Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm

Abstract

Background

Individuals presenting to hospital with self-harm of high lethality or high suicidal intent are at high risk of subsequent suicide.

Aim

To examine factors associated with psychiatric admission and self-harm repetition following high-risk self-harm (HRSH).

Method

A cohort study of 324 consecutive HRSH patients was conducted across three urban hospitals (December 2014–February 2018). Information on self-harm repetition was extracted from the National Self-harm Registry Ireland. Logistic regression models examined predictors of psychiatric admission and self-harm repetition. Propensity score (PS) methods were used to address confounding.

Results

Forty percent of the cohort were admitted to a psychiatric inpatient setting. Factors associated with admission were living alone, depression, previous psychiatric admission, suicide note and uncommon self-harm methods. History of emotional, physical or sexual abuse was associated with not being admitted. Twelve-month self-harm repetition occurred in 17.3% of cases. Following inverse probability weighting according to the PS, psychiatric admission following HRSH was not associated with repetition. Predictors of repetition were recent self-harm history, young age (18–24 years) and previous psychiatric admission.

Conclusion(s)

Findings indicate that psychiatric admission following HRSH is not associated with repeated self-harm and reaffirms the consistent finding that history of self-harm and psychiatric treatment are strong predictors of repetition.

Keywords:

• High-risk self-harm
• psychiatric admission
• repetition
• repeated self-harm propensity score methods

Ethical approval

Ethical approval reference numbers from the Clinical Research Ethics Committee of the Cork University Teaching Hospitals: ECM 4 (v) 12/04/16 & ECM 3 (aaaaa) 21/06/16, and from the HSE Mid-Western Regional Hospital Research Ethics Committee: 018/16.

Acknowledgements

The authors would like to thank those who contributed to the data collection, including Mrs Sarah Nicholson and the National Self-Harm Registry Ireland data registration officers; and to the staff of the hospitals who facilitated the data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Irish Health Research Board (grant number: IRRL-2015-1586). The National Self-Harm Registry Ireland is funded by the Irish Health Service Executive's National Office for Suicide Prevention.