Citation

Griffin E. Lancet Reg. Health West. Pac. 2020; 3: e100034.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.lanwpc.2020.100034

PMID

34173602

Abstract

Those who present to hospital following self-harm are one of the groups at greatest risk for suicide, with 1.6% dying by suicide within 12 months. In addition, a significant proportion will present with a further act of self-harm. In The Lancet Regional Health - Western Pacific, Yi Chai and colleagues present comprehensive data on predictors and patterns of repeat attendance to hospital with self-harm in Hong Kong, over a period of 15 years. Based on a cohort of 99,116 individuals - accounting for 127,801 hospital presentations - the reported 12-month risk of repetition after a self-harm presentation was 14.25% (95% CI: 14.04-14.46%). Male gender, older age, social welfare for payment, self-injury as a method, psychiatric admission and presence of depression, personality disorder or substance misuse all elevated risk of repetition. However the strongest predictor of subsequent repetition was self-harm history, with a five-fold risk for those with four or more previous attendances (HR: 4.81, 95% CI: 4.46-5.18). The study uses a rigorous methodology, linking multiple sources of health data and examining recurrent self-harm presentations over a long follow-up period. Record linkage allowed for a wide range of predictors to be examined, a limitation of many studies on this topic. Some findings may be specific to Hong Kong, including increasing rates of repetition over time. The negative association between self-harm repetition and alcohol misuse may also reflect general population trends.

Few countries have reliable data on self-harm and not many have focused on Asian populations when examining repetition. The reported 12-month risk of repetition is higher than previously reported for the region (approximately 10%) and more similar to estimates from European countries. The authors suggest that this may be due in part to the profile of methods of self-harm in Hong Kong, as well having less bias regarding loss to follow-up than other regional registries. Authors of a recent study from Sri Lanka suggest that low repetition rates may be a feature of low- and middle-income countries, reflecting a range of factors including a high case fatality rate of pesticide poisonings, longer inpatient stays following self-harm and a lower prevalence of mental disorders compared to Western and other high-income countries. As a consequence, country-specific data and prevalence estimates, which take into account contextual factors, are essential to inform health service responses and to monitor trends within regions and across time.

These findings reinforce the need to deliver appropriate interventions following self-harm, as well as standardised care at the time of attendance to hospital. There is some evidence for reduced rates of repetition following routine aspects of clinical management and brief interventions in the emergency department, as well as for psychosocial therapies. Still...

Language: en

Keywords

Self-harm; Hospital-presenting; Interventions; Repetition