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

BACKGROUND Deliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking. AIMS To investigate the risk of suicide after DSH during a long follow-up period. METHOD 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. RESULTS 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. CONCLUSIONS 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.

[1]  J. Lönnqvist,et al.  Attempted suicide in Europe: rates, trend.S and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide , 1996, Acta psychiatrica Scandinavica.

[2]  J. Lönnqvist,et al.  Long‐term risk factors for suicide mortality after attempted suicide ‐ Findings of a 14‐year follow‐up study , 2001, Acta psychiatrica Scandinavica.

[3]  D. Duffy,et al.  The National Suicide Prevention Strategy for England , 2003 .

[4]  T. Rygnestad.  A prospective 5‐year follow‐up study of self‐poisoned patients , 1988, Acta psychiatrica Scandinavica.

[5]  Douglas G Altman,et al.  Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls , 2002, The Lancet.

[6]  A. House,et al.  Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study , 1998, BMJ.

[7]  M. Nordentoft,et al.  High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. , 1993, BMJ.

[8]  R. Jenkins,et al.  Trends in suicide deaths in England and Wales. , 1992 .

[9]  Rachel Jenkins,et al.  How are nations trying to prevent suicide? An analysis of national suicide prevention strategies , 1997, Acta psychiatrica Scandinavica.

[10]  M. Åsberg,et al.  Survival analysis of suicide risk after attempted suicide , 1995, Acta psychiatrica Scandinavica.

[11]  M. Goldacre,et al.  Reliability of routine hospital data on poisoning as measures of deliberate self poisoning in adolescents. , 1990, Journal of epidemiology and community health.

[12]  K. Schapira,et al.  Open verdict v. suicide – importance to research , 2001, British Journal of Psychiatry.

[13]  S Simkin,et al.  Trends in deliberate self-harm in Oxford, 1985–1995 , 1997, British Journal of Psychiatry.

[14]  K. Hawton,et al.  The International Handbook of Suicide and Attempted Suicide , 2002 .

[15]  K. Hawton,et al.  Suicide, and Other Causes of Death, Following Attempted Suicide , 1988, British Journal of Psychiatry.

[16]  Tx Station.  Stata Statistical Software: Release 7. , 2001 .

[17]  J. Lönnqvist,et al.  Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five‐year follow‐up , 1991, Acta psychiatrica Scandinavica.

[18]  R. McClelland,et al.  Mental disorders and suicide in Northern Ireland , 1997, British Journal of Psychiatry.