Abstract:
PURPOSE:Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix. METHODS:Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm. RESULTS:The proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only. CONCLUSIONS:No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.
journal_name
Soc Psychiatry Psychiatr Epidemioljournal_title
Social psychiatry and psychiatric epidemiologyauthors
Carroll R,Corcoran P,Griffin E,Perry I,Arensman E,Gunnell D,Metcalfe Cdoi
10.1007/s00127-016-1247-ysubject
Has Abstractpub_date
2016-11-01 00:00:00pages
1485-1493issue
11eissn
0933-7954issn
1433-9285pii
10.1007/s00127-016-1247-yjournal_volume
51pub_type
杂志文章abstract:PURPOSE:We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates. METHODS:Families with infants born between December 2007 and May 2008 (N = 11,134) were ...
journal_title:Social psychiatry and psychiatric epidemiology
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journal_title:Social psychiatry and psychiatric epidemiology
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journal_title:Social psychiatry and psychiatric epidemiology
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journal_title:Social psychiatry and psychiatric epidemiology
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journal_title:Social psychiatry and psychiatric epidemiology
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更新日期:1996-09-01 00:00:00
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更新日期:1991-01-01 00:00:00
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journal_title:Social psychiatry and psychiatric epidemiology
pub_type: 杂志文章
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更新日期:1997-04-01 00:00:00
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更新日期:2010-02-01 00:00:00