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Jain N, Wijnen B, Lohumi I, Chatterjee S, Evers SMAA. Economic burden of suicides and suicide attempts in low- and middle-income countries: a systematic review of costing studies. Expert Rev Pharmacoecon Outcomes Res 2024:1-13. [PMID: 39099300 DOI: 10.1080/14737167.2024.2388132] [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: 09/28/2023] [Revised: 06/25/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Suicide is a major public health concern in low- and middle-income countries (LMICs) due to its substantial psychological, social, and economic impact. There is little synthesized evidence to estimate the economic burden of suicide and suicide attempts in such economies. The present systematic literature review aims to examine existing evidence on the cost of illness (COI) in the case of suicides and suicide attempts and assess their quality. METHODS A systematic review was carried out using electronic databases, such as Medline, EMBASE, EconLit, PsycINFO, and CINAHL using keywords like 'suicide and suicide attempts,' 'cost of illness,' and economic burden." The quality assessment of studies was conducted along with the per-person cost estimation to understand the variation of methods followed across the studies. RESULT 14 studies qualified for final data extraction and synthesis out of 4,164 studies. The studies showed heterogeneity across objectives, settings, and methods, with cost estimates reflecting a wide range of costings per person in suicide and suicide attempts. CONCLUSION It is challenging to determine and compare the economic estimates of suicide. Intensive research is warranted with standardized cost assessment techniques and wider perspectives to understand the true economic burden of suicide. REGISTRATION PROSPERO Registration No- CRD42022294080.
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Affiliation(s)
- Nikhil Jain
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centre for Mental Health, Law and Policy, Indian Law Society, Pune, India
| | - Ben Wijnen
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Isha Lohumi
- Centre for Mental Health, Law and Policy, Indian Law Society, Pune, India
| | | | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
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Sunzi K, Luo H, Li Y, Zhou X, Lei C. What do older people who have attempted suicide experience? Study protocol for a qualitative meta-synthesis among older adults, family caregivers and healthcare professionals. BMJ Open 2023; 13:e074942. [PMID: 38070934 PMCID: PMC10729173 DOI: 10.1136/bmjopen-2023-074942] [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: 04/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Attempted suicide among older adults represents a significant mental health concern that has witnessed a rising incidence within this demographic in recent years. Research indicates that attempted suicide among the older population serves as a primary risk factor for completed suicide. Consequently, the objective of this study is to provide a comprehensive overview of the prevailing factors that influence suicide attempts among older adults, thereby offering evidence to guide healthcare professionals in designing targeted interventions. METHODS AND ANALYSIS This study will adhere to the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. We will synthesise qualitative studies using a comprehensive and inclusive bibliographic search strategy. The following databases will be searched: PubMed, Embase, Web of Science, CINAHL and the Cochrane Library. The quality of the articles will be assessed using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. At the same time, data extraction will be performed using the Qualitative Assessment and Review Instrument data extraction form proposed by the Joanna Briggs Institute for Evidence-Based Practice. The synthesis of findings will adhere to the principles and procedures of Thomas and Hardens' three-stage thematic synthesis approach. ETHICS AND DISSEMINATION Ethical approval will not be required for this study, as it solely encompasses data derived from previously published research. The findings will be disseminated through publication in a peer-reviewed journal. Moreover, the results will be presented at relevant academic conferences to guarantee that the study's outcomes reach pertinent stakeholders. This protocol is registered with the PROSPERO prospective database for systematic review. PROSPERO REGISTRATION NUMBER CRD42023408385.
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Affiliation(s)
- Kejimu Sunzi
- Department of Nursing, Deyang People's Hospital, Deyang, Sichuan, China
| | - Hui Luo
- Department of Nursing, Sichuan Nursing Vocational College, Deyang, Sichuan, China
| | - Yadi Li
- Department of Traditional Chinese Medicine, Deyang People's Hospital, Deyang, Sichuan, China
| | - Xin Zhou
- Department of Psychosomatic Medicine, Deyang People's Hospital, Deyang, Sichuan, China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, Chongqing, China
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Dyvesether SM, Hastrup LH, Hawton K, Nordentoft M, Erlangsen A. Direct costs of hospital care of self-harm: A national register-based cohort study. Acta Psychiatr Scand 2022; 145:319-331. [PMID: 34758107 DOI: 10.1111/acps.13383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/15/2021] [Accepted: 11/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate national direct hospital costs associated with treatment of self-harm and to analyse whether costs differ with respect to demographic and clinical characteristics. METHODS A cohort design was applied to register data on all people living in Denmark (5.8 million inhabitants) from Jan 1, 2012 to Dec 31, 2016. Self-harm presentations at all hospitals by persons aged 10 years and older were included. Total costs and costs related to somatic and psychiatric care and treatment setting (inpatient, emergency department and outpatient) were calculated (in US dollars). The association between specific characteristics and somatic inpatient costs was analysed adjusted using generalized linear models and expressed as Odds Ratios (OR). RESULTS In all, 42,634 (97.3%) self-harm presentations by 30,366 persons were included. Annual somatic and psychiatric costs amounted to $25,241,518 and $34,696,388, respectively, and the median cost per episode was $2248 (IQR: $1553-$4138). Predictors of high somatic inpatient costs were: admission to intensive care (OR = 15.6; 95% CI, 13.7-17.9), particularly dangerous methods of self-harm, such as being hit by moving objects (OR = 6.5; 95% CI, 2.7-15.7) and shooting (OR = 6.0; 95% CI, 3.4-10.7), and age ≥75 years (OR = 1.8; 95% CI, 1.5-2.2). A small group of persons (0.7%) with ≥10 presentations accounted for 8.2% of somatic and 15.3% of total hospital costs. CONCLUSION Substantial hospital costs were noted for inpatient treatment. Although one-time presenters accounted for the major share of costs, smaller patient groups accounted for considerable shares. Hospital costs of self-harm should be included in evaluation of initiatives for prevention and treatment.
