How Hospitals Care for Suicidal Patients Linked to Risk of Death

A new study suggests that how hospitals manage patients with self-harm behavior may ultimately reduce subsequent mortality.

Researchers at Manchester University (United Kingdom), Royal Derby Hospital (United Kingdom), and other institutions conducted a prospective cohort study of 38,415 individuals who presented with self-harm to five emergency departments in the United Kingdom between 2000 and 2010. The researchers assessed the relation between four aspects of management—psychosocial assessment, medical admission, psychiatric admission, and referral for mental health follow-up—and death by suicide or any cause within 12 months of presentation.

The results showed that 261 (0.7%) of the patients died by suicide and 832 (2.2%) died from any cause within 12 months. Most aspects of management were associated with a higher mortality risk, with psychiatric admission associated with the highest risks for both suicide and all-cause mortality, with significant interactions by sex, age, and history of self-harm. The researchers also found that psychiatric admission may have had a greater effect on reducing deaths among men, those aged 65 and over, and those who had self-harmed previously. The study was published on August 5, 2015, in the Lancet Psychiatry.

“Clearly we need to do more to find out what works following self-harm, and how it works. Attendance at hospital represents an opportunity for services to address underlying issues such as mental health problems, difficult life circumstances, and alcohol use, which contribute to self-harm,” concluded lead author Prof. Nav Kapur, MD, of the University of Manchester center for suicide prevention, and colleagues. “Our research suggests routine aspects of care can be really helpful; doing the simple things well could improve services for patients and may ultimately reduce the number of deaths.”

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