Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment - A neglected population at risk of suicide
ABSTRACT Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients.
The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed.
Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment.
A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.
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ABSTRACT: Psychosocial assessment is central to the management of self-harm, but not all individuals receive an assessment following presentation to hospital. Research exploring the factors associated with assessment and non-assessment is sparse. It is unclear how assessment relates to subsequent outcome. We identified episodes of self-harm presenting to six hospitals in the UK cities of Oxford, Leeds, and Manchester over an 18-month period (1st March 2000 to 31st August 2001). We used established monitoring systems to investigate: the proportion of episodes resulting in a specialist assessment in each hospital; the factors associated with assessment and non-assessment; the relationship between assessment and repetition of self-harm. A total of 7344 individuals presented with 10,498 episodes of self-harm during the study period. Overall, 60% of episodes resulted in a specialist psychosocial assessment. Factors associated with an increased likelihood of assessment included age over 55 years, current psychiatric treatment, admission to a medical ward, and ingestion of antidepressants. Factors associated with a decreased likelihood of assessment included unemployment, self-cutting, attending outside normal working hours, and self-discharge. We found no overall association between assessment and self-harm repetition, but there were differences between hospitals--assessments were protective in one hospital but associated with an increased risk of repetition in another. Some data may have been more likely to be recorded if episodes resulted in a specialist assessment. This was a non-experimental study and so the findings relating specialist assessment to repetition should be interpreted cautiously. Many people who harm themselves, including potentially vulnerable individuals, do not receive an adequate assessment while at hospital. Staff should be aware of the organizational and clinical factors associated with non-assessment. Identifying the active components of psychosocial assessment may help to inform future interventions for self-harm.Journal of Affective Disorders 04/2008; 106(3):285-93. DOI:10.1016/j.jad.2007.07.010 · 3.71 Impact Factor
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ABSTRACT: A study was conducted to detect suicide risk in adolescents and adults seeking treatment in an emergency department (ED) in the Midwest as well as to continue testing reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ) developed by Horowitz et al. This study included ED staff nurses in a Level II Trauma Center who administered the RSQ to adolescent, adult, and geriatric patients, regardless of chief complaint or psychiatric history. Participants consisted of a convenience sample of 202 patients composed of 59 adolescents and 143 adults, including 36 geriatric patients. Psychometric analysis demonstrated a lower-than-expected degree of reliability and an adequate level of criterion-related validity for the RSQ in this sample. Interrater reliability was established. Approximately 42% of all patients who participated screened positive for suicide risk using the RSQ. Results support screening by nurses as part of the admission assessment to determine suicide risk in patients who present to the ED.Clinical Nursing Research 06/2009; 18(3):253-71. DOI:10.1177/1054773809335296 · 0.87 Impact Factor