Research report Psychosocial assessment and repetition of self-harm: The significance of single and multiple repeat episode analyses Helen Bergen a , Keith Hawton a, ⁎, Keith Waters b , Jayne Cooper c , Navneet Kapur c a Centre for Suicide Research, University of Oxford, United Kingdom b Derbyshire Mental Health Service NHS Trust, United Kingdom c Centre for Suicide Prevention, University of Manchester, United Kingdom article info abstract Article history: Received 11 March 2010 Received in revised form 4 May 2010 Accepted 4 May 2010 Available online 1 June 2010 Background: Self-harm is a common reason for presentation to the Emergency Department. An important question is whether psychosocial assessment reduces risk of repeated self-harm. Repetition has been investigated with survival analysis using various models, though many are not appropriate for recurrent events. Methods: Survival analysis was used to investigate associations between psychosocial assessment following an episode of self-harm and subsequent repetition, including (i) one repeat, and (ii) recurrent repetition (≤5 repeats) using (a) an independent episodes model, and (b) a stratified episodes model based on a conditional risk set. Data were from the Multicentre Study on Self-harm in England, 2000 to 2007. Results: Psychosocial assessment following an index episode of self-harm was associated with a 51% (95% CI 42%–58%) decreased risk of a repeat episode in persons with no psychiatric treatment history, and 26% (95% CI 8%–34%) decreased risk in those with a treatment history. For recurrent repetition, assessment was associated with a 57% (95% CI 51%–63%) decreased risk of repetition assuming independent episodes, and 13% (95% CI 1%–24%) decreased risk accounting for ordering and correlation of episodes by the same person (stratified episodes model). All models controlled for age, gender, method, history of self-harm, and centre differences. Limitations: Some missing data on psychiatric treatment for non-assessed patients. Conclusions: Psychosocial assessment appeared to be beneficial in reducing the risk of repetition, especially in the short-term. Findings for recurrent repetition were highly dependent on model assumptions. Analyses should fully account for ordering and correlation of episodes by the same person. © 2010 Elsevier B.V. All rights reserved. Keywords: Self-harm Assessment Repetition Survival analysis Recurrent events 1. Introduction 1.1. Repetition of self-harm Repetition of non-fatal self-harm is common. Approximate- ly 15%–25% of people who self-harm will repeat an episode within one year, and 20–25% over the next few years (Owens et al., 2002; Platt et al., 1988). Subsequent risk of suicide is elevated in people who self-harm relative to the general population (Cooper et al., 2005; Hawton et al., 2003b; Owens et al, 2002), and greater for those with repeated self-harm relative to single-episode self-harm (Haw et al., 2007; Zahl and Hawton, 2004). The costs in terms of public health and individual well- being are great. Psychosocial assessment following self-harm, as outlined in the National Institute for Clinical Excellence (NICE) guidance for England and Wales (National Collaborating Centre for Mental Health, 2004), is a necessary starting point for preventive interventions (e.g. Guthrie et al. (2003), Hawton et al. (1998)). However, despite the advice that all patients Journal of Affective Disorders 127 (2010) 257–265 ⁎ Corresponding author. Centre for Suicide Research University of Oxford, Department of Psychiatry Warneford Hospital, Oxford, OX3 7JX, United Kingdom. Tel.: +44 1865 738585; fax: +44 1865 223933. E-mail address: keith.hawton@psych.ox.ac.uk (K. Hawton). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.05.001 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad