Premature death after self-harm: a multicentre cohort study

Bergen, Helen A.; Hawton, Keith; Waters, Keith; Ness, Jennifer; Cooper, Jayne; Steeg, Sarah; Kapur, Navneet

doi:10.1016/s0140-6736(12)61141-6

Cited by 265 publications

(190 citation statements)

References 25 publications

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“…[3][4][5][6][7][8][9][10][11] Finally, our design was further enhanced by having up to 20 matched comparison individuals for every person in the self-harm cohort to enable examination of mortality outcomes that are particularly rare in the general population, such as suicide.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Deprived populations have a higher incidence of self-harm, 1 and national incidence rates have risen in the wake of the economic downturn and subsequent austerity era. 2 A greatly reduced life expectancy and an elevated risk of early death have been reported among people who seek care at hospitals after self-harm in Australia, 3 Canada, 4 Denmark, 5 England, 6 Finland, 7 New Zealand, 8 Norway, 9 Sweden, 10 and Taiwan. 11 Very little is known, however, about the risk of death among primary care patients who have harmed themselves.…”

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confidence: 99%

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Premature Death Among Primary Care Patients With a History of Self-Harm

et al. 2017

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PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. During 2001During -2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice. METHODS RESULTSWe found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for allcause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide.CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches. Ann Fam Med 2017;15:246-254. https://doi.org/10.1370/afm.2054. INTRODUCTIONS elf-harm is a major public health problem. Deprived populations have a higher incidence of self-harm, 1 and national incidence rates have risen in the wake of the economic downturn and subsequent austerity era.2 A greatly reduced life expectancy and an elevated risk of early death have been reported among people who seek care at hospitals after self-harm in Australia, 3 (Self-Harm: Longer-Term Management, 2011), and was Chair of the NICE Self-harm, Quality Standard Topic Expert Group (2013) For the study reported here, we used electronic health data linked to national mortality records to investigate the risk of dying prematurely after selfharm in a large primary care cohort in England. By examining deaths from both unnatural and natural causes, our intention was to highlight the potential clinical and public health benefits of addressing the physical health as well as the psychosocial needs of these patients. We currently know very little about long-term mortality risk in this population because researcher...

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Section: Strengths and Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

Premature Death Among Primary Care Patients With a History of Self-Harm

et al. 2017

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“…I løpet av det første året er det mange som re-innlegges med rusrelaterte forgiftninger og nye selvmordsforsøk (Heyerdahl et al, 2009). Både kort-og langtidsprognosene er alvorlige, og det er en betydelig risiko for død av selvmord, men også av naturlige årsa-ker (Bergen et al, 2012;Bjornaas, Jacobsen, Haldorsen, & Ekeberg, 2009). Tilstrekkelig oppfølging og behandling av denne pasientgruppen etter utskrivelse fra sykehus er derfor viktig.…”

Section: Suicidologi Nr 3/2016unclassified

“…Det er allikevel et poeng som er viktig å ta med seg inn i den kliniske hverdagen, fordi sykelighet og dødelighet med bakgrunn i somatisk sykdom og livsstilsfaktorer i denne pasientgruppen er forhøyet (Bergen et al, 2012). I klinisk praksis innebaerer det for eksempel at behandlere ved psykiatriske avdelinger som for eksempel DPS også må identifisere livsstilsfaktorer knyttet til helserisiko og vurdere pasientene med tanke på deres somatiske helsetilstand for å forebygge og behandle.…”

Section: Diskusjonunclassified

Oppfølging og behandling etter selvpåført forgiftning

Grimholt¹

2017

Suicid.

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“…Tidligere selvmordsforsøk er en sterk prediktor for selvmord (Bergen et al, 2012), og det er rapportert at svaert mange av de som dør i selvmord har en psykiatrisk diagnose (Qin, 2011). Det har vaert mindre forskningsfokus på beskyttende faktorer, men sosial støtte er vist å vaere assosiert med redusert livstidsprevalens for selvmordsforsøk (Kleiman & Liu, 2013).…”

Section: Innledningunclassified