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J Clin Psychiatry. 2016 Feb;77(2):240-6. doi: 10.4088/JCP.14m09453.

Suicide risk after nonfatal self-harm: a national cohort study, 2000-2008.

Author information

1
Department of Clinical Neuroscience, Centre for Psychiatry Research. Stockholm, Sweden.

Abstract

OBJECTIVE:

To study the short-term risk of suicide after nonfatal deliberate self-harm and its association with coexisting mental disorders and with the method of self-harm used.

METHOD:

We used linked Swedish national registers to design a cohort study with 34,219 individuals (59% females) who were admitted to hospital in 2000-2005 after deliberate self-harm (ICD-10-defined). They were followed for 3-9 years. The studied outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Temporal patterns were plotted with Kaplan-Meier survival curves, calculated separately for each mental disorder and for the method used at the previous self-harm event.

RESULTS:

1,182 subjects committed suicide during follow-up (670 males and 512 females). Coexisting bipolar disorder (in males, adjusted HR = 6.3; 95% confidence interval [CI], 3.8-10.3; in females, adjusted HR = 5.8; 95% CI, 3.4-9.7) and nonorganic psychotic disorder (in males, adjusted HR = 5.1; 95% CI, 3.5-7.4; in females, adjusted HR = 4.6; 95% CI, 2.8-7.7) implied the highest risk of suicide after previous self-harm. Hanging as index self-harm method was a strong predictor of later suicide in both males (adjusted HR = 5.3; 95% CI, 4.0-7.0) and females (adjusted HR = 4.5; 95% CI, 2.5-8.1). Of those with bipolar disorder who used a method other than poisoning at the index event, 20.4% had already committed suicide after 3-9 years.

CONCLUSION:

Individuals with severe mental disorders (affective and psychotic disorders) have a poor prognosis in the first years after hospital admission due to self-harm. The risk of subsequent suicide is higher after attempts by hanging and other self-injury methods (vs self-poisoning). Aftercare for those with a self-harm episode should focus on treatment of the mental disorder present at the time of the episode.

PMID:
26301588
DOI:
10.4088/JCP.14m09453
[Indexed for MEDLINE]
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