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Tanaka C, Tagami T, Nagano M, Nakayama F, Kaneko J, Kuno M. Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients. Acute Med Surg 2024; 11:e942. [PMID: 38500638 PMCID: PMC10946162 DOI: 10.1002/ams2.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Aim Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients. Methods This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis. Results There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29-6.75; paracetamol-OR: 5.47; 95% CI: 2.18-13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07-10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0-1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65-0.80). Conclusion Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Takashi Tagami
- Department of Emergency and Critical Care MedicineNippon Medical School Musashikosugi HospitalKawasakiJapan
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoBunkyoJapan
| | | | - Fumihiko Nakayama
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Junya Kaneko
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Masamune Kuno
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
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Feng YR, Valuri GM, Morgan VA, Preen DB, O’Leary CM, Crampin E, Waterreus A. Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review. Aust N Z J Psychiatry 2023; 57:1208-1222. [PMID: 37161341 PMCID: PMC10466987 DOI: 10.1177/00048674231172116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours. METHODS A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'. RESULTS Studies in young people (n = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies (n = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%. CONCLUSION This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
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Affiliation(s)
- YR Feng
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - GM Valuri
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - DB Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Colleen M O’Leary
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - E Crampin
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Okamoto N, Ikenouchi A, Chibaatar E, Watanabe K, Igata R, Seki I, Yoshimura R. Risk Factors in Japanese Drug Overdose Patients: Identifying Their Associations With Suicide Risk. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231166970. [PMID: 36972707 DOI: 10.1177/00302228231166970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Several suicide attempts presented at the emergency department are due to drug overdose associated with psychiatric disorders. We examined and identified the major risk factors among Japanese drug overdose patients and several close associations of suicide risk. We enrolled 101 patients who attempted suicide by drug overdose between January 2015 and April 2018, assessed their background using the SAD PERSONS scale, and performed association rule analysis to characterize the major risk factors and their associations. We identified three main nodes-depressive state, social support lacking, and no spouse-as considerable risk factors. Furthermore, we identified several close associations of suicide risk and their intensity; in cases with previous suicide attempts and ethanol abuse or substance use, a simultaneous social support lacking is likely. These findings align with previous studies that used conventional statistical analysis on suicide and suicide attempt risk and highlight its importance.
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Affiliation(s)
- Naomichi Okamoto
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Atsuko Ikenouchi
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
- Medical Center for Dementia, University Hospital, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Enkhmurun Chibaatar
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Keita Watanabe
- Open Innovation Institute, Kyoto University, Kyoto, Japan
| | - Ryohei Igata
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Issei Seki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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Muacevic A, Adler JR, Ozaki A, Hori A, Tsuchiya T. Eleven-Year Trend of Drug and Chemical Substance Overdose at a Local Emergency Hospital in Japan. Cureus 2022; 14:e32475. [PMID: 36644086 PMCID: PMC9835393 DOI: 10.7759/cureus.32475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate long-term trends of overdose in the emergency department of a regional core hospital in Sendai, Miyagi Prefecture, Japan, and to identify patient characteristics as well as drugs and chemicals associated with overdose. METHODS Patients who visited the emergency department from January 1, 2010, to December 31, 2020, and were diagnosed with a drug or chemical overdose were included in the study. We conducted a descriptive analysis based on the data collected. RESULTS In total, 577 patients (mean 38.4 years old, female 75.0%) were considered, and 16.8% had a history of repeated overdose. The number of patients during the study period showed a downward trend, with slight increases in 2012 and 2020. In addition, the top four drugs suspected of causing overdose were over the counter (OTC) antipyretic analgesics and cold medicines (N=97), followed by flunitrazepam (N=80), etizolam (N=72), and brotizolam (N=70). CONCLUSION There was a decreasing trend in overdose, and OTC medicines, sedatives, and anxiolytics were the primary medications causing overdose. OTC antipyretic analgesics and cold medicines were the most common suspected overdose drugs, with an increasing trend in the later years.
