suicide status form assessment group therapy; UAGT: usual assessment group therapy; vs: versus</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobbcms6501appjtab1"><div id="bcms6501.appj.tab1" class="table"><h3><span class="label">Table 8</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/NBK588204/table/bcms6501.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6501.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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(2016) Assessing Suicide Risk in the Emergency Department. Journal of Psychosocial Nursing & Mental Health Services
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54: 18–18
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|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
(2016) New Tablet-Based Suicide Risk Assessment Tool Replicates Psychiatrists’ Expertise. Journal of Psychosocial Nursing & Mental Health Services
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54: 58–58
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Abarca, C., Gheza, C., Coda, C.
|
|
et al (2018) Literature review to identify standardized scales for assessing adult suicide risk in the primary health care setting. Medwave
|
|
18: e7246 [<a href="https://pubmed.ncbi.nlm.nih.gov/30339138" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30339138</span></a>]
|
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</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Systematic review</p>
|
|
<p>
|
|
<i>Included studies checked for relevance.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Adrian, Molly (2018) 1.3 The Collaborative Assessment and Management of Suicidality: Application and Adaptations With Youth. Journal of the American Academy of Child & Adolescent Psychiatry
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57: S2–S2
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Published as abstract only</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ali, A. and Hassiotis, A. (2006) Deliberate self-harm and assessing suicidal risk. British Journal of Hospital Medicine
|
|
67: M212–M213 [<a href="https://pubmed.ncbi.nlm.nih.gov/17134097" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17134097</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Anonymous (2011) Suicide assessment team in the ED. Hospital Peer Review
|
|
36: 30–1 [<a href="https://pubmed.ncbi.nlm.nih.gov/21400974" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21400974</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Antai-Otong, D. (2016) What Every ED Nurse Should Know About Suicide Risk Assessment. Journal of Emergency Nursing
|
|
42: 31–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/26825506" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26825506</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arias, S. A., Zhang, Z., Hillerns, C.
|
|
et al (2014) Using structured telephone follow-up assessments to improve suicide-related adverse event detection. Suicide & Life-Threatening Behavior
|
|
44: 537–47 [<a href="/pmc/articles/PMC4153801/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4153801</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24588679" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24588679</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>
|
|
<i>Comparison of different methods of detection of adverse events during treatment as usual</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Betz, M. E., Kautzman, M., Segal, D. L.
|
|
et al (2018) Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Research
|
|
260: 30–35 [<a href="/pmc/articles/PMC5951732/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5951732</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29169036" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29169036</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>
|
|
<i>Compares patients with/without assessment</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bland, Phillip (2018) Assessing suicide and self-harm risk in adolescents. Practitioner
|
|
262: 10–10
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Analyses not in PICO</p>
|
|
<p>
|
|
<i>No mention of assessment</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Carter, T., Walker, G. M., Aubeeluck, A.
|
|
et al (2019) Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review. Journal of Child Health Care
|
|
23: 178–199 [<a href="https://pubmed.ncbi.nlm.nih.gov/30058359" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30058359</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>
|
|
<i>Scoping review of assessment tools for use in self-harm, but not of studies comparing assessment methods</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chu, C., Van Orden, K. A., Ribeiro, J. D.
|
|
et al (2017) Does the timing of suicide risk assessments influence ratings of risk severity?. Professional psychology: research & practice
|
|
48: 107–114 [<a href="/pmc/articles/PMC5603295/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5603295</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28943713" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28943713</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Mixed population [33.1% had a history of suicide attempt(s), 16.6% had a history of self-harm]; results not presented separately for target population</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Clibbens, N. (2019) Primary care suicide screening: the importance of comprehensive clinical assessment. Evidence based nursing. 05 [<a href="https://pubmed.ncbi.nlm.nih.gov/31806667" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31806667</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cochrane-Brink, K. A.; Lofchy, J. S.; Sakinofsky, I. (2000) Clinical rating scales in suicide risk assessment. General Hospital Psychiatry
|
|
22: 445–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/11072061" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11072061</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study conducted pre-2000</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Costanza, A., Amerio, A., Radomska, M.
