Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study

Abstract

Our relapse rate is similar to that in a trial of nicotine patches (37% between years 1 and 3) 3 and in a study using supportive counselling and nicotine gum for 5 years (40% between years 1 and 5). 4 High relapse rates after 1 year are also common in those not attending for treatment. A large general population survey estimated a relapse rate of 35% from non-validated self reports of the duration of abstinence. 5Success rates after 1 year or less of follow up substantially overestimate lifelong cessation after a single treatment episode.Contributors: MAHR, GS, and JAS designed the original study, which GS conducted. JAS and GS designed the long term follow up phase, which GS conducted. JAS analysed the data and wrote the text of the paper. JAS and GS will act as guarantors for the paper. 2 Good services to manage deliberate self poisoning in general hospitals might therefore help to achieve the targets set out by the Health of the Nation strategy to reduce suicide rates. Existing services have not been planned coherently; the care provided by hospitals varying greatly, even in the same region. 3 We assessed the management of self poisoning in four teaching hospitals in England by using standardised methods of notification. Subjects, methods, and resultsWe prospectively identified all patients over 16 years of age who attended four teaching hospitals in Leeds, Leicester, Manchester, and Nottingham for deliberate self poisoning during 4 weeks (November to December 1996). We obtained data by examining computerised databases on wards and in the accident and emergency department, referral ledgers, accident and emergency notes, and copies of specialist assessments of deliberate self poisoning. We checked all inpatient data retrospectively against information on admission and discharge for deliberate self poisoning that we obtained from the patient administration system in each hospital. We collected demographic details of patients, along with details of substance dependence, previous overdoses, and contact with psychiatric services. We also recorded information on the management of the current episode of self poisoning.During the study period 458 patients accounted for 477 hospital attendances for deliberate self poisoning; 223 (49%) of these were women. The mean age of the patients was 30.9 years (SD 11.8 years); 65 (14%) were dependent on alcohol or drugs, 177 (39%) had taken a previous overdose, and 119 (26%) were in contact with psychiatric services. These percentages and the substances ingested were similar across study centres. By contrast, there were striking variations in the management of episodes between study centres, with a fourfold difference in discharge rates from accident and emergency departments, and almost a twofold difference in the proportion of subjects receiving a specialist psychosocial assessment (table). In 220 out of 477 hospital attendances (46%) the patient had no psychosocial assessment at any time during their hospital contact.

The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems

“…It has been demonstrated to be of value in the treatment of patients with emotional problems in general practice (Mynors-Wallis, 1996). If, as suggested by our findings, it is of benefit in many DSH patients this has important implications, particularly in view of the very considerable and growing problem of DSH (Hawton et al 1997 ;Kapur et al 1998).…”

Mental health presentations to an inner-city accident and emergency department

“…This probably explains the relatively high percentage of specialist mental health assessments undertaken in the St Thomas'A&E department compared with those reported in other A&E departments for all psychiatric presentations (52%) (Dunn & Fernando, 1989) and DSH in particular (54%) (Kapur et al, 1998).…”

Detailed analyses of self‐poisoning episodes presenting to a large regional teaching hospital in the UK

“…In keeping with data from this study the average age of presentation with DSH and/or self-poisoning is around 31-34 years [4,5,12,14,15]. Although elderly patients into their nineties [14] have been reported taking overdoses, the proportion of elderly as a percentage of the total is small.…”

“…It is estimated that 170 000 people each year present to hospitals in the UK with self-poisoning [5]. Although mortality in this group is relatively low (0.7%), these patients had more than twice the risk of dying than matched controls in a 23 year follow-up study due to a 17-fold increased suicide risk and a variety of other causes [6].…”

“…In order for strategies to be put in place to try to reduce deaths and the substantial costs to health care services, it is vital that we develop our understanding of the patterns of presentation of self poisoning and organize our services appropriately [5]. Furthermore, because suicide is fortunately a relatively rare outcome of DSH, there have been suggestions that national suicide prevention strategies be based on up to date research on non-fatal self harm with high quality follow-up [8].…”