Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm
Introduction
Deliberate self-harm and intentional injury represent a significant public health concern. Self-harm is the second leading cause of death from injury, and together with road traffic crashes, account for the majority of the total burden of injury [1], [2]. But while the rate of unintentional injuries is projected to decrease, the incidence of intentional injuries is expected to rise significantly. The World Health Organisation (WHO) estimates that between 2002 and 2030, the global burden of self-inflicted injuries is expected to move up three places in the rank order of total DALYs worldwide [3].
Deliberate self-harm has been broadly defined as an act in which an individual deliberately inflicts harm upon themselves, but does not directly result in death [4]. The majority of self-harm cases survive [5], [6], [7], and examination of the outcomes of deliberate self-harm provides important insights into the burden of intentional injury. This can potentially inform clinical decision-making and health care planning for those injured by self-harm.
People who self-harm are at risk of further repeated self-harm and poor outcomes [8], [9], [10], [11], [12]. Their long-term outcomes, such as function and return to work, are largely unknown and have received very little research attention. The strongest evidence available are two birth cohort studies that suggested individuals who self-harm are subject to poor occupational outcomes and poor functioning [12], [13], however these studies provided evidence that was generalisable to self-harm in young people only. The outcomes of self-harm in a major trauma population have not previously been explored to the authors’ knowledge. The aims of this study were to describe the mortality, functional and return to work outcomes in the first two years after injury in a cohort of major trauma patients hospitalised for injuries resulting from deliberate self-harm.
Section snippets
Setting
The Victorian State Trauma Registry (VSTR) is a state-wide, population-based registry which captures information including demographics, cause and intent of injury, diagnoses and comorbidities of all hospitalised major trauma cases [14]. A case is included if any of the following criteria are met: (1) death after injury; (2) Injury Severity Score (ISS) > 12 based on the 2008 version of the Abbreviated Injury Scale; (3) admission to an Intensive Care Unit (ICU) for more than 24 h and requiring
Study population
There were 619 self-harm related major trauma patients captured by the VSTR during the study period. Of these, 482 (77.9%) individuals survived to hospital discharge. Most patients were male, belonged to the younger age groups and there was a high prevalence of psychiatric disorders, particularly mood disorders and alcohol use disorders (Table 1).
Responders vs non-responders
A responder was defined as a person who was successfully followed up i.e. had a valid GOS-E score at any of the follow-up time points. Overall,
Discussion
This study is one of the few studies, and to our knowledge the only population-based study, to describe functional and return to work outcomes of deliberate self-harm [23]. We have shown that most hospitalised self-harm major trauma patients who survived to discharge were alive two years post-injury. The proportion of post-discharge deaths (7.7%) was similar to that of the broader major trauma population (9.7%) [24]. In this cohort of self-harm patients, most were men and young to middle aged,
Conclusions
Overall, the majority of major trauma patients injured from deliberate self-harm who survived to hospital discharge were alive at two years post-injury. Two years following deliberate self-harm, two thirds of major trauma patients had not achieved a good recovery and almost half of patients had not returned to work. Older patients, patients with comorbidities and those who used transport-related methods were associated with poorer functional outcome. Patients with ISS > 24 were associated with
Conflict of interest
The authors report no conflicts of interest. No outside funding was received for this work.
Acknowledgements
The Victorian State Trauma Registry (VSTR) is funded by the Department of Health and Human Services, State Government of Victoria and the Transport Accident Commission. The funding source had no involvement in the preparation of the manuscript. Belinda Gabbe was supported by a National Health and Medical Research Council Career Development Fellowship (GNT1048731) during the preparation of this manuscript. The authors would like to acknowledge the project team: Mimi Morgan, Sue McLellan, Tani
References (47)
- et al.
Suicide following self-harm: findings from the multicentre study of self-harm in England, 2000–2012
J Affect Disord
(2015) - et al.
How do methods of non-fatal self-harm relate to eventual suicide
J Affect Disord
(2012) - et al.
Can repetition of deliberate self-harm be predicted? A prospective multicenter study validating clinical decision rules
J Affect Disord
(2013) - et al.
The Repeated Episodes of Self-Harm (RESH) score: a tool for predicting risk of future episodes of self-harm by hospital patients
J Affect Disord
(2014) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
What domains of the International Classification of Functioning, Disability and Health are covered by the most commonly used measurement instruments in traumatic brain injury research
Clin Neurol Neurosurg
(2012) - et al.
Twelve-month outcomes following surgical repair of the Achilles tendon
Injury
(2016) - et al.
The gender paradox in suicidal behavior and its impact on the suicidal process
J Affect Disord
(2012) - et al.
Sociodemographic and psychopathological risk factors in repeated suicide attempts: gender differences in a prospective study
J Affect Disord
(2012) - et al.
Six year follow-up of a clinical sample of self-harm patients
J Affect Disord
(2010)
The burden of disease and injury in Australia 2003.
The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013
Inj Prev
Projections of global mortality and burden of disease from 2002 to 2030
PLoS Med
Deliberate self harm in adolescents: self report survey in schools in England
BMJ
Mortality and suicide after self-harm: community cohort study in Taiwan
Br J Psychiatry
Fatal and non-fatal repetition of self-harm. Systematic review
Br J Psychiatry
Life events, social support, coping strategies, and quality of life in attempted suicide: a case-control study
Indian J Psychiatry
Suicide attempt in young people: a signal for long-term health care and social needs
JAMA Psychiatry
Clinical and social outcomes of adolescent self-harm: population based birth cohort study
BMJ
Developing Australia's first statewide trauma registry: what are the lessons
ANZ J Surg
Risk adjustment in outcome assessment: the Charlson comorbidity index
Methods Inf Med
Is the Charlson Comorbidity Index useful for predicting trauma outcomes
Acad Emerg Med
Cited by (7)
Deliberate self-harm and trauma – A descriptive analysis from a London major trauma centre
2023, InjuryCitation Excerpt :Currently, there are no key performance indicators for psychiatric care for those patients who are entered into the national Trauma Audit and Research Network (TARN) database. Studies from the United States and Australia have reported on risk factors of mortality in DSH patients [12,13]. Observational studies have demonstrated a high prevalence of depression, anxiety and post-traumatic stress symptoms in patients with trauma [13].
Are trauma surgical societies adequately addressing mental health after injury?
2022, Surgery (United States)Citation Excerpt :The studies examining interventions to improve mental health for these populations were rare. Underscoring the necessity to investigate mental health after trauma openly and comprehensively, we are coming to understand that trauma patients pose a unique and urgent challenge to limit revictimization during their recoveries.4,25,26 Prior literature demonstrates that survivors of traumatic injury carry an increased risk of developing mental health problems after injury.3,10–12,27,28
Association between gender and outcomes of acute burns patients
2021, ANZ Journal of SurgeryRoutine incorporation of longer-term patient-reported outcomes into a Dutch trauma registry
2019, Quality of Life ResearchInteractive Effect between On-Scene Hypoxia and Hypotension on Hospital Mortality and Disability in Severe Trauma
2018, Prehospital Emergency Care