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Christina Lau, 23 Nov 2018

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Risk of suicide following nonfatal attempt high in adolescents, young adults

15 Apr 2018

Adolescents and young adults appear to have a significantly increased risk of suicide following nonfatal self-harm, a study reports. Among this high-risk population, those who have used violent self-harm methods, particularly firearms, are at especially greater risk.

Researchers followed a national cohort of patients (n=32,395) aged 12 to 24 years for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. They determined the incidence of repeat self-harm per 1,000 person-years and suicide deaths per 100,000 person-years.

The 12-month suicide standardized mortality rate ratio after self-harm was notably higher in adolescents than in young adults (46.0; 95 percent CI, 29.9–67.9 vs 19.2; 12.7–28.0). Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls.

On Cox proportional hazards models, the risk of suicide following self-harm was significantly higher in self-harm patients who initially used violent methods (hazard ratio [HR], 18.04; 9.92–32.80), especially firearms (HR, 35.73; 15.42–82.79), relative to those who used nonviolent self-harm methods.

The risk of repeat self-harm was elevated in women vs men (HR, 1.25; 1.18–1.33), patients with personality disorders (HR, 1.55; 1.42–1.69), and patients whose initial self-harm was treated in an inpatient setting (HR, 1.65; 1.49–1.83) vs an emergency department (HR, 0.62; 0.55–0.69) or outpatient setting (reference).

The present data highlight the importance of giving clinical priority to young people after self-harm to ensure their safety, researchers said. Follow-up care may include treating underlying psychiatric disorders, restricting access to lethal means, fortifying psychosocial support and close monitoring for emerging suicidal symptoms.

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