Clinical Trajectories of Suicide Attempts and Self-harm in Patients Admitted to Acute-care Hospitals in Japan: A Nationwide Inpatient Database Study

Abstract

Background: For patients with suicide attempts or self-harm, acute-care hospitals often function as the primary or sole point of contact with the healthcare system. However, little is known about patient characteristics or clinical trajectories of suicide attempts and self-harm episodes among those admitted to acute-care hospitals. This study aimed to describe the characteristics of suicide attempts and self-harm among patients admitted to acute-care hospitals, and the clinical practices provided in these hospitals, using a nationwide inpatient database in Japan. Methods: Using data from the Japanese Diagnosis Procedure Combination inpatient database from June 2015 to March 2017, we identified patients with emergency admission for suicide attempts or self-harm. We did not include patients with elective admission to psychiatric hospitals or outpatients. We described patient characteristics, treatments for physical injuries, psychiatric interventions, and discharge status. Results: We identified 17,881 eligible patients during the 22-month study period. Overall, 38% of the patients did not have any psychiatric or behavioral comorbidities at admission. The most common suicide method was drug overdose (50%), followed by hanging (18%), jumping from a height (13%), cutting or piercing without wrist cutting (7.1%), poisoning (6.6%), and wrist cutting (5.4%). Suicide was completed by 2,639 (15%) patients. Among patients discharged to home, 51% did not receive any psychiatric intervention. In 468 acute-care hospitals (54%), no psychiatric intervention was provided during the study period. Conclusion: We found that half of acute-care hospitals did not provide any hospital-based psychiatric care for patients with suicide attempts or self-harm.

Impact of closure of the in-house psychiatric care unit on prehospital and emergency ward length of stay and disposition locations in patients who attempted suicide

“…The ED often functions as the entry point to the healthcare system for patients who have attempted suicide. [ 7 ] The current results suggest that this important function of the ED was significantly affected by a reduction in in-hospital psychiatric resources. The information presented herein should be considered by hospital administrators and policymakers, as well as by emergency and psychiatric health care providers.…”

“…Patients who have attempted suicide are a distinct demographic in the emergency department (ED). Because many suicide attempts and self-harm episodes result in ED visits, the ED often functions as the primary or sole point of contact with the healthcare system, [ 7 ] and serves as a safety net. In-house psychiatric resources such as suicide risk assessment provided by psychiatric consultants, close monitoring and care provided by psychiatric nurses, and in-house psychiatric wards that admit patients requiring emergency psychiatric care provide important back-up support for this particularly vulnerable patient population in ED.…”

Impact of the COVID‐19 pandemic and subsequent social restrictions on ambulance calls for suicidal and nonsuicidal self‐harm: a population‐based study in Osaka prefecture, Japan

“…Promoting timely access to mental health‐care and enhancing financial and social support could contribute to decrease the incidence of self‐harm 24 . Moreover, a previous study argued that many acute care hospitals in Japan were not able to provide appropriate psychiatric care for patients who engaged in self‐harm 25 . Initiating psychiatric care intervention in the emergency hospitals receiving these patients could help to improve patient care for those who visit the emergency department due to self‐harm.…”

Association between daily ambient temperature and drug overdose in Tokyo: a time-series study

“…Despite a declining trend in suicide in recent years, the rate is still higher than the average among high-income Organization for Economic Co-operation and Development (OECD) nations [ 3 ]. One nationwide descriptive study using data on emergency hospital admissions in Japan showed that among patients, the most common method of unsuccessful suicide or self-harm attempts was drug overdose (50%), followed by hanging, jumping from a height, and cutting or piercing other than wrist cutting; [ 4 ] while for suicide deaths from 1979 to 2016 was majorly driven by hanging [ 5 ]. A study conducted in Akita prefecture have reported male predominance (73.9%) in completed suicides, and contrarily, a female predominance (59.1%) in failed attempts [ 6 ].…”