• Shannon M Fernando, Michael Pugliese, Daniel I McIsaac, Danial Qureshi, Robert Talarico, Manish M Sood, Daniel T Myran, Margaret S Herridge, Dale M Needham, Laveena Munshi, Bram Rochwerg, Kirsten M Fiest, Christina Milani, Magdalena Kisilewicz, O Joseph Bienvenu, Daniel Brodie, Eddy Fan, Robert A Fowler, Niall D Ferguson, Damon C Scales, Hannah Wunsch, Peter Tanuseputro, and Kwadwo Kyeremanteng.
• Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada. Electronic address: sfernando@qmed.ca.
• Chest. 2023 Apr 1; 163 (4): 815825815-825.

BackgroundPatients surviving an ICU admission for deliberate self-harm are at high risk of recurrent self-harm or suicide after discharge. It is unknown whether mental health follow-up after discharge (with either a family physician or psychiatrist) reduces this risk.Research QuestionWhat is the association between mental health follow-up after discharge and recurrent self-harm among patients admitted to the ICU for intentional self-harm?Study Design And MethodsPopulation-based cohort study of consecutive adults (≥ 18 years of age) from Ontario, Canada, who were admitted to ICU because of intentional self-harm between 2009 and 2017. We categorized patients according to follow-up, with 'early follow-up' indicating 1 to 21 days after discharge, 'late follow-up' indicating 22 to 60 days after discharge, and 'no follow-up' indicating no follow-up within 60 days of discharge. We conducted analyses using a cause-specific extended Cox regression model to account for varying time for mental health follow-up relative to the outcomes of interest. The primary outcome was recurrent ICU admission for self-harm within 1 year of discharge.ResultsWe included 9,569 consecutive adults admitted to the ICU for deliberate self-harm. Compared with receiving no mental health follow-up, both early follow-up (hazard ratio [HR], 1.37; 95% CI, 1.07-1.75) and late follow-up (HR, 1.69; 95% CI, 1.22-2.35) were associated with increased risk in recurrent ICU admission for self-harm. As compared with no follow-up, neither early follow-up (HR, 1.10; 95% CI, 0.70-1.73) nor late follow-up (HR, 1.54; 95% CI, 0.84-2.83) were associated with increased risk of death by suicide.InterpreationAmong adults admitted to the ICU for deliberate self-harm, mental health follow-up after discharge was not associated with reduced risk of recurrent ICU admission for self-harm or death resulting from suicide, and patients seeking outpatient follow-up may be those at highest risk of these outcomes. Future research should focus on additional and novel methods of risk mitigation in this vulnerable population.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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