Self-harm Presentations Research Articles

Suicide ideation and subsequent self-harm: Variations in presentations, care and management during the Covid-19 pandemic

ObjectivesThe COVID-19 pandemic and associated societal changes including access to emergency departments (ED) may have influenced suicide ideation (SI) incidence and the case fatality rates. This study quantifies the numbers of individuals presenting to ED with SI before and during the pandemic and examines risk of subsequent presentation to ED with self-harm and mortality.
 MethodsThe Northern Ireland Self-Harm (SH) Registry provided data on suicide ideation and self-harm presentations across 12 ED departments in NI between January 2016 and September 2021. Linkage to health and mortality records provided follow up to September 2021. Cox proportional hazards regression models were employed to assess subsequent self-harm and mortality risk following initial presentation to ED with suicidal ideation.
 ResultsPreliminary findings indicate that during the study period there were 21,601 ED presentations with SI between made by 9184 individuals of whom 2,011 subsequently went on to self-harm. Presentations with SI increased in the four years prior to the pandemic with the highest occurring in 2019. The number of individuals presenting to ED then decreased substantially in March/April 2020 leading to a 37% and 47% reduction, corresponding to the first “lockdown”. Presentations remained lower until June 2020 when restrictions started to ease. Compared to the pre-pandemic period, individuals presenting with SI during the pandemic were approximately 60% less likely to ED with subsequent self-harm (ORadj = 0.41, 95% CI 0.29, 0.59) even after adjustment for variations in the demographic profile of individuals, and the care and management they received at the ED.
 ConclusionRates of ideation followed similar trends to previous years except in the early months of the pandemic. Those presenting with SI during the pandemic conferred a reduced likelihood of re-attending at ED with subsequent self-harm compared to the pre-pandemic period. The possible underlying mechanisms behind these findings will be discussed.

Suicide risk following Emergency Department presentation with self-harm varies by hospital

ObjectivesA large proportion of those who die by suicide present to an Emergency Department (ED) with self-harm (SH) in the year before death. This study examines ‘does risk of death following ED presentation with SH vary according to hospital attended?’
 MethodsThe Northern Ireland Self-Harm Registry provided data on SH presentations to 12 ED departments in NI between 2012-2019. Linkage to health and mortality records provided follow up to December 2019. Cox proportional hazards regression models were employed to assess mortality risk following presentation with SH among 12 ED departments in NI.
 ResultsAnalysis of the 64,350 ED presentations for self-harm by 30,011 individuals confirmed a marked variation across EDs in proportion of patients receiving mental health assessment and likelihood of admission to general and psychiatric wards. There was a significant variation in suicide risk according to ED attended with the three-fold range between the lowest (HRadj 0.32 95%CIs 0.16, 0.67) and highest. These differences persisted even after adjustment for patient characteristics, variation in types of self-harm, and care management at the ED.
 ConclusionManagement of SH cases in the ED is important, however, it is the availability, access and level of engagement with, care in the community rather than the immediate care at EDs that is most critical for patients presenting to ED with self-harm.

Finding Voices: a survey of young people’s experiences of the ED

BackgroundMental health presentations in young people are increasing. Recurrence of self-harm (SH) presentations is common and of great concern since self-harm is known to be a risk factor for suicide....

Self-harm in 5-to-24 year olds: Retrospective examination of hospital presentations to emergency departments in New South Wales, Australia, 2012 to 2020.

