Repeated Suicide Attempts and Suicide Among Individuals With a First Emergency Department Contact for Attempted Suicide

Fedyszyn, Izabela E.; Erlangsen, Annette; Hjorthøj, Carsten; Madsen, Trine; Nordentoft, Merete

doi:10.4088/jcp.15m09793

Cited by 74 publications

(75 citation statements)

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“…Self-poison was the predominant method of attempted suicide, a finding comparable to previous research results reported in the USA (68%) [10], Europe (66% -86%) [5,9,26,28] and Asian (69-86%) [17,18] with the exception of Iran where the most common method of suicide was burning (53.4%) [38]. The most often used substances was benzodiazepines (36,6%), which is similar to previous studies ranging from 39%-61% [18,39] and the second most frequent substance was analgesic.…”

Section: Discussionsupporting

confidence: 89%

“…At least 16% of patients who present to the emergency department for attempted suicide will repeat the attempt within 1 year after their index attempt and about 4% of them will kill themselves in the next 5 years [4]. The highest rates of both repeated attempts and suicide occurred within a week of discharge from an emergency department following the index attempt [5] and approximately half of all repeat event will occur in the first 3 months [6,7]. The risk of repetition also increase sharply with the increasing number of repeat attempted suicide presentation and tended to be associated with shorter intervals between episodes of attempted suicide [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Attempted Suicide Patients Presenting to a Greek Emergency Department

Filippatos¹,

Karasi²

2017

Health Sci J

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Characteristics of Attempted Suicide Patients Presenting to a Greek Emergency Department

Filippatos¹,

Karasi²

2017

Health Sci J

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“…46 In accordance with previous research with adults, violent selfharm methods posed a high risk for subsequent suicide. 8,27,47,48 Acquiring the capability to use more violent or lethal methods, although less common than lower lethality methods, may increase suicide risk by weakening a fear of death. 49 Suicide risk was especially great after initial nonfatal selfharm involving firearms.…”

Section: Figurementioning

confidence: 99%

Suicide After Deliberate Self-Harm in Adolescents and Young Adults

et al. 2018

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OBJECTIVES:Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS:A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. RESULTS:The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. CONCLUSIONS:After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety.abstract

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“…20,21 However, mental disorders are not coded in 25% to 45% of standard ED visits for self-harm. 11,12,[35][36][37][38] However, no national study has focused on the mental health care received after self-harm in the US geriatric population. In United States studies of youth and adults younger than 65 years, 47.1% to 58.8% of discharged patients did not receive any outpatient care within 30 days after an ED visit for self-harm.…”

mentioning

confidence: 99%

“…33,34 National data from other countries exist for emergency care and self-harm outcomes in older adults. 11,12,[35][36][37][38] However, no national study has focused on the mental health care received after self-harm in the US geriatric population. Prior national US studies focused on youth and working-age adults discharged back to the community following ED visits for self-harm have observed low rates of identified mental illness in the ED and receipt of timely outpatient mental health treatment.…”

mentioning

confidence: 99%

Deliberate self‐harm in older adults: A national analysis of US emergency department visits and follow‐up care

Schmutte

Olfson

Xie

et al. 2019

Int J Geriat Psychiatry

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Objective To examine mental health care received by older adults following emergency department (ED) visits for deliberate self‐harm. Methods This retrospective cohort analysis examined 2015 Medicare claims for adults ≥65 years of age with ED visits for deliberate self‐harm (N = 16 495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30‐day follow‐up mental health outpatient care. Results Most patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR = 0.86, 99% CI = 0.79‐0.94) and patients with either one medical comorbidity (ARR = 0.91, 99% CI = 0.83‐0.99) or two to three comorbidities (ARR = 0.93, 99% CI = 0.88‐0.99). Hospitalization was associated with recent depression (ARR = 1.09, 99% CI = 1.03‐1.16) and recent psychiatric inpatient care (ARR = 1.13, 99% CI = 1.04‐1.22). Among patients discharged to the community (n = 3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65‐69 years; ARR = 1.53, 99% CI = 1.31‐1.78), recent mental health care in ED (ARR = 1.50, 99% CI = 1.29‐1.74) or outpatient (ARR = 1.62, 99% CI = 1.44‐1.82) settings, recent diagnosis of mental disorder (ARR = 1.61, 99% CI = 1.43‐1.80), and other/unknown lethality methods of self‐harm (ARR = 1.24, 99% CI = 1.01‐1.52). Among community discharged patients, 39.0% received 30‐day follow‐up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR = 2.65, 99% CI = 2.25‐3.12) and prior outpatient mental health care (ARR = 2.62, 99% CI = 2.28‐3.00). Conclusion Most older adult Medicare beneficiaries who present to EDs with self‐harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow‐up mental health care.

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Repeated Suicide Attempts and Suicide Among Individuals With a First Emergency Department Contact for Attempted Suicide

Abstract: Preventive efforts need to target the period close to discharge from emergency departments.

Cited by 74 publications

References 0 publications

Characteristics of Attempted Suicide Patients Presenting to a Greek Emergency Department

Characteristics of Attempted Suicide Patients Presenting to a Greek Emergency Department

Suicide After Deliberate Self-Harm in Adolescents and Young Adults

Deliberate self‐harm in older adults: A national analysis of US emergency department visits and follow‐up care

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