Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

Robert Carroll, Paul Corcoran, Eve Griffin, Ivan Perry, Ella Arensman, David Gunnell, Chris Metcalfe

Research output: Contribution to journalArticle (Academic Journal)peer-review

9 Citations (Scopus)
248 Downloads (Pure)


Purpose: Self-harm patient management varies markedly between hospitals, with 4-fold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix.

Methods: Data came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm.

Results: The proportion of self-harm patients admitted to a medical bed varied from 10% to 74% between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only.

Conclusions: No strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.
Original languageEnglish
Pages (from-to)1485-1493
Number of pages9
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number11
Early online date14 Jun 2016
Publication statusPublished - Nov 2016

Structured keywords

  • Centre for Surgical Research


  • Self-harm
  • medical admission
  • psychiatric admission
  • instrumental variable
  • repetition
  • confounding
  • suicide


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