There is some evidence that self-harm presentations in children and young people have increased over the past decade, yet there are few up-to-date studies examining these trends. This study aims to describe trends in the rates and severity of emergency department self-harm presentations for youth aged 5-24 years in New South Wales, Australia between 1 January 2012 and 31 December 2020. We analysed self-harm hospital presentations using join point analysis to compare quarterly growth in rates and urgency of presentation since 2012 by age group and sex. Binomial logistic modelling was used to identify risks for re-presentation for self-harm, including age group, sex, country of birth, mode of arrival, inpatient status, triage category, rurality, and socio-economic disadvantage. In total, 83,111 self-harm presentations for 51,181 persons were analysed. Overall rates of self-harm among those aged 5-24 years increased by 2.4% (p < .001) per quarter in females and 1.6% (p < .001) per quarter in males, with statistically significant average quarterly increases observed across all age groups. Overall and age-specific self-harm triage urgency rates increased statistically significantly for potentially serious, and potentially- and immediately life-threatening categories. A higher likelihood of re-presentation to any emergency department for self-harm was associated with younger age, female, residing in a regional area, arriving by ambulance, admitted as an in-patient, and a more severe index self-harm presentation. Hospital self-harm presentations have been growing steadily over the past decade, with the greatest growth in the youngest people. Understanding the reasons for these sustained upward trends is a priority for suicide prevention.

Approach-avoidance biases to self-harm cues in young people with self-harm

BackgroundThe urge to self-harm can be likened to craving in addictive behaviours. However, it remains unclear whether cognitive mechanisms involved in craving, such as attentional biases to cues, also underpin the urge to self-harm. MethodsA Dot Probe Task was used to investigate attentional biases to self-harm cues in young people aged 16–25 with self-harm. Cues were shown for either 0.2 s or 2 s. Dot Probe Task performance in the Self-harm group (N = 50) was compared with age-matched Healthy Controls (N = 50) and age- and negative-affect (Depression Anxiety Stress Scale-21) matched controls with no self-harm (N = 50). ResultsThe Self-harm group showed significantly greater avoidance of self-harm cues than Healthy Controls at 2 s. The Negative Affect group showed significantly less difficulty disengaging from self-harm cues than the Self-harm group and Healthy Controls at 2 s. There were no between-group differences in attentional bias at 0.2 s. LimitationsStudy limitations that may affect attentional biases in the Self-harm group include not measuring indicators of recovery and recruiting only from the community potentially missing more severe self-harm presentations in clinical settings. ConclusionsAvoidance of self-harm cues in young people with self-harm may reflect conflict around self-harm behaviour, consistent with ambivalence models of craving. An ability to disengage from self-harm cues may be a protective factor in young people with higher levels of negative affect who do not self-harm. Whether these attentional biases represent a quantifiable marker of treatment response or susceptibility to relapse in individuals with self-harm remains an area for future investigation.

Which programmes and policies across health and community settings will generate the most significant impacts for youth suicide prevention in Australia and the UK? Protocol for a systems modelling and simulation study

IntroductionSuicide is a leading cause of mortality among young people aged 15–24 globally. Despite the deployment of comprehensive suicide prevention strategies, we still do not know which interventions, for which...

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study

PurposeTo measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007–2019 and identify risk factors for these methods of self-harm.MethodData on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.ResultsThe age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15–24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72–3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16–1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17–1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58–1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41–2.99).ConclusionThe incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study

BackgroundEmergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff’s familiarity with existing guidelines. MethodsAn online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated. ResultsRespondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters. ConclusionsImprovements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.

An Umbrella Systematic Review of Seasonality in Mood Disorders and Suicide Risk: The Impact on Demand for Primary Behavioral Health Care and Acute Psychiatric Services.

Objective: To review the current literature focusing on the most recent systematic reviews relating to mood, suicide, and psychiatric service utilization.Study Selection and Data Extraction: A systematic literature search of PubMed, CINAHL, and PsycINFO databases using the search terms "Systematic review" AND "season*" AND mood OR depression OR bipolar OR psychosis OR suicid* OR psychiatr* initially yielded 209 results. After screening by title and abstract for relevance, 6 records remained, while a further 3 were identified after screening of reference lists. A qualitative synthesis of these results was then performed due to data heterogeneity between studies.Results: We found evidence of winter peaks for depressive symptoms and suggestions of summer peaks for suicidal activity, emergency department (ED) self-harm presentations, and manic-related hospital admissions. Suicide is 11%-23% more frequent in spring and summer. ED suicide attempts are also 1.2-1.7 times higher in spring and summer compared to winter. Admissions for mania are 7.4%-16% higher in spring and summer, while there are 1.5 times more admissions for bipolar depression in winter months.Conclusions: There is a summer peak for many aspects of mental health activity, particularly in terms of acute hospital utilization and suicidality. This is contrary to the winter-related peak of depressive symptoms. Further research is needed to affirm these findings.

Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)

BackgroundAssessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes.ObjectiveWe developed and validated a predictive model...

Risk factors for dementia and self-harm: A linkage study.

People living with dementia experience poor mental health and high rates of self-harm. We investigated risk factors for self-harm in people aged > 40 years living with dementia and risk factors for dementia after self-harm. Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n=154,811) and a self-harm cohort (n=28,972). Using survival analyses, we investigated predictors of self-harm for the dementia cohort, and predictors of dementia for the self-harm cohort. We found self-harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self-harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self-harm. Men who had self-harmed had the greatest risk of dementia diagnoses. Men and people with complex psychiatric profiles and dementia may particularly benefit from post-diagnosis mental and behavioral support to reduce risk of self-harm.

Suicide and Self-Harm Among Immigrant Youth to Ontario, Canada From Muslim Majority Countries: A Population-Based Study.

To examine the association between Muslim religious affiliation and suicide and self-harm presentations among first- and second-generation immigrant youth. We performed a population-based cohort study involving individuals aged 12 to 24 years, living in Ontario, who immigrated to Canada between 1 January 2003 and 31 May 2017 (first generation) and those born to immigrant mothers (second generation). Health administrative and demographic data were used to analyze suicide and self-harm presentations. Sex-stratified logistic regression models generated odds ratios (OR) for suicide and negative binomial regression models generated rate ratios (aRR) for self-harm presentations, adjusting for refugee status and time since migration. Of 1,070,248 immigrant youth (50.1% female), there were 129,919 (23.8%) females and 129,446 (24.2%) males from Muslim-majority countries. Males from Muslim-majority countries had lower suicide rates (3.8/100,000 person years [PY]) compared to males from Muslim-minority countries (5.9/100,000 PY) (OR: 0.62, 95% CI, 0.42-0.92). Rates of suicide between female Muslim-majority and Muslim-minority groups were not different (Muslim-majority 1.8/100,000 PY; Muslim-minority 2.2/100,000 PY) (OR: 0.82, 95% CI, 0.46-1.47). Males from Muslim-majority countries had lower rates of self-harm presentations than males from Muslim-minority (<10%) countries (Muslim majority: 12.2/10,000 PY, Muslim-minority: 14.1/10,000 PY) (aRR: 0.82, 95% CI, 0.75, 0.90). Among female immigrants, rates of self-harm presentations were not different among Muslim-majority (30.1/10,000 PY) compared to Muslim-minority (<10%) (32.9/10,000 PY) (aRR: 0.93, 95% CI, 0.87-1.00) countries. For females, older age at immigration conferred a lower risk of self-harm presentations. Being a male from a Muslim-majority country may confer protection from suicide and self-harm presentations but the same was not observed for females. Approaches to understanding the observed sex-based differences are warranted.

Profile of people attending emergency departments with thoughts of self-harm and suicide: A descriptive study of a nurse-led programme in Ireland.

Increasing research has been conducted on individuals presenting with self-harm at emergency departments (EDs). However, less is known about individuals presenting to EDs with only self-harm ideation. We aimed to describe the characteristics of those attending Irish hospitals with self-harm ideation and investigate any differences in comparison to those presenting with suicide ideation. A prospective cohort study was conducted on Irish ED presentations due to suicidal and self-harm ideation. Data were obtained from the service improvement data set of a dedicated nurse-led National Clinical programme for the assessment of those presenting to Irish emergency departments due to Self-harm and Suicide-related Ideation (NCPSHI). A total of 10 602 anonymized presentation data were analysed from 1 January 2018 to 31 December 2019. Descriptive analysis was conducted to compare those with suicidal and self-harm ideation on sociodemographic and care interventions. Being female and aged <29 were more prevalent among the self-harm ideation presentations. Compared to the self-harm ideation group, a higher proportion of those with suicidal thoughts received an emergency care plan (63% vs 58%, p = 0.002) and General Practitioner letter sent within 24 h of presentation (75% vs 69%, p = 0.045). Little variation was found between hospitals for self-harm ideation in both years. Our study suggests that females and younger populations are more prevalent in hospital presentations due self-harm ideation, while presentations related to suicidal ideation are more often made by males and involving substance use. Attention should be given to the relationship between clinicians' attitudes towards care provision and the content of suicide-related ideation ED disclosure.

