Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2278 (Published 19 November 2008) Cite this as: BMJ 2008;337:a2278
- David Gunnell, professor of epidemiology1,
- Keith Hawton, professor of psychiatry2,
- Davidson Ho, database manager13,
- 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
- 1Department of Social Medicine, University of Bristol, Bristol BS8 2PR
- 2Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford
- 3South West Public Health Observatory, Bristol
- 4Academic Unit of Psychiatry, University of Bristol
- 5Avon and Wiltshire Partnership NHS Trust, Chippenham, Wiltshire
- 6Centre for Suicide Prevention, University of Manchester
- Correspondence to: D Gunnell d.j.gunnell{at}bristol.ac.uk
- Accepted 15 October 2008
Abstract
Objective To determine the risk of non-fatal self harm in the 12 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 psychiatric inpatient care between 1 April 2004 and 31 March 2005 and followed up for one year.
Results 75 401 people were discharged from psychiatric inpatient care over the study period, 4935 (6.5%) of whom were admitted at least once for self harm in the following 12 months. Risk of self harm was greatest in the four weeks after discharge; one third (32%, n=1578) of admissions for self harm occurred in this period. The strongest risk factor for self harm after discharge was admission for self harm in the previous 12 months (hazard ratio 4.9, 95% confidence interval 4.6 to 5.2). The risk of self harm was also higher in females, younger people, those with diagnoses of depression, personality disorders, and substance misuse, and those with short lengths of stay.
Conclusion More than 6% of patients discharged from psychiatric inpatient care are readmitted for an episode of self harm within 12 months, with one third of these episodes occurring in the month after discharge. Self harm after discharge from hospital shares many of the features of suicide after discharge. Interventions should be developed to reduce risk in this period.
Footnotes
Hospital episode statistics data were provided through agreements with the South West Public Health Observatory. The views and opinions expressed in this paper do not necessarily reflect those of the Department of Health or National Institute of Health Research. The funders played no role in the analysis or drafting of this paper.
Contributors: DG had the idea for the study, designed the analysis plan, analysed the data, and wrote the first draft of the paper. NK, KH, and JE helped develop the analysis plan, interpreted the analysis, and contributed to writing the paper. DH extracted the data and drafted the methods section of the paper. SO’C, JP, and JD interpreted the findings and contributed to the writing of the paper. All authors have seen and approved the final version of the manuscript. DG is guarantor.
Funding: This work was funded by a National Institute of Health Research programme grant for applied research.
Competing interests: None declared.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.
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