Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
Keywords
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References
- Deliberate self-harm in Oxford, 1990-2000: a time of change in patient characteristics.Psychol Med. 2003; 33: 987-995
- Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016.Soc Psychiatry Psychiatr Epidemiol. 2018; 53: 663-671
- Prevalence and characteristics of self-harm in adolescents: meta-analyses of community-based studies 1990–2015.J Am Acad Child Adolesc Psychiatry. 2018; 57: 733-741
- Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis, and meta-regression.Suicide Life Threat Behav. 2014; 44: 273-303
- Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents.Eur J Public Health. 2020; 30: 688-692
- Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: a population-based retrospective cohort study in Australia.BMJ Open. 2019; 9e026001
- Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care.BMJ. 2017; 359: j4351
- Is the reported increase in young female hospital-treated intentional self-harm real or artefactual?.Aust N Z J Psychiatry. 2019; 53: 663-672
- Premature death after self-harm: a multicentre cohort study.Lancet. 2012; 380: 1568-1574
- Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study.Lancet Child Adolesc Health. 2020; 4: 111-120
- Emergency department as a first contact for mental health problems in children and youth.J Am Acad Child Adolesc Psychiatry. 2017; 56 (e4): 475-482
- Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic reivew and meta-analysis.PLoS One. 2014; 9e89944
- Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study.Lancet Psychiatry. 2019; 6: 1021-1030
- Sentinel surveillance for self-harm.Crisis. 2019; 40: 1-6
- Detecting suicide-related emergency department visits among adults using the District of Columbia Syndromic Surveillance System.Public Health Rep. 2017; 132: 88s-94s
Public Health Agency Northern Ireland Register of Self-harm: Regional Three-Year Report, 2012/13 to 2014/15. Belfast, Northern Ireland: Public Health Agency; 2015.
- The incidence and repetition of hospital-treated deliberate self harm: findings from the world's first national registry.PLoS One. 2012; 7e31663
Multicentre Study of Self-Harm in England Multicentre study of self-harm in England Oxford, UK: Centre for Suicide Research, University of Oxford; 2018. from: 〈http://cebmh.warne.ox.ac.uk/csr/mcm/index.html〉[Accessed 8 February 2022].
- Establishing a self-harm surveillance register to improve care in a general hospital.Br J Ment Health Nurs. 2015; 4: 20-25
Commonwealth of Australia The Fifth National Mental Health and Suicide Prevention Plan. Canberra, ACT: Commonwealth of Australia; 2017.
Department of Health and Human Services Victorian Suicide Prevention Framework, 2016–2025. Melbourne, VIC: Victorian Government; 2016.
- Development of a self-harm monitoring system for Victoria.Int J Environ Res Public Health. 2020; 17
The Royal Melbourne Hospital. 2019/20 Annual Report 2020.
Australasian College for Emergency Medicine The Australasian Triage Scale; 2013 [Accessed 20 December 2021, from: 〈https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Better-Outcomes-for-Patients/Triage]〉.
National Centre for Classification in Health. The International Statistical Classification of Diseases and Related Health Problems; 10th Revision, Australian Modification (ICD-10-AM). Sydney, NSW, Australia: University of Sydney; 1998.
World Health Organisation. Guidelines for ATC Classification and DDD Assignment. Oslo, Norway; 2019.
- Stata statistical software: release 16.StataCorp LLC, College Station, TX2019
- Lack of impact of past efforts to prevent suicide in Australia: Please explain.Aust N Z J Psychiatry. 2019; 53: 379-380
- Changing rates of self-harm and mental disorders by sex in youths presenting to Ontario emergency departments: repeated cross-sectional study.Can J Psychiatry. 2019; 64: 789-797
- Suicide attempts by self-poisoning in the United States among 10-25 year olds from 2000 to 2018: substances used, temporal changes and demographics.Clin Toxicol (Philos). 2020; 58: 676-687
- Deliberate self-harm among young people gegins to increase at the very early age: a nationwide study.J Korean Med Sci. 2018; 33
- Risk of repeated self-harm and associated factors in children, adolescents and young adults.BMC Psychiatry. 2016; 16: 421
- Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population.Lancet Psychiatry. 2019; 6: 573-581
- Suicide prevention in Australia: does the funding match the burden?.Aust N Z J Psychiatry. 2018; 52: 596-598
- Restriction of non-opioid analgesics sold over-the-counter in Denmark: a national study of impact on poisonings.J Affect Disord. 2020; 268: 61-68
- United Kingdom legislation on pack sizes of analgesics: background, rationale, and effects on suicide and deliberate self‐harm.Suicide Life‐Threatening Behav. 2002; 32: 223-229
- Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland.Br J Clin Pharmacol. 2006; 62: 573-581
Therapeutic Goods Administration. Consultation: Proposed Aamendments to the Poisons Standard in relation to paracetamol; November 2022. Canberra, ACT: Therapeutic Goods Administration. [Accessed 26 September, 2022 from: 〈https://consultations.tga.gov.au/tga/paracetamol_november_2022_acms/]〉.
- Epidemiology and trends in non-fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England.BMJ Open. 2016; 6e010538
- Prevalence and correlates of self-harm in the German general population.PLoS One. 2016; : 11
- Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services.J Affect Disord. 2007; 98: 227-237
- Psychosocial assessment and repetition of self-harm: the significance of single and multiple repeat episode analyses.J Affect Disord. 2010; 127: 257-265
- Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: results of a national study.J Affect Disord. 2005; 89: 91-97
- Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics.BMJ Open. 2016; 6e009749
Article info
Publication history
Published online: January 27, 2023
Accepted:
January 23,
2023
Received in revised form:
January 23,
2023
Received:
September 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
