Systematic meta‐analysis of the risk factors for deliberate self‐harm before and after treatment for first‐episode psychosis

Acta Psychiatrica Scandinavica - Tập 127 Số 6 - Trang 442-454 - 2013
S. Challis1, Olav Nielssen2,1,3, Anthony Harris4,2, Matthew Large5,1,6
1School of Psychiatry; University of New South Wales; Sydney; NSW; Australia
2Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
3St. Vincent's Hospital, Sydney, NSW, Australia
4Brain Dynamics Centre, Westmead Hospital, Sydney, NSW, Australia
5M Large, The Kiloh Centre, The Prince of Wales Hospital, Barker Street, Randwick, NSW, Australia 2031.
6The Prince of Wales Hospital, Sydney, NSW, Australia

Tóm tắt

ObjectiveAttempted suicide and deliberate self‐injury can occur before or after presentation with a first‐episode of psychosis. The aim of the study is to identify the factors associated with suicide attempts or deliberate self‐injury before and after treatment for first‐episode psychosis.MethodA systematic review and meta‐analysis of controlled studies of factors associated with either suicide attempts or deliberate self‐injury, referred to here as deliberate self‐harm (DSH).ResultsThe pooled proportion of patients who reported DSH prior to treatment for first‐episode psychosis was 18.4% (95% Confidence Interval (CI) 14.4–23.3, N = 18 studies, I2 = 93.8). The pooled proportion of patients with DSH during the period of untreated psychosis was 9.8%, (95% CI 6.7–14.2, N = 5 studies, I2 = 58.9). The pooled proportion of patients committing DSH during periods of follow up of between 1 and 7 years was 11.4%, (95% CI, 8.3–15.5, N = 13 studies, I2 = 89.2). Categorical factors associated with an increased risk of DSH were a prior history of DSH (OR = 3.94), expressed suicide ideation (OR = 2.34), greater insight (OR = 1.64), alcohol abuse (OR = 1.68) and substance use (OR = 1.46). Continuous variables associated with an increased risk of DSH were younger age of onset (Standardized Mean Difference (SMD) = −0.28), younger age at first treatment (SMD = −0.18), depressed mood (SMD = 0.49) and the duration of untreated psychosis (SMD = 0.20). Depressed mood and substance use were associated with DSH both before and after treatment, negative symptoms were associated with DSH after treatment but not before treatment. Positive symptoms and social and global functioning were not associated with DSH. Younger age and the duration of untreated psychosis were associated with DSH before treatment but not after treatment.ConclusionEarlier treatment of first‐episode psychosis and successful treatment of depression and substance use could prevent some episodes of DSH and might reduce suicide mortality in early psychosis.

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Tài liệu tham khảo

10.1111/j.1943-278X.1992.tb01040.x

10.1017/S0033291711002807

10.1001/archpsyc.62.3.247

10.1001/archgenpsychiatry.2011.113

10.1176/ajp.154.9.1235

10.4088/JCP.v60n0311

Morgan VA, 2011, People living with psychotic illness 2010

10.1136/bmj.38133.622488.63

10.1001/archgenpsychiatry.2010.157

10.1192/bjp.bp.107.037192

10.1176/ajp.2006.163.5.800

10.1192/bjp.181.43.s98

10.1176/ps.50.1.85

10.1016/j.schres.2006.05.026

10.1111/j.1600-0447.1999.tb10883.x

10.1111/j.1751-7893.2009.00117.x

10.1027/0227-5910/a000058

Nielssen O, 2010, Suicide attempts by jumping and psychotic illness, Aust N Z J Psychiatry, 44, 568

10.1046/j.0001-690X.2003.00232.x

10.1093/schbul/sbp001

10.1111/j.1751-7893.2008.00084.x

10.1016/j.psychres.2010.02.019

10.1016/j.schres.2005.12.846

10.1080/00048670802607162

10.1016/j.schres.2011.03.008

10.1111/j.1600-0447.2010.01672.x

10.3109/10398562.2011.610505

10.1371/journal.pmed.1000100

Borenstein M, 2005, Comprehensive meta‐analysis

10.1300/J079v21n04_02

10.1192/bjp.191.51.s140

10.1016/j.schres.2009.10.009

10.1016/j.psychres.2008.10.006

10.1007/s00787-006-0541-8

10.1046/j.1440-1614.2003.01209.x

10.1016/j.jad.2007.05.027

10.1097/01.CHI.0000046821.95464.CF

10.1111/j.1600-0447.2005.00634.x

10.1111/j.1399-5618.2006.00344.x

10.1016/j.schres.2004.05.015

10.2165/00023210-200721020-00004

10.1192/bjp.187.1.9

10.1177/1359786810385490

10.1016/0010-440X(85)90053-7

10.1017/CBO9780511543937

10.1097/NMD.0b013e318199f452

10.1016/j.comppsych.2010.10.011

10.1016/j.schres.2010.03.022

10.1111/j.1600-0447.1994.tb01573.x

10.3371/CSRP.4.1.2

10.4088/JCP.v68n0209

Harris A, 2005, Clinical profiles, scope and general findings of the Western Sydney First‐episode Psychosis Project, Aust N Z J Psychiatry, 39, 36, 10.1080/j.1440-1614.2005.01517.x

10.1080/08039480410005611

10.1080/00048670802653265

10.1192/pb.bp.108.020362

10.1016/j.schres.2009.06.007

10.1111/j.1600-0447.2009.01506.x

10.1034/j.1600-0447.2001.00202.x

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Acta Psychiatrica Scandinavica

Tập 127 Số 6

442-454

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