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Bae SJ, Lee DH, Lee DH, Seo AY, Choi YH. Comparative Analysis of Characteristics of Patients Who Visited the Emergency Department due to Suicide Attempts During Coronavirus Disease-2019 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221106286. [PMID: 35652505 DOI: 10.1177/00302228221106286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The coronavirus infection 2019 (COVID-19) pandemic has affected on mental health and contributed to increased depression and anxiety. We assessed the impact of the COVID-19 pandemic on suicide-related the emergency department (ED) visits. We compared the characteristics of suicide-related patients who visited the ED between the "COVID-19 period" and the "pre-COVID-19 period". The mean age of patients was younger after COVID-19 pandemic. In comparison by age group, the proportion of patients during the COVID-19 period increased in their teens and 20s, and the rest of the age groups decreased. The proportion of patients who requested help was higher during the COVID-19. The authenticity of suicide attempts showed a higher proportion of patients during the pre-COVID-19. Therefore, during the pandemic, attention should be paid to worsening mental health problems, such as anxiety or depression, rather than the lethality of suicide attempts.
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Affiliation(s)
- Sung Jin Bae
- Department of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Seoul, Chung-Ang University, Gwangmyeong-si, Republic of Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Seoul, Chung-Ang University, Gwangmyeong-si, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Ah Young Seo
- Graduate Student, Graduate School, College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
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Siddiqui M, Al-Amin H, Rabeh MA, Meedany M, Hamdi Y, Ghuloum S. Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study. BMC Psychiatry 2022; 22:326. [PMID: 35534838 PMCID: PMC9082909 DOI: 10.1186/s12888-022-03929-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that sleep disturbances and exercise are risk factors for suicide attempts; however, whether sleep disturbances are independently associated with suicide attempts is debatable. We compared the sleep and exercise patterns of individuals who attempted suicide to those of the general population and investigated whether sleep disturbances were independently associated with suicide attempts. METHODS Over a year, individuals presented to the emergency department at Hamad General Hospital and Mental Health Services in Doha with suicide attempts (n = 127) filled out questionnaires on sleep and exercise, demographics, and clinical measures. A control group (n = 126) from two primary care centers filled out the same questionnaires during the same period. RESULTS Subjects in the suicide group were significantly younger, single, had a lower level of education, and showed considerably more early insomnia, daytime tiredness, interrupted sleep, and no regular exercise. The most common diagnoses seen with suicidality were adjustment disorder and major depression, and the most common method used to attempt suicide was an overdose. After multiple regression analysis, being Arab, belonging to the category "other nationalities," unemployment, and early insomnia were significantly associated with an increased risk of suicide attempts. CONCLUSION This is the first comparative study on suicide in the Arabian Gulf. Individuals in Qatar with acute stress, depressive symptoms, sleep disturbances, and lack of exercise are at increased risk of attempting suicide. Thus, clinicians need to routinely screen for sleep and physical activity because of their significant contribution to physical and mental well-being.
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Affiliation(s)
- Manaal Siddiqui
- grid.416973.e0000 0004 0582 4340Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, 24144 Doha, Qatar
| | - Hassen Al-Amin
- grid.416973.e0000 0004 0582 4340Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, 24144 Doha, Qatar
| | - Mahmoud Abu Rabeh
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud Meedany
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Yasmin Hamdi
- grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar.