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Affiliation(s)
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Psychiatric Center Copenhagen, Hellerup, Denmark
- Copenhagen Research Center for Mental Health CORE, Mental Health Center Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Psychiatric Center Copenhagen, Hellerup, Denmark
- Copenhagen Research Center for Mental Health CORE, Mental Health Center Copenhagen, Hellerup, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Mental Health Research, Australian National University, Canberra, ACT, Australia
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Aragão CDMCD, Mascarenhas MDM. Tendência temporal das notificações de lesão autoprovocada em adolescentes no ambiente escolar, Brasil, 2011-2018. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021820. [DOI: 10.1590/s1679-49742022000100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Analisar a tendência de notificações de lesão autoprovocada entre adolescentes no ambiente escolar, Brasil, 2011 a 2018. Métodos: Estudo ecológico de série temporal, sobre dados do Sistema de Informação de Agravos de Notificação, utilizando-se o modelo de regressão linear de Prais-Winsten. Resultados: Um total de 1.989 casos foram notificados. As taxas de notificação variaram de 0,09 a 2,75/100 mil habitantes, com tendência crescente, tanto no sexo feminino (VPA = 66,0%; IC95% 39,0;98,3) como no masculino (VPA = 55,2%; IC95% 29,9;85,4). A região Norte apresentou tendência estacionária, enquanto as regiões Sudeste e Sul apresentaram tendência crescente, destacando-se o Rio de Janeiro (VPA = 85,5%; IC95% 58,0;117,8) e o Paraná (VPA = 73,6%; IC95% 41,9;112,3). Na região Centro-Oeste, apenas o estado de Mato Grosso do Sul apresentou incremento (VPA = 54,5%; IC95% 16,9;104,2). Conclusão: Verificou-se tendência crescente nas notificações de lesão autoprovocada em adolescentes no ambiente escolar no Brasil, no período estudado.
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Sarkhel S. Mental health insurance and attempted suicide: Need for a reappraisal. Indian J Psychiatry 2021; 63:624-625. [PMID: 35136271 PMCID: PMC8793699 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_902_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sujit Sarkhel
- Department of Psychiatry, IPGMER and SSKM Hospital, Kolkata, West Bengal, India E-mail:
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Cripps RL, Hayes JF, Pitman AL, Osborn DPJ, Werbeloff N. Characteristics and risk of repeat suicidal ideation and self-harm in patients who present to emergency departments with suicidal ideation or self-harm: A prospective cohort study. J Affect Disord 2020; 273:358-363. [PMID: 32560929 DOI: 10.1016/j.jad.2020.03.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Characteristics and outcomes of patients presenting to Emergency Departments (EDs) have been under-examined. This paper describes the characteristics and risk of repeat suicidality amongst patients presenting to EDs with (1) suicidal ideation and (2) self-harm, compared to (3) controls in mental health crisis. METHODS The Clinical Record Interactive Search tool identified 2211 patients who presented to three London EDs with suicidal ideation or self-harm, and 1108 control patients. All patients received a full psychosocial assessment. Chi-squared tests examined group characteristics. Cox regression models assessed the risk of re-presentation with suicidal ideation or self-harm within one year. RESULTS There were a higher proportion of females and individuals under the age of 25 in the self-harm group. Patients presenting with suicidal ideation or self-harm were more likely to be white, live in more deprived areas, and less likely to receive a psychiatric diagnosis within one year compared to controls. Risk of repeat suicidality within one year was 3-4 times higher in those with baseline suicidal ideation (adjusted HR = 3.66, 95% CI 2.44-5.48) or self-harm (HR = 3.53 95% CI 2.47-5.04) compared to controls. LIMITATIONS To be included patients needed to have a full psychosocial assessment. Incomplete records meant 21.4% of the sample was excluded. This will have introduced bias which might confound observed associations. CONCLUSION Individuals presenting with either suicidal ideation or self-harm have similar risk for re-presentation within one year. Both groups would benefit from personalised risk management plans and active follow-up to reduce the risk of repeat suicidal behaviour.
