Deliberate Self-harm Patients Research Articles

Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes

IntroductionDeliberate self-harm (DSH) treated in general hospital is a well-established risk factor for suicide and other cause mortality. However, few studies have used population data to investigate the differential impact of specific psychiatric disorders on the risk of subsequent suicide, by sex and age of the patient in the context of previous DSH episodes. MethodAll patients aged 18 and older treated for DSH in general hospitals during the period 2008–2018 were identified through national registers. Cox proportional hazards regression was used to ascertain the associated risk of death by suicide, mental and behavioural disorder and other external causes. ResultsThe cohort consisted of 39 479 patients of which 878 died by suicide, 461 by mental and behavioural disorders and 1037 by other external causes. Overall, schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide. Large gender and age differences were identified in the risk of suicide associated with personality disorders and affective disorders. Alcohol use disorders and dementia increased the risk of dying by mental and behavioural disorders and alcohol use disorders and other substance use disorders increased the risk of death by external causes. ConclusionSchizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide among DSH patients, but the effect varied by gender, age and history of previous DSH. Psychiatric evaluation of all DSH patients and treatment tailored to the patient's specific needs is essential to reduce the risk of premature death.

Clinical determinants of hospital treated deliberate self-harm repetition: A time to recurrent event analysis.

Psychiatric disorders are strongly associated with hospital treated deliberate self-harm (DSH). However, the effect of specific disorders on risk for DSH repetition in sex-age-subgroups is understudied. The present study aims to assess the influence of various specific psychiatric disorders on risk for subsequent DSH repetition by way of time to recurrent event analysis on a national cohort of DSH patients. Individuals aged 18 and older presenting to somatic hospital for DSH during the period 2008-2018 was identified through national registers. A parametric shared frailty survival analysis was used to investigate the impact of various psychiatric disorders on risk of DSH repetition. The cohort consisted of 39,508 individuals of which 8634 (21.8%) presented with 24,028 repeated episodes of hospital treated DSH. Borderline personality disorder increased the risk of DSH repetition in females (adjusted HR 1.49, CI 1.41-1.57), while alcohol use disorder (HR 1.12, CI 1.04-1.19) and substance use disorders (adjusted HR 1.22, CI 1.14-1.32) increased the risk of repetition in males. The strongest impact of psychiatric disorder on risk of repetition was found among the elderly. Previous history of DSH was associated with the highest increased risk of repetition. Prior history of DSH was strongly associated with DSH repetition, but the influence of psychiatric disorder varied significantly by specific diagnoses and by sex and age of the patients. Efforts to prevent DSH repetition should be age and gender specific and designed to meet the needs of people with different specific psychiatric disorders.

Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study

BackgroundPsychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. AimTo examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. MethodData from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008–2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. ResultsAltogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. LimitationsData was restricted to variables available in the registers. ConclusionsPsychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.

Dynamic Patterns of Symptoms and Functioning in Predicting Deliberate Self-harm in Patients with First-Episode Schizophrenia-Spectrum Disorders Over 3 Years.

Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES). Patients with FES (n = 1234) were followed up for 36 months. Symptomatology, functioning, treatment adherence and self-harm information were obtained monthly over the follow-up period. A time-varying vector autoregressive (VAR) model was used to study the contribution of clinical variables to self-harm over the 36th month. Random forest models for self-harm were established to classify the individuals with self-harm and predict future self-harm events. Over a 36-month period, 187 patients with FES had one or more self-harm events. The depressive symptoms contributed the most to self-harm prediction during the first year, while the importance of positive psychotic symptoms increased from the second year onwards. The random forest model with all static information and symptom instability achieved a good area under the receiver operating characteristic curve (AUROC = 0.77 ± 0.023) for identifying patients with DSH. With a sliding window analysis, the averaged AUROC of predicting a self-event was 0.65 ± 0.102 (ranging from 0.54 to 0.78) with the best model being 6-month predicted future 6-month self-harm for month 11-23 (AUROC = 0.7). Results highlight the importance of the dynamic relationship of depressive and positive psychotic symptoms with self-harm and the possibility of self-harm prediction in FES with longitudinal clinical data.

