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McEvoy D, Joyce M, Mongan D, Clarke M, Codd M. Comparing times of self-harm presentations to hospital emergency departments in children, adolescents, young adults and adults: a national registry study 2007-2019. BMC Psychiatry 2024; 24:474. [PMID: 38937740 PMCID: PMC11210019 DOI: 10.1186/s12888-024-05921-x] [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] [Received: 11/12/2023] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE The few studies that have explored self-harm presentation times at hospital emergency departments (EDs) - an important factor that can determine if a patient receives a mental health assessment - primarily focus on adult samples. This study examined the times of self-harm presentations to EDs, self-harm methods used, mental health assessments, and admission data across different age-groups. METHODS Using data from the National Self-Harm Registry Ireland over a 13-year timeframe (2007-2019), this study compared times, days, seasons, methods of self-harm, and admission data for children (8-12 years), adolescents (13-17 years), young adults (18-25 years) and adults (> 25 years). RESULTS The majority of the 152,474 self-harm presentations (78.6%) for all ages occurred out-of-hours (outside the standard working hours or in-hours times of 09:00-17:00, Monday-Friday). The four hours before midnight had the highest proportions of self-harm presentations for adolescents (27.9%) and adults (23.1%), whereas the four hours after midnight had the highest proportion of self-harm presentations for young adults (22.9%). The 16:00-midnight timeframe had highest proportion of self-harm presentations in children (52.3%). Higher proportions of patients received a mental health assessment in-hours compared to out-of-hours among young adults (78.2% vs. 73.3%) and adults (76.1% vs. 72.0%). Self-harm presentations were lowest during summer months in children and adolescents. DISCUSSION Hospitals should ensure that adequate resources are available for individuals presenting with self-harm, especially in the case of overcrowded EDs, and protocols need to be designed for those presenting with self-harm due to intoxication. In line with national policy, protocols for patients presenting during out-of-hours should be designed that can incorporate services from allied health multidisciplinary teams, social work, addiction services and counselling organisations. Given the lower rates of self-harm during school holidays for children and adolescents, the school environment must be considered in the context of mental health and self-harm public health prevention interventions.
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Affiliation(s)
- David McEvoy
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland.
| | - Mary Joyce
- National Suicide Research Foundation (NSRF), University College Cork, Western Gateway Building, Cork, Ireland
| | - David Mongan
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Mary Clarke
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
| | - Mary Codd
- Physiotherapy and Sports Science, UCD School of Public Health, University College Dublin Belfield, Dublin 4, Ireland
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Murphy S, Ross E, O'Hagan D, Maguire A, O'Reilly D. Suicide risk following ED presentation with self-harm varies by hospital. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1063-1071. [PMID: 37861710 PMCID: PMC11116243 DOI: 10.1007/s00127-023-02561-6] [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: 09/11/2022] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
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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Affiliation(s)
- Siobhan Murphy
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BJ, Northern Ireland.
| | - Emma Ross
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BJ, Northern Ireland
| | | | - Aideen Maguire
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BJ, Northern Ireland
| | - Dermot O'Reilly
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BJ, Northern Ireland
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Cully G, Russell V, Joyce M, Corcoran P, Daly C, Griffin E. Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm. Ir J Med Sci 2024:10.1007/s11845-024-03722-5. [PMID: 38819734 DOI: 10.1007/s11845-024-03722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Presentation to the emergency department (ED) with self-harm provides an important opportunity for intervention. AIMS To investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare. METHOD 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 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 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.
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Affiliation(s)
- Grace Cully
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
| | - Vincent Russell
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
- Health Service Executive, Dublin, Ireland
| | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | | | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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McCarthy M, McIntyre J, Nathan R, Saini P. Factors Influencing Emergency Department Staff Decision-Making for People Attending in Suicidal Crisis: A Systematic Review. Arch Suicide Res 2024; 28:35-49. [PMID: 36724348 DOI: 10.1080/13811118.2023.2173113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emergency department (ED) staff are often the first point of contact for individuals in suicidal crisis. Despite this, there is no published research systematically examining the factors influencing decision-making for this patient group. METHODS MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: (1) suicide, (2) accident and emergency department and (3) decision-making. Three reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analyzing study characteristics and findings. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. RESULTS Seventeen studies met the eligibility criteria and were included in this systematic review. Studies were published from 2004 to 2020 and were of good methodological quality. A number of patient (method of self-harm, age, gender), contextual (availability of services and staff) and staff-related factors (attitudes, training, knowledge) were reported to influence decision-making for patients in suicidal crisis presenting to EDs. CONCLUSION Decision-making in the ED is complex and is influenced by patient, contextual and staff-related factors. These decisions can have an impact on the future care and clinical pathways of patients in suicidal crisis. Additional training is needed for ED staff specifically related to suicide prevention.