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Characteristics of children and adolescents presenting to the emergency department with self-inflicted injury: Retrospective analysis of two teaching hospitals. Pediatr Neonatol 2022; 63:131-138. [PMID: 34711528 DOI: 10.1016/j.pedneo.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Data on Taiwanese adolescents with self-inflicted injuries are limited. We describe the epidemiology of children and adolescents visiting the emergency department for self-inflicted injuries in two geographically distinct teaching hospitals. METHODS Medical records of children 0-18 years old who visited the emergency department of Taipei Tzu Chi Hospital and Chi Mei Medical Center, Tainan between 2016 and 2019 coded with relevant diagnoses were reviewed. Visits with documented self-inflicted injury were included. RESULTS During the 4-year period, 62 children made 74 emergency visits for self-inflicted injury. A total of 88% of visits were made by children with a psychiatric diagnosis, with depressive disorders being the most common (57%). Interpersonal relationship issue was cited as a trigger for self-harm in 49% of visits. Adjusted for annual visit volumes, self-harm visits per 10,000 pediatric emergency visits increased nearly 5 fold between 2016 and 2019, with the most prominent increase in the final year. Poisoning was the most common mechanism of injury and was frequently used by females, as compared to males who tended to jump from heights. Up to 96% of adolescents with previous self-harm seen at the emergency department had sought psychiatric help in the past year. Urban-rural inequity in mental health resource utilization was observed. CONCLUSIONS Visits to the emergency department for self-inflicted injuries among children and adolescents increased, most remarkably in 2019, for both hospitals. Intentional poisoning with prescription and over-the-counter medications was the most common method. There was a high prevalence of psychiatric disorders in our study population. As the emergency department is likely the first point of medical contact for such visits, emergency personnel should be trained appropriately on managing such patients.
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Stewart I, Lees-Deutsch L. Risk Assessment of Self-Injurious Behavior and Suicide Presentation in the Emergency Department: An Integrative Review. J Emerg Nurs 2021; 48:57-73. [PMID: 34782168 DOI: 10.1016/j.jen.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Globally, there is a lack of clarity regarding the best practice to distinguish patients at the highest risk of suicide. This review explores the use of risk assessment tools in emergency departments to identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide. METHODS The review question ("Does the use of risk assessment tools in emergency departments identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide?") focused on exposure and outcome. Studies of any design were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. Study characteristics and concepts were extracted, compared, and verified. An integrative approach was used for reporting through narrative synthesis. RESULTS Nine studies were identified for inclusion. Two risk assessment tools were found to have good predictive ability for suicide ideation and self-harm. Three had modest prediction of patient disposition, but in one study, the clinical impression of nurses had higher predictive ability. One tool showed modest predictive ability for patients requiring admission. DISCUSSION This review found no strong evidence to indicate that any particular risk tool has a superior predictive ability to identify repeat self-harm, suicide attempts, or death by suicide. Best practice lacks clarity to determine patients at highest risk of suicide, but the use of risk assessment tools has been recommended. Nevertheless, such tools should not be used in isolation from clinical judgment and experience to evaluate patients at risk. Education and training to augment risk assessment within the emergency department are recommended.
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Shirzad F, Gholamzad S, Shafiee M, Shariat SV. Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran. BMC Emerg Med 2021; 21:47. [PMID: 33853531 PMCID: PMC8048184 DOI: 10.1186/s12873-021-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. Method We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. Results The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. Conclusion A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Gholamzad
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Shafiee
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychological Health research institute (PHRI), Iran University of Medical Science, Tehran, Iran. .,School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran.
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Kim HJ, Lee DH. Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt. BMC Psychiatry 2021; 21:79. [PMID: 33549077 PMCID: PMC7866662 DOI: 10.1186/s12888-021-03089-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. METHODS This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. RESULTS This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343-3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302-3.119), and consciousness (1.840, 1.253-2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255-1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively. CONCLUSION The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.
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Affiliation(s)
- Hye Jin Kim
- grid.411612.10000 0004 0470 5112Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Anyangchoenro 1071 Yangcheon-gu, Seoul, Republic of Korea.
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Al-Amin H, Singh R, Abdulrazzak M, Ghuloum S. Psychosocial and Clinical Profiles of the Cases Visiting the Emergency Department Due to Accidental Self-harm and Suicide Attempts in Doha, Qatar: A Retrospective Study. Community Ment Health J 2021; 57:315-324. [PMID: 32506256 PMCID: PMC7835152 DOI: 10.1007/s10597-020-00650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/27/2020] [Indexed: 11/24/2022]
Abstract
The aims of this study were to retrospectively assess the profiles of subjects with suicide attempts and self-harm in Doha, Qatar; and whether the available data were complete. We reviewed all the records of fatal and non-fatal suicides together with accidental self-ham cases seen in the major Emergency Department in Doha, over a one-year period. There was 37 completed suicide, mostly male expatriates in mid 30 s who died by hanging. In cases with suicide intent (N = 270), more males were admitted to Psychiatry than women. Overdose was the common method and the majority had mood disorders. In self-harm cases with no suicide intent (N = 150) the majority were not seen by Psychiatry. The profiles of suicide cases in Qatar are similar to those reported internationally. However, there is a major need to establish a comprehensive system to register and assess all self-harm patients in Qatar.
