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Affiliation
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From the Research Unit and the Danish Research Institute for Suicide Prevention, Mental Health Center Copenhagen, Copenhagen; the Department of Clinical Medicine, University of Copenhagen, Copenhagen; the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore; and the Institute of Regional Health Research, University of Southern Denmark, Odense. |
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Abstract
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In this issue, Olfson et al. present data showing a 37-fold higher risk of suicide within the first year after nonfatal deliberate self-harm compared with the U.S. population (1). These alarming findings stem from a large national study based on Medicaid data from 45 states. The cohort consisted of 61,297 patients who were clinically diagnosed with deliberate self-harm between 2001 and 2007. Although the study is not likely to be representative of the entire U.S. population, it provides relevant observations that could help improve follow-up after deliberate self-harm.
Olfson et al. found that among persons who presented with nonfatal deliberate self-harm, the suicide rate was 439 per 100,000 person-years and the rate of repeated self-harm was 26,320 per 100,000 person-years over the following 12 months. In absolute terms, this means that 0.4% died by suicide and 19.7% repeated deliberate self-harm within a year of the initial presentation. The high proportion of suicides is confirmed by recent findings from Sweden, where 4.9% of people with deliberate self-harm died by suicide within a median follow-up of 5.3 years (2). Nationwide Danish studies have found that between 0.9% and 1.2% of people presenting with deliberate self-harm had died by suicide within 12 months, and an international meta-analysis reported a proportion of 1.6% (95% CI=1.2, 2.1) (3–5). Nonfatal repetitions were reported to range between 11.8% and 12.2% in the Danish studies, and the meta-analysis reported a repeat deliberate self-harm rate of 16.3% (95% CI=15.1, 17.7) (4). In comparison, in the Olfson et al. study, a slightly lower 12-month postdischarge suicide rate was reported, but also a slightly higher rate of repeat deliberate self-harm.
As in previous studies (6), elevated risks of both suicide and repeat deliberate self-harm were found across all types of mental disorders among patients after deliberate self-harm. Considering that 20% repeat deliberate self-harm during the first year, the need for effective treatment irrespective of psychiatric diagnosis is evident. Psychotherapeutic or psychosocial treatment administered to patients with deliberate self-harm may reduce the risk of suicide and repeated nonfatal deliberate self-harm (5), as indicated by a recent Cochrane review (7). The World Health Organization recommends that patients presenting with deliberate self-harm be offered mental health care (8). However, as Olfson et al. highlighted, those who did not survive their initial deliberate self-harm episode were less likely to have received treatment for a mental disorder (whether inpatient or outpatient) compared with those who died of suicide later in the follow-up. They were also more likely to have used a violent method. Hence, the window of opportunity for intervening is smaller for this particular group of patients. In this group, only 41% had received mental health treatment during the 6 months before the initial fatal self-harm. Recent mental health care is a well-established marker of risk of suicidal behavior (9). In particular, the period shortly after discharge from an inpatient unit is linked to excess risk, and it may be crucial to ease transitions between care facility and home ...
Language: en |