Health service use in the year before and after self-harm hospital admission
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Introduction Quarterly health service use before and after self-harm hospitalisation Frequency of health services used in the year before and after intentional self-harm Leading principal diagnoses for hospitalisations and medication types dispensed to ex-serving members Mortality of self-harm hospitalised ex-serving membersAmong the 1,634 ex-serving ADF members who were hospitalised for intentional self-harm (the self-harm cohort) over the study period, 98.4% accessed at least one of the five in-scope health services in the year before the hospitalisation. A similar proportion (98.5%) accessed health services in the year after the self-harm hospitalisation. These proportions were significantly higher than the proportion among the 6,957 ex-serving members in the comparison cohort who accessed any health service in the year before (91.8%) and after (93.1%) admission.
The proportions of the self-harm cohort who accessed each health service were similar in the year before and year after the index self-harm event (see Table 1). However, the proportion who accessed admitted care was higher in the year after by 6.1 percentage points (up to 55.0%) and DVA-funded MBS equivalent services by 4.0 percentage points (up to 71.7%).
A significantly higher proportion of the self-harm cohort accessed each health service type compared with the comparison cohort in the year before and after admission (Table 1). The greatest differences between the self-harm cohort and the comparison cohort in the year after admission were for ED presentations (58.0% compared with 26.1%), admitted care (55.0% compared with 30.8%), DVA-funded MBS equivalent services (71.7% compared with 55.5%) and PBS/RPBS (referred to as PBS services throughout) services (94.4% compared with 78.0%).
Across the different MBS subservices analysed, GP services were accessed by the highest proportion of the self-harm cohort in the year after (85.9% compared with 82.8%), followed by allied health services (47.7% compared with 33.8%) and specialist health services (41.2% compared with 34.1%). Allied health services were the subservice with the highest relative access by the self-harm cohort compared with the comparison cohort.
| Health service | Year before (self-harm cohort) | Year after (self-harm cohort) | Year before (comparison cohort) | Year after (comparison cohort) |
|---|---|---|---|---|
Any health service | 98.4% | 98.5% | 91.8% | 93.1% |
MBS service | 91.3% | 91.0% | 85.9% | 87.3% |
PBS service | 92.2% | 94.4% | 73.4% | 78.0% |
DVA-funded MBS equivalent service | 67.7% | 71.7% | 53.4% | 55.5% |
ED presentation | 59.9% | 58.0% | 23.8% | 26.1% |
Admitted care | 48.9% | 55.0% | 28.7% | 30.8% |
Source: AIHW Veterans Health Dataset (VHD), July 2010–June 2020
Mental health services accessed by ex-serving members were identified based on mental health prescriptions dispensed under the PBS and RPBS, Medicare-subsidised mental health services, mental health ED presentations, and mental health hospitalisations (see Technical notes for the classifications). However, it is important to acknowledge that prescriptions for mental health (psychotropic) medications may not always be linked to a formal mental health diagnosis. Some medications may be used for other conditions, and the presence of a prescription alone does not necessarily indicate that a mental health condition was identified or treated.
The proportion of the self-harm cohort who used a mental health service was significantly higher relative to the comparison cohort and increased between the year before and year after self-harm admission (Figure 1). In the year before, 86.1% of the self-harm cohort accessed a mental health service, which increased to 91.8% in the year after. These proportions were well above the 37.0% and 38.8% of the comparison cohort who accessed a mental health service in the year before and after.
The greatest increase in the proportion of the self-harm cohort who accessed a mental health service in the year after was for DVA-funded MBS equivalent services (58.9% compared with 48.8%), MBS services (59.4% compared with 49.7%) and admitted care (31.0% compared with 24.8%) when compared with the year before self-harm admission.
The proportion of the self-harm cohort who accessed admitted care or presented to ED for mental health services was over 8 times the proportion of the comparison cohort in the year after (31.0% compared with 3.2% and 16.6% compared with 1.7% respectively). A significantly higher proportion of the self-harm cohort relative to the comparison cohort accessed a PBS service (86.0% compared with 33.2%), MBS service (59.4% compared with 15.0%) and DVA-funded MBS equivalent service (58.9% compared with 24.5%).