Mortality risk following self-harm in young people: a population cohort study using the Northern Ireland Registry of Self-Harm.

Self-harm is a recognised predictor of suicide and is most common in those aged under 25 years. The aims of this study were to describe the characteristics of young people who present with self-harm; quantify the risk of suicide and other causes of death during follow up, and to identify factors associated with mortality risk. The Northern Ireland Registry of Self-Harm (NIRSH) is a national registry capturing complete data on all presentations made to the 12 Emergency Departments (EDs) in Northern Ireland (NI). Data relating to self-harm presentations registered in the NIRSH between 2012 and 2015 were linked to primary care registrations and death records up until 31st December 2018. Logistic regression was employed to examine the factors associated with self-harm. Cox regression was used to estimate mortality risk following self-harm and explore the associated risk factors. The cohort consisted of 390,740 individuals aged 10-24 years registered with a General Practitioner (GP) in NI. During follow-up, 4,450 individuals presented with self-harm. Rates of self-harm were highest in females, those aged 20-24 years (ORadj = 3.53, 95% CI 3.28-3.80, p< .001), and in the most deprived areas (ORadj = 2.71, 95% CI 2.45-2.99, p< .001). Thirty five individuals who presented with self-harm died by suicide, accounting for 23% of all suicide deaths in the cohort. Suicide risk was increased 19-fold in those who presented with self-harm after adjustment for age, sex and area-level factors (HRadj = 19.00, 95% CI 12.80-28.21, p< .001). Increased suicide risk was observed in males (HRadj = 2.04, 95% CI 0.99-4.23, p= .05) and those using more violent methods of self-injury (HRadj = 3.89, 95% CI 1.65-9.13, p< .001). Young people who self-harm are at a significantly greater risk of suicide. Almost a quarter of young people who died by suicide in NI had presented to EDs with self-harm, highlighting that the ED may provide a nodal point of intervention among a typically hard to identify and reach population.

Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study.

Research has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. The objectives of the study were (a) to examine the sociodemographic and clinical profile of individuals with frequent self-harm (regardless of suicidal intent) episodes and, (b) the association between physical and mental illness comorbidity, self-harm repetition, highly lethal self-harm methods, and suicide intent. The study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n = 183) and semi-structured interviews (n = 36). Multivariate logistic regression models and independent samples t-tests were used to test the association between the sociodemographic and physical and mental disorders comorbidity on highly lethal self-harm methods and suicidal intent, respectively. Thematic analysis was applied to identify themes related to physical and mental illness comorbidity and frequent self-harm repetition. The majority of individuals with frequent self-harm episodes were female (59.6%), single (56.1%), and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90% of the participants had history of a mental or behavioral disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR = 2.89) and alcohol abuse (OR = 2.64) predicted the risk of a highly lethal self-harm method. Suicide intent was significantly higher among those with a diagnosis of major depressive disorder (t = 2.43; p = 0.020). Major qualitative themes were (a) the functional meaning of self-harm (b) self-harm comorbidity (c) family psychiatric history and (d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors. Physical and mental illness comorbidity was high among individuals with frequent self-harm episodes. Male gender and alcohol abuse were associated with highly lethal self-harm methods. The mental and physical illness comorbidity of individuals with frequent self-harm episodes should be addressed via a biopsychosocial assessment and subsequent indicated treatment interventions.

Comparison of mental health presentations of 16–25-year-olds to the Emergency Department during the COVID-19 pandemic.

