National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
PLoS One. 2020 Apr 27;15(4):e0231885. doi: 10.1371/journal.pone.0231885. eCollection 2020.
Patient registry is a valuable source for identification of deliberate self-harm (DSH) incidents on a population basis; however, little research has provided sufficient details that could inform best utilization of this complicated data source for DSH research and statistics. In this study we want to use data from the Norwegian Patient Register to delineate a diagnostic coding system to identify medically treated DSH incidents, to profile general characteristics of these incidents, and to estimate incidence rate of DSHs in the national population of Norway.
We obtained all records of patient contacts to somatic hospitals and emergency centers due to external causes from 2008 through 2013. For each contact, we retrieved clinical data on primary and comorbid diagnoses, urgency of contact, etc., alongside with personal general information. After careful mining, the data were further processed following a multi-step analytic strategy. Descriptive analysis was used to profile DSH incidents and to estimate incidence rates and corresponding 95% confidence intervals.
From 1 459 384 eligible incident contacts for emergency injury treatment, we identified 13 533 incidents that had a recorded diagnosis of DSH, i.e., with a supplemental code of X6n. Upon delineation of these recorded DSHs, we devised a diagnostic coding system to identify all possible DSH incidents. This yielded a total of 38 433 incidents to be considered as likely incidents of DSH (adjusted incidents)-a number that is 2.84 times higher than that of the recorded DSH incidents during the study period. While the proposed diagnostic system captured more incidents by males and old adults, the adjusted DSHs remained more common in females than males, and occurred most frequently within young people of 18-21 years. These incidents imply about 6400 DSH incidents from 5100 persons per year and correspond to a yearly cumulative incidence rate of 121.0 (95% CI: 113.4-128.2) per 100000 population over 10 years old with particularly high rates in teenage girls of 15-19 years old (296.1/100000) and females and males of 20-24 years old (282.5 and 178.8/100000, respectively).
The insightful details of data processing and the rich findings from this study underscore the importance of patient registry in studying and reporting DSH incidents on a population level.
患者登记是基于人群识别故意自伤（DSH）事件的有价值的资源；然而，很少有研究提供足够的详细信息，可以为 DSH 研究和统计的最佳利用这种复杂的数据来源提供信息。在这项研究中，我们希望使用来自挪威患者登记处的数据来确定一个诊断编码系统，以识别经医学治疗的 DSH 事件，分析这些事件的一般特征，并估计挪威全国人口中 DSH 的发病率。
我们获得了 2008 年至 2013 年期间因外部原因到综合医院和急诊中心就诊的所有患者接触记录。对于每次接触，我们检索了主要和合并诊断、接触紧迫性等临床数据，以及个人一般信息。经过仔细挖掘，数据按照多步骤分析策略进一步处理。描述性分析用于分析 DSH 事件，并估计发病率和相应的 95%置信区间。
从 1459384 例符合条件的紧急伤害治疗事件中，我们确定了 13533 例记录诊断为 DSH 的事件，即附加代码为 X6n。在确定这些记录的 DSH 后，我们设计了一个诊断编码系统来识别所有可能的 DSH 事件。这总共产生了 38433 例被认为是可能的 DSH 事件（调整后的事件），这一数字是研究期间记录 DSH 事件的 2.84 倍。虽然拟议的诊断系统通过男性和老年患者捕获了更多的事件，但调整后的 DSH 事件在女性中仍然比男性更常见，并且最常发生在 18-21 岁的年轻人中。这些事件意味着每年有大约 6400 例 DSH 事件来自 5100 名患者，每年累计发病率为 100000 人中 121.0（95%置信区间：113.4-128.2），15-19 岁的少女特别高（296.1/100000），20-24 岁的女性和男性分别为 282.5 和 178.8/100000。
从数据处理的深入细节和研究中丰富的发现可以看出，患者登记在基于人群研究和报告 DSH 事件方面的重要性。
