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Suicide Risk Among Hospitalized Versus Discharged Deliberate Self-Harm Patients: Generalized Random Forest Analysis

Sidra J Goldman-Mellor1, Harish S Bhat2, Michael H Allen3

  • 1Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California.

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Summary
This summary is machine-generated.

Hospitalization after self-harm in emergency departments did not clearly reduce suicide risk in this study. Further research is needed to understand the true impact of inpatient care on suicide prevention for these vulnerable patients.

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Area of Science:

  • Public Health
  • Emergency Medicine
  • Psychiatry

Background:

  • Suicide rates are alarmingly high among emergency department (ED) patients presenting with deliberate self-harm (DSH).
  • Inpatient hospitalization is a common recommendation for DSH patients, yet robust evidence on its suicide prevention efficacy is limited.
  • Confounding by indication and methodological challenges hinder research in this critical area.

Purpose of the Study:

  • To investigate the association between inpatient hospitalization and subsequent suicide risk in emergency department patients with a history of self-harm.
  • To address confounding by indication using advanced statistical methods to estimate the causal impact of hospitalization on suicide.
  • To examine these associations across different demographic subgroups, including sex and age.

Main Methods:

  • Utilized statewide data from 57,312 self-harm ED patients in California (2009-2012), linked to mortality records.
  • Employed generalized random forest methods to estimate the average treatment impact of hospitalization on suicide risk, controlling for observable covariates.
  • Conducted analyses on 12-month and 30-day suicide risks, stratified by sex and age-specific subgroups.

Main Results:

  • Naive analyses indicated higher suicide risk in hospitalized versus discharged patients across all subgroups.
  • Generalized random forest models showed increased suicide risk (per 1,000 patients) for hospitalized males (5.4), younger adults aged 10-29 (2.4), and older adults aged ≥50 (5.8) compared to discharged counterparts.
  • No significant association between hospitalization and suicide risk was found for female patients or those aged 30-49 years; similar patterns emerged in 30-day models.

Conclusions:

  • While EDs aim to hospitalize high-risk self-harm patients, analyses controlling for confounding do not provide clear evidence that hospitalization reduces suicide risk.
  • The possibility of iatrogenic effects (harm caused by medical treatment) cannot be ruled out.
  • Further investigation is crucial to clarify the role and effectiveness of inpatient hospitalization in suicide prevention for self-harm patients.