Griffin Eve, Gunnell David, Corcoran Paul
School of Public Health, University College Cork, Ireland; and National Suicide Research Foundation, Ireland.
National Institute for Health Research Bristol, Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK; and Population Health Sciences, University of Bristol, UK.
BJPsych Open. 2020 Nov 25;6(6):e145. doi: 10.1192/bjo.2020.116.
People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood.
The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm.
Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models.
Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments.
Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.
因自残而入院的人有很高的自杀风险。尽管如此，各医院对这一群体的管理存在很大差异，且影响这些差异的因素尚未得到很好的理解。
本研究的目的是确定与因自残入院后的护理途径相关的具体医院因素和个体因素。
从爱尔兰国家自残登记处获取了2017年和2018年18岁及以上人群的入院数据。使用多级泊松回归模型研究了与自残后四种常见结果（自行出院、医疗和精神科入院以及出院前的社会心理评估）相关的因素。
自残后的护理途径因医院而异，且受到医院和个体因素的影响。个体因素主要与自行出院（包括男性、年轻和饮酒）、医疗入院（年龄较大、仅使用药物过量作为方法和救护车送医）以及精神科入院（男性、与更高致死率相关的方法和年龄较大）相关。自残的医院入院率是与所有研究结果相关的唯一因素。精神科住院设施和精神科专业工作人员的可获得性导致了出院前精神科入院和社会心理评估的差异。医院因素解释了观察到的社会心理评估提供方面的大部分差异。
就诊医院的特征和医院入院率会影响自残后推荐的护理途径。提供现场心理健康设施和精神科专业工作人员对这些患者的精神科护理有很大影响。
