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Under-Recognition Of Mental Disorders As A Cause Of Deliberate Self-Harm

Deliberate self-harm, such as cutting, poisoning or piercing, is an important risk factor for subsequent suicide.//

Researchers from the Columbia University Medical Center, New York set out to examine national patterns in the emergency department assessment and treatment during visits by young people, who are seen following an episode of deliberate self-harm.

They conducted an analysis of a nationally representative sample of hospital emergency department visits from the 1997-2002 National Hospital Ambulatory Medical Care Survey focusing on visits by persons aged 7 to 24 years related to deliberate self-harm. The study also made comparisons of visits that resulted in an inpatient admission with those that resulted in discharge to the community.

The study, which is published in the October issue of the journal Archives of General Psychiatry, found that among young people aged 7 to 24 years, the annual rate of emergency visits with self-harm was 225.3 per 100 000. The study found that only 56% of those who went to emergency departments to be treated for deliberate self-harm were diagnosed with a mental disorder and admitted to the hospital.

A diagnosis of depressive disorders, which is a major risk factor for youth suicide, was strongly associated with inpatient admission. In addition, 29% of the visits resulted in outpatient care referral; 5.8 percent resulted in referral to the emergency department for continuing care, and follow-up care was unspecified in 3.4 percent of the visits.

Results from the study indicate that mental disorders were diagnosed in only approximately one half of emergency department visits by young people, following an episode of deliberate self-harm. This suggests substantial under-recognition of mental illness and likely inadequate referral for follow-up mental health care.

The authors stress that “efforts should be made to fortify mental health assess ments, and one promising strategy involves routine administration of rapid and efficient diagnostic instruments to all young people following deliberate self-inflicted harm. Systematic mental health assessments in the emergency department of young people following an episode of deliberate self-harm may improve detection of mental disorders, and provide an important opportunity for secondary prevention.”

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