Factors influencing the successful connection of deliberate self-injury patients to community-based mental health centers.

The emergency department (ED) is a good place to start preventing actions for suicide attempters. As a preventive factor, early intervention, follow-up management, and connection with community-based mental health care are important. We aimed to determine which factors were important for a successful connection to community-based mental health care services. This study was conducted at two tertiary teaching hospitals from January 2018 to December 2020. There were 1016 deliberate self-harm patients who received the four weeks of follow-up intervention. There were 166 patients in the connected group and 850 patients in the non-connected group. In the logistic regression analysis for the successful connection to community-based mental health care, married patients had an odds ratio (OR) 1.627 (95% CI 0.960-2.758), 1.314 OR (95% CI 0.619-2.790) of separated patients and 5.317 OR (CI 1.864-15.168) of widowed patients compared to single patients. And face-to-face follow-up management had 2.630 OR (95% CI 1.815-3.811) to the successful connection rate to community-based mental healthcare compared to the patients in non-face-to-face management. When deliberately self-injured patients who visited the ED received short-term follow-up intervention after emergency treatment, face-to-face follow-up intervention had a higher connection rate to community-based mental healthcare centers than non-face-to-face follow-up intervention. In the future, for deliberate self-harm patients who visit the ED, the ED staff should manage deliberate self-harm through early detection and face-to-face follow-up intervention, and other methods that can compensate for face-to-face follow-up intervention.

Psychiatric care following deliberate self-harm and prospective mortality: evidence from a national cohort of patients in routine care

IntroductionPsychiatric care following self-harm treatment is pivotal in patients´ life both in short- and long-terms.ObjectivesTo examine follow-up psychiatric care received by patients treated for deliberate self-harm (DSH), and to assess the influence of psychiatric referral and treatment attendance on risk for subsequent mortality.MethodsNationwide registries were interlinked to follow all DSH patients for data on personal socioeconomic status, clinical features of DSH, psychiatric treatment and cause of death. Data were analyzed with Logistic regression and cause-specific survival analysis.Results The study identified 43153 patients involving 69569 DSH episodes. Of these patients 15.7% were referred or transferred to psychiatric services and 51.0% attended psychiatric treatment within subsequent 3 months. Evidently, prior psychiatric history and psychiatric comorbidities had strong influence on both referral and attendance to psychiatric healthcare, personal socioeconomic status also deviated the likelihoods. During the follow-up, 7041 patients died from suicide (n=911) or other causes (n=6130). While suicide risk was highly associated with male gender, middle age, and particularly, prior and coexisting psychopathologies, other cause mortality was strongly associated with old age and socioeconomic disadvantages. Meanwhile, a referral to psychiatric services was associated with suicide risk, and the risk was particularly high for patients who received the referral but did not attend psychiatric treatment. The observed effect was more pronounced during the early years, and in patients of young or middle age and those with a clear intent of self-harm.ConclusionsThe insightful findings highlight the importance of patients´ attendance and engagement in follow-up psychiatric care on risk for subsequent mortality.DisclosureNo significant relationships.

Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study

Abstract:-
 Background: Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).
 Methods:
 This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.
 Results:
 Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value <.001, .016 and <.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p<.0001).
 Conclusion:
 DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised

P652 The burden of mental illness, including deliberate self-harm, before and after a diagnosis of IBD, a UK population study

