Emergency Treatment of Deliberate Self-harm
Emergency Treatment of Deliberate Self-harm
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DOI：
10.1001/archgenpsychiatry.2011.108
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发表时间：
2012-01-01
影响因子：
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通讯作者：
Bridge, Jeffrey A.
中科院分区：
文献类型：
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作者：
Olfson, Mark;Marcus, Steven C.;Bridge, Jeffrey A.
背景：尽管对紧急精神卫生服务的质量存在关注，但对那些因故意伤害自己而被急诊室收治并随后出院的成年人的精神卫生保健了解甚少。目的：描述因故意自残而接受医疗补助的成年受益人急诊科出院的预测因素、急诊心理健康评估和随访门诊心理健康护理。设计：回顾性纵向队列分析。背景：国家医疗补助索赔数据补充了县级社会人口变量和医疗补助州政策调查数据。参与者：年龄在21至64岁之间的成年人，因7355次故意自残而在急诊室接受治疗，重点是那些出院到社区的人（4595次）。主要结局指标：社区出院率和调整风险比（arr）、急诊科心理健康评估以及急诊科就诊后30天内的门诊心理健康访问。结果：大部分患者（62.5%）出院。急诊科出院与患者年龄较年轻（21-31岁vs 45-64岁）（ARR， 1.18[99%可信区间{CI}， 1.10-1.25]）和自残（ARR, 1.18 [99% CI, 1.12-1.24]）直接相关，与中毒（ARR, 0.84 [99% CI, 0.80-0.89]）和近期精神病住院（ARR, 0.74 [99% CI, 0.67-0.81]）负相关。大约一半的出院患者（47.5%）在急诊科接受了心理健康评估，同样比例的出院患者（52.4%）在30天内接受了门诊心理健康随访。随访精神卫生保健与近期门诊精神卫生保健（ARR, 2.30 [99% CI, 2.11-2.50]）和在医疗补助覆盖精神卫生诊所服务的州的治疗（ARR, 1.13 [99% CI, 1.05-1.22]）直接相关，与非裔美国人（ARR, 0.86 [99% CI, 0.75-0.96]）和西班牙裔（ARR, 0.86 [99% CI, 0.75-0.99]）种族/民族呈负相关。结论：大多数因故意自残而接受紧急护理的成年医疗补助受益人都是出院到社区的，许多人没有接受紧急心理健康评估或后续门诊心理健康护理。
Context: Although concern exists over the quality of emergency mental health services, little is known about the mental health care of adults who are admitted to emergency departments for deliberately harming themselves and then discharged to the community.Objective: To describe the predictors of emergency department discharge, the emergency mental health assessments, and the follow-up outpatient mental health care of adult Medicaid beneficiaries treated for deliberate self-harm.Design: A retrospective longitudinal cohort analysis.Setting: National Medicaid claims data supplemented with county-level sociodemographic variables and Medicaid state policy survey data.Participants: Adults aged 21 to 64 years who were treated in emergency departments for 7355 episodes of deliberate self-harm, focusing on those who were discharged to the community (4595 episodes).Main Outcome Measures: Rates and adjusted risk ratios (ARRs) of discharge to the community, mental health assessments in the emergency department, and outpatient mental health visits during the 30 days following the emergency department visit.Results: Most patients (62.5%) were discharged to the community. Emergency department discharge was directly related to younger patient age (21-31 years vs 45-64 years) (ARR, 1.18 [99% confidence interval {CI}, 1.10-1.25]) and self-harm by cutting (ARR, 1.18 [99% CI, 1.12-1.24]) and inversely related to poisoning (ARR, 0.84 [99% CI, 0.80-0.89]) and recent psychiatric hospitalization (ARR, 0.74 [99% CI, 0.67-0.81]). Approximately one-half of discharged patients (47.5%) received a mental health assessment in the emergency department, and a similar percentage of discharged patients (52.4%) received a follow-up outpatient mental health visit within 30 days. Follow-up mental health care was directly related to recent outpatient mental health care (ARR, 2.30 [99% CI, 2.11-2.50]) and treatment in a state with Medicaid coverage of mental health clinic services (ARR, 1.13 [99% CI, 1.05-1.22]) and inversely related to African American (ARR, 0.86 [99% CI, 0.75-0.96]) and Hispanic (ARR, 0.86 [99% CI, 0.75-0.99]) race/ethnicity.Conclusion: Most adult Medicaid beneficiaries who present for emergency care for deliberate self-harm are discharged to the community, and many do not receive emergency mental health assessments or follow-up outpatient mental health care.