Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort
Introduction Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. Objectives and Approach To quantify hospitalisation in the 12 months...
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| Format: | Article |
| Language: | English |
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Swansea University
2018-08-01
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| Series: | International Journal of Population Data Science |
| Online Access: | https://ijpds.org/article/view/595 |
| _version_ | 1797426626071363584 |
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| author | Rebecca Mitchell Cate Cameron |
| author_facet | Rebecca Mitchell Cate Cameron |
| author_sort | Rebecca Mitchell |
| collection | DOAJ |
| description | Introduction
Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm.
Objectives and Approach
To quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs.
Results
There were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64).
Conclusion/Implications
Improved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed. |
| first_indexed | 2024-03-09T08:32:59Z |
| format | Article |
| id | doaj.art-9bd878b62001451cb35d17e069555727 |
| institution | Directory Open Access Journal |
| issn | 2399-4908 |
| language | English |
| last_indexed | 2024-03-09T08:32:59Z |
| publishDate | 2018-08-01 |
| publisher | Swansea University |
| record_format | Article |
| series | International Journal of Population Data Science |
| spelling | doaj.art-9bd878b62001451cb35d17e0695557272023-12-02T19:05:12ZengSwansea UniversityInternational Journal of Population Data Science2399-49082018-08-013410.23889/ijpds.v3i4.595Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohortRebecca Mitchell0Cate Cameron1Australian Institute of Health Innovation, Macquarie UnversityJamieson Trauma InstituteIntroduction Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. Objectives and Approach To quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs. Results There were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64). Conclusion/Implications Improved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed.https://ijpds.org/article/view/595 |
| spellingShingle | Rebecca Mitchell Cate Cameron Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort International Journal of Population Data Science |
| title | Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort |
| title_full | Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort |
| title_fullStr | Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort |
| title_full_unstemmed | Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort |
| title_short | Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort |
| title_sort | self harm hospitalised morbidity and mortality risk in australia using a matched population based cohort |
| url | https://ijpds.org/article/view/595 |
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