A Longitudinal Study of Correlates, Discharge Disposition, and Rate of Re-presentation to Emergency Services of Adults who Engage in Non-suicidal Self-injury

Abstract

Objective

In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI).

Method

Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (n = 158), and a sample of those with SA (n = 172) and no SH or SI (n = 173).

Results

Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ²(1) = 7.457, p = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation.

Conclusions

Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.

HIGHLIGHTS

1. A quarter of people with self-harm re-present to emergency services within four-and-a-half years.

2. Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.

3. There is a need for increased interventions in emergency services for those with self-harm.

Keywords:

• Emergency department
• longitudinal
• non-suicidal self-injury
• self-harm
• suicide attempt

DISCLOSURE STATEMENT

The authors have no financial interests or benefits to disclose.

AUTHOR NOTES

Hayley Chartrand and Bruce Tefft, Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.

Jitender Sareen, Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Diane Hiebert-Murphy, Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.

Laurence Y. Katz, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.

E. David Klonsky, Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.

Yunqiao Wang, Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.

Huntae Kim, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.

James M. Bolton, Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Additional information

Funding

This research was supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Research Award (Dr. Chartrand) and a Social Sciences and Humanities Research Council (SSHRC) Joseph-Armand Bombardier Canada Graduate Scholarship Doctoral Research Award (Dr. Wang). This research was also supported by a Canadian Institutes of Health Research New Investigator Award and a Brain and Behavior Research Foundation NARSAD Young Investigator Award (Dr. Bolton).