Urgent need for better care after self-harm

Erlangsen, Annette; Nordentoft, Merete

doi:10.1016/s2215-0366(19)30376-1

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Patients at acute risk for suicide, however, are often sent home with a referral to their general practitioner, or with no referral at all [19]. For example, data from Ireland [20] indicate that among patients presenting with self-harm full behavior(n = 12,588), 24% were admitted to a general medical ward and only 7% were admitted for psychiatric inpatient treatment with fewer than 1% of refusing admissions.…”

Section: Discussionmentioning

confidence: 99%

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

Ma,

Liang,

Sun

et al. 2024

Preprint

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Background Suicidality is a major reason for psychiatric hospitalization but there have been no studies of the short-term changes in suicidality following psychiatric admission. To assess the short-term changes in suicidality during the first three days after psychiatric admission, when medications and other specific therapies are not likely to have taken effect and the primary benefit is likely to be from hospitalization. Methods A retrospective study of inpatients at risk for suicide was based on nurse-rated suicide assessments documented in medical records at a large psychiatric hospital in southern China. Suicidality was assessed with the Nurses' Global Assessment of Suicide Risk (NGASR) every day (1–3) following admission. Reduction of suicidality from first- to third-day were compared by using McNemar’s Chi-square tests and T-tests, followed by logistic regression to identify correlates of having high risk on day 3 following admission. Results The sample (n = 562) showed a relatively high level of average suicidality (NGASR = 9.2 ± 3.3) at admission with 33.8% reporting a prior suicide attempt. Significant reductions in suicidality were apparent by the third hospital day compared to baseline with NGASR-5 change items score declining from 6.3 ± 2.8 to 4.6 ± 3.0 (p < .001, Cohen’s d = .578), indicating a moderately large change. Compared with those unemployed, being currently employed was associated with greater reduction in likelihood of being at high-risk on day 3 (OR = .568, 95%CI [.361, .895], p = .015). Conclusion This study demonstrates short-term substantial reduction in suicidality after only three days of hospitalization suggesting significant benefit from admission to a safe secure environment.

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Section: Discussionmentioning

confidence: 99%

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

Ma,

Liang,

Sun

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Immediate and effective care for those who present to hospital with self-harm is imperative, given the risk of repeat self-harm in the short term and of suicide in the medium term. 40 The hospital costs of self-harm are significant 41 and investment in such measures may result in savings with regards to admissions and repeat presentations. Mental health-related presentations represent a small but high-risk proportion of all hospital presentations, and should be considered in the allocation of hospital resources.…”

Section: Discussionmentioning

confidence: 99%

Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study

2020

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Background People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood. Aims The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm. Method Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models. Results Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments. Conclusions Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.

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Suicide risk following ED presentation with self-harm varies by hospital

Murphy,

Ross,

O’Hagan

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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Background Patients presenting to Emergency Department (ED) with self-harm are recognized to be at high risk of suicide and other causes of death in the immediate period following ED presentation. It is also recognized that there is a large variation in the management and care pathways that these patients experience at EDs. Aims This study asks if there is a significant variation in mortality risk according to hospital attended and if this is explained by differences in care management. Methods Population-wide data from the Northern Ireland Registry of Self-Harm from April 2012 were linked with centrally held mortality records to December 2019, providing data on self-harm type and ED care. Cox proportional hazards models analyzed mortality risk, coded as suicide, all-external causes and all-cause mortality. Results Analysis of the 64,350 ED presentations for self-harm by 30,011 individuals confirmed a marked variation across EDs in proportion of patients receiving mental health assessment and likelihood of admission to general and psychiatric wards. There was a significant variation in suicide risk following attendance according to ED attended with the three-fold range between the lowest (HRadj 0.32 95% CIs 0.16, 0.67) and highest. These differences persisted even after adjustment for patient characteristics, variation in types of self-harm, and care management at the ED. Conclusions This study suggests that while the management of self-harm cases in the ED is important, it is the availability and access to, and level of engagement with, the subsequent management and care in the community rather than the immediate care at EDs that is most critical for patients presenting to ED with self-harm. However, the initial care in ED is an important gateway in initiating referrals to these services.

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Urgent need for better care after self-harm

Abstract: School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis. Lancet Psychiatry 2019; published online Nov 13.

Cited by 3 publications

References 10 publications

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study

Suicide risk following ED presentation with self-harm varies by hospital

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