Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

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dc.contributor.authorCarroll, R.
dc.contributor.authorCorcoran, Paul
dc.contributor.authorGriffin, Eve
dc.contributor.authorPerry, Ivan J.
dc.contributor.authorArensman, Ella
dc.contributor.authorGunnell, D.
dc.contributor.authorMetcalfe, C.
dc.date.accessioned2019-10-26T07:02:40Z
dc.date.available2019-10-26T07:02:40Z
dc.date.issued2016-06-14
dc.description.abstractPurpose: Self-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix. Methods: Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm. Results: The proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only. Conclusions: No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationCarroll, R., Corcoran, P., Griffin, E., Perry, I., Arensman, E., Gunnell, D. and Metcalfe, C., (2016), 'Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation', Social Psychiatry and Psychiatric Epidemiology, 51(11), pp. 1485-1493. DOI: 10.1007/s00127-016-1247-yen
dc.identifier.doi10.1007/s00127-016-1247-yen
dc.identifier.eissn1433-9285
dc.identifier.endpage1493en
dc.identifier.issn0933-7954
dc.identifier.issued11en
dc.identifier.journaltitleSocial Psychiatry and Psychiatric Epidemiologyen
dc.identifier.startpage1485en
dc.identifier.urihttps://hdl.handle.net/10468/8878
dc.identifier.volume51en
dc.language.isoenen
dc.publisherSpringer Berlin Heidelbergen
dc.relation.urihttps://link.springer.com/article/10.1007%2Fs00127-016-1247-y
dc.rights©The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectSelf-harmen
dc.subjectMedical admissionen
dc.subjectPsychiatric admissionen
dc.subjectInstrumental variableen
dc.subjectRepetitionen
dc.subjectConfoundingen
dc.subjectSuicideen
dc.titleVariation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentationen
dc.typeArticle (peer-reviewed)en
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