Purpose
To explore repetition,
service provision and service engagement following presentation of young people
to emergency services with self-harm.
Methods
969 patients who
presented to accident and emergency services after self-harm were followed up
prospectively for a period of 1 year. Data on rates, method, clinical
history, initial service provision, engagement and repetition (defined as
re-presenting to emergency services with further self-harm) were gathered from
comprehensive electronic records.
Results
Young people were less
likely to repeat self-harm compared to those aged 25 and above. A psychiatric
history and a history of childhood trauma were significant predictors of
repetition. Young people were more likely to receive self-help as their initial
service provision, and less likely to receive acute psychiatric care or a
hospital admission. There were no differences in engagement with services between
young people and those aged 25 and above.
Conclusion
Younger individuals may
be less vulnerable to repetition, and are less likely to represent to services
with repeated self-harm. All young people who present with self-harm should be
screened for mental illness and asked about childhood trauma. Whilst young
people are less likely to be referred to psychiatric services, they do attend
when referred. This may indicate missed opportunity for intervention.
Method of self-harm and precipitating factors by age group
| Variablesa | All ages | 16–24 years | 25+ years |
|---|---|---|---|
| n (%) | n (%) | n (%) | |
| Method of SH (969) | |||
| Self-poisoning | 704 (72.7) | 236 (76.4) | 468 (70.9) |
| Self-injury | 214 (22.0) | 59 (19.1) | 155 (23.5) |
| Both self-injury and self-poisoning | 51 (5.3) | 14 (4.5) | 37 (5.6) |
| Drugs in overdose | |||
| Single drug in overdose (931) | 418 (44.9) | 144 (48.2) | 274 (43.4) |
| Paracetamol | 127 (13.6) | 59 (20.3) | 68 (11.0) |
| Opioid analgesic | 55 (5.9) | 18 (6.2) | 37 (6.0) |
| Antidepressant | 51 (5.5) | 16 (5.5) | 35 (5.6) |
| Multiple drugs in overdose (931) | 297 (31.9) | 94 (31.4) | 203 (32.1) |
| Self-injury (969) | |||
| Self-cutting | 156 (16.1) | 48 (15.5) | 108 (16.4) |
| Other self-injury | 109 (11.2) | 26 (8.4) | 83 (12.6) |
| Alcohol with SH (966) | 334 (34.5) | 69 (22.3) | 265 (40.1) |
| Precipitating factors to SH | |||
| Alcohol misuse (957) | 289 (30.2) | 50 (16.4) | 239 (36.6) |
| Drug misuse (956) | 145 (15.2) | 47 (15.5) | 98 (15.0) |
| Child abuse (sexual/physical/emotional) (952) | 204 (21.4) | 80 (26.4) | 124 (19.1) |
| Adult abuse (sexual/physical/emotional) (943) | 109 (11.4) | 33 (10.9) | 76 (11.7) |
| Bereavement (955) | 145(15.2) | 30 (9.9) | 115 (17.6) |
| Financial problems (956) | 113 (11.8) | 20 (6.6) | 93 (14.3) |
| Housing problems (957) | 75 (7.8) | 16 (5.2) | 59 (9.0) |
| Legal problems (959) | 29 (3.0) | 7 (2.3) | 22 (3.4) |
| Relationship problems (958) | 445 (46.5) | 165 (54.1) | 280 (42.9) |
| Physical health problems (960) | 278 (29.0) | 55 (18.0) | 223 (34.1) |
| Self-harm in response to symptoms (961) | 36 (3.7) | 11 (3.6) | 25 (3.8) |
aNumber of patient cases with available information varied between variables
Below: Kaplan–Meier curve showing cumulative probability of self-harm repetition by age groups
Full article at: http://goo.gl/uydTsf
By:
College of
Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham,
B15 2TT UK
Birmingham and
Solihull Mental Health Foundation Trust, Birmingham, UK
Warwick
University, Coventry, UK
Department of
Psychiatry, University of Oxford, Oxford, UK
Oxford Health NHS
Foundation Trust, Oxford, UK
Rachel Upthegrove, Email: ku.ca.mahb@evorgehtpu.r.
*Corresponding
author.
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