انگیختگی ادراکی ایجاد حافظه های جدید اپیزودیک را بهبود می بخشد

The aim of this study was to investigate the attitudes of accident and emergency (A&E) staff towards patients who self-harm through laceration. Methods We developed a questionnaire using focus group methodology. Questionnaires were distributed to 117 A&E staff members. Results Of the staff, 53.8% responded. The staff believed that self-laceration was an important problem but felt unskilled in managing patients. The staff were unsure of the relationship between self-laceration and both mental illness and risk of suicide. They had previously received little training in managing this condition. In those staff without previous training, a longer period working in A&E was correlated with higher levels of anger towards patients and an inclination not to view patients as mentally ill. A&E staff were keen for further training and wanted a higher proportion of patients to be seen by specialist mental health services.

Deliberate self-harm (DSH) is one of the most common reasons for attendance at accident and emergency (A&E) departments, with an estimated 140,000 attendances in England and Wales each year [1]. In contrast to the trend in completed suicide, there has been a rise in the incidence of DSH in the UK over the last 10 years, particularly in young women, and men aged 55 years or older [2] and [3]. DSH is important for a number of reasons, not the least because up to 13% may go on to complete suicide [4]. In addition, approximately 40% of individuals later reattend A&E with a repeat episode of DSH, and some evidence suggests that this proportion is rising [2] and [5]. Although the majority of patients who self-harm choose self-poisoning, a significant proportion use other methods such as laceration, burning, and hanging. Individuals who use laceration (also known as self-cutting) account for about 5–10% of all self-harm presentations to A&E (approximately 7000–14000 presentations per year nationally) but comprise a much higher proportion of self-harmers in the community [6]. Surprisingly, this group has been remarkably understudied [7]. Compared with patients who self-harm using medication, this population is generally younger and more likely to be male and single [8]. Contrary to some beliefs, patients who use laceration as a form of self-harm may have serious suicidal intent [9]. They are also more likely to reattend A&E after initial presentation than those who harm by self-poisoning [8]. However, self-laceration is not mentioned in the National Suicide Prevention Strategy. There have been a number of guidelines on the management of DSH, most recently from the National Institute of Clinical Excellence (2004; [10]) and the Royal College of Psychiatrists (2004; [11]). Yet, services for this group vary enormously from region to region and from country to country. One possible explanation for this variance might be differences in attitudes of health professionals. It is well recognised that attitudes of the staff exert a major influence on clinical care [12] and [13]. Studies of DSH have shown that multi-professional staff often regard this group as more “difficult to treat” and more challenging than other patients [14]. For example, in a survey of 107 nurses, Sidley and Renton [15] reported that 55% of the staff disliked working with DSH patients. Staff attitudes are often reflected in the opinions from DSH patients themselves. Such patients are the least satisfied group of A&E users [16]. Remarkably, in one study from Bristol, 69% of self-harm individuals were dissatisfied with emergency services [17]. The attitudes of staff to people who self-harm is important because this will determine whether patients are appropriately referred and also whether patients will attend [18]. Importantly, Hickey et al. [19] found that 58% of patients were not accurately assessed and that those who were not assessed were at greater risk of repetition. These surveys of staff attitudes and beliefs are based on unselected DSH patients. To date, no study has differentiated between self-poisoning and self-laceration behaviour. This lack of research led us to design a study to gain an understanding of the attitudes of staff working in a busy general hospital A&E department towards patients who use laceration as the principle method of self-harm.