Epidemiology Mental Health and Self-Harm

Questions: The Director of Psychiatry in a large metropolitan hospital notices that many people admitted to the Emergency Department for deliberate self-harm re-present to the hospital in the weeks and months following a subsequent incident of deliberate self-harm. She wants to reduce the re-admission rates of deliberate self-harm at the hospital, and wonders if a brief contact intervention in the form of a follow-up telephone call (to assess how individuals are feeling, and suggest avenues for community support) might lead to reductions in the number of re-admissions due to deliberate self-harm. 1. Write a focused clinical question for this particular problem that will help you organise a search of the clinical literature for an answer. 2.If you were to search Medline/PubMed for original research on this question, describe what your search strategy would be. Be as specific as you can about keywords, MeSH terms, and delimiters. Explain your rationale for taking this approach and explain your reasoning. Cite the best article from among those you find. 3.What type of study (study design) would best be able to address this question? Discuss why? 4.What information sources would you use to find an answer to questions such as the above? Name as many possible types or categories of information sources as you can that could be used to find relevant evidence. Although some sources are better than others, discuss a few to demonstrate your awareness of the convenience, relevance and quality of common information sources in clinical practice. Answers: (1). The clinical questions asked are Are there any current mental health difficulties? Is there any problem being faced such as financial, personal or work-related? Are there any early instances of Self-harm? Are the former patients regularly attending the rehabilitation centres? (2). Keywords used are Prevention, mental health, self-harm, corrective behaviour, recovery. MeSH terms are self-injurious behaviour. These search results help in identifying factors that contribute to self-harm, prevention of self-harm by counselling. Best article obtained- Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study.(Moran et al., 2012). (3). A survey on chronic self-destruction that explores high-risk behaviour. The report can then analyse the salient points, which can help the people near the high-risk patient to identify the symptoms. Questionnaire on impulsive and self-harm can unearth many facts about self-harm. (4). Information about self-harm can be obtained from the rehabilitated patients. The people who stay near or care for such patients. Earlier studies can help form the basis of information regarding further research (Brent et al., 2013). Reference: Moran, P., Coffey, C., Romaniuk, H., Olsson, C., Borschmann, R., Carlin, J. B., Patton, G. C. (2012). The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. The Lancet, 379(9812), 236-243. Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., Douaihy, A. B. (2013). Protecting adolescents from self-harm: a critical review of intervention studies.Journal of the American Academy of Child Adolescent Psychiatry, 52(12), 1260-1271.