Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
Australas Emerg Care. 2023 Sep;26(3):230-238. doi: 10.1016/j.auec.2023.01.003. Epub 2023 Jan 27.
Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation.
This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012-31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people.
There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02-1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15-1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7-13.2 months).
Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.
全球范围内，自残和自杀的发生率正在上升，尤其是在年轻女性中。急诊科（ED）是自残的年轻人常见的第一个就诊点。我们研究了在以下方面的年龄和性别相关差异：（1）在八年期间的自残发生率；（2）在此期间人口统计学、表现和治疗特征的变化；以及（3）自残再就诊的发生率和时间。
这是一项对 2012 年 1 月 1 日至 2019 年 12 月 31 日期间在澳大利亚墨尔本皇家医院急诊科就诊的年龄在 9 岁及以上的所有自残者的回顾性观察性研究。皇家墨尔本医院是澳大利亚墨尔本最大和最繁忙的急诊科之一，服务于约 150 万人口的主要集水区。
在此期间，有 551692 人到皇家墨尔本医院急诊科就诊（女性占 57.6%）。其中，7736 例（1.4%）与自残有关。这些自残就诊涉及 5428 人（女性占 54.8%），总体重复事件发生率为 11.2%。自残相关就诊每年增加 5%（发病率比 [IRR]1.05，95%CI1.02-1.08）；在八年期间增加了 44%（IRR1.44，95%CI1.15-1.80）。对于年龄<25 岁的年轻人，这种增加更为明显。最常见的方法是自我中毒，主要是苯二氮䓬类或阿片类药物。单纯自我中毒的就诊比例随着时间的推移略有下降，而单纯自我伤害的就诊比例有所增加。对于几乎一半的就诊者，急诊科心理健康工作人员都对其进行了评估。首次再就诊的中位数时间为 4.5 个月（四分位距 [IQR]0.7-13.2 个月）。
医院就诊的自残率可能在上升，尤其是在年轻人中，而大多数自残就诊发生在非办公时间；因此，需要适当的急诊科人员配备、培训和临床护理模式。约有一半的人在首次就诊后三个月内再次出现自残（即首次记录）。应优先建立适当的后续护理服务，包括替代 ED 服务，以实现每周 7 天、每天 24 小时提供服务，以降低重复率。