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Affiliation(s)
- Hassen Al-Amin
- Department of Psychiatry, Weill Cornell Medicine, Doha, Qatar
| | - Rajvir Singh
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Abdulrazzak
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. .,Weill Cornel Medicine-Qatar, Doha, Qatar.
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12
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Ishida T, Kuwahara Y, Shibahashi K, Okura Y, Sugiyama K, Hamabe Y, Mimura M, Suzuki T, Uchida H. Lower mortality from suicidal trauma among patients with a psychiatric diagnosis upon admission: Nationwide japanese retrospective cohort study. Psychiatry Res 2020; 293:113456. [PMID: 32977053 DOI: 10.1016/j.psychres.2020.113456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/05/2020] [Indexed: 11/17/2022]
Abstract
Suicide and self-harm are major public health issues. Few studies have compared mortality from suicidal trauma between patients with and without contact with psychiatric services. This study aimed to compare the in-hospital mortality of suicidal trauma between patients with and without a psychiatric diagnosis upon hospital admission. Data on 15- to 90-year-old patients with suicidal trauma between 2004 and 2015 was extracted from the Japan Trauma Data Bank. In-hospital mortality were compared between patients with and without a psychiatric diagnosis. A total of 9,803 patients were included. The median age was 42 years (interquartile range: 29-59), and 5,010 patients (51.1%) were male. The most frequent method of injury was falling from a height (53.4%), followed by stabbing (32.3%) and burns (6.2%). In total, 4,878 patients (49.8%) had a psychiatric diagnosis upon admission. The proportion of patients with a psychiatric diagnosis was significantly lower among males, teenagers, and older people. In-hospital mortality was significantly lower among patients with a psychiatric diagnosis than those without (10.9%vs18.7%). Contact with psychiatric services might be protective among people with suicidal trauma. However, the proportion of psychiatric service use was generally low. These findings show the importance of delivering appropriate psychiatric services to high-risk patients.
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Affiliation(s)
- Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Yusuke Kuwahara
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yoshihiro Okura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Young JT, Borschmann R, Heffernan E, Spittal MJ, Brophy L, Ogloff JRP, Moran P, Armstrong G, Preen DB, Kinner SA. Contact with Mental Health Services After Acute Care for Self-Harm Among Adults Released from Prison: A Prospective Data Linkage Study. Suicide Life Threat Behav 2020; 50:990-1006. [PMID: 32359122 DOI: 10.1111/sltb.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm. METHOD In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm. RESULTS Of 217 discharges from acute care following self-harm, 55% (n = 119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR) = 0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR = 0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR = 0.98; 95% CI: 0.97-0.99), being female (ARR = 1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR = 1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR = 1.55; 95% CI: 1.08-2.22). CONCLUSION Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis.