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Uddin T, Pitman A, Benson G, Kamal Z, Hawton K, Rowe S. Attitudes toward and experiences of clinical and non-clinical services among individuals who self-harm or attempt suicide: a systematic review. Psychol Med 2024; 54:13-31. [PMID: 37772412 DOI: 10.1017/s0033291723002805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. This systematic review summarized the literature published since then to July 2022 to examine contemporary attitudes toward and experience of clinical and non-clinical services among individuals who self-harm and their relatives. We systematically searched for literature using seven databases. Quality of studies was assessed using the Mixed-Methods Appraisal Tool and findings were summarized using a narrative synthesis. We identified 29 studies that met our inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes toward clinical management and organizational barriers across services. Generally, more positive attitudes were found toward non-clinical services providing therapeutic contact, such as voluntary sector organizations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in attitudes toward and experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centered and compassionate care and deliver more effective, acceptable and accessible services.
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Affiliation(s)
- Tasnim Uddin
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Alexandra Pitman
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gemma Benson
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Zeast Kamal
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Rowe
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
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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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Subramanian Y, Barrett J, Kim S, Carey C, Barry H, MacHale S. A comparison of daytime and out of hour mental health presentations to Beaumont Hospital Emergency Department between 2018 and 2020. Ir J Med Sci 2023; 192:2475-2481. [PMID: 36588147 PMCID: PMC9805908 DOI: 10.1007/s11845-022-03249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND In 2018, there were more than 12,000 self-harm presentations to emergency departments (EDs) in Ireland with 50% occurring between 7p.m. and 3a.m. There is evidence that the assessment quality and follow-up is variable across clinicians. To address this, The National Clinical Programme for the Management of Self-Harm in the ED (NCPSH 2016) was developed to set clear standards. AIM Our aim was to compare diagnosis and management of patients presenting to Beaumont Hospital (BH) ED, across a 3-year period, by the on-site Liaison Psychiatry Service, during normal working hours, to the off-site on call service outside of normal working hours (OOH). METHODS This is a retrospective audit of BH ED patients referred for psychiatric assessment between 2018 and 2020, using patient electronic records for data collection, and Pearson's chi square testing for group differences. Post hoc analysis was performed using adjusted residuals and Bonferroni correction. RESULTS Of 3659 psychiatric referrals to Beaumont ED from 2018 to 2020, alcohol-related disorders were the most common diagnosis and were diagnosed more frequently during normal working hours (n = 592, 16.2%; 22.9% normal hours vs 8.5% OOH, p < 0.001), while personality disorder was diagnosed more frequently out of hours. (n = 432, 11.8%; 9.6% normal hours vs 14.4% out of hours, p < 0.001). There was a statistically significant difference in referral to voluntary services out of hours (7.2% normal hours vs 0.3% OOH). CONCLUSION In contrast to previous findings, our study found higher rates of alcohol-related disorders diagnosed during normal hours vs OOH. Furthermore, voluntary and addiction services were under-utilised OOH and this presents an important teaching opportunity.
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Affiliation(s)
| | | | - San Kim
- Beaumont Hospital, Dublin 9, Ireland
| | - Cornelia Carey
- South Meath Mental Health Services, Ashbourne, Co. Meath Ireland
| | - Helen Barry
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - Siobhan MacHale
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
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Ingram C, Buggy C, Elabbasy D, Perrotta C. Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-22. [PMID: 37361314 PMCID: PMC10233198 DOI: 10.1007/s10389-023-01934-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Aim To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods Peer-reviewed articles and conference abstracts published in English between 2012-2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and - in a subsequent screening stage - at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01934-0.
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Affiliation(s)
- Carolyn Ingram
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Darin Elabbasy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
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Quinlivan L, Gorman L, Marks S, Monaghan E, Asmal S, Webb RT, Kapur N. Liaison psychiatry practitioners' views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study. BJPsych Open 2023; 9:e34. [PMID: 36803955 PMCID: PMC9970172 DOI: 10.1192/bjo.2023.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate. AIMS To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners. METHOD Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data. RESULTS Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services. CONCLUSIONS Our findings highlight practitioners' views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.
