Predictors of Severe Deliberate Self-Harm in Patients Discharged from Psychiatric Hospital: A Prospe

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  Background: Different types of suicidal behaviour are common reasons for psychiatric acute admissions, and people who have been psychiatrically hospitalized are a high-risk group for suicide.The risk is substantial even though this patient group may be high-consumer of treatment services.There is, however, a shortage of prospective studies in unselected large patient cohorts of the association between risk factors, treatment consumption and treatment outcomes with respect to repeated attempted or completed suicide.Aims: To prospectively study risk-and protective factors of deliberate self-harm (DSH) and use of follow up treatments in a large and unselected cohort of patients discharged from a psychiatric acute ward.Methods: Socio-demographic and clinical data for 2842 consecutively admitted patients were prospectively assessed at the index admission and at readmissions to the psychiatric acute ward at Haukeland University Hospital in Bergen, Norway.After discharge from the index admission, the registry of the 2842 patients was linked to the registers of all somatic hospital admissions in the same catchment area and to the Norwegian cause of death register.Additionally, data on follow-up treatment at specialist outpatient clinics were obtained through linkage with outpatient registers.Mean follow-up time was about 2.5 years.Results: After discharge from index admission 41% of the patients (n=1174) had a total of 3309 psychiatric acute readmissions, of which about 58% were related to either suicidal ideation/plan (42%), or overt deliberate self-harm (DSH) behaviour (16%).During the follow-up period, about 65% of the cohort members (n=1847) had altogether more than 49 000 psychiatric outpatient treatment contacts.Nearly 43% (n=1215) of the patients were admitted to somatic hospital at least once for any reason.About 11% (n=305) had a total of 797 somatic hospital admissions related to DSH, of which 3.5% (n=98) patients had a total of 342 somatic admissions due to accidental substance overdoses, and about 28% (n=796) had a total of 3061 somatic admissions for other medical reasons.During the same follow-up period there were 43 confirmed suicides, 26 deaths by poisoning that were most likely accidental substance overdoses, three fall accidents, four transport accidents and nine deaths by other types of accidents.Results from multivariate Cox regression analyses for different patient-and treatment-related risk-and protective factors of DSH will be presented.Conclusion: Suicide risk is frequently involved in psychiatric acute admissions, and patients who have been psychiatrically hospitalized are at high risk of both performing severe deliberate self-harm and of committing suicide.In our cohort this high risk group received a substantial amount of specialist care after discharge.Despite this, risk of attempted and completed suicide was considerable, which suggests that after-care services should be reviewed for their improvement potentials.
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