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Deliberate self-harm and trauma – A descriptive analysis from a London major trauma centre

Published:November 25, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.053

      Highlights

      • The psychiatric morbidity of injured patients presenting with deliberate self-harm (DSH) which is often overlooked as a cause of major trauma.
      • Timely review of patients with DSJ by liaison psychiatry is an essential part of patient care ensuring the appropriate level of care.
      • Raising awareness of patients with mental health needs across the pathway for the major trauma patients is crucial.

      Abstract

      Objectives

      The objective of this study is to present a retrospective analysis of patients presenting to a Major Trauma Centre (MTC) following deliberate self-harm (DSH) and identifying the precipitants of DSH and psychiatric morbidity that will serve to inform the provision of care for these patients.

      Patients and methods

      This was a retrospective observational study from a London Major Trauma Centre that identified all injured patients that presented with deliberate self-harm. Data was analysed from our established trauma database. The data was analysed using descriptive statistics.

      Results

      This included 347 patients of whom 253 were male and 94 were female. The median age was 36 (range 14–93) years. Penetrating injuries (shooting and stabbing) occurred in 187 (54%) patients and blunt injuries in 160 (46%) patients. Self-stabbing (52%) was the most common cause for presentation followed by jumping from a height (26%). The median Injury Severity Score (ISS) was 4 (range 1–9). The median LOS was 3 days (range 0–109), with a mean stay of 8 days. Over half of the patients (n = 189) had previous contact with mental health services. Social and mental health were the main triggers for DSH.

      Conclusions

      Societal and economic factors as well as a mental disorder are associated with trauma related DSH. These complex group of patients presenting to MTCs have not only acute surgical needs but social and psychological as well. Raising awareness of patients’ mental health needs across the whole pathway for the major trauma patient is crucial to ensure that appropriate risk assessments are undertaken at every stage. It is also essential to provide psychological support to the multi-disciplinary team for their wellbeing.

      Keywords

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