Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort

Abstract

We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

Adolescent self‐harm with and without suicidality: cross‐sectional and longitudinal analyses of a Swedish regional register

“…In summary, despite the relatively short follow-up time, the results point toward a worse prognosis among those who present with SH or SU and substantially worse among those with SH+SU, which suggest that both SH and SU need to inform risk-assessment for several adverse outcomes. Previous studies show consistent and strong associations between self-harm, recurrent care due to self-harm (Beckman et al, 2016;Mars, Heron, Crane, Hawton, Kidger et al, 2014), and suicide attempts and/or completed suicide (Andover, Morris, Wren, & Bruzzese, 2012;Carr et al, 2017). Although we could not differentiate SH from suicide attempts in terms of outcome, the observed patterns in this study are similar in that SH of any kind was associated with an elevated risk of later recurrent care contact due to intentional self-injury (suicide attempts included).…”

“…Previous studies show consistent and strong associations between self‐harm, recurrent care due to self‐harm (Beckman et al., ; Mars, Heron, Crane, Hawton, Kidger et al., ), and suicide attempts and/or completed suicide (Andover, Morris, Wren, & Bruzzese, ; Carr et al., ). Although we could not differentiate SH from suicide attempts in terms of outcome, the observed patterns in this study are similar in that SH of any kind was associated with an elevated risk of later recurrent care contact due to intentional self‐injury (suicide attempts included).…”

“…For example, those with SH with suicidal intent have elevated odds of depression and anxiety, compared to those harming themselves without suicidal motives (Mars, Heron, Crane, Hawton, Kidger et al., ). SH with unclear intent has also been shown to be a risk factor of future suicide, affective and anxiety disorders, psychiatric inpatient care and psychotropic medication (Beckman et al., ), substance dependence (Beckman et al., ; Moran et al., ), violence (Sahlin et al., ), and labor market marginalization (Mars, Heron, Crane, Hawton, Lewis et al., ). To our best knowledge, there is only one longitudinal comparison between individuals with nonsuicidal and suicidal SH (Mars, Heron, Crane, Hawton, Lewis et al., ), showing that both groups were at increased risk of several adverse outcomes, but the suicidal SH group were generally at greater risk.…”

Method of self‐harm in adolescents and young adults and risk of subsequent suicide

“…Self-harm is an important risk factor for suicide in young people (Hawton, Saunders, & O'Connor, 2012). Indicators of a higher risk of suicide in young people who self-harm include male gender, previous self-harm, high suicide intent, mental disorders in general and psychotic disorders in particular, as well as family history of suicide (Beckman et al, 2016;Hawton & Harriss, 2007;Hawton, Bergen et al, 2012). Many young self-harm patients are initially treated in nonpsychiatric services (emergency rooms, medical, surgical and orthopaedic wards).…”

“…Violent methods might, therefore, perhaps indicate a higher suicidal intent in women compared to men. Furthermore, analytical models need to take into consideration known risk factors for a suicide following self-harm including repetition of selfharm; the presence of a mental disorder and a family history of suicide (Beckman et al, 2016;Hawton & Harriss, 2007;Hawton, Bergen et al, 2012). Low socioeconomic status might have an impact on suicidal behaviour in young people and should also be considered when analysing suicide risk (Burrows & Laflamme, 2010).…”