Department of Public Health (Cork & Kerry), St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland.
J Affect Disord. 2018 Mar 15;229:523-531. doi: 10.1016/j.jad.2017.12.040. Epub 2017 Dec 27.
Self-harm is a strong predictor of future suicide, but little is known about self-harm among the homeless population. The study aim was to estimate the incidence of self-harm among the homeless population and to assess factors associated with self-harm.
Data on self-harm presentations to 34 hospital emergency departments in Ireland were collected by the National Self-Harm Registry Ireland (NSHRI). Index presentations between 2010 and 2014 were included for the homeless and fixed residence populations. Incidence rates of self-harm were calculated using NSHRI data and census estimates. Factors associated with self-harm and repeated self-harm were analysed by multivariable-adjusted logistic regression.
The age-standardised incidence rate of self-harm was 30 times higher among the homeless (5572 presentations per 100,000) compared with those with a fixed residence (187 presentations per 100,000). Homeless people had significantly higher odds of being male (OR 1.86, 95%CI 1.56-2.23), presenting with self-cutting (vs. overdose, OR 2.15, 95%CI 1.74-2.66) and having psychiatric admission (vs. general admission, OR 2.43, 95%CI 1.66-3.57). Homeless people had higher odds of self-harm repetition within 12 months (vs. fixed residence, OR 1.46, 95%CI 1.21-1.77). The odds of repetition were significantly increased among homeless who engaged in self-cutting (vs. overdose, OR 1.76, 95%CI 1.17-2.65) and did not receive psychiatric review at index presentation (vs. reviewed, OR 1.54, 95%CI 1.05-2.26).
The study only reflects self-harm presenting to hospital, and assumes no change in homelessness status after index presentation. Residual confounding may affect the results.
There is a disproportionate burden of self-harm among the homeless. Targeted preventive actions are warranted.
自残是未来自杀的一个强有力的预测指标，但人们对无家可归人群中的自残行为知之甚少。本研究旨在估算无家可归人群中的自残发生率，并评估与自残相关的因素。
爱尔兰国家自残登记处（NSHRI）收集了 2010 年至 2014 年期间 34 家医院急诊部门的自残就诊数据。将无家可归者和固定居住者的自残就诊纳入本研究。利用 NSHRI 数据和人口普查估计值计算自残发生率。采用多变量调整后的逻辑回归分析与自残和重复自残相关的因素。
与有固定住所的人相比（每 100,000 人 187 例），无家可归者的自残发生率标准化年龄调整率高 30 倍（每 100,000 人 5572 例）。无家可归者更有可能为男性（比值比 1.86，95%置信区间 1.56-2.23）、出现自伤（与药物过量相比，比值比 2.15，95%置信区间 1.74-2.66）和接受精神科住院治疗（与普通住院相比，比值比 2.43，95%置信区间 1.66-3.57）。无家可归者在 12 个月内重复自残的可能性更高（与有固定住所者相比，比值比 1.46，95%置信区间 1.21-1.77）。与药物过量相比（比值比 1.76，95%置信区间 1.17-2.65），无家可归者选择自伤（比值比 1.54，95%置信区间 1.05-2.26）和首次就诊时未接受精神科评估（比值比 1.54，95%置信区间 1.05-2.26），其重复自残的可能性显著增加。
本研究仅反映了医院就诊的自残情况，并假设就诊后无家可归状况没有变化。残余混杂因素可能会影响结果。
无家可归者中自残负担不成比例。需要采取有针对性的预防措施。
