Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-31T15:20:55.007Z Has data issue: false hasContentIssue false
  • English
  • Français

General Hospital Admission in the Management of Parasuicide

A Randomised Controlled Trial

Published online by Cambridge University Press:  02 January 2018

John Waterhouse  and
Stephen Platt
John Waterhouse*
Affiliation:
Institute of Research in Social Sciences, University of York, Crichton Royal Hospital, Dumfries DG1 4TG
Stephen Platt
Affiliation:
MRC Unit for Epidemiological Studies in Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department. This group was then randomly allocated to hospital admission (38 cases) or discharge home (39 cases). One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms, and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. This lends support to recent government recommendations, but caution should be exercised before such a result is generalised.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 156 , Issue 2 , February 1990 , pp. 236 - 242
Copyright
Copyright © Royal College of Psychiatrists, 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A. T., Weissman, A., Lester, D., et al (1974) The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861–865.10.1037/h0037562CrossRefGoogle ScholarPubMed
Black, D. & Creed, F. (1988) Assessment of self-poisoning patients by psychiatrists and junior medical staff. Journal of the Royal Society of Medicine, 81, 97–99.10.1177/014107688808100216CrossRefGoogle ScholarPubMed
Catalan, J., Marsack, P., Hawton, K. E., et al (1980) Comparison of doctors and nurses in the assessment of deliberate self-poisoning patients. Psychological Medicine, 10, 483–491.10.1017/S0033291700047371CrossRefGoogle ScholarPubMed
Central and Scottish Health Services Councils (1968) Hospital Treatment of Acute Poisonings. London: HMSO.Google Scholar
Chowdhury, N. L., Hicks, R. G. & Kreitman, N. (1973) Evaluation of an aftercare service for parasuicide (attempted suicide) patients. Social Psychiatry, 8, 67–81.10.1007/BF00589238CrossRefGoogle Scholar
Cohen, J. (1960) A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.10.1177/001316446002000104CrossRefGoogle Scholar
Department of Health and Social Security (1984) The Management of Deliberate Self-Harm. HN (84) 25. London: DHSS.Google Scholar
Dyer, J. A. T. & Kreitman, N. (1984) Hopelessness, depression and suicidal intent in parasuicide. British Journal of Psychiatry, 144, 127–134.10.1192/bjp.144.2.127CrossRefGoogle ScholarPubMed
Gardner, R., Hanka, R., O'Brien, V. C., et al (1977) Psychological and social evaluation in cases of deliberate self-poisoning admitted to a general hospital. British Medical Journal, ii, 1567–1570.10.1136/bmj.2.6102.1567CrossRefGoogle Scholar
Gardner, R., Hanka, R., Roberts, S. J., et al (1982) Psychological and social evaluation in cases of deliberate self-poisoning seen in an accident department. British Medical Journal, 284, 491–493.10.1136/bmj.284.6314.491CrossRefGoogle Scholar
Gibbons, J. S., Butler, J., Unwin, P., et al (1978) Evaluation of a social work service for self-poisoning patients. British Journal of Psychiatry, 133, 111–118.10.1192/bjp.133.2.111CrossRefGoogle ScholarPubMed
Greer, S. & Bagley, C. (1971) Effects of psychiatric intervention in attempted suicide: a controlled study. British Medical Journal, 61, 310–312.10.1136/bmj.1.5744.310CrossRefGoogle Scholar
Hawton, K., Bancroft, J., Catalan, J., et al (1981) Domiciliary and out-patient treatment of self-poisoning patients by medical and non-medical staff. Psychological Medicine, 11, 169–177.10.1017/S0033291700053381CrossRefGoogle ScholarPubMed
Hawton, K., McKeown, S., Day, A., et al (1987) Evaluation of outpatient counselling compared with general practitioner care following overdoses. Psychological Medicine, 17, 751–761.10.1017/S0033291700025988CrossRefGoogle ScholarPubMed
Herz, M. I., Endicott, J. & Spitzer, R. L. (1977) Brief hospitalisation: a two-year follow-up. American Journal of Psychiatry, 134, 502–507.Google ScholarPubMed
Hill, D. (1980) The continuing need for assessment of self-poisoned patients by psychiatrists. In The Misuse of Psychotropic Drugs (eds Murray, R., Ghodse, H., Harris, C., et al), pp. 45–46. London: Gaskell.Google Scholar
Hirsch, S. R., Platt, S. D., Knights, A. C., et al (1979) Shortening hospital stay for psychiatric care: effect on patients and their families. British Medical Journal, i, 442–446.10.1136/bmj.1.6161.442CrossRefGoogle Scholar
