Deliberate self-harm and relationship to alcohol use at an emergency department in eastern Taiwan

Suicide incidence has increased dramatically in recent years in Taiwan. In 2004, 3,468 lives were lost due to suicide and the total mortality was 15.3/100,000. It is well known that alcohol drinking raises the risk of deliberate self-harm (DSH), especially among psychologically distressed subjects. This study investigated the characteristics of DSH patients and their association with acute alcohol drinking. Since 2004, an injury surveillance system has been set up in a medical center, collecting the minimal information recommended by the World Health Organization. Attending nurses collected information and assessed each injured patient as to whether he/she smelled of alcohol. Medical records of DSH injuries were reviewed for confirmation of any prior DSH and any known mental disorder was checked. Of 11,837 injuries, 123 (1.0%) were DSH. Those who were first-time DSH patients (n = 115) were studied. About half of the patients were female and 83.5% were aged between 20 and 54 years. More than half of the DSH incidents occurred at home and 80.1% cases were stabbing or cutting injuries. Injuries were defined as alcohol-related based on the report of "alcohol odor'' or "intoxicated'' by the nurse or a positive blood alcohol test. In total, 55 (47.8%) DSH injuries were found to be alcohol-related. The proportion of alcohol-related injuries was highest (60.0%) in the age range 45-64 years. Of those patients who tested positive for alcohol (n = 21), the mean blood alcohol concentration was 211.2 mg/dL (standard deviation, 79.1). Most subjects were discharged from the emergency department (75.7%). Only 20 DSH patients (17.1%) went on to receive a psychiatric consultation. DSH is not uncommon in eastern Taiwan. Half of our cases were associated with alcohol use. Males had the same risk of injuring themselves and were more likely than females to adopt "severe" methods to injure themselves. Further studies into the causes of DSH or parasuicide attempts are needed. Psychiatric consultation is essential in caring for DSH patients and in preventing suicide. ADSH injury also offers an opportunity to recognize alcohol problems.