Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services

Background: Variation in number, characteristics and management of deliberate self-harm (DSH) patients presenting to hospital during the 24-h cycle and day of the week may have implications for patient services. We have investigated how patient characteristics and clinical management of DSH episodes vary according to hour and day of presentation. Methods: Time of presentation was studied in 5348 DSH patients who presented to a general hospital following 9101 episodes during a 6-year period. Patient characteristics were identified through routine clinical monitoring. Results: Presentations varied markedly during the 24-h cycle, ranging from a peak between 8 pin and 3 am (average hourly rate of 6.6% of all episodes) to a low between 4 am and 10 am (1.4%). The majority (72.0%) occurred outside office hours. DSH associated with alcohol use and interpersonal problems was more frequent during the late evening or night, and at the weekend. A greater proportion of daytime presentations involved high suicide intent (although a larger number of high intent acts presented at other times), and more were admitted and assessed. Limitations: This study was based on DSH presentations to one hospital. Time and date of presentation and of psychosocial assessment, not time of DSH, were available for analysis. Conclusions: Peak times for DSH presentations are at night and the weekend, suggesting that specialist DSH services in general hospitals should be available 24 h a day, 7 days a week. Time of presentation should not be used as a proxy measure of suicide intent. (c) 2006 Elsevier B.V. All rights reserved.