Screening for selvskading i barne- og ungdomspsykiatriske poliklinikker – erfaringer fra rekruttering til en randomisert kontrollert studie
DOI:
https://doi.org/10.5617/suicidologi.2269Abstract
I forbindelse med en randomisert kontrollert behandlingsstudie ble 5 poliklinikker involvert i screening av unge over 12 år for selvskading. Av 1999 henviste unge ble 25 inkludert i behandlingsstudien. Vi ønsket å studere screeningsprosessen. 47 % ble stilt det aktuelle screeningspørsmålet om de hadde skadet seg selv. Av disse 987 svarte 241 ja (24,4 %). Mange tilfredsstilte ikke inklusjonskriterier eller ønsket ikke å være med, og 85 ble henvist til prosjektet. Av disse gjennomgikk 36 en grundig vurdering. Det var mange likheter mellom de 241 og de 25 som til slutt ble inkludert: Det som skilte dem var henvisning for selvskade, antall selvskader, antall henvisningsgrunner. Tross tett oppfølging fra prosjektet var screeningen langt fra komplett. Noen av poliklinikkene screenet flere enn de andre, men andel som ble fanget opp av prosjektet varierte lite mellom poliklinikkene. Klinisk skjønn ble trolig brukt med hell, men med over 24 % som selv-skader bør alle få screeningsspørsmål. Konklusjon: Implementering av rutiner er ikke enkelt. De som til slutt ble inkludert, skilte seg lite fra andre som selvskader. Det som skiller dem ut er et høyt lidelsestrykk, uttrykt ved mange selvskadinger, mange grunner for henvisning, og oftest henvisning for internaliserende lidelser. Five outpatient clinics were engaged in screening referred patients 13-17 year of age, for deliberate self-harm, to a randomized controlled treatment study. Of 1999 patients referred, 25 were finally included. We wanted to study the screening process. The screening included 987 (47 %). Self-harm was confirmed by 241 (24.4 %). Of these inclusion criteria seemed fulfilled and inclusion accepted for 86. Of these 36 were thoroughly evaluated. Compared to the 241, the 25 had selfharmed more often and were more often referred for self-harm and for more than one reason. In spite of close monitoring from the project, the screening was far from complete. The clinics included from 34 % to 77 % of referrals, but the percentage of referred patients reporting selfharm differed insignificantly between clinics. Clinical judgment was probably used with some success, but with more than 24 % confirming self-harm, every patient above 12 year should be asked about self-harm. Conclusion: Implementation of new routines is not easy. Those who were included did not differ much from those confirming self-harm. The included patients seemed to have a high level of distress, as they had self-harmed more often, more reasons for referral were given, and they were more often referred for internalizing problems.References
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