Chartrand Hayley, Tefft Bruce, Sareen Jitender, Hiebert-Murphy Diane, Katz Laurence Y, Klonsky E David, Wang Yunqiao, Kim Huntae, Bolton James M
Arch Suicide Res. 2022 Jul-Sep;26(3):1141-1158. doi: 10.1080/13811118.2020.1856259. Epub 2020 Dec 11.
In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI).
Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI ( = 158), and a sample of those with SA ( = 172) and no SH or SI ( = 173).
Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ(1) = 7.457, = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation.
Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.HIGHLIGHTSA quarter of people with self-harm re-present to emergency services within four-and-a-half years.Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.There is a need for increased interventions in emergency services for those with self-harm.
在《精神疾病诊断与统计手册》第5版（DSM - 5）中，非自杀性自伤（NSSI）和自杀未遂（SA）在“有待进一步研究的状况”章节中被归类为不同的疾病。然而，一些人对区分NSSI和SA的有效性提出了质疑。本研究的目的是纵向考察有NSSI行为的成年人的相关因素、出院处置情况以及再次前往急诊服务的比率，并将他们与（a）有SA行为的成年人以及（b）无自我伤害或自杀观念（SI）的成年人进行比较。
数据来自2009年1月至2012年6月期间加拿大温尼伯市三级护理医院急诊科向成人精神科服务机构的4772次就诊记录。对所有有NSSI行为的就诊记录（n = 158）以及一部分有SA行为的记录（n = 172）和无自我伤害或自杀观念的记录（n = 173）进行了病历审查。
在返回急诊服务的成年人中，最初表现为SA的人比表现为NSSI的人再次就诊的时间要早得多。（χ(1) = 7.457，P = 0.006）。那些最初表现为NSSI且返回医院的人并非再次进行NSSI，而是大多数再次就诊时伴有自杀念头和SA行为。此外，那些再次表现为NSSI和SA行为的人住院或接受心理健康服务转诊的可能性较小，并且在初次就诊时更有可能被安排常规护理出院。
总体而言，这些发现表明对于某些有NSSI行为的人，尤其是那些再次前往急诊服务的人，存在自我伤害行为升级的轨迹。
要点
四分之一的自我伤害者在四年半内会再次前往急诊服务。
自杀未遂者再次就诊的时间比非自杀性自伤者明显更早。
有必要加强对有自我伤害行为者在急诊服务中的干预措施。
