Results of a long-term follow-up study of suicide after self-harm, published in the Lancet Psychiatry, found that the period immediately after hospital presentation may be an important time for intervention.
Galit Geulayov, PhD, from the Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, United Kingdom, and colleagues conducted a multicenter study of individuals older than 15 years who presented at an emergency department in England after nonfatal self-harm from January 1, 2000 to December 31, 2013. The researchers also performed a mortality follow-up through 2015 and gathered information on method of self-harm, socioeconomic deprivation, and demographic factors, which were entered into regression models.
During the study period, 90,614 relevant presentations were made to hospitals involving 49,783 individuals with full information, and 703 patients died by suicide. Per 100,000 person-years, the incidence of suicide was 163.1. In the year after hospital discharge for nonfatal self-harm, suicide was 55.5 times higher than in the general population, and represented 35.9% of all suicides in the sample.
Self-poisoning and self-injury accounted for 80% and 25% of presentations, respectively. Although 64.9% of deaths by suicide were a result of self-injury, mainly hanging or asphyxiation, 35.1% corresponded to self-poisoning, chiefly with psychotropic drugs, sedatives, narcotics, or psychodysleptics. In adjusted analyses, greater risk for suicide was associated with self-harm by self-injury vs self-poisoning (adjusted odds ratio [OR], 1.36; P =.007), particularly for hanging, asphyxiation, or traffic-related acts, but not for self-cutting.
Compared with women, men were 3 times more likely to die by suicide after self-harm (OR, 3.36; 95% CI, 2.77-4.08; P <.0001). For every 1-year increase in age at presentation, there was a corresponding 3% increase in risk for suicide (OR, 1.03; P <.0001).
At the time of self-harm presentations, 42.5% of patients were living in areas characterized by high levels of socioeconomic deprivation. Those in the least-deprived areas (adjusted OR, 1.76; P <.0001) or the second least-deprived areas (adjusted OR, 1.64; P =.002) had a greater risk of dying by suicide compared with their counterparts in the most deprived areas.
Overall, the study confirmed prior findings related to self-harm acts and risk for suicide. However, the researchers were perplexed by their finding that those in the least socioeconomically deprived areas were at greater risk of dying by suicide, which contradicts the literature showing that “socioeconomic deprivation is positively related to risk of self-harm and suicide.”
Study limitations included the reliance on area data of socioeconomic deprivation, rather than data on an individual level, as well as a lack of mortality data beyond 2015.
The researchers wrote, “Presentation to hospital for self-harm offers an opportunity for intervention.” They concluded, “Awareness of characteristics which increase the risk of subsequent suicide, including male gender, older age, method of self-harm, and area of residence can assist in understanding risk of suicide as part of a comprehensive assessment after an episode of self-harm.”
Geulayov G, Casy D, Bale L. Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study [published online November 6, 2019]. Lancet. doi:10.1016/52215-0366(19)30402-X.