Attendance at the accident and emergency department in the year before suicide: retrospective study.
Open accessAbstract
Background: The National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact. Aims: To determine the proportion of suicides preceded by accident and emergency attendance in the previous year. Method: We obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from thecity's accident and emergency departments for a year before each death. Results: Eighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits dueto self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as‘not in contact’ with local mental health services. Conclusions: Although many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely.
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“The risk of suicide in people who have self-harmed is estimated to be 50 times greater than that of the general population and 15% of people who die by suicide present to hospital following selfharm in the year leading up to their death (Gairin et al., 2003; Hawton et al., 2015).”
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The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies
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Routine use of the Beck Scale for Suicide Ideation in a psychiatric emergency department
Healy, D. J., Barry, K., Blow, F. C., Welsh, D. E., & Milner, K. K. (2006) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2006.04.003 · Cited by 49 · see citing works
“Many patients have contact with health care professionals prior to committing suicide [3–6].”
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“One study found that 39% of adolescents who died by suicide had attended an ED in the year before their death.(7) Finally, the ED setting may also provide access to male adolescents, who are at the highest risk for death by suicide(1) but are often difficult to identify as they are less likely to seek primary care(8)…”
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“[11] Individuals who commit suicide frequently visit a health care provider in the months preceding their death,[12, 13] and for most, their suicidality is not recognized by their physicians.”
BackgroundDisparities in Treatment of Older Adults with Suicide Risk in the Emergency Department
Arias, S. A., Boudreaux, E. D., Segal, D. L., Miller, I. W., Camargo, C. A., & Betz, M. E. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15011 · Cited by 44 · see citing works
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“Of those who do, a substantial proportion will have visited the ED for suicidality the year before they die [23-25].”
Ross, A. M., White, E., Powell, D., Nelson, S., Horowitz, L., & Wharff, E. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.11.052 · Cited by 40 · see citing works
Interventions to prevent self-harm: what does the evidence say?
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“Of those who die by suicide, over 50% have a history of SH and 15% have presented to hospital with SH in the preceding year.(8) SH is not only a problem in terms of healthcare.”
BackgroundIncrease in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013
Vancayseele, N., Portzky, G., & van Heeringen, K. (2016) · PLoS ONE · doi:10.1371/journal.pone.0156711 · Cited by 36 · see citing works
“Self-harm occurs 10 to 20 times more frequently than suicide, and a history of self-harm is a major risk factor for suicide, being present in at least 40% of suicides [4–7] with in many cases an episode of self-harm shortly before their fatal act [8, 9].”
BackgroundHafferty, J. D., Navrady, L. B., Adams, M. J., Howard, D. M., Campbell, A. I., Whalley, H. C., Lawrie, S. M., Nicodemus, K. K., Porteous, D. J., Deary, I. J., et al. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01725-7 · Cited by 35 · see citing works
Suicide Risk Screening in an Emergency Department
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Suicide prevention in Japan: Government and community measures, and high‐risk interventions
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Multicenter Study of Predictors of Suicide Screening in Emergency Departments
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“This may be because ED staff have not been properly trained to manage patients presenting with suicide related complaints.(8) In addition, the number of mental health evaluations for patients presenting with psychiatric complaints was low.”
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“[9] showed that 39% of suicide victims visited the ED at one point in the year before their death.”
BackgroundAlcohol use disorder and non‐fatal suicide attempt: findings from a Swedish National Cohort Study
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Subsequent Suicide Mortality among Emergency Department Patients Seen for Suicidal Behavior
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“In addition, many individuals who die by suicide attend EDs, primary care clinics or medical inpatient units in their last year of life [11, 15, 16].”
BackgroundPredictors of emergency department visits for suicidal ideation and suicide attempt
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The association between the Kessler 10 and suicidality: a cross-sectional analysis
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“Failure to identify individuals with active suicidal ideation has been shown to occur at high rates in both primary health settings [5] and emergency departments (EDs) [6,7].”
BackgroundInterpersonal violence and the prediction of short-term risk of repeat suicide attempt
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Prevalence and cognitive underpinnings of isolated apathy in young healthy subjects.
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“However, despite the recognition of several strong risk factors for suicide such as mental disorders, alcohol and drug use, physical injuries, and intoxication or overdose, several studies indicate that suicidal ideation and planning are not always readily identified among the ED users [12-15].”
BackgroundWidnall, E., Epstein, S., Polling, C., Velupillai, S. U., Jewell, A., Dutta, R., Simonoff, E. A., Stewart, R. J., Gilbert, R. E., Ford, T. J., et al. (2022) · BMC Medicine · doi:10.1186/s12916-022-02329-w · Cited by 23 · see citing works
“Within the UK, a study of serious case reviews found 10–20% of young people who die by suicide visit a hospital for selfharm in the year prior to their death [7, 8].”
BackgroundEmergency Department Visits Prior to Suicide and Homicide
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“19 18-44 131 063 (53) 894 (58) 343 (38) 228 (26) 323 (36) 45-64 81 311 (33) 589 (38) 199 (34) 143 (24) 247 (42) 65 36 565 (15) 57 (4) 24 (42) 13 (23) 20 (35) Hospital <.”
Diurba, S., Johnson, R. L., Siry‐Bove, B., Knoepke, C. E., Suresh, K., Simpson, S. A., Azrael, D. R., Ranney, M. L., Wintemute, G. J., & Betz, M. E. (2020) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12649 · Cited by 22 · see citing works
Psychiatric Emergencies in Pregnant Women
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“One study reported that up to 69% may present to the ED for a non–suicide-related issue before suicide.(46) Making detection more difficult, patients present for somatic complaints and do not offer information on worsening mood or decreased interest and pleasure unless asked.”
BackgroundDevelopment of a Self-Harm Monitoring System for Victoria
Robinson, J., Witt, K., Lamblin, M., Spittal, M. J., Carter, G. L., Verspoor, K. M., Page, A., Rajaram, G., Rozova, V. S., Hill, N. T. M., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249385 · Cited by 19 · see citing works
“Approximately 15% of people who present to an ED with self-harm die by suicide within one year [14], although the risk of suicide can remain elevated for many years [15].”
Background
- Authors
- Gairin, I., House, A., & Owens, D.
- Affiliations
- University of Leeds (GB)
- Corresponding author
- Gairin, Isaura
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2003-07
- Volume
- 183
- Issue
- 1
- Pages
- 28-33
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2020894389
- Cited by
- 263
- References
- 22
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 11 · 2023: 8 · 2022: 14 · 2021: 21 · 2020: 20 · 2019: 12 · 2018: 17 · 2017: 16 · 2016: 16 · 2015: 22 · 2014: 12 · 2013: 16 · 2012: 12
- FWCI
- 7.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- suicide, non-fatal self-harm, mental health service contact, suicide prevention
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Emergencies, Emergency Service, Hospital, Female, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Retrospective Studies, Risk, Suicide, Self-Injurious Behavior
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