Jacqueline Birtwistle1, Rachael Kelley1, Allan House1, David Owens2. 1. Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom. 2. Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom. Electronic address: d.w.owens@leeds.ac.uk.
Abstract
BACKGROUND: Assessment and aftercare for people who self-harm needs to be related to an understanding of risks of adverse outcomes. We aimed to determine whether self-harm by a combination of methods and its early repetition are associated with adverse outcomes - especially non-fatal repetition and suicide. METHOD: 10,829 consecutive general hospital attendances due to self-harm in one large English city were monitored, through scrutiny of Emergency Department attendances, over three years and followed up to determine the incidence of non-fatal repetition. Subsequent deaths, by any cause and by suicide, were determined from national statistical records. RESULTS: 6155 patients accounted for the 10,829 episodes: 72% by self-poisoning, 21% self-injury, and 746 episodes (7%) due to a combination of methods. After a combined-methods index episode, non-fatal repetition (P=0.001) and suicide (P=0.002) occurred sooner and more frequently than it did among those who had self-poisoned. Further hospital attendance due to self-harm within a month was associated with a 3.7-fold (95% CI 2.1-6.4) risk of subsequent suicide. LIMITATIONS: The data exclude self-harm episodes that do not result in a hospital attendance. Index episodes in the study are not generally life-time first episodes so follow-up data are based on an arbitrary start-point. Both of these limitations are common to all studies of this kind. CONCLUSIONS: At psychosocial assessment and the making of aftercare arrangements, combined methods of self-harm or another recent episode should be considered 'red-flag' indicators for attention to care.
BACKGROUND: Assessment and aftercare for people who self-harm needs to be related to an understanding of risks of adverse outcomes. We aimed to determine whether self-harm by a combination of methods and its early repetition are associated with adverse outcomes - especially non-fatal repetition and suicide. METHOD: 10,829 consecutive general hospital attendances due to self-harm in one large English city were monitored, through scrutiny of Emergency Department attendances, over three years and followed up to determine the incidence of non-fatal repetition. Subsequent deaths, by any cause and by suicide, were determined from national statistical records. RESULTS: 6155 patients accounted for the 10,829 episodes: 72% by self-poisoning, 21% self-injury, and 746 episodes (7%) due to a combination of methods. After a combined-methods index episode, non-fatal repetition (P=0.001) and suicide (P=0.002) occurred sooner and more frequently than it did among those who had self-poisoned. Further hospital attendance due to self-harm within a month was associated with a 3.7-fold (95% CI 2.1-6.4) risk of subsequent suicide. LIMITATIONS: The data exclude self-harm episodes that do not result in a hospital attendance. Index episodes in the study are not generally life-time first episodes so follow-up data are based on an arbitrary start-point. Both of these limitations are common to all studies of this kind. CONCLUSIONS: At psychosocial assessment and the making of aftercare arrangements, combined methods of self-harm or another recent episode should be considered 'red-flag' indicators for attention to care.
Authors: Jamie Kammer; Mahfuza Rahman; Molly Finnerty; Deborah Layman; Katrina Vega; Hanga Galfalvy; Christa Labouliere; Gregory K Brown; Kelly Green; Anni Cummings; Prabu Vasan; Barbara Stanley Journal: J Behav Health Serv Res Date: 2021-04 Impact factor: 1.505
Authors: David Owens; Alexandra Wright-Hughes; Liz Graham; Paul Blenkiron; Kayleigh Burton; Michelle Collinson; Amanda Farrin; Simon Hatcher; Katie Martin; John O'Dwyer; Louise Pembroke; David Protheroe; Sandy Tubeuf; Allan House Journal: Pilot Feasibility Stud Date: 2020-08-19
Authors: Leah Quinlivan; Louise Gorman; Donna L Littlewood; Elizabeth Monaghan; Stephen J Barlow; Stephen Campbell; Roger T Webb; Nav Kapur Journal: Aust N Z J Psychiatry Date: 2021-05-21 Impact factor: 5.744