Original article Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study L. Mellesdal a, *, R.A. Kroken a , O. Lutro b , T. Wentzel-Larsen c,d,e , E. Kjelby a , K.J. Oedegaard a,f , H.A. Jørgensen f , L. Mehlum g a Division of Psychiatry, Haukeland University Hospital, Norway b Department of Medicine, Haukeland University Hospital, Norway c Centre for Clinical Research, Haukeland University Hospital, Norway d Norwegian Centre for Violence and Traumatic Stress Studies, Norway e Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway f Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway g National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway 1. Introduction Self-harm represents a large public health problem, not only in terms of the burden such behaviour impinges on patients, their families [22] and health care providers [17], but self-harm is also an important risk factor for completed suicide [1]. Patients with psychiatric disorders [21,24], in particular patients recently discharged from psychiatric inpatient treatment [5,15], have a substantially increased risk of committing suicide. Patients with suicide risk related psychiatric admissions are also more likely to become rapidly re-hospitalised because of such risk [7]. Management of patients’ imminent and/or overt self-harm behaviour is an important and common task in emergency psychiatric inpatient units and effective intervention for self-harm is assumed to represent the best opportunity to prevent future suicidal behaviour [6]. However, up to now, the vast majority of studies on suicidal behaviour after psychiatric hospitalisation have focused on completed suicide. An interview-based study of patients discharged from psy- chiatric hospital found that 18% and 5% of the patients were involved in respectively suicide attempt or non-suicidal self-harm within one year post discharge [18]. A national register based study [2] of patients discharged from psychiatric hospitals found that 6.5% had at least one self-harm admission to somatic or psychiatric hospital during the year following discharge. We have not been able to find other studies showing rates of hospital treated self- harm after discharge from psychiatric hospital in unselected European Psychiatry xxx (2013) xxx–xxx * Corresponding author. E-mail addresses: liv.mellesdal@helse-bergen.no, liv.mellesdal@online.no (L. Mellesdal). A R T I C L E I N F O Article history: Received 1 March 2013 Received in revised form 4 June 2013 Accepted 30 June 2013 Available online xxx Keywords: Self-harm Suicide attempt Underdiagnosing Psychiatric Somatic Admission A B S T R A C T Background: Few studies have examined rate and predictors of self-harm in discharged psychiatric patients. Aims: To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission. Method: Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self- harm, with covariates changing during follow-up entered time dependently. Results: During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self- harm admissions were given hospital self-harm diagnosis. Conclusions: Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self- harm admissions may cause incorrect follow-up treatments and unreliable register data. ß 2013 Elsevier Masson SAS. All rights reserved. G Model EURPSY-3085; No. of Pages 7 Please cite this article in press as: Mellesdal L, et al. Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study. European Psychiatry (2013), http://dx.doi.org/10.1016/j.eurpsy.2013.06.006 Available online at www.sciencedirect.com 0924-9338/$ – see front matter ß 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.eurpsy.2013.06.006