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Affiliation(s)
- Leah Quinlivan
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Louise Gorman
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Stephen Marks
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK
| | - Elizabeth Monaghan
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Sadika Asmal
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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10
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Evoy DM, Clarke M, Joyce M. Time of self-harm presentations to hospital emergency departments: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2023; 58:335-354. [PMID: 36053313 PMCID: PMC9971130 DOI: 10.1007/s00127-022-02353-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The time at which a self-harm presentation occurs has been shown to be a significant factor as to whether a patient receives a psychiatric assessment or not, which may benefit the patient's future care. This scoping review sought to identify studies that report on the peak time of day for self-harm presentations to hospital Emergency Departments (EDs). This could help hospital managers to properly allocate the appropriate services for self-harm patients when they are needed the most. METHODS A scoping review of the literature from the year 2000 until 30th June 2021 was carried out using the PubMed, Web of Science, Embase and the Cochrane library databases. RESULTS There were 22 studies that were included for data extraction. The findings from 20 of these studies indicate that self-harm presentations tend to occur outside of working hours (09:00-17:00, Monday to Friday). The majority of studies found that the peak time for self-harm presentations was in the hours before and after midnight. CONCLUSIONS While this scoping review identified a satisfactory number of studies for data extraction, examination of time of day of presentation was a secondary outcome across most studies. Given that the majority of studies focused on adult samples, further research is necessary to investigate peak times for other age cohorts. More research on this topic is also needed in low- and middle-income countries. Consideration should be given to ensure that the necessary resources to treat hospital presenting self-harm are allocated outside of typical working hours.
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Affiliation(s)
- David Mc Evoy
- Population Health and Health Services, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland.
| | - Mary Clarke
- grid.4912.e0000 0004 0488 7120Population Health and Health Services, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland ,grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Mary Joyce
- grid.7872.a0000000123318773National Suicide Research Foundation (NSRF), Western Gateway Building, University College Cork, Cork, Ireland
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11
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Lunde KB, Mehlum L, Melle I, Qin P. Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study. J Psychiatr Res 2022; 151:575-582. [PMID: 35636035 DOI: 10.1016/j.jpsychires.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18-35 years during the period 2008-2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention.
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Affiliation(s)
- Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway.
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
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12
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Quinlivan L, Gorman L, Littlewood DL, Monaghan E, Barlow SJ, Campbell S, Webb RT, Kapur N. ‘Wasn’t offered one, too poorly to ask for one’ – Reasons why
some patients do not receive a psychosocial assessment following
self-harm: Qualitative patient and carer survey. Aust N Z J Psychiatry 2022; 56:398-407. [PMID: 34015945 PMCID: PMC8941717 DOI: 10.1177/00048674211011262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. METHODS Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. RESULTS Patients' reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). CONCLUSION Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.
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Affiliation(s)
- Leah Quinlivan
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK,Leah Quinlivan, Centre for Mental
Health and Safety, The University of Manchester, Jean McFarlane
Building, Oxford Road, Manchester M13 9PL, UK.
| | - Louise Gorman
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Donna L Littlewood
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Monaghan
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J Barlow
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Roger T Webb
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK,Greater Manchester Mental Health
NHS Foundation Trust, Manchester, UK
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13
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Cully G, Leahy D, Shiely F, Arensman E. Patients' Experiences of Engagement with Healthcare Services Following a High-Risk Self-Harm Presentation to a Hospital Emergency Department: A Mixed Methods Study. Arch Suicide Res 2022; 26:91-111. [PMID: 32576083 DOI: 10.1080/13811118.2020.1779153] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Experiences of engaging with healthcare services following a self-harm presentation to hospital of high lethality or high suicidal intent have not been examined previously, despite this subgroup of self-harm patients being at high risk of suicide. Therefore, this study addressed this issue by documenting patients' experiences of engaging with healthcare services after a high-risk self-harm (HRSH) presentation to hospital. Demographic, psychiatric and psychosocial factors associated with variations in perceptions of care received were also examined. Quantitative information was obtained by interview administered questionnaires 0-3 months following a HRSH presentation to hospital. Semi-structured follow-up interviews, conducted, 6-9 months later, provided qualitative data (n = 32). Satisfaction with aftercare varied. Positive experiences of care included "supportive and compassionate relationships" and "timely and comprehensive follow-up care." The establishment of trust in the services encouraged help-seeking and psychotropic treatment adherence. Conversely, "superficial and unsupportive relationships" and "care lacking continuity and comprehensiveness" left some participants feeling isolated, contributing to inhibited help-seeking and resistance to psychotropic treatment. Participants with a history of self-harm and mental health service engagement were more likely to report dissatisfaction with care provided. Those who described unsupportive relationships more frequently reported repeated self-harm, alcohol misuse, and hopelessness at follow-up. Our findings show that satisfaction with services, help-seeking and treatment adherence may be improved by ensuring the consistent provision of timely, comprehensive and supportive aftercare following a HRSH presentation. Absence of these aspects of care may contribute to ongoing distress and further suicidal behavior.
