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Emergency department management and outcome for self-poisoning: a cohort study

Emergency department management and outcome for self-poisoning: a cohort study
Emergency department management and outcome for self-poisoning: a cohort study
Self-poisoning in adults is an important public health problem across the world, but evidence to guide psychological management is lacking. In the current cohort study we wished to investigate whether aspects of routine Emergency Department management such as receiving a psycho-social assessment, or being referred for specialist follow up, affected the rate of repetition of self-poisoning. The study was carried out in four inner city hospitals in Greater Manchester, United Kingdom, over a 5-month period. We used hospital information systems and reviewed the case notes of every patient presenting to the Emergency Department to identify prospectively all adult patients presenting with deliberate self-poisoning. Data regarding the Emergency Department management of each episode were collected. The Manchester and Salford self-harm database was used to determine the number of individuals who went on to repeat self-poisoning within 6 months of their index episode. During the recruitment period 658 individuals presented with self-poisoning. Traditional risk factors for repetition such as substance dependence, psychiatric contact, and previous self-poisoning were associated with a greater likelihood of receiving a psycho-social assessment or being referred for specialist follow-up. Ninety-six patients (14.6%) repeated self-poisoning within 6 months of their index episode. After adjustment for baseline demographic and clinical characteristics and hospital, receiving a psycho-social assessment was not associated with reduced repetition but being referred for specialist follow-up was [adjusted hazard ratio for repetition (95% CI): 0.49 (0.25 to 0.84), P=.01]. We found that being referred for active follow-up after self-poisoning was associated with a reduced risk of repetition. The implications of this finding are discussed. Further studies using both cohort and randomized controlled study designs will help inform management strategies for patients who poison themselves.
0163-8343
36-41
Kapur, Navneet
a73bd22e-148e-42a1-810f-b39aabbf3bed
Cooper, Jayne
5f709742-2a36-4f6c-ba4d-cf16644ecc42
Hiroeh, Urara
5f647427-7694-48c6-b7e3-01243af5b5e7
May, Chris
227ab47a-1ca0-4437-905a-bd90feacc3d5
Appleby, Louis
305e6269-0579-4f38-80a5-dc075c646b9b
House, Allan
b20d3cd3-6b90-48d7-a6b6-c036094ec9cb
Kapur, Navneet
a73bd22e-148e-42a1-810f-b39aabbf3bed
Cooper, Jayne
5f709742-2a36-4f6c-ba4d-cf16644ecc42
Hiroeh, Urara
5f647427-7694-48c6-b7e3-01243af5b5e7
May, Chris
227ab47a-1ca0-4437-905a-bd90feacc3d5
Appleby, Louis
305e6269-0579-4f38-80a5-dc075c646b9b
House, Allan
b20d3cd3-6b90-48d7-a6b6-c036094ec9cb

Kapur, Navneet, Cooper, Jayne, Hiroeh, Urara, May, Chris, Appleby, Louis and House, Allan (2004) Emergency department management and outcome for self-poisoning: a cohort study. General Hospital Psychiatry, 26 (1), 36-41. (doi:10.1016/j.genhosppsych.2003.06.002). (PMID:14757301)

Record type: Article

Abstract

Self-poisoning in adults is an important public health problem across the world, but evidence to guide psychological management is lacking. In the current cohort study we wished to investigate whether aspects of routine Emergency Department management such as receiving a psycho-social assessment, or being referred for specialist follow up, affected the rate of repetition of self-poisoning. The study was carried out in four inner city hospitals in Greater Manchester, United Kingdom, over a 5-month period. We used hospital information systems and reviewed the case notes of every patient presenting to the Emergency Department to identify prospectively all adult patients presenting with deliberate self-poisoning. Data regarding the Emergency Department management of each episode were collected. The Manchester and Salford self-harm database was used to determine the number of individuals who went on to repeat self-poisoning within 6 months of their index episode. During the recruitment period 658 individuals presented with self-poisoning. Traditional risk factors for repetition such as substance dependence, psychiatric contact, and previous self-poisoning were associated with a greater likelihood of receiving a psycho-social assessment or being referred for specialist follow-up. Ninety-six patients (14.6%) repeated self-poisoning within 6 months of their index episode. After adjustment for baseline demographic and clinical characteristics and hospital, receiving a psycho-social assessment was not associated with reduced repetition but being referred for specialist follow-up was [adjusted hazard ratio for repetition (95% CI): 0.49 (0.25 to 0.84), P=.01]. We found that being referred for active follow-up after self-poisoning was associated with a reduced risk of repetition. The implications of this finding are discussed. Further studies using both cohort and randomized controlled study designs will help inform management strategies for patients who poison themselves.

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Published date: January 2004
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 370250
URI: http://eprints.soton.ac.uk/id/eprint/370250
ISSN: 0163-8343
PURE UUID: 9734b535-23a7-4cbd-9da9-500f5c8ebd3d

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Date deposited: 27 Oct 2014 12:15
Last modified: 15 Jul 2019 21:41

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