title: Self-reported Usual Care for Self-directed Violence During the 6 Months Before Emergency Department Admission.
abstract: BACKGROUND
  The literature describing the health services individuals receive before and following self-directed violence (SDV) is limited.
  
  
  OBJECTIVE
  This study examines services received for the 6 months preceding admission to an urban county medical center emergency department (ED) for SDV. We predicted that individuals with at least 1 prior act of SDV in the past 6 months would have received more services than those for whom the index admission was their only recent act.
  
  
  METHODS
  Participants were recruited from ED admissions during shifts selected to maximize representativeness. Participants (n=202) were interviewed using the Suicide Attempt Self-Injury Interview, Suicide Attempt Self-Injury Count, Treatment History Interview, Mini International Neuropsychiatric Interview, Brief Symptom Index, and SF-12.
  
  
  RESULTS
  The majority of index acts of SDV (79%) were suicide attempts. The participants were characterized by low socioeconomic status, substantial symptomatology, low physical and mental health functioning, and multiple psychiatric diagnoses. In the preceding 6 months, 34% were admitted to a hospital and 56% received crisis services (including 44% in the ED). Although three quarters (76%) had seen an outpatient medical provider and most (70%) received psychotropic medications, less than half of the sample received psychiatric services (40%) or outpatient psychosocial treatment (48%). As predicted, utilization for most types of usual care was higher for those engaging in SDV in the 6 months preceding the index admission.
  
  
  CONCLUSIONS
  Individuals admitted to this ED for SDV received inadequate outpatient psychosocial and psychiatric services despite severe illness and disability.
authors.affiliation: *Department of Psychiatry & Behavioral Sciences, Harborview Medical Center †Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington ‡Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Katherine Anne
authors.initials: KA
authors.lastname: Comtois
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Kerbrat
authors.forename: David C
authors.initials: DC
authors.lastname: Atkins
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D057566:Self Report; D012959:Socioeconomic Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents