Patient and care setting characteristics related to adverse events of self-harm, suicide attempt and suicide: a Danish nationwide study

Patients dying by suicide while receiving healthcare services contradicts patient safety and is considered an adverse event (AE) - an unintended event during any part of the patient’s care process, not limited to e.g., adverse drug reactions, and results in preventable harm. This study examined potential relationships between patient and care setting characteristics and AE reports of self-harm, suicide attempts and suicide, overall and by sex. We used Chi-square Independence Test to analyse relationships between patient and care setting characteristics and AEs of self-harm and suicidal behaviour reported to the Danish Patient Safety Database from January 1st, 2022, to December 31st, 2022. AEs of self-harm were reported more from assisted living facilities, and suicide attempts and suicide were reported more from hospitals. Distinct patterns were found between males and females. AEs of self-harm was overrepresented among females in the age group 10–25 and males in the age group 26–50, while suicide was more frequent in the age group 51–90 for both sexes. Suicide attempts among females, and suicide among males and females occurred more often away from the reporting facility. The information and level of details in the AEs varied greatly, with a large lack of sufficient information from the free-text fields describing the AE. Future initiatives should be targeted at improving patient safety at assisted living facilities, as well as during agreed leave, absconding and discharge from hospitals. Lastly, a more thoroughly reporting of AEs, e.g., by adding checkboxes tailored to the specific types of AEs, might generate knowledge that could improve patient safety.