Identifying risk of deliberate self-harm through longitudinal monitoring of psychological distress in an inpatient psychiatric population

Abstract

BackgroundWhile cross-sectional correlates of deliberate self-harm, such as psychological distress, have been identified; it is still difficult to predict which individuals experiencing distress will engage in deliberate self-harm, and when this may occur. Therefore, this study aimed to explore the ability of longitudinal measurements of psychological distress to predict deliberate self-harm in a psychiatric population.MethodParticipants (N = 933; age range 14–93 (M = 38.95, SD = 14.64; 70% female) were monitored daily in terms of suicidal ideation, depression, anxiety, worthlessness and perceptions of not coping. Latent Growth Curve Analysis was used to check if groups of inpatients reporting suicidal ideation, who shared early change in measures of psychological distress, existed. Logistic regression tested whether different groups were at higher (or lower) risks of deliberate self-harm.ResultsFour groups were found. Of these, Non-Responders (high symptoms, remaining high) were more likely to engage in deliberate self-harm than patients with high, medium and low symptoms which improved over one week. Group membership was a greater predictor of deliberate self-harm than initial distress scores. Females and patients with personality disorders were significantly more likely to be Non-Responders.ConclusionsContinuous monitoring and subsequent grouping of inpatients according to their early change in psychological distress provides a novel and practical approach to risk management. A lack of early improvement in psychological distress may indicate a higher risk of deliberate self-harm.

Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9)

“…Thus early identification and alteration in treatment approach may ultimately decrease the likelihood of adverse outcomes. Implementing an early detection system that is easy for clinicians to monitor in real time has recently been implemented in the treating individuals at risk of self-harm (Kashyap et al, 2015), making the cost and time of routine monitoring more clinically relevant for those treating high-risk populations.…”

Nursing diagnoses related to psychiatric adult inpatient care

“…() described that 11% of all inpatients harmed themselves, 4% attempted suicide and did 2.5% both. Cutting or scratching (73.6%) was by far the most frequently found expression of self‐harm followed by punching surfaces (7.5%) and burning (5.7%) (Kashyap, Hooke, & Page, ). Risk of harming others was identified in one quarter of involuntary, and more than 7% of all admitted patients (Edlinger et al., ).…”

Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay

“…The DI-5 has demonstrated high internal consistency and test-retest reliability in clinical samples, 18 and sound construct validity, exhibiting high correlations with other mental health measures in clinical samples. [18][19][20]…”