Background Self-harm is a significant public health issue, and is an important risk factor for suicide. The Irish National Registry of Deliberate Self-Harm records data on emergency department (ED) presentations involving self-harm, providing a unique opportunity to establish the longitudinal patterns of aftercare for hospital-treated self-harm. Therefore, the specific objectives of this study were to investigate the variation in aftercare of self-harm patients based on standard demographic and clinical characteristics; and to identify factors which predict aftercare following self-harm.
Methods Data on presentations to Irish EDs involving self-harm from the Registry was utilised, covering an eight-year period (2004–2012). Aftercare following ED attendance was measured at four levels: admission to a general ward, admission to a psychiatric ward, left without being seen, and not admitted.
Results In total, 101,904 episodes of self-harm were made during the study period, involving 63,457 individuals. On average, 41% of self-harm episodes were not admitted to the presenting hospital. The findings showed that over the course of the study there was a declining number of presentations resulting in patient admission to the presenting hospital following attendance with self-harm (from 40% in 2004 to 28% in 2012). There was regional variation in aftercare following self-harm, with general admission rates ranging from 11% to 61% across HSE Hospital Groups. Multinomial logistic regression identified that the factor which most strongly affected aftercare was the presenting hospital. The study also identified that being male, older age, method, repeat self-harm, time of attendance and residence of the patient all influence the care of self-harm patients. Psychiatric admission was most common when highly lethal methods of self-harm were used (OR = 4.00, 95% CI 3.63–4.41). A relatively large proportion of patients left the ED without being seen (15%) and the risk of doing so was highest for self-harm repeaters (OR = 1.64; 95% CI 1.55–1.74 for those with 5 or more presentations).
Discussion The results of this study showed that non-clinical factors of self-harm presentations most strongly influenced the odds of a person being admitted to a hospital following self-harm. This study is the first to use national data to explore the patterns of aftercare involving a well-defined form of medically-serious suicidal behaviour. In particular, the hospital variation in aftercare poses a challenge for the assessment and management of self-harm patients, and would suggest that the implementation of international guidelines (e.g. NICE Guidelines) in the management of self-harm in the ED is not uniform nationally.
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