Suicide Risk After Nonfatal Self-Harm

Runeson, Bo; Haglund, Axel; Lichtenstein, Paul; Tidemalm, Dag

doi:10.4088/jcp.14m09453

Cited by 113 publications

(80 citation statements)

References 28 publications

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“…This distinction between violent method and poisoning is established in previous research1729. It is also supported by research showing that the risk of subsequent suicide is significantly lower after poisoning when compared with other methods1213. Information regarding outcome was extracted from the patient’s electronic medical records.…”

Section: Methodsmentioning

confidence: 84%

“…For men we found no significant association, but the number of men with violent reattempts was small, limiting the statistical power. Violent methods are associated with higher immediate lethality17 and elevated risk of later suicide1213, probably to a certain extent because it indicates a stronger suicidal intention. In large epidemiological studies of suicide attempters, women tend to choose violent methods more seldom than men1213, in contrast with our present result.…”

Section: Discussionmentioning

confidence: 99%

“…Violent methods are associated with higher immediate lethality17 and elevated risk of later suicide1213, probably to a certain extent because it indicates a stronger suicidal intention. In large epidemiological studies of suicide attempters, women tend to choose violent methods more seldom than men1213, in contrast with our present result. An important methodological difference that partly may explain this is that we in our clinical sample excluded self-harmers without suicide intent, something that cannot be done in larger epidemiological studies based on data relying on ICD-10 codes, which do not differentiate between non-suicidal self-harm and suicide attempt.…”

Section: Discussionmentioning

confidence: 99%

“…Young age and female gender influence the risk of repetition891011. Coexisting severe psychiatric disorder and violent method used at an initial attempt indicate higher risk of a subsequent suicide31213. A repeat attempt further elevates the risk of suicide mortality1415.…”

mentioning

confidence: 99%

“…Violent methods such as using firearms, hanging and jumping from a height are associated with higher immediate lethality of an attempt17 as well as elevated risk of future suicide1213. Further, violent methods are less common than poisonings and have been shown to be associated with higher levels of reported lifetime aggression18.…”

mentioning

confidence: 99%

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Interpersonal violence and the prediction of short-term risk of repeat suicide attempt

Haglund

Lindh

Lysell

et al. 2016

Sci Rep

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In this multi-center cohort study, suicide attempters presenting to hospital (N = 355, 63% women) were interviewed using the Karolinska Interpersonal Violence Scale (KIVS) and followed-up by medical record review. Main outcome was non-fatal or fatal repeat suicide attempt within six months. Also, repeat attempt using a violent method was used as an additional outcome in separate analyses. Data were analyzed for the total group and for men and women separately. Repeat attempts were observed within six months in 78 persons (22%) and 21 (6%) of these used a violent method. KIVS total score of 6 or more was associated with repeat suicide attempt within six months (OR = 1.81, CI 1.08–3.02) and predicted new attempts with a sensitivity of 62% and a specificity of 53%. A three-fold increase in odds ratio was observed for repeat attempt using a violent method (OR = 3.40, CI 1.22–9.49). An association between exposure to violence in adulthood and violent reattempt was seen in women (OR = 1.38, CI 1.06–1.82). The overall conclusions are that information about interpersonal violence may help predict short-term risk for repeat suicide attempt, and that structured assessment of interpersonal violence may be of value in risk assessment after attempted suicide.

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Section: Methodsmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Interpersonal violence and the prediction of short-term risk of repeat suicide attempt

Haglund

Lindh

Lysell

et al. 2016

Sci Rep

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Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

Mortier,

Conde,

Alayo

et al. 2024

JAMA Netw Open

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ImportanceThere is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization.ObjectiveTo compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization.Design, Setting, and ParticipantsThis retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024.ExposuresSocioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations.Main Outcomes and MeasuresPostdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted.ResultsA total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males).Conclusions and RelevanceIn this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.

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