Importance Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. Objective To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. Design, Setting, and Participants Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. Exposures Socioeconomic characteristics, psychiatric history, and clinical features of DSH. Main Outcomes and Measures Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. Results The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. Conclusions and Relevance This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.

中文翻译：

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挪威患者蓄意自残治疗后的精神病学服务转诊和出勤协会。

重要性 故意自残 (DSH) 躯体治疗后的精神科护理对患者的短期和长期生活至关重要，但指导此类护理的证据有限。目的 研究在医院急诊科接受 DSH（即故意自伤或自毒，无论动机如何）的患者的后续精神科护理，并评估精神科转诊和治疗出席率与随后死亡风险的关联这些病人。设计、设置和参与者来自几个挪威登记处的回顾性数据相互关联，以跟踪全国队列中所有住院治疗的 DSH 患者，时间从 2008 年到 2018 年长达 11 年。分析了 2021 年 3 月到 2021 年 10 月的数据。 , 精神病史, DSH 的临床特征。主要结果和测量转诊到精神科服务、接受精神科治疗和预期死亡率是随访期间的三阶段结果。使用比值比的逻辑回归和具有风险比的特定原因生存分析来检查暴露和结果之间的关联。结果 该研究确定了 43 153 名患者（24 286 [56.3%] 女性；索引 DSH 时的中位 [IQR] 年龄为 39.0 [23.0-56.0] 岁）涉及 69 569 次 DSH 发作。在这些患者中，6762 名 (15.7%) 在 DSH 躯体治疗后转诊至精神科，22008 名 (51.0%) 患者在 DSH 躯体治疗后出院后 3 个月内接受精神科治疗。先前的精神病史和与 DSH 共病的精神疾病与转诊和参加精神病治疗有关。在随访期间，7041 名患者死于自杀 (n = 911) 或其他原因 (n = 6130)。虽然自杀风险与 35 至 64 岁的男性性别相关，尤其是既往和共存的精神病理学，但其他原因死亡率与 65 岁及以上的年龄和社会经济劣势相关。接受精神科转诊的患者自杀风险通常增加，但在接受转诊但随后未接受精神科治疗的患者中自杀风险特别高（调整后的风险比，3.07；95% CI，2.28-4.12）。在随访的头几年，在 10 至 34 岁或 35 至 64 岁的患者以及有明显自残意图的患者中，观察到的关联更为明显。结论和相关性 这项全国队列研究发现 DSH 治疗后的精神科护理出勤率与预期死亡率之间存在关联，强调了患者参与精神科治疗的重要性。