|
|
et al (2020) Suicidality Assessment of the Elderly With Physical Illness in the Emergency Department. Frontiers in Psychiatry
|
|
11 (no pagination) [<a href="/pmc/articles/PMC7516267/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7516267</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33024437" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33024437</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Crowder, R., Van der Putt, R., Ashby, C. A.
|
|
et al (2004) Deliberate self-harm patients who discharge themselves from the general hospital without adequate psychosocial assessment. Crisis: Journal of Crisis Intervention & Suicide
|
|
25: 183–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/15580854" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15580854</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>
|
|
<i>Study does not compare two models of assessment</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cwik, M. F.; O’Keefe, V. M.; Haroz, E. E. (2020) Suicide in the pediatric population: screening, risk assessment and treatment. International Review of Psychiatry
|
|
32: 254–264 [<a href="/pmc/articles/PMC7190447/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7190447</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31922455" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31922455</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Davoren, M., Byrne, O., O’Connell, P.
|
|
et al (2015) Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission. BMC Psychiatry
|
|
15: 301 [<a href="/pmc/articles/PMC4657210/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4657210</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26597630" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26597630</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Population did not include people who have self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
de Chenu, Linda (2011) Working with Suicidal Individuals: A Guide to Providing Understanding Assessment and Support. British Journal of Social Work
|
|
41: 1615–1616
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
DeVylder, J. E., Ryan, T. C., Cwik, M.
|
|
et al (2019) Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department. JAMA Network Open
|
|
2: e1914070 [<a href="/pmc/articles/PMC6822088/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6822088</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31651971" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31651971</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Population not people who have self-harmed. People with behavioural or psychiatric or medical presenting problems without self-harm assessed for future risk</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ellis, Thomas E. (2011) Preventing patient suicide: clinical assessment and management. Journal of Psychiatric Practice
|
|
17: 447–448
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ellis, Thomas E., Rufino, Katrina A., Allen, Jon G.
|
|
et al (2015) Impact of a suicide-specific intervention within inpatient psychiatric care: The Collaborative Assessment and Management of Suicidality. Suicide and Life-Threatening Behavior
|
|
45: 556–566 [<a href="https://pubmed.ncbi.nlm.nih.gov/25581595" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25581595</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Population did not include people who have self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Franks, M., Cramer, R. J., Cunningham, C. A.
|
|
et al (2020) Psychometric assessment of two suicide screeners when used under routine conditions in military outpatient treatment programs. Psychological services. 02 [<a href="https://pubmed.ncbi.nlm.nih.gov/32118461" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32118461</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Active-duty military personnel in mental health or substance abuse treatment at a military hospital. Unclear how many had self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Frierson, R. L. (2007) The suicidal patient: risk assessment, management, and documentation. Psychiatric Times
|
|
24: 29–32
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gerson, Ruth, and Feuer, Vera (2018) Innovations in Emergency Assessment and Management of Suicide Risk. Journal of the American Academy of Child & Adolescent Psychiatry
|
|
57: S32–S32
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Published as abstract only</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Greydanus, Donald E. and Pratt, Helen D. (2015) Predicting, Assessing, and Treating Self-Harm in Adolescents. Psychiatric Times
|
|
32: 1–5
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Harris, K. M. and Goh, M. T. T. (2016) Is suicide assessment harmful to participants? Findings from a randomized controlled trial. International Journal of Mental Health Nursing [<a href="https://pubmed.ncbi.nlm.nih.gov/27083774" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27083774</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Population not people who have self-harmed (Singapore residents ≥18 years of age, adequate English language skills, and not currently in psychiatric treatment)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hawton, K. (2003) Psychiatric assessment and management of deliberate self-poisoning patients. Medicine (13573039) 31: 16–7]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Huth-Bocks, A. C., Kerr, D. C. R., Ivey, A. Z.
