Borschmann Rohan, Thomas Emma, Moran Paul, Carroll Megan, Heffernan Ed, Spittal Matthew J, Sutherland Georgina, Alati Rosa, Kinner Stuart A
1 Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2017 Mar;51(3):250-259. doi: 10.1177/0004867416640090. Epub 2016 Sep 29.
Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison.
Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations.
During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]).
Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.
与普通人群相比，囚犯自残和自杀的风险更高，出狱后自杀风险比仍被监禁者高三倍。然而，令人惊讶的是，对于出狱后自残的发生率知之甚少。我们旨在确定出狱后成年人自残导致的急诊科就诊的发生率，识别其风险因素并描述其特征。
对1325名出狱前接受访谈的成年人进行队列研究，并前瞻性地与州惩教和急诊科记录相联系。对所有因自残导致的急诊科就诊数据进行二次编码，以描述这些就诊情况。我们使用负二项回归来识别此类就诊的独立预测因素。
在3192人年的随访期间（每位参与者的中位随访时间为2.6年），共有3755次急诊科就诊。总共有83名（6.4%）参与者因自残就诊，占就诊次数的165次（4.4%）。男性和女性自残的粗发病率分别为每1000人年49.2次（95%置信区间：[41.2, 58.