IntroductionStudies reported an initial decrease in the number of presentations and incidence of self-harm in young people during the pandemic. As the pandemic progressed young people may have experienced increased levels of distress, contributing to worsened mental health. There is a need for mental health services to evaluate the presentations of young people presenting to the Emergency Department (ED) so that services can meet the needs of young people.ObjectivesTo examine the mental health presentations of young people (aged 16-25) to the ED and how this may have changed since the start of the pandemic.MethodsThis study reviewed all 16–25-year-olds presenting to the Mater Misericordiae University Hospital (MMUH) who were triaged with a mental health issue in a 2 month period (September-October) over three years – 2019 (Period A), 2020 (Period B), 2021 (Period C). Approval for this service evaluation was granted by the Clinical Audit and Effectiveness Committee at the MMUH.ResultsOf 232 presentations across all periods, there was no significant difference in the number of presentations in each study period - Period A (n=76), Period B (n=79) and Period C (n=77). In all three periods, most presentations occurred out of hours (A: 57.9% [n=44]; B: 74.7% [n=59]; C: 68.8% [n=53]) statistically significant (p=0.034) from before (A) to during the pandemic (B and C). Out of hours arrival by ambulance was most common in in Periods A and B (45.5% and 55.9%). Over all three periods discharge home was the most frequent outcome of assessment (A: 69.7% [n=53]; B: 70.9% [n=56]; C: 76.6% [n=59]). Overall, there was a decrease in self-harm presentations over the period (A: 47.4% [n=36]; B: 41.8% [n=33]; C: 40.3% [n=31]). The percentage of presentations with self-laceration increased during the pandemic (A: 33.3% [n=12]; B: 39.4% [n=13]; C: 48.4% [n=15]). There was a significant increase in attendees who were already taking psychotropic medications (p&lt;0.001).ConclusionsThe findings suggest that the majority of 16–25-year-olds present out of hours and do not require admission. Although the number of presentations remained similar, the increase in out of hours presentations and arrivals by ambulance in Period B may reflect increased distress in the initial stages of the pandemic, and restricted access to services. The higher rates of medication prescribing suggests that these young people are already receiving health care, but that their needs are not being fully met. Mental health services should be designed to provide access to mental health care out of hours when young people are most likely to require them.Disclosure of InterestNone Declared

Presentations of self-harm and suicide-related ideation among the Irish Traveller indigenous population to hospital emergency departments: evidence from the National Clinical Programme for self-harm.

Previous research has examined the suicide risk of the Irish Traveller population, but less is known about self-harm and suicidal ideation among this ethnic minority group, which are established risk factors for suicide. The aim of the current study was to compare the presentation-based self-harm and suicide-related ideation of Traveller to non-Traveller patients and describe any ethnic disparities in the aftercare of their presentation. Data were obtained from the service improvement database of an Irish dedicated national programme for the assessment of those presenting to emergency departments (EDs) due to self-harm and suicide-related ideation. Presentation data from 24 EDs were analysed and Poisson regression was used to assess the age-sex-adjusted relative risk of hospital-presenting self-harm and suicide-related ideation. 24,473 presentations were recorded with 3% of the presentations made by Irish Travellers. Female Traveller patients had 3·04 (95% CI 2·51-3·68) higher risk for suicide-related ideation and 3·85 (95% CI 3·37-4·41) for self-harm, compared to white Irish female patients. Male Traveller patients had 4·46 (95% CI 3·86-5·16) higher risk for suicide-related ideation and 5·43 (95% CI 4·75-6·21) higher rates for self-harm. The highest rate ratios for self-harm were observed among older Traveller patients [male: 9·23 (95% CI 5·93-14·39); female: 6·79 (95% CI 4·37-10·57)]. A higher proportion of Traveller patients requested no next of kin involvement, compared to other ethnicities. Given that Irish Travellers are at higher risk of self-harm and suicide-related ideation presentations compared to other ethnic groups, EDs should be viewed as an important suicide intervention point.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital.

To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset. Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic. A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic. Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

Characteristics of self-harm presentations to the emergency department of the Royal Melbourne Hospital, 2012–2019: Data from the Self-Harm Monitoring System for Victoria

BackgroundRates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation. MethodsThis was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people. ResultsThere were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months). ConclusionsRates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.