Tilbake til søkeresultatene

BEDREHELSE-Bedre helse og livskvalitet

Prospective outcome of referral psychotherapies for patients with deliberate self-harm in routine care

Alternativ tittel: Utfallet av psykoterapi hos pasienter henvist etter villet egenskade - en prospektiv naturalistisk registerbasert undersøkelse

Tildelt: kr 6,2 mill.

Villet egenskade er en hyppig grunn til akutt innleggelse i somatisk sykehus og er en sterk prediktor for gjentatt villet egenskade, selvmord og andre årsaker til for tidlig død. Derfor er det viktig å gi god behandling og oppfølging etter villet egenskade og dette kan ha stor betydning for deres helse både på kort og lang sikt. Imidlertid er kunnskapsgrunnlaget med hensynet til hva som er mest effektiv oppfølging sparsomt. I dette prosjektet tok vi sikte på å gjennomføre en grundig undersøkelse av hvilken oppfølgende psykisk behandling pasienter, som fikk somatisk akuttbehandling grunnet villet egenskade, faktisk får og hvordan det går med dem i etterkant ved å bruke virkelige data fra norske befolkningsregistre. Vi har fulgt en nasjonal kohort av pasienter med villet egenskade behandlet siden 2008 og undersøkt hvor ofte disse pasientene fikk en henvisning til psykiske helsetjenester; hvilke pasienter som mottok psykiatrisk behandlingen de var henvist til; og hvordan det å bli henvist til psykiatrisk behandling og faktisk fremmøte, påvirket risikoen for etterfølgende selvmord hos disse pasientene. Vi har også fått viktig innsikt i oppfølging av psykiatrisk behandling for unge pasienter med villet egenskade, og vurdert påvirkningen av ulike spesifikke psykiatriske lidelser på villet egenskade i løpe av voksenlivet. Disse funnene kan ha betydelige implikasjoner for tilrettelegging av høykvalitets oppfølgingsbehandling for selvskadende pasienter, og bidra dermed til å forebygge gjentakelse av villet egenskade og dødsfall ved selvmord i denne høyrisikopopulasjonen.

The project has resulted in publication of 7 original research articles and 1 article in a Norwegian journal insofar, with at least 1 more article in the phase of finalisation, and will produce 2 PhD dissertations to be submitted within the next a few months as being expected. The project has produced a number of significant outcomes and findings that have strong implications for future research, clinical management and prevention strategies about patients with deliberate self-harm in Norway and internationally. 1) It produced a data-driven diagnostic coding system that can be used to identify incidents of deliberate self-harm from Norwegian Patient Register and to estimate the incidence rate in the population – challenging and fundamentally important issues (P. Qin, Burrell, Bøe, & Mehlum, 2020; Ping Qin & Mehlum, 2020). 2) It provided a systematic overview flowchart on how many patients with deliberate self-harm received a referral to psychiatric services after somatic treatment, how many of the patients subsequently attended to psychiatric services, and how many of these died by suicide and other causes during the follow-up; and moreover, what were important factors associated with each of these stage outcomes (P. Qin, Stanley, Melle, & Mehlum, 2022). 3) It identified education and sick leave being the most important risk factors for deliberate self-harm in young adults, investigated the direct transferal to psychiatric inpatient services and important factors associated with such a decision, and moreover, assessed how immediate psychiatric inpatient treatment could affect the risk for self-harm repetition among these young patient group prospectively (Lunde, Mehlum, Melle, & Qin, 2021, 2022, 2023). 4) It identified specific psychiatric disorders often co-existing when deliberate self-harm occurred, and evaluated the influence of these disorders on self-harm repetition and risk for eventual mortality by suicide, other external cause and the cause of mental illness and behavior disorders (Bøe, Mehlum, Melle, & Qin, 2022a, 2022b, 2023).

Deliberate self-harm is a frequent reason for emergency contacts and denotes a strong predictor for self-harm repetition, suicide and premature mortality in the population. Follow-up care for self-harming patients is of great importance in clinical management; however, the evidence-base to guide this management is sparse. We propose to use rich data from Norwegian registers for a thorough investigation on referrals to psychotherapies and their prospective outcome for patients with deliberate self-harm. We will study types of referral psychotherapies, factors determining specific referrals, therapy engagement and prospective influence on patients' health and social performance. We hypothesize that referral psychotherapy treatment and treatment engagement have a positive effect on prospective health and non-health outcomes of the patients. We will identify a national cohort of patients who have been treated for deliberate self-harm since 2008 and retrieve personal data on clinical features, psychotherapy referrals, treatments engagement, cause of death, socioeconomic status, etc., from relevant registers. We will follow the patients for outcomes of self-harm repetition, suicide and premature mortality as well as education and labor market performance. To assess the effect of specific referral psychotherapies, we will use patients who did not receive any treatment referral as the generic reference and use a propensity score matching design to draw 3 controls per case upon the closest match of the scores. Linkage across national registers will make the present study insofar the most comprehensive assessment of follow-up intervention for self-harm patients in routine care. The study will generate insightful knowledge about referral psychotherapies in a 'real' world. The findings will have significant implication for service provision and clinical management of self-harm patients, and may ultimately result in fewer suicide deaths and self-harm episodes.

Publikasjoner hentet fra Cristin

Ingen publikasjoner funnet

Ingen publikasjoner funnet

Ingen publikasjoner funnet

Budsjettformål:

BEDREHELSE-Bedre helse og livskvalitet