Citation

Miller MC, Hempstead K, Nguyen T, Barber C, Rosenberg-Wohl S, Azrael DR. Am. J. Public Health 2013; 103(6): e61-8.

Affiliation

Matthew Miller, Catherine Barber, and Deborah Azrael are with the Department of Health Policy and Management, Injury Control Research Center, Harvard School of Public Health, Boston, MA. Katherine Hempstead is with the Rutgers Center for State Health Policy, Rutgers University, New Brunswick, NJ. Tuan Nguyen is with Department of Statistics and Biostatistics, Rutgers University At the time of the study, Sarah Rosenberg-Wohl was a student at Harvard College, Cambridge, MA.

Copyright

(Copyright © 2013, American Public Health Association)

DOI

10.2105/AJPH.2013.301326

PMID

23597351

Abstract

Objectives. We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide. Methods. We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers. Results. Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode. Conclusions. Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e8. doi:10.2105/AJPH.2013.301326).

Language: en