The role of the General Practitioner in the management of patients with self-harm behaviour in primary care: a systematic review

Problem

Self-harm (SH) is a multifactorial clinical presentation and major risk factor for suicide. Around 220,000 people present with SH annually to emergency departments across England, highlighting SH as a significant healthcare problem. Two-thirds of people will present to their General Practitioner (GP) in the month preceding an episode of SH, with one-third having suicidal ideation. In addition, an estimated two-thirds of patients consult their GP within a month following an episode of SH. Thus, GPs may be well placed to identify those at risk of SH and intervene to prevent further SH and suicide. This systematic review aims to explore the role of the GP in the management of SH, as a key to understanding potential factors/interventions for reducing the number of SH episodes, repetition of SH, and ultimately prevention of suicide.

Approach

This review is being conducted and reported in accordance with PRISMA guidelines (PROSPERO CRD42018084703). A systematic search of published literature on the role of the GP in the management of SH was conducted in electronic databases: MEDLINE, PsychINFO, EMBASE, CINAHL, AMED, and Web of Science from their inception till February 2018. Using pre-defined eligibility criteria, titles, abstracts, and full texts of articles are being independently screened by pairs of reviewers, with discrepancies resolved by discussion or a third reviewer. The quality of eligible studies will be appraised using the Mixed Methods Appraisal Tool. Using a pretested standardised form, data to be extracted will include: study design; healthcare setting; study population characteristics; nature of SH; and attitudes, knowledge, and perceptions of GPs on their role in SH management. A narrative synthesis of findings from included studies will be conducted using framework analysis, allowing for synthesis of evidence from multiple study designs to ‘tell the story’ of the GP role.

Findings

6,976 unique citations were identified through database searching. The review is currently on-going and findings will be presented.

Consequences

This systematic review will synthesise current evidence regarding knowledge and attitudes of GPs on their role in the management of people who SH and facilitators to support management in primary care. The review will highlight areas of need for GPs to support their role in managing people at risk of SH, or who have harmed themselves. This is important for the potential development of future SH interventions in primary care.