Emergency Department Recognition of Mental Disorders and Short-Term Outcome of Deliberate Self-Harm

• Published in: The American journal of psychiatry 2013-12, Vol.170 (12), p.1442-1450
• Main Authors: Olfson, Mark, Marcus, Steven C., Bridge, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Clinical outcomes; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; General aspects; Hospitalization - statistics & numerical data; Humans; Male; Medical diagnosis; Medical sciences; Mental disorders; Mental Disorders - complications; Mental Disorders - diagnosis; Middle Aged; Odds Ratio; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk Factors; Self destructive behavior; Self-Injurious Behavior - complications; Self-Injurious Behavior - diagnosis
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2013.12121506

ObjectiveThe authors sought to characterize the short-term risks of repeat self-harm and psychiatric hospital admission for deliberate self-harm patients discharged from emergency departments to the community, focusing on recognition of mental disorders in the emergency department.MethodA retrospective longitudinal cohort analysis of national Medicaid claims data was conducted of adults 21–64 years of age with deliberate self-harm who were discharged from emergency departments (N=5,567). Rates and adjusted risk ratios are presented of repeat self-harm visits and inpatient psychiatric admission during the 30 days following the initial emergency visit.ResultsApproximately 9.7% of self-harm visits were followed by repeat self-harm visits and 13.6% by inpatient psychiatric admissions within 30 days after the initial emergency visit. The rate of repeat self-harm visits was inversely related to recognition of a mental disorder in the emergency department (adjusted risk ratio [ARR]=0.66, 95% CI=0.55–0.79) and directly related to recent diagnosis of anxiety disorders (ARR=1.56, 95% CI=1.30–1.86) or personality disorders (ARR=1.67, 95% CI=1.19–2.34). Recognition of a mental disorder in the emergency department was inversely related to repeat self-harm among patients with no recent mental disorder diagnosis (ARR=0.57, 95% CI=0.41–0.79); any recent mental disorder diagnosis (ARR=0.70, 95%=0.57–0.87); and depressive (ARR=0.71, 95% CI=0.54–0.94), bipolar (ARR=0.70, 95% CI=0.51–0.94), and substance use (ARR=0.71, 95% CI=0.53–0.96) disorder diagnoses. Recognition of a mental disorder was also inversely related to subsequent inpatient psychiatric admission (ARR=0.81, 95% CI=0.71–0.93).ConclusionsAdults who are discharged to the community after emergency visits for deliberate self-harm are at high short-term risk of repeat deliberate self-harm and hospital admission, although these risks may be attenuated by clinical recognition of a mental disorder in the emergency department.