Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: Results of a national study
Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: Results of a national study
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DOI：
10.1016/j.jad.2005.08.011
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发表时间：
2005-12-01
影响因子：
6.6
通讯作者：
Gunnell, D
中科院分区：
文献类型：
--
作者：
Bennewith, O;Peters, TJ;Gunnell, D
背景：心理健康服务人员对自残患者进行心理社会评估是其护理的一个重要方面。然而，在英国，在自残事件发生后到综合医院就诊的人中，约有一半没有得到这样的评估。我们调查了造成这种情况的原因，以及在没有进行心理社会评估的情况下自行出院或计划出院的患者的特征。方法：对英格兰32个急诊科进行为期8周的自残率审计。如果没有由心理健康服务机构进行专门的心理社会评估，则要求提供有关原因的资料。由于数据不完整，32家医院中有10家被排除在分析之外。结果：22家医院自残就诊2780例。对59%的发作进行了心理社会评估。在未接受评估的人中，57%自行出院，其余由医院工作人员出院。在多变量模型中，男性、服用非法药物/酒精、非办公时间出勤和未住院与自我出院风险增加有关。年轻的受试者更有可能自我释放，但这种关联可以用年龄相关的入院模式来解释。年龄小（< 45岁）、无自残史和未入院与医院工作人员未经心理社会评估而出院的可能性增加有关。在考虑到较低的入院率后，那些自我撕裂的人在没有评估的情况下明显增加的出院风险被减弱了。局限性：10家医院的数据缺失导致其被排除在分析之外。审计表上只报告了解雇的主要原因。结论：那些自杀风险较高的患者——老年患者和有自残史的患者——在没有进行心理社会评估的情况下出院的可能性最小。然而，男性（与女性相比，自杀的风险更高）、服用过非法药物或/和酒精的人以及“非工作时间”就诊的人更有可能自我释放。需要根据有关这些人目前不参与服务的原因的进一步信息对服务进行修改和评估。(c) 2005 Elsevier B.V.版权所有
Background: Psychosocial assessment of self-harm patients by mental health service staff is an important aspect of their care. Nevertheless, in England around half of those attending a general hospital following a self-harm episode do not receive such an assessment. We have investigated the reasons for this and the characteristics of patients associated with self-discharge or planned discharge without a psychosocial assessment.Method: 8-week audits of self-harm attendances were carried out in 32 Accident and Emergency Departments in England. Where a specialist psychosocial assessment by mental health services was not carried out, information on the reason for this was requested. Due to incomplete data 10 of the 32 hospitals were excluded from analysis.Results: There were 2780 self-harm attendances at the 22 hospitals. Psychosocial assessments were carried out on 59% of episodes. Among those not assessed, 57% discharged themselves and the remainder were discharged by hospital staff. In multivariable models, being male, taking illegal drugs/alcohol, attendance out of office hours and not being admitted to a hospital bed were associated with an increased risk of self-discharge. Younger subjects were more likely to self-discharge, but this association was explained by age-related admission patterns. Young age (< 45 years), no previous self-harm and not being admitted were associated with an increased likelihood of discharge by hospital staff without a psychosocial assessment. The apparent increased risk of discharge without an assessment for those who self-lacerated was attenuated after allowing for their lower admissions rates.Limitations: Missing data from 10 hospitals led to their exclusion from analysis. Only the primary reason for discharge was reported on the audit forms.Conclusions: Those at elevated risk of suicide - older patients and those with a history of self-harm - were the least likely to be discharged by hospital staff without a psychosocial assessment. However, males (at increased risk of suicide compared with females), those who had taken illegal drugs or/and alcohol and those attending 'out of hours' were more likely to self-discharge. Services need to be modified and evaluated, based on further information about why such individuals are not currently engaging in services. (c) 2005 Elsevier B.V. All rights reserved.