Abstract

Objectives

People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm.

Method

Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted.

Results

Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies—safety planning and follow-up contact—were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear.

Conclusions

There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts.

• HIGHLIGHTS

• More RCTs are needed to improve the evidence base for ED providers managing self-harm

• Safety planning and follow up contacts are linked to reductions in repeat suicide attempts

• Future research should investigate the impact of staff training on patient outcomes

中文翻译：

---

对急诊科提供者的培训干预以及急诊科提供者为自残患者提供的心理社会干预的系统审查

摘要

目标

自残者经常到急诊室 (ED) 就诊，接受没有接受过专业心理健康培训的全科医疗人员的治疗。我们系统地审查了（i）针对全科急诊服务提供者的培训干预措施和（ii）主要由全科急诊服务提供者为自残者提供的心理社会干预措施。

方法

检索了五个数据库，查找报告对通才急诊科工作人员进行培训干预（至少 50% 的样本需要是通才急诊科工作人员）或主要由通才急诊科工作人员对自残者进行社会心理干预的研究。研究设计/国家没有限制。进行了叙事合成。

结果

来自高收入国家的十五项研究被纳入其中。九项方法学质量中等的研究评估了全科急诊提供者的培训（n  = 1587）。六项方法学质量良好的研究评估了针对自残成年人的心理社会干预措施（n  = 3133）。仅确定了一项随机对照试验。培训与任职前员工知识的提高有关，但与技能、态度和信心的提高不太一致。缺乏关于患者结果的证据。涉及常见自杀预防策略（安全计划和后续联系）的患者层面干预措施始终与自杀企图减少相关。对治疗参与度和精神病入院的影响尚不清楚。

结论

显然需要进一步的随机对照试验来改善急诊科全科医生管理自残患者的证据基础。有证据表明，培训对于提高员工知识、态度和技能以及安全规划和后续联系对于减少重复自杀企图都有潜在好处。

• 强调

• 需要更多的随机对照试验来改善急诊服务提供者管理自我伤害的证据基础

• 安全计划和后续联系与减少重复自杀企图有关

• 未来的研究应该调查员工培训对患者治疗结果的影响