Hickey L, Hawton K, Fagg J, Weitzel H
Centre for Suicide Research, Oxford University, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
J Psychosom Res. 2001 Feb;50(2):87-93. doi: 10.1016/s0022-3999(00)00225-7.
Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients.
The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed.
Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment.
A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.
蓄意自我伤害（DSH）患者尽管有自杀风险，但往往在未接受精神科评估的情况下就直接从急诊部门出院。本研究的目的是确定这些患者的特征和结局。
对在两年期间直接从急诊部门出院的DSH患者的特征进行调查，比较接受精神科评估的患者和未接受评估的患者。在配对对照设计中，将一组未接受精神科评估的患者的结局与一组接受评估的患者的结局进行比较。
直接从急诊部门出院的DSH患者中，58.9%（145/246）未接受精神科评估。未接受评估的患者更有可能有DSH既往史，年龄在20 - 34岁之间，并且在急诊部门表现出行为困难。下午5点至上午9点就诊的患者比上午9点至下午5点就诊的患者接受评估的可能性更小。在随后一年中，37.5%的未接受评估的患者再次出现DSH，而配对的接受评估患者中这一比例为18.2%。他们也更有可能接受精神科治疗。
直接从急诊部门出院的DSH患者中有很大一部分未接受精神科评估。未接受评估的患者与接受评估的患者相比，可能有更高的再次发生DSH和自杀身亡的风险。医院服务需要进行合理安排，以便在急诊部门接受治疗的DSH患者能够接受心理社会问题和风险评估。
