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Emergency room recognition of mental disorders can reduce the number of repeat cases of deliberate self-harm, according to a report in yesterday’s AJP In Advance. Researchers in the Department of Psychiatry at Columbia University lead a study that assessed the effectiveness of emergency department (ED)diagnosis of psychiatric disorders among patients treated for intentional self-injury. Data came from the files of 5,567 Medicaid recipients aged 21 to 64, who visited the ED for deliberate violent or nonviolent self-harm. Patients’ medical records were evaluated for repeated self-harm events and psychiatric hospital admission 30 days after index ED visit.
The results showed that nearly 10% of the patients returned to the ED for deliberate self-harm within 30 days after initial hospital visits for the same issue. Incidence of repeat self-harm visits was inversely proportional to the ED's recognition of mental disorders—mainly bipolar and anxiety disorders—regardless of the precedent psychiatric diagnosis. Approximately 13.6% of the self-injury visits were followed by psychiatric hospitalization within the 30-day period. Diagnosis of mental disorders by the ED decreased the likelihood of psychiatric hospitalization by 4.4%, compared with that of undiagnosed patients.
Lead author Mark Olfson, M.D., M.P.H., told Psychiatric News that "many emergency departments do not have access to mental health professionals...they focus on treating medical injury rather than underlying psychiatric disorders." He is confident that including a mental health focus on ED treatment for intentional self-harm may prevent repeated self-injury and hospitalization and reduce suicide risk.
Read more about deliberate self-harm in Psychiatric News here and in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition here.
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