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The risk of repeated self-harm and suicide after emergency department presentation with self-harm2.44 MB
Published (Version of record)CC BY-NC-ND V4.0, Open Access
Published (Version of record)CC BY-NC-ND V4.0, Open
Journal article
The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, Australia
The Lancet regional health. Western Pacific, Vol.54, pp.1-10
01/2025
PMID: 39896899
Appears in Recent Faculty of Health Publications
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Abstract
Background
Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide.
Methods
This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months.
Findings
During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%–19.3%) at 12-months and 24.3% (95%CI, 23.9%–24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%–0.7%) at 12-months and 1.0% (95%CI, 0.9%–1.1%) at 24-months.
Interpretation
One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority.
Details
- Title
- The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, Australia
- Creators
- Richard A.F. Pellatt - Emergency Department, Gold Coast Hospital and Health Service, Southport, QLD, AustraliaDavid R. Painter - Menzies Health Institute Queensland, Griffith University, QLD, AustraliaJesse T. Young - University of MelbourneKairi Kõlves - Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, AustraliaGerben Keijzers - Bond UniversityStuart A. Kinner - University of MelbourneEd Heffernan - Park Centre for Mental HealthJulia Crilly - Griffith UniversityMental Health in Emergency Department Research Investigators
- Contributors
- Marc Broadbent - University of the Sunshine CoastAmy Johnston - Southern Cross UniversityMelinda Martin-Khan - University of QueenslandPaul Scuffham - Griffith UniversityMarianne Wallis - Southern Cross UniversityPing Zhang - Griffith University
- Publication Details
- The Lancet regional health. Western Pacific, Vol.54, pp.1-10
- Publisher
- Elsevier Ltd; AMSTERDAM
- Grant note
- This study was funded by an Emergency Medicine Foundation (EMF) grant (EMJS-382-R35-2021) and a National Health and Research Council Grant (1121898).
- Identifiers
- 991013252650902368
- Academic Unit
- Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article