Suicide among Psychiatric in-Patients in the Wellington Region
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To identify risk factors for in-patient suicide, a case-control study of in-patient suicide was conducted in the Wellington Area Health Board region between 1984 and 1989 on 27 cases and 86 controls. The risk of in-patient suicide was increased among individuals who had been compulsorily admitted, suffered from schizophrenia, had a past history of deliberate self harm, had been in hospital for more than a month, or were unmarried. Notably, there was no relationship with physical health, a history of substance abuse, number of psychiatric admissions and time since the last known episode of deliberate self harm. These characteristics can assist clinical assessment of individual suicidal risk. Further evaluation of the relation of compulsory admission to suicide is required.Keywords:
Psychiatric hospital
Deliberate self-harm
Background: Hospital-treated deliberate self-harm (DSH) is common, costly, and strongly associated with suicide. Whilst effective psychosocial interventions exist, little is known about what key factors might modify the clinical decision to refer an individual to psychiatric in- and/or out-patient treatment following an episode of hospital-treated DSH.Methods: We searched five electronic databases (CENTRAL, CDSR, MEDLINE, Embase, and PsycINFO) until 3 January 2023 for studies reporting data on either the proportion of patients and/or events that receive a referral and/or discharge to a psychiatric inpatient hospital/ward and/or referral and/or discharge to psychiatric outpatient treatment service after an episode of hospital-treated DSH. Pooled weighted prevalence estimates were calculated using the random effects model with the Freedman-Tukey double arcsine adjustment in R, version 4·0·5. We also investigated whether several study-level and macro-level factors explained variability for these outcomes using random-effects meta-regression.Findings: 131 publications, representing 188 unique studies, which reported data on 243,943 individual participants who had engaged in a total of 174,359 episodes of DSH. Around one-in-five adults were referred for inpatient psychiatric and, of these, around one-fifth received at least one session. In contrast, around half of young people, and one-third of older adults were referred for inpatient psychiatric care, whilst one-fifth of young people and just over one-in-ten of older adults received this care. For both adults and older adults, around one-third were referred to outpatient psychiatric care, whilst half of all young people were referred to outpatient psychiatric care. Of those referred, around half received at least one treatment session across the age range. Event rate estimates were generally of a lower magnitude. More recent studies were associated with a small increase in the proportion of presentations (events) that were referred to, and received, psychiatric outpatient treatment. No macro-level factor explained between-study heterogeneity.Interpretation: There is considerable scope for improvement in the allocation and provision of both in- and outpatient psychiatric care following hospital-presenting DSH, particularly considering that the period after discharge from general hospitals represents the peak risk period for repeat DSH and suicide. Given the marked between-study heterogeneity the basis for allocation of aftercare treatment is therefore not yet known and should be further studied.Funding: There was no specific funding for this review.Funding: Whilst no specific funding was received for this review, individual authors wish to acknowledge the following sources of support: KW is supported by a National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (1177787) and a Dame Kate Campbell Fellowship from The University of Melbourne. KMG and BL are recipients of PhD scholarships from the Suicide Prevention Research Fund, awarded by Suicide Prevention Australia and, in KMG’s case, in partnership with Regional Australia Bank. KMG’s position is also funded by the Burdekin Suicide Prevention initiative provided by the Hunter New England Mental Health Services. NTMH is funded by the Forrest Research Foundation Prospect Fellowship.Declaration of Interest: GC and KM authored studies included in the review. We declare no other competing interests.
Deliberate self-harm
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Very few studies have shown the relation between psychiatric morbidity and hospital care safety. Some studies emphasise the importance of proper management of care safety for patients treated in psychiatric settings. Therefore, it is of great importance to deeply analyse the psychiatric morbidity impact on the safety of patient care in non-psychiatric settings. A cross-sectional study has been carried out, based on a simple random sample of N = 941 psychiatric consultations collected over a three-year period (2012-014) representative of N = 4548, sent to the intensive psychiatric hospital service by the wards of a university hospital. Demographic characteristics and psychiatric morbidity of hospital inpatients are associated with the four main outcomes/events due to the patients' active participation in the care processes (patient fall, patients' departure, suicide attempt or self-harm and acts of violence against professionals).
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Deliberate self-harm
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Psychiatric hospital
Deliberate self-harm
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The need to control violent and non-violent harm has been central to human existence since societies first emerged. This book analyses the problem of harm in world politics which stems from the fact that societies require the power to harm in order to defend themselves from internal and external threats, but must also control the capacity to harm so that people cannot kill, injure, humiliate or exploit others as they please. Andrew Linklater analyses writings in moral and legal philosophy that define and classify forms of harm, and discusses the ways in which different theories of international relations suggest the power to harm can be controlled so that societies can co-exist with the minimum of violent and non-violent harm. Linklater argues for new connections between the English School study of international society and Norbert Elias' analysis of civilizing processes in order to advance the study of harm in world politics.
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Abstract Many activities impose risks of harm on other people. One such class of risks are those that individuals culpably impose on others, such as the risk arising from reckless driving. Do such risks in themselves constitute a harm, over and above any harm that actually eventuates? This paper considers three recent views that each answer in the affirmative. I argue that each fails to overcome what I call the ‘interference objection’. The risk of harm itself, whether taken as a subjective or an objective risk, is unable to interfere with the interests of victims in order to constitute a harm. This does not mean that a risk of harm cannot itself be wrongful, but the conclusion does weaken the moral objectionableness of impositions of risks of harm.
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