Abstract Background The burden of mental illness among IBD patients is recognised to be greater than among their healthy peers. Due to the bi-directional influence of the gut-brain axis,mental health may be linked to IBD outcomes and vice versa. The aim of this study was to use population level data to describe the incidence of anxiety, depression, insomnia, severe mental illness and deliberate self-harm in patients with IBD. Methods A retrospective cohort study was conducted using The Health improvement Network (THIN) database to estimate the incidence rates of anxiety, depression, insomnia, severe mental illness and deliberate self harm in patients with IBD between 1995 to 2021 and matched controls with no pre-existing mental health illness.The prevalence of pre-existing depression, anxiety and insomnia prior to IBD diagnosis was assessed for IBD patients and matched controls.The association between deliberate self harm and incident mental health diagnoses following IBD diagnosis were estimated using Cox regression analysis. Results We identified 59,613 incident cases of IBD,34,615 (58.1%) had UC and 25,000 (41.9%) had Crohn’s disease. The median age was;41.5 (IQR 29.6–57.5) years,with an equal proportion of males and females with IBD (49.2% vs 50.8%). Patients with a diagnosis of IBD had an increased prevalence of anxiety 10 years (3.0% vs 2.5%,p<0.001) and 2 years prior to diagnosis (6.2% and 5.3%,p<0.001). A similar pattern was seen for insomnia at 10 years (1.0% vs 0.9%, p=0.028) and 2 years (3.4% vs 3.0%, p<0.001) and for depression at 10 years (3.7% vs 4.5%, p<0.001) and 2 years (8.1% vs 9.6%, p<0.001). The incidence of mental illness was higher in IBD patients than controls for; anxiety [6.1 vs 5.3 per 1000 patient years,HR 1.14(1.09–1.20),p<0.001], depression [11.3 vs 7.5 per 1000 patient years,HR 1.34 (1.28–1.39),p<0.001], insomnia [9.6 vs 6.0 per 1000 patient years,HR 1.54(1.5–1.6),p<0.001] and DSH [1.6 vs 1.2 per 1000 patient years,HR 1.20(1.07–1.35),p<0.001]. Associations of deliberate self harm in this patient groups included: IBD (HR 1.20(1.07–1.35),p=0.002),female gender (HR 1.06(1.35–1.60),p<0.001),age quintile <27.4 years (HR 4.48(3.95–5.93),p<0.001) compared to >61.3 years,anxiety (HR 1.57(1.35–1.82),p<0.001),depression (HR 5.97(5.33–6.69),p<0.001),insomnia (HR 2.32(2.02–2.66),p<0.001), and severe mental illness (HR 5.74(4.56–7.22),p<0.001). Conclusion There is an additional burden of mental illness in patients who are later diagnosed with IBD. Following diagnosis,the incidence of depression, anxiety, insomnia and deliberate self harm is higher in individuals with IBD than controls.Patients who develop mental illness in the setting of IBD are at particularly high risk of deliberate self-harm.

Prevalence, Spectrum, and Outcome of Deliberate Self-harm Presenting to Emergency Department during COVID-19 Pandemic of 2020.

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic, and the lockdown imposed, has had profound social and economic consequences and thereby implications on psychological health. This study aims to understand the effects of the pandemic and the lockdown on the prevalence, spectrum, and outcome of patients presenting with deliberate self-harm (DSH) to the emergency department (ED).Materials and methodsThis was a retrospective, observational study done in the ED of a tertiary care hospital in South India on DSH victims presenting from January to August 2020, spanning the prelockdown, lockdown, and unlock phases of the pandemic, and compared with data from a similar period in 2018.ResultsOur study population included 507 DSH victims (prevalence: 1.2%) from January to August 2020. The percentage of DSH cases showed a slight increase among the prelockdown (203/17,234: 1.18%), the lockdown (179/14,687: 1.22%), and the unlock phases (125/9,977: 1.25%). There was a female preponderance (286/507: 56.4%), and the mean age was 33.2 years. Of the 507 patients, 369 (72.8%) were admitted and 19 (3.7%) died. The lockdown period in 2020 showed a 40.9% absolute decrease in the number of DSH victims presenting to the ED as compared to an equivalent period in 2018. The proportion of patients taking plant poisons was significantly lower [odds ratio (OR) 0.38, 95% confidence intervals (CI) 0.18–0.81, p = 0.012] and that of corrosive ingestion was significantly higher (OR 2.94, 95% CI 1.57–5.48, p = 0.001) in the lockdown phase as compared to a lockdown-control phase of 2018.ConclusionThere was a reduction in the absolute number of patients presenting with DSH to the ED during January–August 2020, and more so during the lockdown phase (March 24–June 30), as compared to a similar period in 2018. There was no significant difference in the hospital outcome of DSH patients between the two periods.How to cite this articleJohn SM, John A, Hazra D, Murugan S, Abhilash KPP. Prevalence, Spectrum, and Outcome of Deliberate Self-harm Presenting to Emergency Department during COVID-19 Pandemic of 2020. Indian J Crit Care Med 2021;25(12):1387–1394.

