title: Self-harm induced somatic admission after discharge from psychiatric hospital - a prospective cohort study.
abstract: BACKGROUND
  Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.
  
  
  OBJECTIVE
  To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.
  
  
  METHODS
  Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.
  
  
  RESULTS
  During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.
  
  
  CONCLUSIONS
  Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Norway. Electronic address: liv.mellesdal@helse-bergen.no.
authors.forename: L
authors.initials: L
authors.lastname: Mellesdal
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Norway.
authors.forename: R A
authors.initials: RA
authors.lastname: Kroken
authors.affiliation: Department of Medicine, Haukeland University Hospital, Norway.
authors.forename: O
authors.initials: O
authors.lastname: Lutro
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Kjelby
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: K J
authors.initials: KJ
authors.lastname: Oedegaard
authors.affiliation: Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: H A
authors.initials: HA
authors.lastname: Jørgensen
authors.affiliation: National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Mehlum
mesh_terms: D000328:Adult; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
keywords: Admission; Psychiatric; Self-harm; Somatic; Suicide attempt; Underdiagnosing