Psychiatric follow-up and repeated hospital presentation of DSH: A national study on young adults

Psychiatric care following discharge from general hospital treatment of deliberate self-harm (DSH) is important to reduce patients´ risk of relapse. Whether such follow-up is associated with DSH repetition in young adults is not sufficiently understood. This study examined the association between psychiatric service attendance within seven days of discharge and repeated hospital-presented DSH within 3, 6, and 12 months in patients aged 18-35 years.

Incident episodes of hospital-presented DSH from 2010 to 2017 were identified from the Norwegian Patient Register. Those already psychiatrically admitted or who died during the general hospital or in the seven days after discharge were excluded. Psychiatric service attendance was categorized as 'no attendance', 'outpatient attendance', and 'inpatient admissions.' The association between psychiatric service attendance and subsequent DSH repetition was examined with an Inverse Probability of Treatment Weighted logistic regression model.

Of the 11,308 patients identified, 17.3 % had a psychiatric outpatient attendance, and 19.9 % had an inpatient admission. Outpatient attendance was not associated with a reduced risk of repeated DSH and inpatient admissions were associated with an increased risk in certain subgroups, notably patients: aged 18-24 years; without a recorded mood disorder diagnosis; or no history of hospital-treated DSH.

Our data did not contain all relevant confounders. Unmeasured confounding is therefore likely to influence the results.

Although no conclusions regarding treatment effectiveness can be drawn from these findings, the study highlights that patients with the most severe psychiatric symptoms and at the highest risk of DSH relapse received follow-up.