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Arnon S, Shahar G, Brunstein Klomek A. Continuity of care in suicide prevention: current status and future directions. Front Public Health 2024; 11:1266717. [PMID: 38259744 PMCID: PMC10800998 DOI: 10.3389/fpubh.2023.1266717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide. Methods The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention. Results The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations. Conclusion CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.
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Affiliation(s)
- Shay Arnon
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Cully G, Corcoran P, Gunnell D, Chang SS, McElroy B, O'Connell S, Arensman E, Perry IJ, Griffin E. Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care. BMC Psychiatry 2023; 23:917. [PMID: 38062378 PMCID: PMC10701986 DOI: 10.1186/s12888-023-05340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. METHODS Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. RESULTS There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). CONCLUSION The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.
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Affiliation(s)
- G Cully
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - D Gunnell
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - S S Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - B McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - S O'Connell
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - E Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Spittal MJ, Shand F, Christensen H, Brophy L, Pirkis J. Community mental health care after self-harm: A retrospective cohort study. Aust N Z J Psychiatry 2017; 51:727-735. [PMID: 27821412 DOI: 10.1177/0004867416676366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). METHODS We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. RESULTS A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. CONCLUSION Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community.
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Affiliation(s)
- Matthew J Spittal
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Fiona Shand
- 2 Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- 2 Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Brophy
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jane Pirkis
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Ferreira AD, Sponholz A, Mantovani C, Pazin-Filho A, Passos ADC, Botega NJ, Del-Ben CM. Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital. Arch Suicide Res 2016; 20:191-204. [PMID: 25961847 DOI: 10.1080/13811118.2015.1004491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.
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Carroll R, Metcalfe C, Gunnell D. Hospital management of self-harm patients and risk of repetition: systematic review and meta-analysis. J Affect Disord 2014; 168:476-83. [PMID: 25128754 DOI: 10.1016/j.jad.2014.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/21/2014] [Accepted: 06/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking. METHODS We undertook a systematic review to investigate whether between study differences in reported clinical management of self-harm patients were associated with the risk of repeat self-harm and suicide. RESULTS Altogether 64 prospective studies were identified that described the clinical care of self-harm patients and the incidence of repeat self-harm and suicide. The proportion of a cohort psychosocially assessed was not associated with the recorded incidence of repeat self-harm or suicide; the incidence of repeat self-harm was 16.7% (95% CI 13.8-20.1) in studies in the lowest tertile of assessment levels and 19.0% (95% CI 15.7-23.0) in the highest tertile. There was no association of repeat self-harm with differing levels of hospital admission (n=47 studies) or receiving specialist follow-up (n=12 studies). In studies reporting on levels of hospital admission and suicide (n=5), cohorts where a higher proportion of patients were admitted to a hospital bed reported a lower incidence of subsequent suicide (0.6%, 95% CI 0.5-0.8) compared to cohorts with lower levels of admission (1.9%, 95% CI 1.1-3.2). LIMITATIONS In some analyses power was limited due to the small number of studies reporting the exposures of interest. Case mix and aspects of care are likely to vary between studies. DISCUSSION There is little clear evidence to suggest routine aspects of self-harm patient care, including psychosocial assessment, reduce the risk of subsequent suicide and repeat self-harm.
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Affiliation(s)
- R Carroll
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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