Citation

Lawrence RE, Fuchs B, Krumheuer A, Perez-Coste M, Loh R, Simpson SA, Stanley B. J. Acad. Consult. Liaison Psychiatry 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.jaclp.2021.10.003

PMID

34695618

Abstract

BACKGROUND: Some patients engage in self-harm behaviors while in the emergency department; both suicidal and non-suicidal self-harm. Little is known about what motivates these behaviors. This gap in the empirical literature limits efforts to develop early identification and risk mitigation strategies.

METHOD: Authors reviewed self-harm incident reports and medical records from two academic urban emergency departments. Event timing and self-harm methods were extracted. Authors performed a qualitative content analysis of self-harm narratives to examine the question, "Which factors motivate patients to engage in deliberate (non-accidental) self-harm in the emergency department?" RESULT: The sample included N=184 self-harm incidents involving N=118 unique patients. A wide variety of self-harm methods were present in the data. Suicidal intent was present in a minority of incidents. Other motives included psychosis, intoxication, aggression, managing distress, communication, and manipulation.

CONCLUSION: Self-harm behaviors in the emergency department encompassed a variety of methods and motivations. These findings suggest risk mitigation strategies that emphasize suicide screening, reducing environmental hazards, and increasing observation are unlikely to achieve the goal of zero harm. Strategies focusing on engagement may create more fruitful opportunities to improve patient safety.

Language: en

Keywords

suicide; self-harm; emergency psychiatry; hospital psychiatry; patient safety; zero harm