Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis

Abstract

ABSTRACT Objectives: This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. Design: A longitudinal whole-of-population record linkage study was conducted (2014–2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. Setting: Australia’s most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. Participants: Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. Intervention: CMH care within 14 days from index, versus not. Measurements: Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. Results: Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. Conclusions: CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.