TY - JOUR
T1 - Outpatient Mental Health Follow-up and Recurrent Self-harm and Suicide Among Patients Admitted to the ICU for Self-harm
T2 - A Population-based Cohort Study
AU - Fernando, Shannon M.
AU - Pugliese, Michael
AU - McIsaac, Daniel I.
AU - Qureshi, Danial
AU - Talarico, Robert
AU - Sood, Manish M.
AU - Myran, Daniel T.
AU - Herridge, Margaret S.
AU - Needham, Dale M.
AU - Munshi, Laveena
AU - Rochwerg, Bram
AU - Fiest, Kirsten M.
AU - Milani, Christina
AU - Kisilewicz, Magdalena
AU - Bienvenu, O. Joseph
AU - Brodie, Daniel
AU - Fan, Eddy
AU - Fowler, Robert A.
AU - Ferguson, Niall D.
AU - Scales, Damon C.
AU - Wunsch, Hannah
AU - Tanuseputro, Peter
AU - Kyeremanteng, Kwadwo
N1 - Funding Information:
The authors have reported to CHEST the following: M. M. S. reports CME funding from AstraZeneca and is supported by the Jindal Research Chair in the Prevention of Kidney Disease at the University of Ottawa. D. M. N. reports prior financial support for consultancy from Haisco-USA Pharmaceuticals, GlaxoSmithKline (UK), and Novartis Pharma (Switzerland) and current financial or in-kind support as part of National Institutes of Health-funded research from Baxter Healthcare Corporation and Reck Medical Devices, all of which are outside of the submitted work. D. B. reports receiving research support from ALung Technologies outside of the submitted work and has served on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira, and Cellenkos. E. F. reports receiving personal fees from ALung Technologies, Baxter, Boehringer-Ingelheim, Fresenius Medical Care, and MC3 Cardiopulmonary outside of the submitted work. N. D. F. reports consulting for Baxter and Xenios outside of the submitted work. K. K. reports receiving personal fees from Edwards Life Sciences outside of the submitted work and is the creator and director of Solving Wellness, an online platform that seeks to improve the physical and mental health of health-care professionals. None declared (S. M. F., M. P., D. I. M., D. Q., R. T., D. T. M., M. S. H., L. M., B. R., K. M. F., C. M., M. K., O. J. B., R. A. F., D. C. S., H. W., P. T.).
Funding Information:
This study was funded by the Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health. Parts of this material are based on data or information, or both, compiled and provided by the Canadian Institute for Health Information, as well as the Ontario Registrar General information on deaths, the original source of which is ServiceOntario. R. A. F. is the H. Barrie Fairley Professor of Critical Care at the University Health Network and Interdepartmental Division of Critical Care Medicine at the University of Toronto. H. W. is supported by a Canada Research Chair in Critical Care Organization and Outcomes. P. T. is supported by a Physician Services Incorporated Graham Farquharson Knowledge Translation Fellowship.
Publisher Copyright:
© 2022 American College of Chest Physicians
PY - 2023/4
Y1 - 2023/4
N2 - Background: Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk. Research Question: What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm? Study Design and Methods: Population-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with ‘early follow-up’ indicating 1 to 21 days after discharge, ‘late follow-up’ indicating 22 to 60 days after discharge, and ‘no follow-up’ indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge. Results: We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide. Interpreation: Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.
AB - Background: Patients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk. Research Question: What is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm? Study Design and Methods: Population-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with ‘early follow-up’ indicating 1 to 21 days after discharge, ‘late follow-up’ indicating 22 to 60 days after discharge, and ‘no follow-up’ indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge. Results: We included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide. Interpreation: Among adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.
KW - intensive care
KW - mental health
KW - postintensive care syndrome
KW - self-harm
KW - suicide
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U2 - 10.1016/j.chest.2022.10.021
DO - 10.1016/j.chest.2022.10.021
M3 - Article
C2 - 36445799
AN - SCOPUS:85150281524
SN - 0012-3692
VL - 163
SP - 815
EP - 825
JO - CHEST
JF - CHEST
IS - 4
ER -