Obstructive sleep apnea and risk of suicide and self-harm: a Danish Nationwide Cohort Study.

In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self-harm in patients with obstructive sleep apnea (OSA). We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self-harm in patients with OSA with the reference cohort. We identified 48 168 patients with OSA. A total of 135 patients had died by suicide, compared with 999 suicides in the reference cohort. Patients with OSA had an increased risk of dying by suicide when compared with the reference cohort (hazard ratio, 1.29; 95% CI = 1.07% to 1.55%; and subhazard ratio, 1.23; 95% CI = 1.10% to 1.45%). We identified 1004 events of self-harm among patients with OSA, and 5270 events in the reference group. The overall risk of self-harm was increased in patients with OSA when compared with the reference group (hazard ratio, 1.28; 95% CI = 1.19% to 1.37%). This is the first study to estimate the risk of suicide and deliberate self-harm in patients with OSA. We found that patients with OSA have an increased risk of both suicide and deliberate self-harm when compared with a large reference cohort, thereby highlighting the importance of a mental health screening in these patients.

Suicide Risk Among Hospitalized Versus Discharged Deliberate Self-Harm Patients: Generalized Random Forest Analysis Using a Large Claims Data Set

Suicide rates are extremely high among emergency department patients seen for deliberate self-harm. Inpatient hospitalization is often recommended for these patients, but evidence on the suicide prevention impacts of hospitalization is scarce. Confounding by indication and challenges to implementing randomized designs are barriers to advances in this field. Investigators used 2009-2012 statewide data on 57,312 self-harm emergency department patients from California, linked to mortality records. Naive 12-month and 30-day suicide risks were estimated among patients who were hospitalized versus those who were discharged. Then, generalized random forest methods were applied to estimate the average treatment impacts of hospitalization on suicide, conditioning on observable covariates. Associations were calculated separately for sex- and age-specific subgroups. Analyses were conducted in February 2019-August 2021. In naive analyses, suicide risk was significantly higher in hospitalized than in discharged patients in each subgroup. In 12-month models accounting for the observed covariates through generalized random forest methods, hospitalized male patients had 5.4 more suicides per 1,000 patients (95% CI=3.0, 7.8), hospitalized patients aged 10-29 years had 2.4 more suicides per 1,000 (95% CI=1.1, 3.6), and those aged ≥50 years had 5.8 more suicides per 1,000 (95% CI=0.5, 11.2) than corresponding discharged patients. Hospitalization was not significantly associated with suicide among female patients or patients aged 30-49 years in generalized random forest analyses. Patterns were similar in 30-day generalized random forest models. Emergency department personnel intend to hospitalize self-harm patients with high suicide risk; this study suggests that this goal is largely realized. Analyses that control for confounding by observable covariates did not find clear evidence that hospitalization reduces suicide risk and could not rule out the possibility of iatrogenic effects.

