Direct costs of hospital care of self-harm: A national register-based cohort study.

OBJECTIVE: To estimate national direct hospital costs associated with treatment of self-harm and to analyse whether costs differ with respect to demographic and clinical characteristics. METHODS: A cohort design was applied to register data on all people living in Denmark (5.8 million inhabitants) from Jan 1, 2012 to Dec 31, 2016. Self-harm presentations at all hospitals by persons aged 10 years and older were included. Total costs and costs related to somatic and psychiatric care and treatment setting (inpatient, emergency department and outpatient) were calculated (in US dollars). The association between specific characteristics and somatic inpatient costs was analysed adjusted using generalized linear models and expressed as Odds Ratios (OR). RESULTS: In all, 42,634 (97.3%) self-harm presentations by 30,366 persons were included. Annual somatic and psychiatric costs amounted to $25,241,518 and $34,696,388, respectively, and the median cost per episode was $2248 (IQR: $1553-$4138). Predictors of high somatic inpatient costs were: admission to intensive care (OR = 15.6; 95% CI, 13.7-17.9), particularly dangerous methods of self-harm, such as being hit by moving objects (OR = 6.5; 95% CI, 2.7-15.7) and shooting (OR = 6.0; 95% CI, 3.4-10.7), and age ≥75 years (OR = 1.8; 95% CI, 1.5-2.2). A small group of persons (0.7%) with ≥10 presentations accounted for 8.2% of somatic and 15.3% of total hospital costs. CONCLUSION: Substantial hospital costs were noted for inpatient treatment. Although one-time presenters accounted for the major share of costs, smaller patient groups accounted for considerable shares. Hospital costs of self-harm should be included in evaluation of initiatives for prevention and treatment.

Joinpoint regression analysis of suicides in Denmark during 1980-2015.

INTRODUCTION: Major advances have been achieved in suicide prevention over the past decades. Effective suicide prevention requires vigilant monitoring of suicide trends. The aim of this study was to assess the change in the Danish suicide rate over time using joinpoint regression analysis and to examine the distribution of suicide methods in the 1980-2015 period. METHODS: Nationwide register data were obtained from the Central Research Register and the Danish Cause of Death Register. Rates were calculated per 100,000 persons by gender and agegroup. Joinpoint regression analysis was used to assess changes over time in the overall suicide rate. RESULTS: The suicide rate declined from 40.4 (95% confidence interval (CI): 38.4-42.3) in 1980 to 11.9 (95% CI: 10.9-12.9) in 2015. A significant reduction ranging between 2 and 6% was observed during 1980-1999 after which the decrease was modest. The rate was higher for men than for women (rate ratio 1.9; 95% CI: 1.7-2.1), and more so by the end of the period (rate ratio = 2.4; 95% CI: 1.9-2.8). The suicide rate was found to increase with increasing age. Hanging, poisoning and shooting were the most frequent methods for men, whereas poisoning followed by hanging and drowning were the most frequent methods for women. CONCLUSIONS: The suicide rate fell sharply between 1980 and 1999 in Denmark, but since then the decrease has been modest, especially since 2007. Further reduction in the suicide rate requires new and effective measures. FUNDING: none. TRIAL REGISTRATION: not relevant.