TY  - JOUR
PY  - 2024//
TI  - Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm
JO  - Irish journal of medical science
A1  - Russell, Vincent
A1  - Cully, Grace
A1  - Joyce, Mary
A1  - Corcoran, Paul
A1  - Daly, Caroline
A1  - Griffin, Eve
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0021-1265
UR  - http://dx.doi.org/10.1007/s11845-024-03722-5
ID  - ref1
ER  -