Factors linked to self-harm in early psychosis identified

Jan 14 2013

By Mark Cowen, Senior medwireNews Reporter

A meta-analysis of published studies has identified factors associated with deliberate self-harm (DSH) before and after treatment in patients with first-episode psychosis (FEP).

M Large (The Prince of Wales Hospital, Sydney, Australia) and team found that depression and substance use are associated with DSH before and after treatment of FEP, while increased duration of untreated psychosis is only associated with DSH before treatment.

"Controlling positive symptoms and reducing disability arising from psychosis are the main aims in the management of early psychosis," comment the researchers in Acta Psychiatrica Scandinavica.

"However, the results of this study suggest that more effective treatment of depressed mood and substance use disorders would reduce the risk of DSH and suicide in early psychosis, and should be important additional aims of first-episode psychosis treatment," they add.

The team searched the literature for studies of DSH in patients with FEP and identified 23, involving more than 11,000 patients, that met criteria for inclusion in the meta-analysis.

Overall, 18.4% of patients had engaged in DSH before treatment for psychosis and 11.4% reported DSH after receiving treatment (up to 7 years of follow up).

Analysis of the data revealed that categoric factors associated with an increased risk for DSH were a previous history of DSH (odds ratio [OR]=3.94), suicide ideation (OR=2.34), alcohol abuse (OR=1.68) and substance use (OR=1.46).

Continuous variables associated with an increased risk for DSH were younger age at 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), and negative symptom severity (SMD=0.10).

The researchers note that depressed mood and substance use were associated with DSH both before and after treatment, while negative symptom severity was associated with DSH after, but not before, treatment.

Younger age at first treatment and duration of untreated psychosis were associated with DSH before, but not after, treatment.

Large et al conclude: The results suggest that more effective treatment of depression and substance use in FEP could reduce the incidence of DSH and in all probability suicide.

"Reducing the duration of undiagnosed and untreated psychosis may also contribute to a reduction in DSH before treatment, and has the potential to reduce DSH after treatment because of the strength of the association between past DSH and future DSH."

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