|
RESEARCH WEEKLY: Early Treatment Engagement and Self-Harm
By Shanti Silver
(April 5, 2023) People with psychotic disorders are 13 times more likely to die from suicide than the general population. According to some studies, nearly one-third of early deaths among people with psychosis are caused by self-inflicted injury or poisoning. The greatest risk for self-harm is in the first three to six months after receiving a diagnosis. Therefore, it is important to examine ways to prevent self-injury among people with psychosis soon after their diagnosis.
Although intentional self-harm does not always have the goal of ending one's life, it is still a prominent risk factor for suicide, both in the general population and among people with psychosis. However, self-harm and other suicidal behaviors are often overlooked in research evaluations of treatments for early-stage psychosis. A recent publication from “Psychiatric Services” sought to fill this gap in knowledge through examining the relationship between early treatment engagement and self-harm among people who were recently diagnosed with a psychotic disorder.
Methods
This study was conducted using Medicaid data from more than 6,000 young adults and adolescents from Ohio, all of whom had been diagnosed with a psychotic disorder. Because the authors were interested in studying the impact of beginning treatment soon after receiving a diagnosis of a psychotic disorder, they chose not to include people who had received outpatient treatment for their mental health within six months before their diagnosis.
To investigate the relationship between early treatment engagement and self-harm, the study compared the risk of self-harm for people who began treatment two weeks after receiving a diagnosis compared with people who did not begin treatment soon after their diagnosis. The study also compared the risk of self-harm between people who continued to engage in treatment in the three months after they began treatment to those that did not continue treatment.
Key findings
People who began treatment soon after their diagnosis were significantly less likely to intentionally self-harm compared with those who had not. However, there was no difference in the risk of self-harm for those who continued to engage in treatment within three months of their initial treatment visit and those who did not. Only 55 percent of people who received treatment within two weeks of their diagnosis had continued to engage in treatment three months later.
People who were female or who had a schizophrenia diagnosis were comparatively less likely to begin treatment within two weeks of receiving their diagnosis, according to the results. People who were Black, had comorbid substance use disorders, or who had schizophrenia were less likely to continue engaging in treatment.
Implications
The authors note that the lack of a relationship between treatment engagement and self-harm is somewhat surprising. It is estimated that approximately half of people with psychotic disorders will stop engaging in their treatment prematurely. People who discontinue treatment early may be more likely to lack insight, have problems with substance abuse, and be more isolated than those who continue in treatment. The authors suggest that the lack of a relationship between treatment engagement and self-harm may indicate that services for people in early stages of psychosis are not doing enough to address suicidal and self-harm behaviors.
According to the authors, only a small number of studies have examined if early psychosis programs can decrease suicidal behaviors. Because the few studies that have been conducted do not produce consistent results, it is difficult to determine if these types of programs have an impact on suicidal behaviors. In response to this, the authors point out results from a recent meta-analysis that found interventions that focus on suicide can reduce suicidal ideation and suicide for people with psychosis. The authors suggest that this sort of specialized intervention might be the key to reducing suicide risk among people with psychotic disorders when engagement with treatment as usual is not sufficient.
| 
