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Am J Psychiatry. 2017 Aug 1;174(8):765-774. doi: 10.1176/appi.ajp.2017.16111288. Epub 2017 Mar 21.

Suicide Following Deliberate Self-Harm.

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From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York; the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers, State University of New Jersey, New Brunswick; the Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, N.J.; and the Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Md.



The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm.


A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.


During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days.


Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.


Emergency Psychiatry; Epidemiology; Suicide

[Indexed for MEDLINE]

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