People who present to the hospital for self-harm should be provided with early follow-up care and risk reduction strategies, according to the authors of a new study published in the Lancet Psychiatry, which found that the risk of suicide for these patients was 163.1 per 100,000 person-years.
The findings, from the ongoing Multicentre Study of Self-harm in England, are based on data from 90,614 self-harm episodes involving individuals aged ≥15 years who attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm. Over 16 years of follow-up, 703 patients died by suicide.
The incidence of suicide was 260.0 per 100,000 person-years in men and 94.6 per 100,000 person-years in women. Men were three times more likely than women to die by suicide after self-harm (OR, 3.36; 95% CI 2.77-4.08; P<.0001>
The incidence of suicide was highest in the year after discharge (511.1 per 100,000 person-years), particularly in the first month (1787.1 per 100,000 person-years).
Presentations involving both self-injury and self-poisoning were associated with higher suicide risk than self-poisoning alone (adjusted OR, 2.06; 95% CI 1.42-2.99; P<.0001 attempted hanging or asphyxiation and traffic-related acts were associated with a greater risk of suicide than self-poisoning alone.>
Those living in the least deprived areas had a greater risk of dying by suicide after adjusting for sex, age, previous self-harm and psychiatric treatment. The authors say the reasons for this finding merit further research.
The authors say the findings underscore the need for effective clinical management for all patients, which should include both a comprehensive assessment of the patients’ mental state, needs and risks, together with implementation of risk reduction strategies, including safety planning.