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Affiliation(s)
- Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia
| | - Ed Heffernan
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Mind Australia, Heidelberg, Vic., Australia.,School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology & Victorian Institute of Forensic Mental Health, Alphington, Vic., Australia
| | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gregory Armstrong
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Mater Research Institute-UQ, University of Queensland, South Brisbane, Qld, Australia.,Griffith Criminology Institute, Griffith University, Mt Gravatt, Qld, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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14
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Sedghy Z, Yoosefi N, Navidian A. The effect of motivational interviewing-based training on the rate of using mental health services and intensity of suicidal ideation in individuals with suicide attempt admitted to the emergency department. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:247. [PMID: 33209939 PMCID: PMC7652075 DOI: 10.4103/jehp.jehp_344_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Unless mental health care is provided to suicide attempters after discharge from the emergency department, suicide prevention opportunities may be lost. The purpose of this study was to determine the effect of motivational interviewing (MI)-based training on using mental health services and reducing the severity of suicidal thoughts. METHODS This quasi-experimental study was performed on seventy suicide attempters who had been admitted to the emergency department of three university hospitals in Southeast Iran in 2019. Eligible patients were chosen through convenience sampling, and they were randomly divided into the experimental (n = 35) and control (n = 35) groups. The intervention group received three MI sessions on the day of discharge and the 1st week after discharge. Twelve weeks after the intervention, the Beck Scale for Suicidal Ideation and the using mental health services were completed in both the groups. Data were analyzed using Chi-squared test, independent t-test, and paired t-test. RESULTS While there was no significant difference between the two groups in terms of the mean score of suicidal ideation on the pretest, the experimental group experienced a significant decrease in this respect at the end of the study; thus, this group scored 8.86 ± 5.30, which is considerably lower than that obtained in the control group (15.85 ± 6.65) (P = 0.0001). Furthermore, at the end of the study, the rate of using mental health services increased much more in the experimental group than in the control group (P = 0.01). CONCLUSION MI training had a significant positive impact on mitigating suicidal ideation and promoting mental health services use. To improve mental health and to better serve suicidal individuals, it is recommended that short-term interventions be developed in the form of post-discharge education for suicidal patients admitted to the emergency department.
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Affiliation(s)
- Zohreh Sedghy
- Department of Nursing, Nursing and Midwifery School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Naser Yoosefi
- Department of Counseling and Psychology, University of Kurdistan, Kurdistan, Iran
| | - Ali Navidian
- Pregnancy Health Research Center, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
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15
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Pieterse D, Hoare J, Louw KA, Breet E, Henry M, Lewis I, Bantjes J. Methods of deliberate self-harm in a tertiary hospital in South Africa. S Afr J Psychiatr 2020; 26:1399. [PMID: 32391183 PMCID: PMC7203532 DOI: 10.4102/sajpsychiatry.v26i0.1399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. Aim The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. Setting The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. Method Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. Results Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. Conclusion Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.
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Affiliation(s)
- Deirdre Pieterse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kerry-Ann Louw
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elsie Breet
- Department of Psychology, Stellenbosch University, Cape Town, South Africa
| | - Michelle Henry
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Ian Lewis
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Cape Town, South Africa
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16
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Mohr NM, Wu C, Ward MJ, McNaughton CD, Richardson K, Kaboli PJ. Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: A cohort study. BMC Health Serv Res 2020; 20:110. [PMID: 32050947 PMCID: PMC7014752 DOI: 10.1186/s12913-020-4956-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-facility transfer is an important strategy for improving access to specialized health services, but transfers are complicated by over-triage, under-triage, travel burdens, and costs. The purpose of this study is to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. METHODS This observational cohort study included all patients treated in VHA EDs between 2012 and 2014 who were transferred to another VHA hospital. Potentially avoidable transfers were defined as patients who were either discharged from the receiving ED or admitted to the receiving hospital for ≤1 day without having an invasive procedure performed. We conducted facility- and diagnosis-level analyses to identify subgroups of patients for whom potentially avoidable transfers had increased prevalence. RESULTS Of 6,173,189 ED visits during the 3-year study period, 18,852 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p < 0.001), and 22.8% of all VHA-to-VHA transfers were potentially avoidable transfers. The 3 disease categories most commonly associated with inter-facility transfer were mental health (34%), cardiac (12%), and digestive diagnoses (9%). CONCLUSIONS VHA inter-facility transfer is commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.
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Affiliation(s)
- Nicholas M. Mohr
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA USA
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242 USA
| | - Chaorong Wu
- Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, Iowa USA
| | - Michael J. Ward
- Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Candace D. McNaughton
- Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Kelly Richardson
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA USA
| | - Peter J. Kaboli
- Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa USA
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