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14
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Griffin E, McHugh SM, Jeffers A, Gunnell D, Arensman E, Perry IJ, Cully G, McElroy B, Maxwell M, Chang SS, Ruane-McAteer E, Corcoran P. Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment. BMJ Open 2021; 11:e055962. [PMID: 34952886 PMCID: PMC9066339 DOI: 10.1136/bmjopen-2021-055962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A National Clinical Programme for the Management of Hospital-Presenting Self-Harm (NCP-SH) was introduced in Ireland in 2014. This involved the development of a model of care to standardise the management of self-harm in emergency departments, to be delivered by dedicated clinical nurse specialists. The core components of the programme were to: ensure an empathic and timely response, conduct a biopsychosocial assessment, involve family members in assessment and discharge planning, and provide a bridge to next care. The overall aim of the programme was to reduce the rate of repeat self-harm. This multistage study will evaluate the impact of the NCP-SH on hospital-presenting self-harm and to identify determinants influencing its implementation. METHODS Employing a sequential mixed methods design, the first stage will use data from the National Self-Harm Registry Ireland to examine the impact of the NCP-SH on self-harm repetition, along with other aspects of care, including provision of psychosocial assessments and changes in admissions and postdischarge referrals. A cost-effectiveness analysis will assess the cost per repeat self-harm attendance avoided as a result of the NCP-SH. The second stage will identify the influences of implementation fidelity-adherence to the programme's core components-using a combination of document analysis and semistructured interviews with staff of the programme, guided by the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION This study has received full ethical approval and will run until August 2023. This study is novel in that it will identify important factors influencing successful implementation of complex programmes. It is expected that the findings will provide important learnings for the integration of mental health services in general hospital settings and will be disseminated via peer-review publications along with reports for clinicians and policy-makers.
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Affiliation(s)
- Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | | | - David Gunnell
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Grace Cully
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Brendan McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Eimear Ruane-McAteer
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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15
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Cully G, Corcoran P, Leahy D, Cassidy E, Steeg S, Griffin E, Shiely F, Arensman E. Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm. J Ment Health 2021; 30:751-759. [PMID: 34749587 DOI: 10.1080/09638237.2021.1979488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Individuals presenting to hospital with self-harm of high lethality or high suicidal intent are at high risk of subsequent suicide. AIM To examine factors associated with psychiatric admission and self-harm repetition following high-risk self-harm (HRSH). METHOD A cohort study of 324 consecutive HRSH patients was conducted across three urban hospitals (December 2014-February 2018). Information on self-harm repetition was extracted from the National Self-harm Registry Ireland. Logistic regression models examined predictors of psychiatric admission and self-harm repetition. Propensity score (PS) methods were used to address confounding. RESULTS Forty percent of the cohort were admitted to a psychiatric inpatient setting. Factors associated with admission were living alone, depression, previous psychiatric admission, suicide note and uncommon self-harm methods. History of emotional, physical or sexual abuse was associated with not being admitted. Twelve-month self-harm repetition occurred in 17.3% of cases. Following inverse probability weighting according to the PS, psychiatric admission following HRSH was not associated with repetition. Predictors of repetition were recent self-harm history, young age (18-24 years) and previous psychiatric admission. CONCLUSION(S) Findings indicate that psychiatric admission following HRSH is not associated with repeated self-harm and reaffirms the consistent finding that history of self-harm and psychiatric treatment are strong predictors of repetition.
