The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context
Summary: Background: Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems an...
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Elsevier
2025-01-01
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| Series: | The Lancet Regional Health. Western Pacific |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606524002578 |
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| author | Richard A.F. Pellatt David R. Painter Jesse T. Young Kairi Kõlves Gerben Keijzers Stuart A. Kinner Ed Heffernan Julia Crilly Marc Broadbent Amy Johnston Melinda Martin-Khan Paul Scuffham Marianne Wallis Ping Zhang |
| author_facet | Richard A.F. Pellatt David R. Painter Jesse T. Young Kairi Kõlves Gerben Keijzers Stuart A. Kinner Ed Heffernan Julia Crilly Marc Broadbent Amy Johnston Melinda Martin-Khan Paul Scuffham Marianne Wallis Ping Zhang |
| author_sort | Richard A.F. Pellatt |
| collection | DOAJ |
| description | Summary: Background: Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide. Methods: This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months. Findings: During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%–19.3%) at 12-months and 24.3% (95%CI, 23.9%–24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%–0.7%) at 12-months and 1.0% (95%CI, 0.9%–1.1%) at 24-months. Interpretation: One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority. Funding: This study was funded by an Emergency Medicine Foundation (EMF) grant (EMJS-382-R35-2021) and a National Health and Research Council Grant (1121898). |
| format | Article |
| id | doaj-art-9274d4c917e1465fa48aba2a49defb5a |
| institution | Kabale University |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-9274d4c917e1465fa48aba2a49defb5a2025-01-18T05:05:18ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-01-0154101263The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in contextRichard A.F. Pellatt0David R. Painter1Jesse T. Young2Kairi Kõlves3Gerben Keijzers4Stuart A. Kinner5Ed Heffernan6Julia Crilly7Marc BroadbentAmy JohnstonMelinda Martin-KhanPaul ScuffhamMarianne WallisPing ZhangEmergency Department, Gold Coast Hospital and Health Service, Southport, QLD, Australia; LifeFlight Retrieval Medicine, Brisbane, QLD, Australia; Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; School of Medicine, Griffith University, Southport, QLD, Australia; Corresponding author. Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia.Menzies Health Institute Queensland, Griffith University, QLD, AustraliaInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; National Drug Research Institute, Curtin University, Perth, WA, AustraliaAustralian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, AustraliaEmergency Department, Gold Coast Hospital and Health Service, Southport, QLD, Australia; Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; School of Medicine, Griffith University, Southport, QLD, AustraliaJustice Health Group, Curtin University, Perth, WA, Australia; School of Population Health, Curtin University, Perth, WA, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; Justice Health Group, Murdoch Children’s Research Institute, Melbourne, VIC, AustraliaQueensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, AustraliaEmergency Department, Gold Coast Hospital and Health Service, Southport, QLD, Australia; Menzies Health Institute Queensland, Griffith University, QLD, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Centre for Mental Health, Griffith University, Gold Coast, QLD, AustraliaSummary: Background: Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide. Methods: This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months. Findings: During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%–19.3%) at 12-months and 24.3% (95%CI, 23.9%–24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%–0.7%) at 12-months and 1.0% (95%CI, 0.9%–1.1%) at 24-months. Interpretation: One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority. Funding: This study was funded by an Emergency Medicine Foundation (EMF) grant (EMJS-382-R35-2021) and a National Health and Research Council Grant (1121898).http://www.sciencedirect.com/science/article/pii/S2666606524002578Data linkageEmergency departmentMental healthIntentional self-harmSuicide |
| spellingShingle | Richard A.F. Pellatt David R. Painter Jesse T. Young Kairi Kõlves Gerben Keijzers Stuart A. Kinner Ed Heffernan Julia Crilly Marc Broadbent Amy Johnston Melinda Martin-Khan Paul Scuffham Marianne Wallis Ping Zhang The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context The Lancet Regional Health. Western Pacific Data linkage Emergency department Mental health Intentional self-harm Suicide |
| title | The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context |
| title_full | The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context |
| title_fullStr | The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context |
| title_full_unstemmed | The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context |
| title_short | The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, AustraliaResearch in context |
| title_sort | risk of repeated self harm and suicide after emergency department presentation with self harm in mental health presenters a retrospective cohort study with data linkage in queensland australiaresearch in context |
| topic | Data linkage Emergency department Mental health Intentional self-harm Suicide |
| url | http://www.sciencedirect.com/science/article/pii/S2666606524002578 |
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