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The association between domestic violence and self harm in emergency medicine patients

Aims: This study compared rates of self harm among victims of domestic assault presenting to an emergency department (ED) with those rates among other ED patients. It also explored the temporal and numeric relation between domestic assaults and self harm. Methods: A retrospective matched cohort study was conducted using the medical records of a single ED. The cases were patients who had presented to the ED as a consequence of domestic assault. Two control groups matched for age, sex, and Cambridge postcode were randomly generated from the ED patient list. The second control group cases were also matched for postcode sector as a surrogate approximate for socioeconomic status in addition to age and sex. Cases and controls were followed up between November 1996 and 1 October 2004 documenting the number and timing of episodes of self harm reported in the study period. Results: Altogether, 294 cases and 558 controls were followed up. Patients suffering domestic assault were more likely to present with self harm than controls (RR 3.6 95% CI 2.1–6.5). This effect appeared to be independent of deprivation. Patients suffering domestic assault had more ED contacts than controls. There was a moderate correlation between the number of episodes of self harm and number of assaults (Spearman’s rho 0.3 p<0.001). Socioeconomic status was a poor predictor of self harm. Emergency physicians should consider asking about suicidal ideation in victims of domestic assault.