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Suicide risk high following deliberate self-harm

06 Aug 2017

It is common for adults treated for deliberate self-harm to repeat self-injury the following year, a recent study has found.

Additionally, there is a very high risk of suicide among patients who use a violent method, specifically firearms, for their self-harm. This is particularly true right after the initial event, which emphasizes the importance of careful assessment and close follow-up of this group.

To identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm, researchers followed for up to 1 year a national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (n=61,297).

The authors determined 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. Cox proportional hazard models were used to estimate hazard ratios (HRs) of repeat self-harm and suicide.

The respective rates of repeat self-harm and completed suicide were 263.2 per 1,000 person-years and 439.1 per 100,000 person-years during the 12 months after nonfatal self-harm. This is 37.2 times greater than in a matched general population cohort.

Compared with self-harm patients using nonviolent methods (HR, 7.5; 95 percent CI, 5.5 to 10.1), those using violent ones, especially firearms (HR, 15.86; 10.7 to 23.4; computed with poisoning as reference) had higher risk of suicide after initial self-harm events, and to a lesser extent after events of patients who had recently received outpatient mental healthcare (HR, 1.6; 1.2 to 2.0).

Furthermore, self-harm patients who used violent methods had significantly higher risk of suicide than those using nonviolent methods during the first 30 days after the initial event (HR, 17.5; 11.2 to 27.3), but not during the following 335 days.

Close follow-up of these patients is warranted, according to researchers.

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