Abstract

Objective

In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI).

Method

Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (n = 158), and a sample of those with SA (n = 172) and no SH or SI (n = 173).

Results

Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ²(1) = 7.457, p = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation.

Conclusions

Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.

1. HIGHLIGHTS

2. A quarter of people with self-harm re-present to emergency services within four-and-a-half years.

3. Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.

4. There is a need for increased interventions in emergency services for those with self-harm.

中文翻译：

---

从事非自杀性自伤的成年人的相关性、出院处置和再就诊率的纵向研究

摘要

客观的

在 DSM-5 中，非自杀性自伤 (NSSI) 和自杀未遂 (SA) 在进一步研究的条件部分被归类为不同的疾病。然而，有些人质疑区分 NSSI 和 SA 的有效性。本研究的目的是纵向检查参与 NSSI 的成年人的相关性、出院处置和再次到急诊服务的比率，并将其与 (a) 参与 SA 的成年人和 (b) 没有自我的成年人进行比较-伤害或自杀意念（SI）。

方法

数据来自 2009 年 1 月至 2012 年 6 月期间在加拿大温尼伯三级医院急诊科接受成人精神科服务的 4,772 次就诊。对所有 NSSI ( n  = 158) 就诊和 SA 患者样本进行图表审查( n  = 172) 并且没有 SH 或 SI ( n  = 173)。

结果

在返回紧急服务的成年人中，最初出现 SA 的人比那些出现 NSSI 的人重新出现的时间要快得多。(χ ² (1) = 7.457, p  = 0.006)。那些最初出现 NSSI 并返回医院的人并没有再次出现 NSSI，而是大多数人重新出现了自杀念头和 SA。此外，那些再次出现 NSSI 和 SA 的人不太可能住院或接受心理健康服务的转诊，并且更有可能在初次就诊时出院接受常规护理。

结论

总体而言，这些发现表明某些参与 NSSI 的人，尤其是那些重新出现在紧急服务机构的人，自残行为升级的轨迹。

1. 强调

2. 四分之一的自残者会在四年半内重新接受紧急服务。

3. 那些有自杀企图的人比非自杀性自残的人重新出现的时间要快得多。

4. 有必要增加对自残者的紧急服务干预。