Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study

doi:10.1136/bmj.a2278

Published 18 November 2008, doi:10.1136/bmj.a2278
Cite this as: BMJ 2008;337:a2278

Research

Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study

David Gunnell, professor of epidemiology¹, Keith Hawton, professor of psychiatry², Davidson Ho, database manager¹^,3, Jonathan Evans, consultant senior lecturer in psychiatry⁴, Susan O’Connor, consultant psychiatrist⁵, John Potokar, consultant senior lecturer in psychiatry⁴, Jenny Donovan, professor of social medicine¹, Nav Kapur, professor of psychiatry and population health⁶

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ² Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, ³ South West Public Health Observatory, Bristol, ⁴ Academic Unit of Psychiatry, University of Bristol, ⁵ Avon and Wiltshire Partnership NHS Trust, Chippenham, Wiltshire, ⁶ Centre for Suicide Prevention, University of Manchester

Correspondence to: D Gunnell d.j.gunnell{at}bristol.ac.uk

Objective To determine the risk of non-fatal self harm in the12 months after discharge from psychiatric inpatient care.

Design Cohort study based on national hospital episode statistics.

Setting England.

Population Patients aged 16-64 years discharged from psychiatricinpatient care between 1 April 2004 and 31 March 2005 and followedup for one year.

Results 75 401 people were discharged from psychiatric inpatientcare over the study period, 4935 (6.5%) of whom were admittedat least once for self harm in the following 12 months. Riskof self harm was greatest in the four weeks after discharge;one third (32%, n=1578) of admissions for self harm occurredin this period. The strongest risk factor for self harm afterdischarge was admission for self harm in the previous 12 months(hazard ratio 4.9, 95% confidence interval 4.6 to 5.2). Therisk of self harm was also higher in females, younger people,those with diagnoses of depression, personality disorders, andsubstance misuse, and those with short lengths of stay.

Conclusion More than 6% of patients discharged from psychiatricinpatient care are readmitted for an episode of self harm within12 months, with one third of these episodes occurring in themonth after discharge. Self harm after discharge from hospitalshares many of the features of suicide after discharge. Interventionsshould be developed to reduce risk in this period.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Suicide risk after a suicide attempt: Udo Reulbach and Stefan Bleich
BMJ 2008 337: a2512. [Extract] [Full Text]

Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968-92: John R Geddes and Ed Juszczak
BMJ 1995 311: 357-360. [Abstract] [Full Text]

Prevention of suicide: aspirations and evidence: D Gunnell and S Frankel
BMJ 1994 308: 1227-1233. [Extract] [Full Text]

This article has been cited by other articles:

(2008). Suicide Risk After Recent Attempt or Psychiatric Hospitalization. JWatch Psychiatry 2008: 1-1 [Full text]
Reulbach, U., Bleich, S. (2008). Suicide risk after a suicide attempt. BMJ 337: a2512-a2512 [Full text]