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Affiliation(s)
- Grace Cully
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Dorothy Leahy
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland.,Liaison Psychiatry Service, Acute Mental Health Unit, Cork University Hospital, Cork, Ireland
| | - Sarah Steeg
- Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Frances Shiely
- School of Public Health, University College Cork, Cork, Ireland.,HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
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16
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Trajectories in suicide attempt method lethality over a five-year period: Associations with suicide attempt repetition, all-cause, and suicide mortality. PLoS One 2021; 16:e0245780. [PMID: 33481936 PMCID: PMC7822301 DOI: 10.1371/journal.pone.0245780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
It is not known if there are discernible patterns in method lethality over successive episodes of self–harm and, if so, how these may be differentially associated with risks of self–harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all–cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: –39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all–cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub–Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub–groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm.
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17
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Griffin E, Gunnell D, Corcoran P. Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study. BJPsych Open 2020; 6:e145. [PMID: 33234189 PMCID: PMC7745229 DOI: 10.1192/bjo.2020.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
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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Affiliation(s)
- Eve Griffin
- School of Public Health, University College Cork, Ireland; and National Suicide Research Foundation, Ireland
| | - David Gunnell
- National Institute for Health Research Bristol, Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK; and Population Health Sciences, University of Bristol, UK
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18
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Marchant A, Turner S, Balbuena L, Peters E, Williams D, Lloyd K, Lyons R, John A. Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK. Arch Dis Child 2020; 105:347-354. [PMID: 31611193 PMCID: PMC7146921 DOI: 10.1136/archdischild-2019-317248] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10-24 years old in Wales, UK. METHODS A whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented. RESULTS A total of 937 697 individuals aged 10-24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15-19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10-15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty. CONCLUSIONS This is the first study to compare self-harm in people aged 10-24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.
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Affiliation(s)
- Amanda Marchant
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Samantha Turner
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Evyn Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Dave Williams
- Child and Adolescent Psychiatry, Aneurin Bevan Health Board, Newport, UK
| | - Keith Lloyd
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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19
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MacDonald S, Sampson C, Turley R, Biddle L, Ring N, Begley R, Evans R. Patients' Experiences of Emergency Hospital Care Following Self-Harm: Systematic Review and Thematic Synthesis of Qualitative Research. QUALITATIVE HEALTH RESEARCH 2020; 30:471-485. [PMID: 31933427 DOI: 10.1177/1049732319886566] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rates of hospital presentation for self-harm have increased in recent years, and although clinical practice guidelines on clinical provision prioritize positive patient experiences, the quality of provision remains variable. This systematic review provides an updated and extended synthesis of qualitative research on the following: (a) patients' experiences of treatment following presentation to hospital; and (b) patients' perceptions of the impact of treatment on recurrent self-harm and/or suicidal ideation, and future help-seeking. Twenty-six studies were identified for inclusion in the final synthesis. Three meta-themes emerged: (a) individuals undertake extensive identity work when presenting with self-harm, navigating the process of becoming a patient, and negotiating the type of patient they want to be; (b) care ranges from gentle to hostile, with care at admission and discharge being particularly disorientating; and (c) negative experiences of clinical treatment may increase future self-harm. Emerging research gaps include the need for further theoretically informed qualitative research in this area.
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Affiliation(s)
| | | | | | - Lucy Biddle
- University of Bristol, Bristol, United Kingdom
| | - Nicola Ring
- Edinburgh Napier University (Sighthill Campus), Midlothian, United Kingdom
| | - Roisin Begley
- University Hospital of Wales, Cardiff, United Kingdom
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20
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Quinlivan L, Littlewood DL, Webb RT, Kapur N. Patient safety and suicide prevention in mental health services: time for a new paradigm? J Ment Health 2020; 29:1-5. [DOI: 10.1080/09638237.2020.1714013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Donna L. Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Roger T. Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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21
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Boffin N, Van Casteren V, De Ridder K. Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices. BMJ Open 2019; 9:e028546. [PMID: 31061060 PMCID: PMC6501981 DOI: 10.1136/bmjopen-2018-028546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES First, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs. SETTING 105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013-2016. PARTICIPANTS 245 suicide attempts by regular patients. OUTCOMES MEASURES Ten care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time. RESULTS As for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP-patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP-patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant. CONCLUSIONS GPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.
