Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment - A neglected population at risk of suicide
Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment - A neglected population at risk of suicide
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DOI：
10.1016/s0022-3999(00)00225-7
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发表时间：
2001-02-01
影响因子：
4.7
通讯作者：
Weitzel, H
中科院分区：
文献类型：
--
作者：
Hickey, L;Hawton, K;Weitzel, H
目的：故意自残（DSH）患者，尽管他们有自杀的危险，经常直接从事故和急诊（A&E）部门出院，而不进行精神病学评估。本研究的目的是确定这些患者的特征和预后。方法：对2年内直接从急诊科出院的DSH患者的特点进行调查，比较有精神病学评估的患者和没有进行精神病学评估的患者。在匹配对照设计中，将未接受精神病学评估的一组患者的结果与接受精神病学评估的一组患者的结果进行比较。结果：直接从急诊科出院的dsi - 1患者中，58.9%（145/246）未进行精神病学评估。未评估的患者更有可能有DSH病史，年龄在20-34岁之间，并且在急诊科表现出困难的行为。在下午5点至上午9点就诊的患者比在上午9点至下午5点就诊的患者更不可能接受评估。在随后的一年中，37.5%的未接受评估的患者发生了进一步的DSH，而在匹配的接受评估的患者中，这一比例为18.2%。他们也更有可能接受精神治疗。结论：从急诊科直接出院的DSH患者中有相当大比例没有接受精神病学评估。与接受评估的患者相比，未接受评估的患者进一步发生DSH和自杀的风险更高。需要组织医院服务，以便在急症室管理的DSH患者能够接受心理社会问题和风险的评估。(C) 2001爱思唯尔科学公司版权所有。
Objectives: Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. Methods: The characteristics, of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. Results: Of DSI-I patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m, Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. Conclusion: A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk. (C) 2001 Elsevier Science Inc. All rights reserved.