|
|
et al (2007) Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior. Journal of the American Academy of Child & Adolescent Psychiatry
|
|
46: 387–395 [<a href="https://pubmed.ncbi.nlm.nih.gov/17314725" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17314725</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>54% had previous suicide attempt, but unclear about other self-harm. Results not reported separately for target population</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Johnson, L. L., O’Connor, S. S., Kaminer, B.
|
|
et al (2019) Evaluation of Structured Assessment and Mediating Factors of Suicide-Focused Group Therapy for Veterans Recently Discharged from Inpatient Psychiatry. Archives of Suicide Research
|
|
23: 15–33 [<a href="https://pubmed.ncbi.nlm.nih.gov/29220609" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29220609</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Duplicate</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Joiner, T. E. and Ribeiro, J. D. (2011) Assessment and management of suicidal behavior in children and adolescents. Pediatric Annals
|
|
40: 319–324 [<a href="https://pubmed.ncbi.nlm.nih.gov/21678891" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21678891</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kapusta, Nestor D. (2012) Non-suicidal Self-injury and Suicide Risk Assessment, quo vadis DSM-V?. Suicidology Online
|
|
3: 1–3
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kishi, Y. and Kathol, R. G. (2002) Assessment of patients who attempt suicide. Primary Care Companion to the Journal of Clinical Psychiatry
|
|
4: 132–136 [<a href="/pmc/articles/PMC315481/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC315481</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15014720" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15014720</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kollmann, B., Darwiesh, T., Tuscher, O.
|
|
et al (2020) The Importance of Assessing Mental Health Issues and Preventing Suicidality in Studies on Healthy Participants. American Journal of Bioethics
|
|
20: 75–77 [<a href="https://pubmed.ncbi.nlm.nih.gov/32945743" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32945743</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Healthy participants</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Large, M. M. (2010) No evidence for improvement in the accuracy of suicide risk assessment. Journal of Nervous and Mental Disease
|
|
198: 604 [<a href="https://pubmed.ncbi.nlm.nih.gov/20699730" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20699730</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Letter to editor</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Large, M. and Ryan, C. (2014) Suicide risk assessment: Myth and reality. International Journal of Clinical Practice
|
|
68: 679–681 [<a href="https://pubmed.ncbi.nlm.nih.gov/24837091" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24837091</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Large, Matthew Michael (2016) What Every ED Nurse Should Know About Suicide Risk Assessment. JEN: Journal of Emergency Nursing
|
|
42: 199–200 [<a href="https://pubmed.ncbi.nlm.nih.gov/27156602" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27156602</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Letter to editor</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lindh, A. U., Beckman, K., Carlborg, A.
|
|
et al (2020) Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. Journal of Affective Disorders
|
|
263: 445–449 [<a href="https://pubmed.ncbi.nlm.nih.gov/31969276" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31969276</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>
|
|
<i>All participants received both assessment tools. (Analysis was on suicide within 12 months of index assessment and included only participants that had both a clinical risk assessment and suicide intent scale risk score. The focus of the analysis was the accuracy of each in the prediction of suicide risk)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Maheshwari, R. and Joshi, P. (2012) Assessment, referral, and treatment of suicidal adolescents. Pediatric Annals
|
|
41: 516–521 [<a href="https://pubmed.ncbi.nlm.nih.gov/23205654" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23205654</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Marfe, E. (2003) Assessing risk following deliberate self-harm. Paediatric Nursing
|
|
15: 32–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/14603773" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14603773</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Non-comparative study</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Martin, G. and Brown, S. (2020) Psychiatric assessment of self-poisoning. Medicine (United Kingdom)
|
|
48: 173–175
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
McAllister, M. (2011) Assessment following self-harm: Nurses provide comparable risk assessment to psychiatrists but are less likely to admit for in-hospital treatment. Evidence-Based Nursing
|
|
14: 83–84 [<a href="https://pubmed.ncbi.nlm.nih.gov/21561852" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21561852</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Molero, P., Grunebaum, M. F., Galfalvy, H. C.
|
|
et al (2014) Past suicide attempts in depressed inpatients: clinical versus research assessment. Archives of Suicide Research
|
|
18: 50–7 [<a href="/pmc/articles/PMC3988802/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3988802</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24350632" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24350632</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Mixed population [18–24/50 participants reported prior suicide attempt; no information about self-harm]; results not presented separately for target population</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mott, J. (2011) Suicide assessment in the school setting. NASN school nurse
|
|
26: 102–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/21446315" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21446315</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Murphy, Andrea L., Gardner, David M., Chen, Timothy F.
|
|
et al (2015) Community pharmacists and the assessment and management of suicide risk. Canadian Pharmacists Journal
|
|
148: 171–175 [<a href="/pmc/articles/PMC4530357/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4530357</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26448768" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26448768</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Oquendo, M. A. and Bernanke, J. A. (2017) Suicide risk assessment: tools and challenges. World Psychiatry
|
|
16: 28–29 [<a href="/pmc/articles/PMC5269494/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5269494</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28127916" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28127916</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ospina-Pinillos, L., Davenport, T., Iorfino, F.
|
|
et al (2018) Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study. Journal of Medical Internet Research
|
|
20: e259 [<a href="/pmc/articles/PMC6231849/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6231849</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30201602" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30201602</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Mixed population [35/72 participants reported self-harm]; results not presented separately for target population</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ougrin, D.; Ng, A. V.; Low, J. (2008) Therapeutic assessment based on cognitive - Analytic therapy for young people presenting with self-harm: Pilot study. Psychiatric Bulletin
|
|
32: 423–426
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Non-randomised study, N<100 in at least one group</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Phillips, J. (2004) Risk assessment and management of suicide and self-harm: within a forensic learning disability setting. Learning Disability Practice
|
|
7: 12–18
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pistorello, J., Jobes, D. A., Gallop, R.
|
|
et al (2020) A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality (CAMS) Versus Treatment as Usual (TAU) for Suicidal College Students. Archives of Suicide Research [<a href="/pmc/articles/PMC7585690/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7585690</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32275480" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32275480</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>
|
|
<i>‘Collaborative Assessment and Management of Suicidality’ versus ‘treatment as usual’</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Randall, J. R.; Colman, I.; Rowe, B. H. (2011) A systematic review of psychometric assessment of self-harm risk in the emergency department. Journal of Affective Disorders
|
|
134: 348–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/21658779" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21658779</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review</p>
|
|
<p>
|
|
<i>Included studies checked for relevance</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Randall, J. R., Sareen, J., Chateau, D.
|
|
et al (2019) Predicting Future Suicide: Clinician Opinion versus a Standardized Assessment Tool. Suicide & Life-Threatening Behavior
|
|
49: 941–951 [<a href="https://pubmed.ncbi.nlm.nih.gov/29920749" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29920749</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Consecutive adult referrals to psychiatric services with no exclusion criteria. Unclear how many had self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rao, S., Broadbear, J. H., Thompson, K.
|
|
et al (2017) Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder. Australasian Psychiatry
|
|
25: 460–465 [<a href="https://pubmed.ncbi.nlm.nih.gov/28488884" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28488884</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Population was not people who had self-harmed. Physician assessment of case vignettes describing a fictional patient</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Reid, J. M., Storch, E. A., Murphy, T. K.
|
|
et al (2010) Development and psychometric evaluation of the treatment-emergent activation and suicidality assessment profile. Child & Youth Care Forum
|
|
39: 113–124 [<a href="/pmc/articles/PMC2867356/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2867356</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20473344" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20473344</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Children who exhibited one of the following psychiatric disorders: OCD; major depression; generalized anxiety disorder; social phobia; or separation anxiety disorder. Unclear how many had self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Reshetukha, T. R., Alavi, N., Prost, E.
|
|
et al (2018) Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt. General Hospital Psychiatry
|
|
52: 34–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/29549821" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29549821</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparison not in PICO</p>
|
|
<p>
|
|
<i>No comparison of assessment methods</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ronquillo, L., Minassian, A., Vilke, G. M.
