The management of adolescents presenting to hospital for self-harm must be improved to reduce future suicide risk, according to the authors of a UK study published in The Lancet Child & Adolescent Health.
The study used data of 9173 individuals aged 10-18 years who presented to the emergency department of five study hospitals in Oxford, Manchester and Derby between 1 January 2000 and 31 December 2013 after non-fatal self-harm.
By 31 December 2015, 124 (1%) of the 9173 individuals had died. Approximately 44 per cent of deaths were due to suicide. Of the 9173 who presented with self-harm, 0.6 per cent ultimately died by suicide. More than three-quarters of 55 suicides occurred after age 18 years.
The 12-month incidence of suicide in this cohort was more than 30 times higher than in the general population of 10-18-year-olds in England (standardised mortality ratio, 31.0; 95% CI, 15.5-61.9).
Increased suicide risk was associated with male sex (adjusted HR [aHR], 2.50; 95% CI, 1.46-4.26); being older at presentation for self-harm (aHR, 1.82; 95% CI, 0.93-3.54); use of self-injury for self-harm (aHR, 2.11; 95% CI, 1.17-3.81), especially hanging or asphyxiation (aHR, 4.90; 95% CI, 1.47-16.39); and repeated self-harm (aHR, 1.87; 95% CI, 1.10-3.20).
The authors say the results highlight the importance of effective management of children and adolescents presenting with self-harm.
Careful psychosocial assessment is needed to identify factors that might indicate particular risk and to plan appropriate follow-up care, which should incorporate assessment for possible substance use, they say.
They add that clinicians should not assume that self-cutting indicates a lower risk for future suicide than other methods of self-harm.