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Affiliation(s)
- Rachel L Cripps
- Division of Psychiatry, University College London, United Kingdom
| | - Joseph F Hayes
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - Alexandra L Pitman
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - David P J Osborn
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - Nomi Werbeloff
- School of Social Work, Bar Ilan University, Ramat Gan, Israel.
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Kirigia JM, Muthuri RD, Muthuri NG. The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums. Healthcare (Basel) 2020; 8:E84. [PMID: 32252495 PMCID: PMC7348721 DOI: 10.3390/healthcare8020084] [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] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.
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Affiliation(s)
- Joses M. Kirigia
- Department of Research, African Sustainable Development Research Consortium (ASDRC), Nairobi 00100, Kenya
| | - Rosenabi D.K. Muthuri
- Faculty of Health Sciences, University of Pretoria, Hatfield, Pretoria 0002, South Africa;
| | - Newton G. Muthuri
- School of Business, United States International University, P. O. Box 14634-00800, Nairobi 00800, Kenya;
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Jackson J, Nugawela MD, De Vocht F, Moran P, Hollingworth W, Knipe D, Munien N, Gunnell D, Redaniel MT. Long-term impact of the expansion of a hospital liaison psychiatry service on patient care and costs following emergency department attendances for self-harm. BJPsych Open 2020; 6:e34. [PMID: 32238204 PMCID: PMC7176831 DOI: 10.1192/bjo.2020.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In September 2014, as part of a national initiative to increase access to liaison psychiatry services, the liaison psychiatry services at Bristol Royal Infirmary received new investment of £250 000 per annum, expanding its availability from 40 to 98 h per week. The long-term impact on patient outcomes and costs, of patients presenting to the emergency department with self-harm, is unknown. AIMS To assess the long-term impact of the investment on patient care outcomes and costs, of patients presenting to the emergency department with self-harm. METHOD Monthly data for all self-harm emergency department attendances between 1 September 2011 and 30 September 2017 was modelled using Bayesian structural time series to estimate expected outcomes in the absence of expanded operating hours (the counterfactual). The difference between the observed and expected trends for each outcome were interpreted as the effects of the investment. RESULTS Over the 3 years after service expansion, the mean number of self-harm attendances increased 13%. Median waiting time from arrival to psychosocial assessment was 2 h shorter (18.6% decrease, 95% Bayesian credible interval (BCI) -30.2% to -2.8%), there were 45 more referrals to other agencies (86.1% increase, 95% BCI 60.6% to 110.9%) and a small increase in the number of psychosocial assessments (11.7% increase, 95% BCI -3.4% to 28.5%) per month. Monthly mean net hospital costs were £34 more per episode (5.3% increase, 95% BCI -11.6% to 25.5%). CONCLUSIONS Despite annual increases in emergency department attendances, investment was associated with reduced waiting times for psychosocial assessment and more referrals to other agencies, with only a small increase in cost per episode.
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Affiliation(s)
- Joni Jackson
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Manjula D Nugawela
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Nik Munien
- University Hospitals Bristol NHS Foundation Trust, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
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Tsiachristas A, McDaid D, Casey D, Brand F, Leal J, Park AL, Geulayov G, Hawton K. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis. Lancet Psychiatry 2017; 4:759-767. [PMID: 28890321 PMCID: PMC5614771 DOI: 10.1016/s2215-0366(17)30367-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/25/2017] [Accepted: 08/07/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. METHODS In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. FINDINGS Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; p<0·0001). Costs were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean costs of psychosocial assessments were £228 for adults and £392 for individuals younger than 18 years. INTERPRETATION If our findings are extrapolated to England, the estimated overall annual cost of general hospital management of self-harm is £162 million per year. More use of psychosocial assessment and other preventive measures, especially for young people and against self-poisoning, could potentially lower future costs at a time of major cost pressures in the NHS. FUNDING National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research, Care Oxford at Oxford Health NHS Foundation Trust, and Department of Health.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fiona Brand
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Opmeer BC, Hollingworth W, Marques EMR, Margelyte R, Gunnell D. Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm. BMJ Open 2017; 7:e016906. [PMID: 28827260 PMCID: PMC5724115 DOI: 10.1136/bmjopen-2017-016906] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/05/2017] [Accepted: 07/04/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. DESIGN Retrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data. SETTING A large hospital in South West England. SUBJECTS Patients attending the ED for self-harm. INTERVENTIONS Extension of the LPS' working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investment MAIN OUTCOME MEASURES: Number and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance. RESULTS 298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (-£84; 95% CI -£254 to £77). CONCLUSIONS The extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS' working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation.
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Affiliation(s)
- Brent C Opmeer
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol, Bristol, UK
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - William Hollingworth
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Ruta Margelyte
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Gunnell
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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