The timing of acts of deliberate self-harm: is there any relation with suicidal intent, mental disorder or psychiatric management?

Objective: To investigate the common perception that more serious suicide a ttempts tend to occur earlier in the day. Methods: Prospective study of 158 adults referred for psychiatric assessment from the general hospital follo wing an episode of deliberate self-harm. The main outcome measures used wer e Beck's Suicide Intent score, ICD-10 psychiatric diagnosis, alcohol consum ption at the time of the attempt, and follow-up decision recorded by the in terviewing duty psychiatrist. The patient also completed a checklist of cur rent precipitating problems. Results: A marked circadian variation in timin g of the act was found, peaking between 2200 and 2400 h. "Early" acts (0300 -1459 h) were significantly less likely to involve alcohol consumption, mor e likely to lead to admission to a medical ward, and involved more patient- identified problems than "late" acts. People who took overdoses early in th e day were more likely to have concerns about their own mental health. Comp ared to earlier acts of self-harm, late evening (2200-2359 h) cases were le ss likely to be diagnosed as depressed or offered psychiatric follow up. No relation was found between time of day of self-harm and Beck's Suicide Int ent score. Conclusions: Implications arise regarding clinical risk assessme nt and current staffing levels in the accident and emergency department. Th e interviewing psychiatrist could concentrate on excluding depression and t eaching problem solving to those who self-harm in the morning or afternoon, and on the detection and treatment of alcohol dependence for late evening cases. (C) 2000 Elsevier Science Inc. All rights reserved.