Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment

Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

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Integrated Care Pathway for Children Who Attempt Deliberate Self Harm

Journal of integrated Care Pathways ◽

10.1177/147322970300700304 ◽

2003 ◽

Vol 7 (3) ◽

pp. 107-128 ◽

Cited By ~ 2

Author(s):

Nien Gardner ◽

Brenda Fletcher

Keyword(s):

Integrated Care ◽

Care Pathway ◽

Deliberate Self Harm ◽

Self Harm ◽

Integrated Care Pathway

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Deliberate Self-Harm in the Emergency Department

Crisis ◽

10.1027/0227-5910.30.2.85 ◽

2009 ◽

Vol 30 (2) ◽

pp. 85-89 ◽

Cited By ~ 12

Author(s):

Muhammad Shahid ◽

Murad M. Khan ◽

Muhammad Saleem Khan ◽

Yasir Jamal ◽

Aaref Badshah ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Medical Advice ◽

Psychosocial Assessment ◽

Against Medical Advice ◽

Deliberate Self Harm ◽

Increased Risk ◽

Self Harm ◽

Medical Wards

Background: Suicidal behavior is an understudied subject in Pakistan, a South-Asian developing country with a predominantly Muslim population. Aims: This study examined the characteristics and management of patients presenting with Deliberate Self-Harm (DSH) to the Emergency Department (ED) of a tertiary care teaching hospital in Karachi, Pakistan. Methods: A retrospective chart review of all patients (n = 98), over a period of 12 months was carried out. The demographic details of patients; method of DSH and, if drugs were used, their type, route, and quantity; reason for DSH; past psychiatric history; and outcome were recorded. Results: The mean age of subjects was 23.5 years. The majority of patients were female; most had used drugs for DSH. After initial treatment in the ED, 34 patients were admitted to medical wards for further treatment, 12 were discharged from ED, while 52 patients left against medical advice. The main reasons for leaving against medical advice were financial constraints and fear of legal issues. Seven patients had at least one previous episode of DSH. Conclusions: Patients who left the ED without psychosocial assessment are at increased risk for repetition of DSH as well as suicide.

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Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

The British Journal of Psychiatry ◽

10.1192/bjp.185.1.70 ◽

2004 ◽

Vol 185 (1) ◽

pp. 70-75 ◽

Cited By ~ 264

Author(s):

Daniel Louis Zahl ◽

Keith Hawton

Keyword(s):

Relative Risk ◽

Suicide Risk ◽

Single Episode ◽

Deliberate Self Harm ◽

Young Females ◽

Follow Up Study ◽

Increased Risk ◽

Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

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Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

The Psychiatrist ◽

10.1192/pb.bp.108.023929 ◽

2010 ◽

Vol 34 (6) ◽

pp. 226-230 ◽

Cited By ~ 1

Author(s):

Nicholas Holdsworth ◽

Hugh Griffiths ◽

David Crawford

Keyword(s):

Alcohol Use ◽

General Hospital ◽

Screening Tool ◽

District General Hospital ◽

Alcohol Screening ◽

Screening Tools ◽

Psychosocial Assessment ◽

Different Types ◽

Self Harm ◽

Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.ResultsThe proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.Clinical implicationsThe routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

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Depression and Deliberate Self-Harm Among Rural Adolescents of Sichuan Province in Western China: A 2-Year Longitudinal Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.605785 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shimin Lai ◽

Chang Su ◽

Shasha Song ◽

Mingxia Yan ◽

Chengmeng Tang ◽

...

Keyword(s):

Social Support ◽

Influencing Factors ◽

Rating Scale ◽

Self Esteem ◽

Sichuan Province ◽

Western China ◽

Rural Adolescents ◽

Deliberate Self Harm ◽

Increased Risk ◽

Self Harm

Objective: To explore the change in the prevalence and association of depression and deliberate self-harm and their common and independent influencing factors among western Chinese rural adolescents.Methods: A total of 2,744 junior and senior high school students from two rural schools in Sichuan Province, China, participated in the baseline survey and were invited to participate in two follow-up surveys. The Center for Epidemiologic Studies-Depression Scale, a deliberate self-harm item, the Social Support Rating Scale, the Rosenberg Self-esteem Scale and the Connor-Davidson Resilience Scale were administered. A bivariate four-level logistic regression model was used for analysis.Results: The prevalence of depression and deliberate self-harm were 39.6 and 21.2%, respectively. Regular physical exercise, a good relationship with parents, high resilience, and high self-esteem were common protective factors for both depression and deliberate self-harm. Feeling disliked by teachers was a common risk factor for both. Being female, having a mother who emigrated as a migrant worker before the student was 3 years old, feeling disliked by classmates and having a poor family economic status were associated only with an increased risk of depression. Participants with medium social support were less likely to report deliberate self-harm than those with low or high support. Depression and deliberate self-harm were clustered at the class level.Conclusions: The comorbidity of depression and deliberate self-harm in rural adolescents should be given ample attention. Interventions should consider the class clustering of depression and deliberate self-harm and their common and unique influencing factors.

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Impulsivity or Comorbidity in Bulimia Nervosa

The British Journal of Psychiatry ◽

10.1192/bjp.169.4.451 ◽

1996 ◽

Vol 169 (4) ◽

pp. 451-458 ◽

Cited By ~ 92

Author(s):

Sarah L. Welch ◽

Christopher G. Fairburn

Keyword(s):

Bulimia Nervosa ◽

Illicit Drugs ◽

Community Sample ◽

Sampling Bias ◽

Drug Misuse ◽

Control Group ◽

Deliberate Self Harm ◽

Self Harm ◽

Diagnostic Subgroup ◽

Normal Controls

BackgroundStudies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct diagnostic subgroup, sometimes termed “multi-impulsive bulimia”. However, these studies have been uncontrolled and of clinic samples and may be subject to sampling bias.MethodOne hundred and two women with DSM–III–R bulimia nervosa were compared with 204 normal controls and 102 controls with other psychiatric disorders, all recruited from the same community sample. Interview measures were used for diagnosis and for the assessment of alcohol and drug misuse and deliberate self-harm.ResultsBulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only six (6%) bulimia nervosa cases had two or more of these behaviours concurrently.ConclusionSampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.

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