Outpatient Mental Health Follow-up and Recurrent Self-harm and Suicide Among Patients Admitted to the ICU for Self-harm A Population-based Cohort Study

被引：4

作者：

Fernando, Shannon M. ^{[1
,6
,10
]}

Pugliese, Michael ^{[6
,11
]}

McIsaac, Daniel I. ^{[2
,3
,6
,11
]}

Qureshi, Danial ^{[2
,6
,7
,11
]}

Talarico, Robert ^{[6
,11
]}

Sood, Manish M. ^{[2
,4
,6
,11
]}

Myran, Daniel T. ^{[2
,6
]}

Herridge, Margaret S. ^{[12
,13
,14
,15
,16
]}

Needham, Dale M. ^{[25
,26
]}

Munshi, Laveena ^{[12
,13
,15
,16
]}

Rochwerg, Bram ^{[19
,20
]}

Fiest, Kirsten M. ^{[21
,22
,23
,24
]}

Milani, Christina ^{[2
,7
,11
]}

Kisilewicz, Magdalena ^{[8
]}

Bienvenu, O. Joseph ^{[27
]}

Brodie, Daniel ^{[28
,29
]}

Fan, Eddy ^{[12
,13
,14
,15
,16
]}

Fowler, Robert A. ^{[11
,12
,13
,17
]}

Ferguson, Niall D. ^{[12
,13
,14
,15
,16
]}

Scales, Damon C. ^{[11
,12
,13
,17
,18
]}

Wunsch, Hannah ^{[11
,12
,13
,17
]}

Tanuseputro, Peter ^{[2
,5
,6
,7
,11
]}

Kyeremanteng, Kwadwo ^{[1
,5
,6
,9
]}

机构：

[1] Univ Ottawa, Dept Med, Div Crit Care, Ottawa, ON, Canada

[2] Univ Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada

[3] Univ Ottawa, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[4] Univ Ottawa, Div Nephrol, Ottawa, ON, Canada

[5] Univ Ottawa, Div Palliat Care, Dept Med, Ottawa, ON, Canada

[6] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[7] Queensway Carleton Hosp, Bruyere Res Inst, Ottawa, ON, Canada

[8] Queensway Carleton Hosp, Dept Crit Care, Ottawa, ON, Canada

[9] Queensway Carleton Hosp, Inst Savoir Montfort, Ottawa, ON, Canada

[10] Lakeridge Hlth Corp, Dept Crit Care, Oshawa, ON, Canada

[11] Univ Toronto, Dalla Lana Sch Publ Hlth, ICES, Toronto, ON, Canada

[12] Univ Toronto, Dalla Lana Sch Publ Hlth, Interdepartmental Div Crit Care Med, Toronto, ON, Canada

[13] Univ Toronto, Dalla Lana Sch Publ Hlth, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[14] Univ Hlth Network, Toronto Gen Hosp Res Inst, Toronto, ON, Canada

[15] Sinai Hlth Syst, Dept Med, Toronto, ON, Canada

[16] Univ Hlth Network, Toronto, ON, Canada

[17] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

[18] St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[19] McMaster Univ, Div Crit Care, Dept Med, Hamilton, ON, Canada

[20] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[21] Univ Calgary, Dept Crit Care Med, Calgary, AB, Canada

[22] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada

[23] Univ Calgary, Obrien Inst Publ Hlth, Calgary, AB, Canada

[24] Univ Calgary, Cumming Sch Med, Dept Psychiat, Calgary, AB, Canada

[25] Johns Hopkins Univ, Sch Med, Div Pulm & Crit Care Med, Dept Med, Baltimore, MD USA

[26] Johns Hopkins Univ, Sch Med, Dept Phys Med & Rehabil, Baltimore, MD USA

[27] Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD USA

[28] Columbia Univ, Coll Phys & Surg, Div Pulm Allergy & Crit Care Med, New York, NY USA

[29] New York Presbyterian Hosp, Ctr Acute Resp Failure, New York, NY USA

来源：

CHEST | 2023年 / 163卷 / 04期

关键词：

intensive care; mental health; postintensive care syndrome; self-harm; suicide; INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; LONG-TERM OUTCOMES; QUALITY-OF-LIFE; DRUG OVERDOSE; MORTALITY; ADMISSION; SURVIVAL; GUIDANCE; AUTHORS;

D O I：

10.1016/j.chest.2022.10.021

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk.RESEARCH QUESTION: What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm?STUDY DESIGN AND METHODS: Population-based cohort study of consecutive adults ($ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self -harm between 2009 and 2017. We categorized patients according to follow-up, with 'early follow-up' indicating 1 to 21 days after discharge, 'late follow-up' indicating 22 to 60 days after discharge, and 'no follow-up' indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge.RESULTS: We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were asso-ciated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide.INTERPREATION: Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.

引用

页码：815 / 825

页数：11

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