Figure 1: Proportion of ex-serving members who accessed a health service among those admitted to hospital for intentional self-harm and those who were admitted for non-injury related reasons in the year before and after admission
Bar chart showing the proportion of ex-serving members who accessed health service among those admitted for self-harm and those admitted for non-injury reasons in the year before and after admission.
Almost all the self-harm cohort accessed a non-mental health service (98%) in the year before and after, with this proportion significantly higher than the comparison cohort (92% before and 93% after). The greatest increase in the proportion of the self-harm cohort who accessed a non-mental health service in the year after was for admitted care (41% compared with 35%), DVA-funded MBS equivalent services (70% compared with 65%) and presentations to ED (44% compared with 40%) when compared with the year before self-harm admission (Figure 1).
Quarterly health service use before and after self-harm hospitalisation
This report presents the proportion of ex-serving members who accessed health services for each quarter in the year before and after admission for self-harm to identify patterns in service use. Quarterly information provides more detail on the timing of potential intervention prior to self-harm as well as when additional support is required after the self-harm event, noting that risk may not have been present or recognised at the time of contact prior to the admission.
The proportion of the self-harm cohort who accessed a health service was highest in the quarter before (92.4%) and after (94.1%) the self-harm admission (Figure 2). These proportions were higher than in the comparison cohort (75.3% and 76.7% respectively). For the comparison cohort, the proportion who accessed a health service gradually increased within the year before and after admission.
The highest proportion of the self-harm cohort accessing a mental health service and non-mental health service occurred in the quarter after self-harm admission. The proportion accessing mental health services in the quarter after was higher than (85% up from 75%) in the quarter before admission. Further, use in the quarter before admission was itself much higher than in the three preceding quarters (62–69%).
Among the self-harm cohort, use of each health service type increased in the quarters closest to the self-harm admission, and was highest in the quarter afterwards. The proportion of the self-harm cohort who accessed MBS services (from 72.4% to 77.7%) and admitted care services (from 20.0% to 24.8%) was also highest in the quarter before the index admission relative to other quarters. There was no increase in the comparison cohort in the same period.
Between the quarter before and after the index self-harm admission, the greatest increases in the proportion of the self-harm cohort who accessed health services were for allied health services (from 18.3% to 28.0%) and specialist services (from 20.9% to 25.6%). Figure 2 shows the patterns for each health service type.
Figure 2: Proportion of ex-serving members who accessed a health service by those admitted to hospital for intentional self-harm and those who were admitted for non-injury related reasons (comparison cohort) in each quarter in the year before and after admission
Line chart showing the proportion of ex-serving members accessing health services in each quarter in the year before and after hospital admission for self-harm or non-injury reasons.
Frequency of health services used in the year before and after intentional self-harm
The previous results outlined the proportion of ex-serving members who accessed health services. However, it is also important to understand the frequency of health service use for those that accessed health services. This report therefore examines the average annual number of services that were used per person by ex-serving members in the self-harm cohort and in the comparison cohort in the year before and after admission. The average annual number of services per person was calculated based on all ex-serving members in each cohort, not just those who used health services, to also consider the persons who did not access any services.
Ex-serving members in the self-harm cohort used twice as many health services on average, per person per year than those in the comparison cohort, in both the year before (90 services compared with 44) and after (107 services compared with 49) index admission (Table 2).
Ex-serving members in the self-harm cohort used a higher number of services per person across all service types in the year after compared with the year before self-harm admission, except for ED presentations which were steady. The greatest increased health service use per person in the year after was for DVA-funded MBS equivalent services (from 53 to 77), prescriptions supplied under the PBS/RPBS (from 33 to 38) and MBS services (from 35 to 38). There was a large relative increase of 40% in the use of admitted care (from 1.5 to 2.1) services.
In the year after, ex-serving members in the self-harm cohort used approximately twice or more the amount of each service type relative to the comparison cohort, but the largest relative differences were seen in the year after for:
- ED presentations (1.9 per person in self-harm cohort compared with 0.5 per person in the comparison cohort)
- admitted care (2.1 compared with 0.7)
- prescriptions supplied under the PBS/RPBS (38 compared with 17).
