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Review
. 2024 Jan 11;10(1):e29.
doi: 10.1192/bjo.2023.625.

Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis

Katrina Witt  1 , Katie McGill  2 , Bernard Leckning  3 , Nicole T M Hill  4 , Benjamin M Davies  5 , Jo Robinson  1 , Gregory Carter  6
Affiliations
Review

Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis

Katrina Witt et al. BJPsych Open. .

Abstract

Background: Hospital-treated self-harm is common, costly and associated with repeated self-harm and suicide. Providing a comprehensive psychosocial assessment following self-harm is recommended by professional bodies and may improve outcomes.

Aims: To review the provision of psychosocial assessments after hospital-presenting self-harm and the extent to which macro-level factors indicative of service provision explain variability in these estimates.

Method: We searched five electronic databases to 3 January 2023 for studies reporting data on the proportion of patients and/or events that were provided a psychosocial assessment. Pooled weighted prevalence estimates were calculated with the random-effects model. Random-effects meta-regression was used to investigate between-study variability.

Results: 119 publications (69 unique samples) were included. Across ages, two-thirds of patients had a psychosocial assessment (0.67, 95% CI 0.58-0.76). The proportion was higher for young people and older adults (0.75, 95% CI 0.36-0.99 and 0.83, 95% CI 0.48-1.00, respectively) compared with adults (0.64, 95% CI 0.54-0.73). For events, around half of all presentations had these assessments across the age range. No macro-level factor explained between-study heterogeneity.

Conclusions: There is room for improvement in the universal provision of psychosocial assessments for self-harm. This represents a missed opportunity to review and tailor aftercare supports for those at risk. Given the marked unexplained heterogeneity between studies, the person- and system-level factors that influence provision of psychosocial assessments after self-harm should be studied further.

Keywords: Self-harm; mental health services; psychosocial interventions; risk assessment; suicide.

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Conflict of interest statement

G.C., K.M. and K.W. authored studies included in the review. G.C. reports non-financial support and other from Otsuka Australia Pharmaceutical, non-financial support and other from Servier Australia, non-financial support and other from iNova Pharmaceuticals (Australia), non-financial support and other from Teva Pharma Australia, non-financial support and other from Janssen Australia and New Zealand (Janssen-Cilag) outside the submitted work. All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Mixed-effects pooled estimates of the proportion of persons (individuals) resulting in a psychosocial assessment in the emergency department following a hospital presentation for self-harm. The red boxes indicate the weighting applied to the study effect size in the analysis. Please see supplementary material for full reference details of studies mentioned in this figure. IV, inverse variance.
Fig. 2
Fig. 2
Mixed-effects pooled estimates of the proportion of admissions (events) resulting in a psychosocial assessment in the emergency department following a hospital presentation for self-harm. The red boxes indicate the weighting applied to the study effect size in the analysis. Please see supplementary material for full reference details of studies mentioned in this figure. IV, inverse variance.
See this image and copyright information in PMC

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