title: Deliberate self-harm patients in the emergency department: factors associated with repeated self-harm among 1524 patients.
abstract: OBJECTIVE
  (1) investigate risk factors associated with repeated deliberate self-harm (DSH) among patients attending the emergency department due to DSH, (2) stratify these patients into risk categories for repeated DSH and (3) estimate the proportion of repeated DSH within 12 months.
  
  
  METHODS
  A consecutive series of individuals who attended one of Scandinavia's largest emergency departments during 2003-2005 due to DSH. Data on sociodemographic factors, diagnoses and treatment, previous DSH at any healthcare facility in Sweden (2002-2005) and circumstances of the index DSH episode were collected from hospital charts and national databases. A nationwide register based on follow-ups of any new DSH or death by suicide during 2003-2006.
  
  
  METHODS
  Repeated DSH episode or suicide.
  
  
  RESULTS
  1524 patients were included. The cumulative incidence for patients repeating DSH within 12 months after the index episode was 26.8% (95% CI: 24.6 to 29.0). Risk factors associated with repeating DSH included previous DSH, female gender, self-injury as a method for DSH and if the self-injury required a surgical procedure, current psychiatric or antidepressant treatment and if the patient suffered from a substance use disorder or adult personality disorder or did not have children under the age of six.
  
  
  CONCLUSIONS
  Patients attending an emergency department due to DSH have a high risk of repeating their self-harm behaviour. We present a model for risk stratification for repeated DSH describing low-risk (18%), median-risk (28% to 32%) and high-risk (47% to 72%). Our results might help caretakers to direct optimal resources to these groups.
authors.affiliation: Department of Clinical Science and Education, Section of Internal Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. katarina.bilen@sodersjukhuset.se
authors.forename: Katarina
authors.initials: K
authors.lastname: Bilén
authors.forename: Carin
authors.initials: C
authors.lastname: Ottosson
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Carina
authors.initials: C
authors.lastname: Ursing
authors.forename: Pentti
authors.initials: P
authors.lastname: Ranta
authors.forename: Karin
authors.initials: K
authors.lastname: Ekdahl
authors.forename: Hans
authors.initials: H
authors.lastname: Pettersson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000150:complications; D013405:Suicide / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult