title: Patient characteristics and behaviours associated with self-harm and  attempted suicide in acute psychiatric wards.
abstract: OBJECTIVE
  The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours.
  
  
  BACKGROUND
  Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission.
  
  
  METHODS
  Retrospective case note analysis.
  
  
  METHODS
  Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients.
  
  
  RESULTS
  One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm.
  
  
  CONCLUSIONS
  A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible.
  
  
  CONCLUSIONS
  At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention.
authors.affiliation: Health Service and Population Research, Institute of Psychiatry, Kings College London, London, UK. duncan.stewart@kcl.ac.uk
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.forename: Jamie
authors.initials: J
authors.lastname: Ross
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watson
authors.forename: Karen
authors.initials: K
authors.lastname: James
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000374:Aggression / Q000523:psychology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D003220:Conflict, Psychological; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011567:Psychiatric Department, Hospital; D012189:Retrospective Studies; D018570:Risk Assessment; D012309:Risk-Taking; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology*; D017678:Sex Distribution; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D015996:Survival Rate; D016312:Treatment Refusal; D006113:United Kingdom; D055815:Young Adult