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The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, Australia
Journal article   Open access   Peer reviewed

The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, Australia

Richard A.F. Pellatt, David R. Painter, Jesse T. Young, Kairi Kõlves, Gerben Keijzers, Stuart A. Kinner, Ed Heffernan, Julia Crilly, Mental Health in Emergency Department Research Investigators, Marc Broadbent, …
The Lancet Regional Health. Western Pacific, Vol.54, pp.1-10
2025
DOI: https://doi.org/10.1016/j.lanwpc.2024.101263
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The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters_ a retrospective cohort study with data linkage in Queensland, Australia2.42 MBDownloadView
Published VersionCC BY-NC-ND V4.0,  Open Access

Abstract

Data linkage Emergency department Intentional self-harm Mental health Suicide
Background Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide. Methods This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months. Findings During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%–19.3%) at 12-months and 24.3% (95%CI, 23.9%–24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%–0.7%) at 12-months and 1.0% (95%CI, 0.9%–1.1%) at 24-months. Interpretation One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority.

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