National audit to assess standards of care for deliberate self-harm patients presenting to trauma centres with penetrating wounds and recommendations for action

The authors assessed the standard of care for patients presenting with deliberate self-harm (DSH) injuries to major trauma centres (MTCs) in England as well as hospitals within the major trauma network in Scotland. This was to generate an understanding of current practice, identify any shortfall and develop recommendations to improve safety and patient care. We contacted all MTCs in England and hospitals in the major trauma network in Scotland, asking their permission to be included in this study. Emergency department (ED) consultants at each unit were then invited to complete a telephone questionnaire clarifying their current management policies of DSH patients against NICE guidance. The telephone questionnaire was carried out by the same author to ensure interpretation was consistent. Twenty-seven MTCs within England as well as the four hospitals in the major trauma network within Scotland were contacted. There was a total of 15 responses - 14 responses from MTCs within England and 1 response from a hospital in the trauma network in Scotland. The clear deficit in practice was identified and recommendations were generated. Our study has shown that patients are transferred following DSH without a clear review of their physical, psychological and social needs. We hope to share our recommendations for the implementation of a local protocol to improve standards and safety.

Study on suicidal intent and its relationship with psychiatric morbidity in cases of deliberate self-harm

Background: Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that is uniquely associated with suicidal behavior because of high levels of psychiatric co-morbidity. The present study was planned to undertake on suicidal intent in such deliberate self-harm patients. Aims: The aim is to determine the suicidal intent and to assess the relationship with psychiatric morbidity in patients of deliberate self-harm Settings: Patients of deliberate self-harm. Design: Cross-sectional study. Materials and Methods: The sample consisted of 50 patients of deliberate self-harm admitted during study period of 6 months in appropriate in-patient unit for observation and necessary intervention, who fulfils inclusion criteria. A semi structured pro forma was used for collection of socio-demographic data, case history and Beck's Suicide intent scale was used which is designed to assess the severity of intention to die associated with an episode of deliberate self-harm. Statistical Analysis Used: Descriptive statistics such as mean, standard deviation, and percentage was used to present the data. To assess the relationship between the suicidal intent and psychiatric morbidity, Chi-square test was used. A P Results: Self poisoning (80%) was found to be the most common method employed in deliberate self-harm. 74% of the deliberate self-harm attempts were impulsive in nature. Altercation with the spouse (30%) was the most common precipitating factor. Psychiatric morbidity was found to be associated with suicidal intent (P = 0.0068). Conclusions: In conclusion, even with low intent to harm self we have to be careful while examining the patients of psychiatric morbidity. They are at risk of attempting harm to self. We cannot ignore the patients just on the basis of low intent to harm self.

Gender Differences in Emotional Dysregulation and Deliberate Self-harm in Patients With Tramadol Dependence

Objectives: Gender differences in substance dependence across many domains including emotional dysregulation and deliberate self-harm (DSH) has not been studied widely. Tramadol dependence is the most one lacking empirical research and evidence regarding these differences; therefore, our aim is to detect gender differences in patients with tramadol dependence as regards emotional dysregulation and DSH. Materials and Methods: The study included 30 male and 30 female patients with tramadol dependence [diagnosis was made by Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I)]. Assessment of emotional dysregulation and DSH was done by the Difficulties in Emotion Dysregulation Scale, the Deliberate Self-Harm Inventory—Short Version. Results: Female patients are higher in emotional dysregulation and induce DSH more evidently than male patients with tramadol dependence. There was a statistically significant positive correlation between overall emotional dysregulation and overall DSH in both groups. Conclusion: The results will be useful in clinical practice for the management of patients with tramadol dependence.

Self-inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation

Background: Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed. Methods: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted. Results and discussion: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up. Conclusion: Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.

