TY  - JOUR
PY  - 2022//
TI  - 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
JO  - Chest
A1  - Fernando, Shannon M.
A1  - Pugliese, Michael
A1  - McIsaac, Daniel I.
A1  - Qureshi, Danial
A1  - Talarico, Robert
A1  - Sood, Manish M.
A1  - Myran, Daniel T.
A1  - Herridge, Margaret S.
A1  - Needham, Dale M.
A1  - Munshi, Laveena
A1  - Rochwerg, Bram
A1  - Fiest, Kirsten M.
A1  - Milani, Christina
A1  - Kisilewicz, Magdalena
A1  - Bienvenu, O. Joseph
A1  - Brodie, Daniel
A1  - Fan, Eddy
A1  - Fowler, Robert A.
A1  - Ferguson, Niall D.
A1  - Scales, Damon C.
A1  - Wunsch, Hannah
A1  - Tanuseputro, Peter
A1  - Kyeremanteng, Kwadwo
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0012-3692
UR  - http://dx.doi.org/10.1016/j.chest.2022.10.021
ID  - ref1
ER  -