Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm

2021 ◽  
pp. 1-9
Author(s):  
Grace Cully ◽  
Paul Corcoran ◽  
Dorothy Leahy ◽  
Eugene Cassidy ◽  
Sarah Steeg ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Psychiatric Admission ◽  
Factors Associated ◽  
Self Harm

Predictors of thromboprophylaxis in hospitalised medical patients

2015 ◽  
Vol 113 (05) ◽  
pp. 1127-1134 ◽  
Author(s):  
David Spirk ◽  
Mathieu Nendaz ◽  
Drahomir Aujesky ◽  
Daniel Hayoz ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Score ◽  
Low Risk ◽  
Medical Patients ◽  
Clinical Factors ◽  
Thromboembolic Risk ◽  
Factors Associated ◽  
Risk Patients

summaryBoth, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials. gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75–8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69–4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31–4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among highrisk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

scholarly journals Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study

2014 ◽  
Vol 204 (5) ◽  
pp. 376-382 ◽  
Author(s):  
Chi-Leung Kwok ◽  
Paul S. F. Yip ◽  
David Gunnell ◽  
Chian-Jue Kuo ◽  
Ying-Yeh Chen
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Median Time ◽  
Cumulative Risk ◽  
The West ◽  
Factors Associated ◽  
Taipei City ◽  
Self Harm ◽  
Independent Risk Factors

BackgroundRepeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia.AimsTo investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan.MethodProspective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004–December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm.ResultsIn total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7–10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05–1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm.ConclusionsThe risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.

scholarly journals Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study

BJPsych Open ◽  
2020 ◽  
Vol 6 (6) ◽  
Author(s):  
Eve Griffin ◽  
David Gunnell ◽  
Paul Corcoran
Keyword(s):  
Mental Health ◽  
Male Gender ◽  
Individual Factors ◽  
Health Staff ◽  
Care Pathways ◽  
Mental Health Staff ◽  
Psychiatric Admission ◽  
Recommended Care ◽  
Factors Associated ◽  
Self Harm

Background People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood. Aims The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm. Method Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models. Results Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments. Conclusions Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.

scholarly journals Prevention of Suicidal Behavior in Prisons

Crisis ◽  
2016 ◽  
Vol 37 (5) ◽  
pp. 323-334 ◽  
Author(s):  
Lisa Marzano ◽  
Keith Hawton ◽  
Adrienne Rivlin ◽  
E. Naomi Smith ◽  
Mary Piper ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Psychiatric Morbidity ◽  
Clinical Factors ◽  
Factors Associated ◽  
Self Harm ◽  
Specific Factors

Abstract. Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.

scholarly journals Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study

2014 ◽  
Vol 29 (4) ◽  
pp. 246-252 ◽  
Author(s):  
L. Mellesdal ◽  
R.A. Kroken ◽  
O. Lutro ◽  
T. Wentzel-Larsen ◽  
E. Kjelby ◽  
...  
Keyword(s):  
Cohort Study ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Psychiatric Patients ◽  
First Year ◽  
Recurrent Depression ◽  
Psychiatric Admission ◽  
Self Harm ◽  
Observation Period

AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

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