Kennedy, P. F. (1972) Efficacy of a regional poisoning treatment centre in preventing further suicidal behaviour. British Medical Journal, iv, 255–257.10.1136/bmj.4.5835.255CrossRefGoogle Scholar
Kennedy, P. F. & Hird, F. (1980) Description and evaluation of a short-stay admission ward. British Journal of Psychiatry, 136, 205–215.10.1192/bjp.136.3.205CrossRefGoogle ScholarPubMed
Kessel, N. (1985) Patients who take overdoses. British Medical Journal, 290, 1297–1298.10.1136/bmj.290.6478.1297CrossRefGoogle ScholarPubMed
Kreitman, N. (1977) Parasuicide. London: Wiley.Google Scholar
Kreitman, N. (1979) Reflections on the management of parasuicide. British Journal of Psychiatry, 135, 275–277.10.1192/bjp.135.3.275CrossRefGoogle ScholarPubMed
Kreitman, N. (1980) Services for parasuicide and the place of a poisoning unit. In The Suicide Syndrome (eds Farmer, R. & Hirsch, S.), pp. 259–262. London: Croom Helm.Google Scholar
Newson-Smith, J. G. B. & Hirsch, S. R. (1979a) A comparison of social workers and psychiatrists in evaluating parasuicides. British Journal of Psychiatry, 134, 335–342.10.1192/bjp.134.4.335CrossRefGoogle Scholar
Newson-Smith, J. G. B. & Hirsch, S. R. (1979b) Psychiatric symptoms in self-poisoning patients. Psychological Medicine, 9, 493–500.10.1017/S0033291700032049CrossRefGoogle ScholarPubMed
Office of Health Economics (1981) Suicide and Deliberate Self-harm. London: OHE.Google Scholar
Patel, A. R. (1975) Attitudes toward self-poisoning. British Medical Journal, ii, 426–430.10.1136/bmj.2.5968.426CrossRefGoogle Scholar
Platt, S., Weyman, A., Hirsch, S. R., et al (1980) The social behaviour assessment schedule (SBAS): rationale, contents, scoring and reliability of a new interview schedule. Social Psychiatry, 15, 43–55.10.1007/BF00577960CrossRefGoogle Scholar
Platt, S., & Hirsch, S. R. (1981) The effects of brief hospitalisation upon the psychiatric patient's household. Acta Psychiatrica Scandinavica, 64, 199–216.10.1111/j.1600-0447.1981.tb00776.xCrossRefGoogle ScholarPubMed
Platt, S., & Hirsch, S. R. & Knights, A. C. (1981) Effects of brief hospitalisation on psychiatric patients' behaviour and social functioning. Acta Psychiatrica Scandinavica, 63, 117–128.10.1111/j.1600-0447.1981.tb00658.xCrossRefGoogle ScholarPubMed
Platt, S., Weyman, A. & Hirsch, S. (1983) Social Behaviour Assessment Schedule (3rd edn). Windsor: NFER-Nelson.Google Scholar
Platt, S., & Salter, D. (1987) A comparative investigation of health workers' attitudes towards parasuicide. Social Psychiatry, 22, 202–208.10.1007/BF00583555CrossRefGoogle ScholarPubMed
Ramon, S., Bancroft, J. M. J. & Skrimshire, A. M. (1975) Attitudes towards self-poisoning among physicians and nurses in a general hospital. British Journal of Psychiatry, 127, 257–264.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (1983) Guidance on the management of deliberate self-harm. Bulletin of the Royal College of Psychiatrists, 7, 210–212.Google Scholar
Spitzer, R. L., Fleiss, J. L., Burdock, E. I., et al (1964) The Mental Status Schedule: rationale, reliability, validity. Comprehensive Psychiatry, 5, 384–395.10.1016/S0010-440X(64)80048-1CrossRefGoogle Scholar
Spitzer, R. L., Endicott, J., Fleiss, J. L., et al (1970) The Psychiatric Status Schedule: a technique for evaluating psychopathology and impairment in role functioning. Archives of General Psychiatry, 23, 41–55.10.1001/archpsyc.1970.01750010043009CrossRefGoogle ScholarPubMed
Stengel, E. (1952) Experience into attempted suicide. Proceedings of the Royal Society of Medicine, 45, 613.10.1177/003591575204500910CrossRefGoogle Scholar
Stengel, E. & Cook, N. G. (1958) Attempted Suicide. Maudsley Monograph No. 4. London: Oxford University Press.Google Scholar
Waterhouse, J. (1983) The setting up of an evaluative study to determine the efficacy of hospital admission in the management of parasuicide. MMedSc Thesis, University of Leeds.Google Scholar
Weissman, M. M. (1974) The epidemiology of suicide attempts, 1960–1971. Archives of General Psychiatry, 30, 737–746.10.1001/archpsyc.1974.01760120003001CrossRefGoogle Scholar
Wexler, L., Weissman, M. M. & Kasl, S. V. (1978) Suicide attempts 1970–1975: updating a United States study and comparisons with international trends. British Journal of Psychiatry, 132, 180–185.10.1192/bjp.132.2.180CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.