Electronic Letters to:
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eLetters: Electronic letters published:
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Request for Sub-Group Analysis
- Mukesh Kripalani, Dr. Ramanand Badanapuram, Dr. Amanda Gash (1 August 2007)
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Authors' Reply: Request for sub-group analysis.
- Robert Young (24 August 2007)
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Mukesh Kripalani, SpR Liaison psychiatry Royal college of psychiatrists, uk, Dr. Ramanand Badanapuram, Dr. Amanda Gash
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drmukesh{at}doctors.org.uk Mukesh Kripalani, et al.
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We read with interest the article “Young people who self harm” in the July edition of BJPsych 2007 but feel the outcome of factors considered could have been more viable if a further sub-group analysis was done in those patients who repeat self harm. We believe that a significant amount of our time is taken up by people who self harm repeatedly. This subset of clients are often entrenched in their behavior patterns and use services disproportionately. Existing data has not analyzed factors responsible for repetition adequately and we feel that the study mentioned above missed out on an excellent opportunity, albeit in a younger age group, for the same. An analysis of our data from the Integrated Care Pathway (ICP), (Rajwal & Gash, 2006) show repetition rates of 40% for 2004, 42% for 2005 and 43% 2006 of all our referrals each year. This means that 18% of our patients in 2004, 18.9% in 2005 and 19.2% in 2006 were responsible for the above statistics year on year. This is data is of course from adults of working age and only includes repetition in the same calendar year. About 13% of our referrals are below the age of 21 of which 18% are repetitions. Hence we can see that a small proportion of our clients are responsible for a large percentage of our work. Our data also backs up the study mentioned above on the lack of a gender bias to the prevalence of self-harm. Females comprised of 50.2% of our referrals in 2006 but only 49.0% of repeaters. This means that the old myth of higher proportion of females self-harming has not been borne out by our statistics, albeit in the entire adult age group. We would be interested to discover from the authors data if results would be different in the sub-group who had repeated self-harm. Acknowledgements: Sue Morris, Senior Nurse, Self-Harm Team Middlesborough and Liaison Team St. Luke’s Hospital, M'bro. Reference: MADHURI, R. & GASH, A., (2006) Risk assessment in self-harm. Psychiatric Bulletin, 30, 436. Declaration of Interest: Nil Authors: Dr. Mukesh Kripalani, Dr. Ramanand Badanapuram and Dr. Amanda Gash Corresponding Author: Dr. Mukesh Kripalani, SpR, Bath Villa Annex, St. Luke's Hospital, M'bro. Tel: 01642516160 Fax: 01642516161 Dr. Ramanand Badanapuram, SHO, St. Luke's Hospital, M'bro Dr. Amanda Gash, Consultant Liaison Psychiatrist, St. Luke's Hospital, M'bro. |
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Robert Young, Research Associate MRC Social & Public Health Science Unit
Send letter to journal:
robert{at}sphsu.mrc.ac.uk Robert Young
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Kripalani, Badanapuram and Gash, raise an important issue, suggesting that repeated self-harmers may constitute a distinctive clinical sub- group. We initially avoided including repeated self-harm in our study because there remains considerable uncertainty about an appropriate definition. However, following discussion with Kripalani (personal communication, 2007), we agreed a three-way classification of repeated self-harm among young people: Repeated self-harmers (19 out of 89 cases), self-harm both in the past and currently or using several (3+) methods, (since it is unlikely that multiple methods of self-injury refers to a single incident); Single-incident (17/89), explicit statement of transient incident; Unsure (53/89), the remainder. The crude repetition rate of 20% is typical for self-harm (Bennewith, et al. 2002). We proceeded to re-run virtually all of the analyses presented in our original paper (Young et al., 2007) for repeat self-harmers (available on request/online). In summary, we can confirm that repeated self-harm was unrelated to sex, or social class of origin, but was related to current labour market position, with youth outside the labour market more likely self-harm repeatedly. Repeaters were more likely to self-harm via all methods with the exception of taking pills/tablets and more violent methods, which were common to all groups. Repeaters were far more likely to self-harm in order to relieve negative emotions (anger, anxiety or to punish themselves), while self-harm in order to kill oneself was common to all groups. Taken together this confirms that repeated self-harmers are more likely to use self-injury as a coping mechanism. With regard to service use, repeaters were nearly twice as likely to have used casualty (emergency services) and over three times more likely to have used psychological services since age -11. This suggests that young people and adults who repeatedly self-harm are heavy users of both health services in general and psychiatric health services in particular and this is compatible with Kripalani, Badanapuram and Gash’s, assertion that a small proportion of clients may account for a large percentage of resources. Distinguishing between repeated and other forms of self-harm could provide useful clinical information, provided both researchers and clinicians can agree a clear definition. Bennewith O, Stocks N, Gunnell D, Peters TJ, Evans MO & Sharp DJ. (2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Medical Journal, 324, 1254-1257. Young R, van Beinum M, Sweeting H & West P. (2007) Young people who self-harm. British Journal of Psychiatry, 191, 44-49. |
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