%0 Journal Article
%T Outpatient mental health follow-up and recurrent self-harm and suicide among patients admitted to the ICU for self-harm: a population-based cohort study
%J Chest
%D 2022
%A Fernando, Shannon M.
%A Pugliese, Michael
%A McIsaac, Daniel I.
%A Qureshi, Danial
%A Talarico, Robert
%A Sood, Manish M.
%A Myran, Daniel T.
%A Herridge, Margaret S.
%A Needham, Dale M.
%A Munshi, Laveena
%A Rochwerg, Bram
%A Fiest, Kirsten M.
%A Milani, Christina
%A Kisilewicz, Magdalena
%A Bienvenu, O. Joseph
%A Brodie, Daniel
%A Fan, Eddy
%A Fowler, Robert A.
%A Ferguson, Niall D.
%A Scales, Damon C.
%A Wunsch, Hannah
%A Tanuseputro, Peter
%A Kyeremanteng, Kwadwo
%V ePub
%N ePub
%P ePub-ePub
%X 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. <br><br>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.<p /> <p>Language: en</p>
%G en
%I American College of Chest Physicians
%@ 0012-3692
%U http://dx.doi.org/10.1016/j.chest.2022.10.021