Mortality risk following self‐harm in young people: a population cohort study using the Northern Ireland Registry of Self‐Harm

Abstract

Background Self‐harm is a recognised predictor of suicide and is most common in those aged under 25 years. The aims of this study were to describe the characteristics of young people who present with self‐harm; quantify the risk of suicide and other causes of death during follow up, and to identify factors associated with mortality risk. Methods The Northern Ireland Registry of Self‐Harm (NIRSH) is a national registry capturing complete data on all presentations made to the 12 Emergency Departments (EDs) in Northern Ireland (NI). Data relating to self‐harm presentations registered in the NIRSH between 2012 and 2015 were linked to primary care registrations and death records up until 31st December 2018. Logistic regression was employed to examine the factors associated with self‐harm. Cox regression was used to estimate mortality risk following self‐harm and explore the associated risk factors. Results The cohort consisted of 390,740 individuals aged 10–24 years registered with a General Practitioner (GP) in NI. During follow‐up, 4,450 individuals presented with self‐harm. Rates of self‐harm were highest in females, those aged 20–24 years (ORadj = 3.53, 95% CI 3.28–3.80, p < .001), and in the most deprived areas (ORadj = 2.71, 95% CI 2.45–2.99, p < .001). Thirty five individuals who presented with self‐harm died by suicide, accounting for 23% of all suicide deaths in the cohort. Suicide risk was increased 19‐fold in those who presented with self‐harm after adjustment for age, sex and area‐level factors (HRadj = 19.00, 95% CI 12.80–28.21, p < .001). Increased suicide risk was observed in males (HRadj = 2.04, 95% CI 0.99–4.23, p = .05) and those using more violent methods of self‐injury (HRadj = 3.89, 95% CI 1.65–9.13, p < .001). Conclusions Young people who self‐harm are at a significantly greater risk of suicide. Almost a quarter of young people who died by suicide in NI had presented to EDs with self‐harm, highlighting that the ED may provide a nodal point of intervention among a typically hard to identify and reach population.

Cohort profile: The Social media, smartphone use and Self-harm in Young People (3S-YP) study–A prospective, observational cohort study of young people in contact with mental health services

“…In our cohort, we observed high rates of historical self-harm in both self-and clinicianrecorded data. The rates are considerably higher compared to community studies-which have reported aggregate lifetime risk of self-harm in young people between 11.0-17.0% globally [41] -although there is substantial variation in the literature owing to methodological differences between studies [41][42][43][44]. In clinical populations with known mental health problems, it is unsurprising that these risks are higher [45].…”

The relationship between childhood maltreatment and self-harm: the mediating roles of alexithymia, dissociation, internalizing and posttraumatic symptoms

“…Risk factors for self-harm include low socio-economic status, female gender, sexual orientation (LGBT), a history of childhood maltreatment, family history of suicide, bullying, impulsivity, low self-esteem, and mental disorder (Knipe et al, 2022 ; Nock, 2014 ; Stänicke et al, 2024 ). Self-harm is often accompanied by several mental illnesses, and is known to be a risk factor for suicidality (Klonsky et al, 2013 ; Ross et al, 2023 ; Tuisku et al, 2014 ). Particularly, it has been reported that self-harm is related to a wide range of mental disorders such as mood disorders (e.g.…”

Age of first self-harm act in childhood and adolescence: A scoping review protocol

“…Self-harm in childhood and adolescence is a concerning public health phenomenon associated with an increased risk of psychological distress, future self-harm ( Mars et al, 2014 ) and dying by suicide ( Hawton et al, 2020 ; Ross et al, 2023 ). Self-harm is defined in this review as ‘an act with non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour, that without intervention from others will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes that the person desires via the actual or expected physical consequences’ ( Schmidtke et al, 1996 ).…”