Citation

Fernando SM, Pugliese M, McIsaac DI, Qureshi D, Talarico R, Sood MM, Myran DT, Herridge MS, Needham DM, Munshi L, Rochwerg B, Fiest KM, Milani C, Kisilewicz M, Bienvenu OJ, Brodie D, Fan E, Fowler RA, Ferguson ND, Scales DC, Wunsch H, Tanuseputro P, Kyeremanteng K. Chest 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, American College of Chest Physicians)

DOI

10.1016/j.chest.2022.10.021

PMID

36445799

Abstract

BACKGROUND: Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk. RESEARCH QUESTION: What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm? STUDY DESIGN AND METHODS: Population-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with early follow-up indicating 1 to 21 days after discharge, late follow-up indicating 22 to 60 days after discharge, and no follow-up indicating within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge.

RESULTS: We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, early follow-up (HR, 1.10; 95% CI, 0.70-1.73]) was not associated with death resulting from suicide, but late follow-up (HR, 1.54; 95% CI, 1.37-1.83) was associated with an increase in death resulting from suicide. INTERPREATION: Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.

Language: en

Keywords

mental health; suicide; self-harm; chronic critical illness; intensive care; postintensive care syndrome