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Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study

Published online by Cambridge University Press:  15 April 2020

L. Mellesdal ,
R.A. Kroken ,
O. Lutro ,
T. Wentzel-Larsen ,
E. Kjelby ,
K.J. Oedegaard ,
H.A. Jørgensen  and
L. Mehlum
L. Mellesdal*
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Norway
R.A. Kroken
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Norway
O. Lutro
Affiliation:
Department of Medicine, Haukeland University Hospital, Norway
T. Wentzel-Larsen
Affiliation:
Centre for Clinical Research, Haukeland University Hospital, Norway Norwegian Centre for Violence and Traumatic Stress Studies, Norway Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway
E. Kjelby
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Norway
K.J. Oedegaard
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Norway Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
H.A. Jørgensen
Affiliation:
Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
L. Mehlum
Affiliation:
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
*
*Corresponding author. E-mail addresses:liv.mellesdal@helse-bergen.no, liv.mellesdal@online.no (L. Mellesdal).
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Abstract

Background:

Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.

Aims:

To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.

Method:

Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.

Results:

During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.

Conclusions:

Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

Keywords

Self-harmSuicide attemptUnderdiagnosingPsychiatricSomaticAdmission
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 4 , May 2014 , pp. 246 - 252
Copyright
Copyright © European Psychiatric Association 2014

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