For a study, researchers sought to analyze the relationship between psychiatric referral and treatment attendance and the risk of eventual death in patients treated for deliberate self-harm (DSH) (i.e., deliberate self-injury or self-poisoning, regardless of motive) at hospital emergency departments.
Retrospective data from three Norwegian registries were connected to create a nationwide cohort of all patients with hospital-treated DSH from 2008 to 2018. From March to October 2021, data were evaluated.
The three-stage outcomes during follow-up were referral to psychiatric services, attendance at psychiatric treatment, and projected mortality. To investigate the relationships between exposures and outcomes, logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were utilized. The analysis included 69,569 DSH events and 43,153 patients (24,286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years). After somatic therapy for DSH, 6,762 (15.7%) of these patients were referred to psychiatric services, and 22,008 (51.0%) underwent psychiatric treatment within 3 months after discharge. Prior psychiatric history and psychiatric illnesses co-occurring with DSH were linked to referral and attendance at psychiatric treatment. During the study, 7,041 individuals died by suicide (n=911) or other reasons (n=6,130). While male sex, age 35 to 64 years, and notably preceding and concurrent psychopathologies were related to suicide risk, age 65 years and beyond and socioeconomic disadvantage were connected with other-cause death. Patients who got psychiatric referrals had an elevated risk of suicide in general, but the risk was especially significant among patients who received a referral but did not get psychiatric care (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed connection was stronger in the early years of follow-up, in patients aged 10 to 34 years or 35 to 64 years, and in those with a clear intent to self-harm.
The nationwide cohort study discovered a link between psychiatric care attendance after DSH therapy and projected mortality, emphasizing the significance of patient involvement in psychiatric treatment.