Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm.
Assessment
Emergency department
Emergency psychiatry
Hospital services
Repetition
Self-harm
Journal
Irish journal of medical science
ISSN: 1863-4362
Titre abrégé: Ir J Med Sci
Pays: Ireland
ID NLM: 7806864
Informations de publication
Date de publication:
31 May 2024
31 May 2024
Historique:
received:
12
09
2023
accepted:
19
05
2024
medline:
31
5
2024
pubmed:
31
5
2024
entrez:
31
5
2024
Statut:
aheadofprint
Résumé
Presentation to the emergency department (ED) with self-harm provides an important opportunity for intervention. To investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare. Data on consecutive self-harm presentations to EDs for the years 2013-2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated. Half of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health-related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51-0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017-2019 vs. 2013-2016), but was more likely for those brought by ambulance, presenting outside 9 am-5 pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14-10.62). The findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.
Sections du résumé
BACKGROUND
BACKGROUND
Presentation to the emergency department (ED) with self-harm provides an important opportunity for intervention.
AIMS
OBJECTIVE
To investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare.
METHOD
METHODS
Data on consecutive self-harm presentations to EDs for the years 2013-2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated.
RESULTS
RESULTS
Half of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health-related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51-0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017-2019 vs. 2013-2016), but was more likely for those brought by ambulance, presenting outside 9 am-5 pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14-10.62).
CONCLUSIONS
CONCLUSIONS
The findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.
Identifiants
pubmed: 38819734
doi: 10.1007/s11845-024-03722-5
pii: 10.1007/s11845-024-03722-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
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