Premature death after self-harm: a multicentre cohort study (original) (raw)
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Premature Death Among Primary Care Patients With a History of Self-Harm
Annals of family medicine, 2017
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 2001-2013, 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. We 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...
Six year follow-up of a clinical sample of self-harm patients
Journal of Affective Disorders, 2010
Background: Mortality from suicide and other causes is significantly increased in patients who engage in self-harm, but their long-term morbidity and quality of life are poorly defined. As the majority of self-harm patients are under the age of 35 years, understanding their longer term health outcomes is important if we are to adequately manage their care. The aim of this study was to investigate the long-term mortality, morbidity and quality of life of such patients. Method: A representative cohort of patients who had presented to hospital following an episode of self-harm was traced after 6 years. Mortality and repetition of self-harm were primary outcome measures. Psychiatric morbidity and indices of quality of life, and social functioning were also obtained. Results: 143/150 (95.3%) patients were traced after a mean of 6.2 years. Eight (5.6%) had died during follow-up, significantly more than general population estimates (p ≤ 0.001), four of these (2.8%) by probable suicide. Further self-harm occurred in 58/101 (57.4%) participants; 70/ 97 (72.2%) fulfilled criteria for at least one psychiatric disorder, and 51.3% screened positive for harmful use of alcohol. Measures of health status (EQ-5D and SF36-II) were significantly lower (p b 0.001) than in the general population. Limitations: Due to the nature of this population group the attrition rate at 6 years is high; although this is the most complete such study to date. Conclusion: Despite positive outcomes in some patients, overall levels of mortality, morbidity, and harmful use of alcohol are high, whilst quality of life is reported as low. This has significant implications for the long-term management of this group.
Self-harm in Oxford, England: epidemiological and clinical trends, 1996–2010
Social Psychiatry and Psychiatric Epidemiology, 2014
Background Self-harm is a major healthcare problem and changes in its prevalence and characteristics can have important implications for clinical services, treatment and prevention. Methods We analysed data on all self-harm presentations to the general hospital in Oxford between 1996 and 2010 using the Oxford Monitoring System for Self-harm. We investigated trends in prevalence, methods and repetition of self-harm, and receipt of psychosocial assessment. For patients receiving a psychosocial assessment, we investigated trends in alcohol use and misuse, prior psychiatric treatment and self-harm, problems, and suicidal intent. Results Rates of self-harm rose in both genders between 1996 and 2002/2003, after which they declined. There was evidence of a possible cohort effect, whereby higher rates in younger males in earlier years transferred over time to older age groups. Self-cutting, hanging and jumping became more common. Paracetamol was involved in 44.9 % of all selfpoisoning episodes. Overdoses of antidepressants (particularly selective serotonin reuptake inhibitors) increased, as did those of mood stabilisers, non-opiate analgesics excluding paracetamol (e.g. non-steroidal anti-inflammatory drugs), and non-ingestible poisons. Alcohol use in relation to self-harm and alcohol-related problems became more common, as did history of prior psychiatric treatment and, especially, of self-harm, and employment problems from 2008. Despite national guidance, the proportion of patients undergoing psychosocial assessment declined. Conclusions Major changes in the extent and nature of self-harm occurred over the study period, some suggestive of increased psychopathology and others reflecting prescribing practices and changes in drinking patterns. The findings emphasise the need for psychosocial assessment following self-harm, to identify treatment needs and reduce repetition.
Management of patients presenting with self-harm
British journal of hospital medicine (London, England : 2005), 2016
including the URL of the record and the reason for the withdrawal request. Highlights We investigated self-harm in 12-25 year olds attending the emergency department A striking excess of females in younger patients had receded by young adulthood Physical severity of self-harm and the use of self-injury increased with age Repeat self-harm was more likely among the younger people in the sample The youngest people were more likely to receive adequate assessment and aftercare
The Lancet Psychiatry, 2019
Background Self-harm is the strongest risk factor for subsequent suicide, but risk may vary. We compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and variations in area-level socioeconomic deprivation, and estimated the incidence of suicide by time after hospital attendance. Methods In this ongoing Multicentre Study of Self-harm in England, the study population consists of individuals aged at least 15 years who had attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Information on method of self-harm was obtained through systematic monitoring in hospitals. Level of socioeconomic deprivation was based on the Index of Multiple Deprivation (IMD) characterising the area where patients lived, grouping them according to IMD quintiles. Mortality follow-up was up to Dec 31, 2015, resulting in up to 16 years of follow-up. We calculated incidence of suicide since first hospital presentation by follow-up period and estimated the association between individual factors (age, gender, method of self-harm, IMD, and number of non-fatal self-harm presentations to hospital) and suicide using mixed-effect models.
The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001–2013
BMC Psychiatry, 2016
Background: Most of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings. Little is known about the frequency of self-harm in primary care patient populations. This is the first study to describe the epidemiology of self-harm presentations to primary care using broadly representative national data from across the United Kingdom (UK). Methods: Using the Clinical Practice Research Datalink (CPRD), we calculated directly standardised rates of incidence and annual presentation during 2001-2013. Rates were compared by gender and age and across the nations of the UK, and also by degree of socioeconomic deprivation measured ecologically at general practice level. Results: We found significantly elevated rates in females vs. males for incidence (rate ratio-RR, 1.45, 95 % confidence interval-CI, 1.42-1.47) and for annual presentation (RR 1.56, CI 1.54-1.58). An increasing trend over time in incidence was apparent for males (P < 0.001) but not females (P = 0.08), and both genders exhibited rising temporal trends in presentation rates (P < 0.001). We observed a decreasing gradient of risk with increasing age and markedly elevated risk for females in the youngest age group (aged 15-24 years vs. all other females: RR 3.75, CI 3.67-3.83). Increasing presentation rates over time were observed for males across all age bands (P < 0.001). We found higher rates when comparing Northern Ireland, Scotland, and Wales with England, and increasing rates of presentation over time for all four nations. We also observed higher rates with increasing levels of deprivation-most vs. least deprived male patients: RR 2.17, CI 2.10-2.25. Conclusions: Incorporating data from primary care yields a more comprehensive quantification of the health burden of self-harm. These novel findings may be useful in informing public health programmes and the targeting of high-risk groups toward the ultimate goal of lowering risk of self-harm repetition and premature death in this population.
Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design
Australian & New Zealand Journal of Psychiatry, 2017
Objective: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. Method: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. Results: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 week...
General hospital services for those who carry out deliberate self-harm
Psychiatric Bulletin, 1998
self-harm General hospital services for those who carry out deliberate permissions Reprints/ permissions@rcpsych.ac.uk to To obtain reprints or permission to reproduce material from this paper, please write to this article at You can respond http://pb.rcpsych.org/cgi/eletter-submit/22/2/88 from Downloaded The Royal College of Psychiatrists Published by on July 21, 2011 http://pb.rcpsych.org/ http://pb.rcpsych.org/site/subscriptions/ go to: The Psychiatrist To subscribe to ORIGINAL PAPERS
BMJ open, 2016
Rates of hospital presentation for self-harm in England were compared using different national and local data sources. The study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data. Local area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES). Rate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources. The total number of self-harm episodes between 2010 and 2012 was 13 547 based on Multicentre Study data, 9600 based on HES emergency department data...