Prevalence and correlates of domestic violence among people seeking treatment for self-harm: data from a regional self-harm register.

BACKGROUND: Previous research suggests that there is an association between domestic violence (DV) and self-harm (SH). Yet, the prevalence and clinical significance of DV among individuals presenting acutely to hospital with SH in the UK is unknown. OBJECTIVE: To measure the prevalence and correlates of DV among patients presenting to hospital with SH. METHODS: We conducted a cross-sectional study using registry data in order to describe the prevalence of DV within a UK population of people presenting to the emergency department (ED) with SH (n=1142). RESULTS: 11.1% (95% CI 9.4% to 13.1%) of the sample reported DV. Those reporting DV were more likely to be female and separated from a partner. DV was associated with self-poisoning and with previous occurrence of SH. CONCLUSION: Our findings suggest that DV victimisation is more prevalent among those presenting to ED with self-harm than among the general population of ED attenders, and that the presence of DV may signify increased risk among those presenting to ED with SH.

Measuring outcomes in trials of interventions for people who self-harm: qualitative study of service users' views.

BACKGROUND: Patients often have very different ideas from clinicians about what they want treatments to achieve. Their views on what outcomes are important are not always reflected in trials. AIMS: To elicit the views of people who self-harm on the most commonly used outcome measures and to identify the outcomes that matter to them. METHOD: We conducted in-depth interviews with 18 people with histories of self-harm, recruited from hospital and community settings. We conducted thematic analysis using a framework approach and used visual mapping to arrive at our final analysis and interpretation. RESULTS: Participants' accounts contained a number of challenges to the validity and meaningfulness of current trial outcome measures. Five broad issues emerged: (a) relationship between frequency and severity of self-harm; (b) behavioural substitution; (b) self-management skills; (d) the role of self-harm as survival tool and affect regulator, and (e) strategic self-presentation. We show how these affect the visibility and measurability of commonly used outcomes. The outcomes that mattered to participants focused on positive achievements in three domains: (a) general functioning and activities of everyday living; (b) social participation, and (c) engagement with services. Participants conceptualised these as both measures and means of sustained improvement. CONCLUSIONS: Our findings suggest that current self-harm trial science rests on flawed assumptions about the relationship between mental states and behaviours and about our ability to measure both. Greater understanding of the outcomes that matter to people who self-harm is needed to inform both intervention development and trial design.