Citation

Comtois KA, Kerbrat AH, Atkins DC, Roy-Byrne PP, Katon W. Med. Care. 2015; 53(1): 45-53.

Affiliation

*Department of Psychiatry & Behavioral Sciences, Harborview Medical Center †Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington ‡Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.

Copyright

(Copyright © 2015, American Public Health Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/MLR.0000000000000252

PMID

25494233

Abstract

BACKGROUND:: The literature describing the health services individuals receive before and following self-directed violence (SDV) is limited.

OBJECTIVES:: This study examines services received for the 6 months preceding admission to an urban county medical center emergency department (ED) for SDV. We predicted that individuals with at least 1 prior act of SDV in the past 6 months would have received more services than those for whom the index admission was their only recent act.

METHODS:: Participants were recruited from ED admissions during shifts selected to maximize representativeness. Participants (n=202) were interviewed using the Suicide Attempt Self-Injury Interview, Suicide Attempt Self-Injury Count, Treatment History Interview, Mini International Neuropsychiatric Interview, Brief Symptom Index, and SF-12.

RESULTS:: The majority of index acts of SDV (79%) were suicide attempts. The participants were characterized by low socioeconomic status, substantial symptomatology, low physical and mental health functioning, and multiple psychiatric diagnoses. In the preceding 6 months, 34% were admitted to a hospital and 56% received crisis services (including 44% in the ED). Although three quarters (76%) had seen an outpatient medical provider and most (70%) received psychotropic medications, less than half of the sample received psychiatric services (40%) or outpatient psychosocial treatment (48%). As predicted, utilization for most types of usual care was higher for those engaging in SDV in the 6 months preceding the index admission.

CONCLUSION:: Individuals admitted to this ED for SDV received inadequate outpatient psychosocial and psychiatric services despite severe illness and disability.

Language: en