Pellatt Richard A F, Painter David R, Young Jesse T, Kõlves Kairi, Keijzers Gerben, Kinner Stuart A, Heffernan Ed, Crilly Julia
Emergency Department, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
LifeFlight Retrieval Medicine, Brisbane, QLD, Australia.
Lancet Reg Health West Pac. 2025 Jan 16;54:101263. doi: 10.1016/j.lanwpc.2024.101263. eCollection 2025 Jan.
Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide.
This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months.
During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%-19.3%) at 12-months and 24.3% (95%CI, 23.9%-24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%-0.7%) at 12-months and 1.0% (95%CI, 0.9%-1.1%) at 24-months.
One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority.
This study was funded by an Emergency Medicine Foundation (EMF) grant (EMJS-382-R35-2021) and a National Health and Research Council Grant (1121898).
因首次自伤事件前往急诊科就诊被认为是后续反复自伤和自杀的一个风险因素。我们描述了澳大利亚昆士兰州因心理健康问题和自伤前往急诊科就诊的成年人（>18岁）的人口统计学和临床特征，并确定了与反复自伤和自杀相关的风险因素。
这是一项全州范围的回顾性队列研究，研究对象为在六年期间（2012年1月1日至2017年12月31日）因首次自伤就诊于澳大利亚昆士兰州27家公立急诊科中的任何一家的成年人。我们将急诊科记录与全州死亡登记册相链接。主要结局是再次因自伤就诊或自杀死亡。我们构建了一个多变量Cox回归模型，以确定再次因自伤就诊或自杀死亡的独立风险因素。我们计算了12个月和24个月时因自伤和自杀再次前往急诊科就诊的风险。
在研究期间，43797名个体因与自伤相关的诊断前往昆士兰州急诊科就诊。队列中有一半为女性（n = 20980，47.9%），年龄在35岁以下（n = 23871，54.5%）。四分之一（n = 10991；25.1%）有反复自伤事件，515人（1.2%）自杀死亡。社会经济劣势、乘救护车到达、自行就诊、中小型医院规模、不太紧急的分诊类别、未住院状态以及既往心理健康或身体健康就诊与再次因自伤就诊相关。自杀与男性、年龄较大和住院相关。12个月时反复自伤风险为18.9%（95%CI，18.5%-19.3%），24个月时为24.3%（95%CI，23.9%-24.7%）。12个月时自杀风险为0.7%（95%CI，0.6%-0.7%），24个月时为1.0%（95%CI，0.9%-1.1%）。
四分之一的人因自伤再次前往急诊科就诊。自杀尤其与老年男性相关。实施基于证据的干预措施以支持因自伤前往急诊科就诊的人群应成为公共卫生优先事项。
本研究由急诊医学基金会（EMF）资助（EMJS-382-R35-2021）和国家卫生与研究委员会资助（1121898）。
