The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

26
Brief Contact Interventions
Current Evidence and Future Research
Directions

Allison J. Milner and Gregory L. Carter


Introduction

Hospital-treated self-harm (defined as self-injury or self-poisoning with or without suicidal intent) comprises a serious public health burden and is associated with considerable costs for individuals and health-care systems. Repetition of hospitaltreated self-harm is estimated to be around 16% in the first 12 months of follow-up, and the risk of eventual death by suicide among patients who self-harm is markedly higher than in the general population, although the absolute risk is low; 1.5% after 12 months and 3.9% after 60 months (Carroll, Metcalfe, & Gunnell, 2014; Owens, Horrocks, & House, 2002). Furthermore, attempts to develop risk assessment measures that can accurately predict those that will repeat self-harm have been largely unsuccessful because they have yielded positive predictive values that are too low for effective use in clinical practice (Spittal, Pirkis, Miller, Carter, & Studdert, 2014).

There are only a limited number of psychological or psychosocial therapeutic aftercare interventions that have been shown to be effective in reducing repetition of hospital-treated self-harm (Guthrie et al., 2001; Hawton et al., 1999). There is also evidence of effectiveness of treatments such as dialectical behavior therapy (National Institute for Health and Care Excellence, 2011), mentalization (Bateman & Fonagy, 1999, 2009), and cognitive behavioral therapy (Brown et al., 2005), in subgroups meeting diagnostic criteria for borderline personality disorder. As these treatments are resource intensive and require specialist training, they may not be feasible or acceptable in some contexts. Moreover, patients who engage in self-harm generally exhibit low adherence to treatment, often fail to engage in aftercare, and tend to drop out of treatment prematurely (Jauregui, Martinez, Rubio, & SantoDomingo, 1999; van Heeringen, 1992; van Heeringen, Jannes, Buylaert, & Henderick, 2002).

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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