There is a higher risk of self-harm or suicide admissions following discharge from inpatient psychiatric care (IPC), particularly in the first few days and weeks after discharge. Similarly, children and adolescents who admit to emergency departments following discharge from IPC often experience worse outcomes than those with emergency department visits for other reasons. However, the evidence on how children access other healthcare including general practice and the trends related to those who present to emergency services and readmit due to self-harm, suicide and other mental health purposes remains sparse. Given the ever-changing environments and influences (pervasive social media) newer data are needed to assess whether the planned support at discharge in this vulnerable group is meeting their needs.
This epidemiological analysis involves data on NHS-patient anonymised electronic records in England. Firstly, we will measure the risk of self-harm or attempt at suicide, during the year after leaving a IPC. Secondly, we will measure the risks of admitting to emergency services for any mental illness or substance abuse related purpose after 1-year of being discharging from a IPC. In both assessments children who have been discharged will be compared to children from the general population with the same sex, age, and GP practice to see whether the relative risks are different. This analysis will help to better understand the risks of self-harm and suicide in youngsters and the associated trends that demographic, health-related and social predictors can have in those who present to emergency services.
Analysis 1 is a matched cohort study aiming to estimate the absolute and relative risk of self-harm or attempts of suicide of children/adolescents (19 years or below) in the first year after discharge from a IPC in England compared with the matched general population. Cumulative incidence will be calculated for children discharged for the first time between 1st of January 2001 and 30th June 2023 and for a general population comparison cohort matched on youth age, sex and registered general practice. Hazard ratios comparing risks between the two groups will be calculated using Cox proportional hazards models at different time points within the first year. This type of analysis has been previously used by our group on a project assessing suicide and mortality outcomes in all age groups (ISAC protocol 20_038).
Analysis 2 is a matched cohort study which will assess the risks of admission to emergency services for any mental illness or substance abuse related purpose after 1 year of being discharging from a IPC. Hazard ratios comparing risks of admission to emergency service and the general population will be calculated using Cox proportional hazards or more flexible random-effects parametric survival models.
In both analyses, we will assess the association that demographic characteristics, illness and treatments and social predictors have with those who present to hospital or emergency services due to self-harm or attempted suicide.
In addition, as a sensitivity analysis we will also assess readmissions for self-harm and suicide and admission to emergency services at 1-, 2-, 3- and 6-months following discharge.
Research findings aim to inform health service planning, influencing NICE guidance and the NHS Long-Term Plan. The goal is to support expanded access to community-based mental health services, establish new services in underserved areas, and increase overall investment in children and young people's mental health.
Primary outcomes:
Analysis 1 First occurrence of self-harm or suicide after 1 year of being discharged from IPC.
Analysis 2 First admission to emergency services for any mental illness or substance related abuse, after 1 year of being discharged from IPC.
Secondary (exploratory) outcomes: Readmissions at 1, 2, 3 and 6 months due to self-harm, suicide or emergency services due to mental illness; Mortality; primary care clinical contacts; outpatient visits.
Alexander Hodkinson - Chief Investigator - University of Manchester
Alexander Hodkinson - Corresponding Applicant - University of Manchester
Carolyn Chew-Graham - Collaborator - Keele University
Darren Ashcroft - Collaborator - University of Manchester
Evangelos Kontopantelis - Collaborator - University of Manchester
Maria Panagioti - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Navneet Kapur - Collaborator - University of Manchester
Rebecca Musgrove - Collaborator - NHS England
Roger Webb - Collaborator - University of Manchester
Shruti Garg - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation