@article{ref1,
title="Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm",
journal="Irish journal of medical science",
year="2024",
author="Russell, Vincent and Cully, Grace and Joyce, Mary and Corcoran, Paul and Daly, Caroline and Griffin, Eve",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Presentation to the emergency department (ED) with self-harm provides an important opportunity for intervention. AIMS: To investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare. <br><br>METHOD: Data on consecutive self-harm presentations to EDs for the years 2013-2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated. <br><br>RESULTS: Half of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health-related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51-0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017-2019 vs. 2013-2016), but was more likely for those brought by ambulance, presenting outside 9 am-5 pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14-10.62). <br><br>CONCLUSIONS: The findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.<p /> <p>Language: en</p>",
language="en",
issn="0021-1265",
doi="10.1007/s11845-024-03722-5",
url="http://dx.doi.org/10.1007/s11845-024-03722-5"
}