Indigenous need arise to protect human from self-harm behavior in Pakistan: translation and validation of inventory of statements about self-injury

Purpose The purpose of this paper is to highlight the indigenous need to counter self-harm behavior in Pakistan and establish the reliability and validity of scale with translation, adaptation and cross-language validation of the inventory of statements about self-injury (ISAS) for future health studies (Klonsky and Glenn, 2009). Design/methodology/approach The present study was a cross-sectional study using a quantitative method. Response items rating is made from three-point Likert-type scales ranging from the 0-not relevant, 1-somewhat relevant or 2-very relevant. ISAS has been comprised of 13 potential functions of deliberate self-harm (DSH) and all subscales have been translated from the English language into the Urdu language with a sample of 30 individuals and further applied on 200 samples of DSH patients for factorial validation. The standard back-translation method was used for translation and adaptation of the scale (Anderson and Brislin, 1976; Brislin, 1976; Hambleton, 1994). Findings The overall scale has good internal consistency reliability. Confirmatory factor analysis was performed to confirm the factorial validity of ISAS. Results revealed that all the items have confirmed strong factorial validity in the context of Pakistani culture and quite helpful in hospital settings to address this health issue. Originality/value Self-harm is considered as a major health issue in the young population of the world and therefore, the investigated scale provides an assessment of DSH and intentions of performing self-injury to achieve a better understanding of such behaviors in DSH patients, which will help further to develop measures to prevent such behavior.

Methods of deliberate self-harm in a tertiary hospital in South Africa.

BackgroundLittle is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm.AimThe aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA.SettingThe study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa.MethodData were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH.ResultsSelf-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH.ConclusionImproved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

Profile of deliberate self-harm patients presenting to the Emergency department and their outcome

Background: Deliberate self-harm (DSH) is one of the leading causes of mortality and morbidity in India. According to the World Health Organization (WHO), each year 800,000 people die globally by DSH, 200,000 of which occur in India.

The Relationship Between Evidence-Based Practices and Emergency Department Managers' Perceptions on Quality of Care for Self-Harm Patients.

OBJECTIVE: To understand the extent to which implementation of evidence-based practices affects emergency department (ED) nurse managers' perceptions of quality of care provided to deliberate self-harm patients. METHODS: ED nursing leadership from a nationally representative sample of 513 hospitals completed a survey on the ED management of deliberate self-harm patients, including the quality of care for deliberate self-harm patients on a 1 to 5 point Likert-type scale. Unadjusted and adjusted analyses, controlling for relevant hospital characteristics, examined associations between the provision of evidence-based practices and quality of care. RESULTS: The overall mean quality rating was 3.09. Adjusted quality ratings were higher for EDs that routinely engaged in discharge planning (β = 0.488) and safety planning (β = 0.736) processes. Ratings were also higher for hospitals with higher levels of mental health staff (β = 0.368) and for teaching hospitals (β = 0.319). CONCLUSION: Preliminary findings suggest a national institutional readiness for further implementation of evidence-based practices for deliberate self-harm patients.

If You Could Change 1 Thing to Improve the Quality of Emergency Care for Deliberate Self-harm Patients, What Would It Be? A National Survey of Nursing Leadership

IntroductionEmergency departments increasingly treat patients for deliberate self-harm. This study sought to understand emergency department nursing leadership perspectives on how to improve the quality of emergency care for these patients. MethodsED nursing managers and directors from a national sample of 476 hospitals responded to an open-ended question asking for the 1 thing they would change to improve the quality of care for self-harm patients who present in their emergency departments. We identified and coded key themes for improving the emergency management of these patients, then examined the distribution of these themes and differences by hospital characteristics, including urbanicity, patient volume, and teaching status. ResultsFive themes regarding how to improve care for deliberate self-harm patients were identified: greater access to hospital mental health staff or treatment (26.4%); better access to community-based services and resources (26.4%); more inpatient psychiatric beds readily accessible (20.9%); separate safe spaces in the emergency department (18.6%); and dedicated staff coverage (7.8%). Endorsement of findings did not differ based on hospital characteristics. DiscussionED nursing leadership strongly endorsed the need for greater access to both hospital- and community-based mental health treatment resources for deliberate self-harm patients. Additional ED staff and training, along with greater continuity among systems of care in the community, would further improve the quality of emergency care for these patients. Broad policies that address the scarcity of mental health services should also be considered to provide comprehensive care for this high-risk patient population. Key wordsEmergency department management of self-harm; Mental health care; Emergency nursing care