Emergency Treatment of Self-injurious Behavior

Are We Doing Our Best?

Steven Dubovsky, MD

Disclosures

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In This Article

Abstract and Introduction

Abstract

Many patients with self-injury, including those with the greatest risks, never receive a psychiatric evaluation.

Introduction

A single emergency department (ED) visit for deliberately self-injurious behavior is associated with a sixfold increased lifetime risk for suicide. To examine how patients with self-injury are treated, researchers reviewed Medicaid records for adults treated in EDs for self-harm in 2006. Of 7355 visits, 4595 visits (62%; 4440 patients) involved discharge to the community, and 2760 visits (38%) involved admission to the hospital.

Of the patients who were sent home, only 48% had a mental health evaluation in the ED, and 52% received outpatient follow-up in the next 30 days. Compared with patients sent home, admitted patients were more likely to be older and to have had a more lethal form of self-harm (e.g., gunshot) and previous mental health treatment, but were no more likely to have had previous self-harm, depression, schizophrenia, or a substance use disorder. Among patients who went home, a history of previous mental health treatment increased the likelihood of outpatient follow-up — but having potentially more lethal self-harm behavior did not increase that likelihood.

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