Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital

TLDR

Deliberate self‑harm is the strongest risk factor for future suicide, yet up‑to‑date information on the extent of risk is lacking. The study investigates the risk of suicide after deliberate self‑harm over a long follow‑up period. The authors conducted a mortality follow‑up study of 11 583 deliberate self‑harm patients from 1978–1997, using hospital and national mortality registers, and identified 300 suicides or probable suicides. During follow‑up, suicide risk was 0.7 % in the first year (66 times the general population risk), rising to 3.0 % at 15 years, with markedly higher risk in men (HR 2.8) and increasing with age, underscoring the need to reduce suicide risk after deliberate self‑harm.

Abstract

Deliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking.To investigate the risk of suicide after DSH during a long follow-up period.A mortality follow-up study to 2000 was conducted on 11 583 patients who presented to hospital after DSH between 1978 and 1997. Data were obtained from a general hospital DSH register in Oxford and the Office for National Statistics, and from equivalent mortality registers in Scotland and Northern Ireland.Three hundred patients had died by suicide or probable suicide. The risk in the first year of follow-up was 0.7% (95% CI 0.6-0.9%), which was 66 (95% CI 52-82) times the annual risk of suicide in the general population. The risk after 5 years was 1.7%, at 10 years 2.4% and at 15 years 3.0%. The risk was far higher in men than in women (hazard ratio 2.8,95% CI 2.2-3.6). In both genders it increased markedly with age at initial presentation.Following DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.