Deliberate self-harm (DSH) out of hour's presentations

Area of Science:

• Pediatric Emergency Medicine
• Child and Adolescent Psychiatry
• Public Health

Background:

• Deliberate self-harm (DSH) in young people is a significant public health issue.
• DSH is a major risk factor for completed suicide among adolescents.
• Current emergency service structures may not adequately address the timing of DSH presentations.

Purpose of the Study:

• To determine the time of presentation for children attending paediatric accident and emergency (A&E) services for DSH.
• To analyze patterns of DSH presentation outside of typical working hours.

Main Methods:

• Retrospective review of case notes for children presenting with DSH or suicidal ideation.
• Data collection focused on the time of presentation to an acute paediatric hospital between 1993-2003.
• Analysis of 172 cases with recorded presentation times.

Main Results:

• 80% (137 out of 172) of children presented outside of standard working hours (9 am-5 pm, Monday-Friday).
• Children presenting outside of hours were more likely to have consumed alcohol, attempted suicide, and have a family history of psychiatric illness.
• This indicates a distinct at-risk subgroup presenting during non-traditional hours.

Conclusions:

• Urgent development of out-of-hours Child and Adolescent Psychiatry (CAP) services is essential.
• Accessible mental health assessments for young people presenting with DSH are crucial.
• Addressing the timing of DSH presentations is vital for suicide prevention strategies.