School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland.
School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation Ireland, 4.28 Western Gateway Building, Cork, Ireland.
J Affect Disord. 2019 Mar 1;246:843-850. doi: 10.1016/j.jad.2018.10.372. Epub 2018 Nov 29.
Risk of self-harm repetition has consistently been shown to be higher following self-cutting compared to intentional drug overdose (IDO) and other self-harm methods. The utility of previous evidence is limited due to the large heterogeneous method categories studied. This study examined risk of hospital presented self-harm repetition according to specific characteristics of self-harm methods.
Data on consecutive self-harm presentations to hospital emergency departments (2010-2016) were obtained from the National Self-Harm Registry Ireland. Associations between self-harm method and repetition were analysed using survival analyses.
Overall, 65,690 self-harm presentations were made involving 46,661 individuals. Self-harm methods associated with increased repetition risk included minor self-cutting, severe self-cutting, multiple drug IDOs involving psychotropic drugs and self-harm by blunt object. Minor self-cutting was the method associated with highest repetition risk (adjusted hazard ratio (AHR) 1.38, 95% CI 1.31-1.45). Risk of repetition was comparable following IDOs of four or more drugs involving psychotropic drugs (AHR = 1.29, 95% CI 1.20-1.39), severe self-cutting (AHR 1.25, 95% CI 1.16-1.34) and blunt object (AHR = 1.23, 95% CI 1.07-1.42).
Information was not available on suicide or other causes of mortality.
Self-harm method and the associated risk of repetition should form a core part of biopsychosocial assessments and should inform follow-up care for self-harm patients. The observed differences in repetition associated with specific characteristics of IDO underline the importance of safety planning and monitoring prescribing for people who have engaged in IDO.
与故意药物过量（IDO）和其他自伤方法相比，自伤后再次自伤的风险一直被证明更高。由于研究的方法类别差异较大，以前的证据的实用性有限。本研究根据自伤方法的具体特征，检查了因医院就诊的自伤重复发生的风险。
从爱尔兰国家自伤登记处获得了 2010 年至 2016 年连续到医院急诊就诊的自伤患者的数据。使用生存分析分析了自伤方法与重复之间的关系。
共有 65690 例自伤就诊，涉及 46661 人。与重复风险增加相关的自伤方法包括轻微自伤、严重自伤、涉及精神药物的多种药物 IDO 和钝器自伤。轻微自伤是与最高重复风险相关的方法（调整后的危险比（AHR）为 1.38，95%CI 为 1.31-1.45）。涉及精神药物的 IDO 超过四种药物（AHR=1.29，95%CI 1.20-1.39）、严重自伤（AHR 1.25，95%CI 1.16-1.34）和钝器（AHR=1.23，95%CI 1.07-1.42）的 IDO 后重复风险相当。
没有关于自杀或其他死亡原因的信息。
自伤方法及其与重复相关的风险应成为生物心理社会评估的核心部分，并为自伤患者的随访护理提供信息。观察到的与 IDO 特定特征相关的重复差异强调了为已进行 IDO 的人制定安全计划和监测处方的重要性。
