Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm
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.
Funding
Open Access funding provided by the IReL Consortium
Irish Health Research Board grant number EIA-2019–005
History
Data Availability Statement
Access to data from the National Self-Harm Registry Ireland may be requested by contacting the National Suicide Research Foundation ( info@nsrf.ie ). Access to the syntax used for this study can be requested from the corresponding author ( grace.cully@ucc.ie )Comments
The original article is available at https://link.springer.com/Published Citation
Cully G. et al. Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm. Ir J Med Sci. 2024 Oct;193(5):2443-2451Publication Date
31 May 2024External DOI
PubMed ID
38819734Department/Unit
- Beaumont Hospital
- Psychiatry
Publisher
Royal Academy of Medicine of IrelandVersion
- Published Version (Version of Record)