National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.
JAMA Psychiatry. 2022 Jul 1;79(7):651-658. doi: 10.1001/jamapsychiatry.2022.1124.
Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited.
To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021.
Socioeconomic characteristics, psychiatric history, and clinical features of DSH.
Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes.
The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm.
This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.
精神科护理在躯体治疗故意自伤（DSH）后对患者的短期和长期生活都至关重要，但指导这种护理的证据有限。
检查医院急诊科治疗 DSH（即故意自我伤害或自我中毒，无论动机如何）的患者的后续精神科护理，并评估精神科转诊和治疗就诊与这些患者随后死亡风险的相关性。
设计、地点和参与者：从几个挪威登记处的回顾性数据中进行链接，以对 2008 年至 2018 年期间长达 11 年的所有因 DSH 住院治疗的全国队列患者进行随访。数据于 2021 年 3 月至 10 月进行分析。
社会经济特征、精神病史和 DSH 的临床特征。
转诊至精神科服务、接受精神科治疗以及随访期间的预期死亡率是 3 个阶段的结果。使用优势比的逻辑回归和风险比的特定原因生存分析来检查暴露与结果之间的关联。
本研究确定了 43153 名患者（24286 名[56.3%]为女性；指数 DSH 时的中位[IQR]年龄，39.0[23.0-56.0]岁），涉及 69569 次 DSH 发作。在这些患者中，6762 名（15.7%）在躯体治疗 DSH 后被转诊至精神科服务，22008 名（51.0%）在躯体治疗后 3 个月内接受了精神科治疗。既往精神病史和与 DSH 并存的精神障碍与转诊和接受精神科护理均相关。在随访期间，7041 名患者自杀（n=911）或其他原因（n=6130）死亡。虽然自杀风险与男性、35 至 64 岁以及特别是既往和并存的精神病理学有关，但其他原因的死亡率与 65 岁及以上年龄和社会经济劣势有关。接受精神科转诊的患者一般自杀风险增加，但在接受转诊但随后未接受精神科治疗的患者中风险特别高（调整后的风险比，3.07；95%CI，2.28-4.12）。在随访的最初几年以及年龄在 10 至 34 岁或 35 至 64 岁之间以及有明确自伤意图的患者中，观察到的关联更为明显。
这项全国性队列研究发现，接受 DSH 治疗后的精神科护理就诊与前瞻性死亡率之间存在关联，突出了患者参与精神科治疗的重要性。