Across the different MBS subservices analysed, GP services were used the most by the self-harm cohort in the year after (11.7 compared with 6.3) followed by specialist services (4.0 compared with 1.2) and allied health services (2.3 compared with 0.9). Specialist services were the subservice with the highest relative use by ex-serving members in the self-harm cohort compared with the comparison cohort.
Health service | Year before (self-harm cohort) | Year after (self-harm cohort) | Year before (comparison cohort) | Year after (comparison cohort) |
|---|---|---|---|---|
Any health service | 90.2 | 107.7 | 44.4 | 49.3 |
MBS service | 34.7 | 38.4 | 18.9 | 19.7 |
PBS service | 33.0 | 37.5 | 14.9 | 16.9 |
DVA-funded MBS equivalent service | 53.4 | 77.0 | 33.5 | 39.6 |
ED presentation | 1.9 | 1.9 | 0.4 | 0.5 |
Admitted care | 1.5 | 2.1 | 0.6 | 0.7 |
Source: AIHW Veterans Health Dataset (VHD), July 2010–June 2020
Leading principal diagnoses for hospitalisations and medication types dispensed to ex-serving members
This section examines the most common reasons for hospitalisation in addition to the most frequently dispensed medication types among the self-harm and comparison cohort to identify key patterns in health service use. Comparing these factors may provide insight into the differing health burdens and treatment needs of each group, highlighting areas for targeted interventions and resource allocation.
The principal diagnosis is generally the main reason someone needed to be admitted to hospital. The top five most common principal diagnoses (at the International Classification of Diseases Chapter level) based on the number of hospitalisations are presented in Figure 3.
Mental and behavioural disorders was the most common principal diagnosis among ex-serving members in the self-harm cohort in the year before (46%) and after (52%) admission. This was followed by injury and poisoning and symptoms and signs, which includes symptoms such as abnormalities of heartbeat, abnormalities of breathing, chest pain, nausea and vomiting, headache, and convulsions (with the order varying based on year before and after). The comparison cohort had much lower proportions of admissions for mental and behavioural disorders (15% before and 16% after), with the most common reason for admission being for factors influencing health status which includes care involving dialysis, radiotherapy or chemotherapy (16% before and 18% after).
Medicines are organised into Anatomical Therapeutic Chemical (ATC) classification groups according to the body system or organ on which they primarily act. The five leading types of prescription medications dispensed is reported in Figure 3 using the ATC3 groups (pharmacological subgroup) based on the number of prescriptions dispensed.
Anti-depressants were the most common medication type dispensed to ex-serving members in the self-harm cohort in the year before (23%) and after (25%), followed by opioids, antipsychotics and anxiolytics. For people in the comparison cohort, anti-depressants were also the most common medication type dispensed although absolute proportions were lower (around 15%), while opioids were the second most common, followed by drugs for peptic ulcer and gastroesophageal reflux disease and lipid-modifying agents.
Figure 3: Top five principal diagnoses and medication types dispensed to ex-serving members admitted to hospital for intentional self-harm (self-harm cohort) and those who were admitted for non-injury related reasons (comparison cohort) in the year before and after admission
Chart showing the top 5 hospital diagnoses and top 5 medication types dispensed to ex-serving members in the year before and after admission for self-harm or non-injury reasons.
Mortality of self-harm hospitalised ex-serving members
Of ex-serving members hospitalised for self-harm in the study, 49 or 3.0% died from any cause within the year after the admission for self-harm. In comparison, 23 or 0.3% of the comparison cohort died from any cause in the year after hospitalisation. The mortality rate in the self-harm cohort was 9.2 times higher than in the comparison cohort (30.6 compared with 3.3 per 1,000 person-years).
To understand how much of the increased mortality may be associated with the self-harm event, AIHW calculated the attributable fraction (Mitchell and Cameron 2018). This metric estimates the proportion of deaths occurring among those in the self-harm cohort. In the year following admission, the attributable fraction was 89%, indicating that up to 89% of deaths in the self-harm cohort may be associated with the self-harm event. Further, within the self-harm cohort, 30 or 61% of the deaths were due to suicide, highlighting the risk of suicide-related mortality following hospitalisation for self-harm.