|
|
et al (2012) Literature-based recommendations for suicide assessment in the emergency department: a review. Journal of Emergency Medicine
|
|
43: 836–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/23040403" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23040403</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Narrative review</p>
|
|
<p>
|
|
<i>Case reports and narrative literature review. Does not compare assessment methods or models</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rudd, Kimberly Butterfly, Breen, Robert, Srinivasan, Shilpa et al (2019) SUICIDE IN LATE-LIFE: COLLABORATIVE APPROACHES FOR ASSESSMENT, PREVENTION, AND TREATMENT: Session 202. American Journal of Geriatric Psychiatry
|
|
27: S13–S14
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Published as abstract only</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Russell, J. and Mitchell, J. R. (2000) The assessment of a “nurse led” deliberate selfharm service. Health Bulletin
|
|
58: 221–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/12813830" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12813830</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Non-comparative study</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Simon, Robert I. (2011) Improving Suicide Risk Assessment. Psychiatric Times
|
|
28: 16–21
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Smith, E. M. (2018) Suicide risk assessment and prevention. Nursing Management
|
|
49: 22–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/30299377" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30299377</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stewart, S.
|
|
Evelyn; Manion, I. G.; Davidson, S. (2002) Emergency management of the adolescent suicide attempter: A review of the literature. Journal of Adolescent Health
|
|
30: 312–325 [<a href="https://pubmed.ncbi.nlm.nih.gov/11996780" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11996780</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study conducted pre-2000</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Targum, S. D.; Friedman, F.; Pacheco, M. N. (2014) Assessment of suicidal behavior in the emergency department. Innovations in Clinical Neuroscience
|
|
11: 194–200 [<a href="/pmc/articles/PMC4267796/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4267796</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25520899" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25520899</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Valente, S. M. (2010) Assessing patients for suicide risk. Nursing
|
|
40: 36–40; quiz 40 [<a href="https://pubmed.ncbi.nlm.nih.gov/20386397" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20386397</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Narrative review</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Waern, M.; Dombrovski, A. Y.; Szanto, K. (2011) Is the proposed DSM-V Suicide Assessment Dimension suitable for seniors?. International Psychogeriatrics
|
|
23: 671–672 [<a href="/pmc/articles/PMC3674860/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3674860</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20849677" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20849677</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Letter to editor</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ward-Ciesielski, E. F. and Wilks, C. R. (2020) Conducting Research with Individuals at Risk for Suicide: Protocol for Assessment and Risk Management. Suicide & life-threatening behavior
|
|
50: 461–471 [<a href="/pmc/articles/PMC7148174/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7148174</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31702077" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31702077</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not in PICO</p>
|
|
<p>
|
|
<i>Suicidal adults using or not using alcohol to regulate emotions. Do not appear to have self-harmed</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Weston, S. N. (2003) Comparison of the assessment by doctors and nurses of deliberate self-harm. Psychiatric Bulletin
|
|
27: 57–60
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes not in PICO</p>
|
|
<p>
|
|
<i>Outcomes are clinician referral decisions</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_bcms6501.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Witt, K., Spittal, M. J., Carter, G.
|
|
et al (2017) Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry
|
|
17: 297 [<a href="/pmc/articles/PMC5558658/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5558658</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28810841" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28810841</span></a>]
|
|
</td><td headers="hd_h_bcms6501.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention not in PICO</p>
|
|
<p>
|
|
<i>Interventions for self-harm were not related to assessment but management of self-harm</i>
|
|
</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobbcms6501appjtab2"><div id="bcms6501.appj.tab2" class="table"><h3><span class="label">Table 9</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/NBK588204/table/bcms6501.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__bcms6501.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_bcms6501.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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
|
|
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_bcms6501.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_bcms6501.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_bcms6501.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 (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_bcms6501.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
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_bcms6501.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_bcms6501.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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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>]
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|
</td><td headers="hd_h_bcms6501.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_bcms6501.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>]
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|
</td><td headers="hd_h_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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
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</td><td headers="hd_h_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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 (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_bcms6501.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_bcms6501.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_bcms6501.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
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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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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
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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_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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>]
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</td><td headers="hd_h_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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>]
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|
</td><td headers="hd_h_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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_bcms6501.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></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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