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Affiliation(s)
- Nicole Boffin
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Karin De Ridder
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
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22
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Cully G, Corcoran P, Leahy D, Griffin E, Dillon C, Cassidy E, Shiely F, Arensman E. Method of self-harm and risk of self-harm repetition: findings from a national self-harm registry. J Affect Disord 2019; 246:843-850. [PMID: 30795489 DOI: 10.1016/j.jad.2018.10.372] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/14/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk of self-harm repetition has consistently been shown to be higher following self-cutting compared to intentional drug overdose (IDO) and other self-harm methods. The utility of previous evidence is limited due to the large heterogeneous method categories studied. This study examined risk of hospital presented self-harm repetition according to specific characteristics of self-harm methods. METHODS Data on consecutive self-harm presentations to hospital emergency departments (2010-2016) were obtained from the National Self-Harm Registry Ireland. Associations between self-harm method and repetition were analysed using survival analyses. RESULTS Overall, 65,690 self-harm presentations were made involving 46,661 individuals. Self-harm methods associated with increased repetition risk included minor self-cutting, severe self-cutting, multiple drug IDOs involving psychotropic drugs and self-harm by blunt object. Minor self-cutting was the method associated with highest repetition risk (adjusted hazard ratio (AHR) 1.38, 95% CI 1.31-1.45). Risk of repetition was comparable following IDOs of four or more drugs involving psychotropic drugs (AHR = 1.29, 95% CI 1.20-1.39), severe self-cutting (AHR 1.25, 95% CI 1.16-1.34) and blunt object (AHR = 1.23, 95% CI 1.07-1.42). LIMITATIONS Information was not available on suicide or other causes of mortality. CONCLUSIONS Self-harm method and the associated risk of repetition should form a core part of biopsychosocial assessments and should inform follow-up care for self-harm patients. The observed differences in repetition associated with specific characteristics of IDO underline the importance of safety planning and monitoring prescribing for people who have engaged in IDO.
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Affiliation(s)
- G Cully
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland.
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland
| | - D Leahy
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland
| | - E Griffin
- National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland
| | - C Dillon
- National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland
| | - E Cassidy
- Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - F Shiely
- School of Public Health, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland
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23
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Karami M, Yazdi-Ravandi S, Ghaleiha A, Olfatifar M. Comparison of the Clusters and Non-Clusters Areas of Attempted Suicide Cases in Hamadan Province, Western Iran: Findings from a Pilot Study (2016-2017). J Res Health Sci 2018; 18:e00425. [PMID: 30270217 PMCID: PMC6941641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Suicide behaviors are complex and multifactorial problems that in the most of the societies are considered as the public health challenge. However, its underlying reasons and spatial pattern remain unclear in Hamadan Province, western Iran. STUDY DESIGN Secondary analysis of existing data. METHODS We assessed the spatial pattern pre-city regarding some influencing factors by scan-statistics and logistic regression to detect clusters areas and its comparison with other areas for the period of 2016-2017. All of the registered cases of attempted suicide in a quality registry system of suicide in Sina (Farshchian) Hospital affiliated to Hamadan University of Medical Sciences, Hamadan, Iran were enrolled. RESULTS Two significant clusters were detected in study areas, formed with relative risk at 5.28 (P=0.001) and 6.33 (P=0.017), and with the centrality of Asadabad and Razan, respectively. Clusters and non-clusters areas were differed in terms of location (OR=0.15, 95%, CI: 0.07, 0.31), self-harms methods (OR=0.28, 95%, CI: 0.9, 0.88) and education. Residents of rural areas, illiterate people and non-drug user cases have more likely to be in a cluster. CONCLUSIONS Clusters were not formed equally among cities of Hamadan Province. Accordingly, we suggest the implementation of appropriate, long-term and evidence-based educations for high-risk and vulnerable groups through the intersectoral interventions in different parts of Hamadan Province (considering the cluster and non-clusters areas) to avert deaths and related injuries from attempted suicide.
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Affiliation(s)
- Manoochehr Karami
- 1 Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Yazdi-Ravandi
- 2 Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
,3 Young Researchers and Elite Club, Rudehen Branch, Islamic Azad University, Rudehen, Iran
| | - Ali Ghaleiha
- 2 Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Meysam Olfatifar
- 4 Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,5 Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
,Correspondence: Meysam Olfatifar (MSc) Tel: +98 21 22439982 E-mail:
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