Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?
(English)Manuscript (preprint) (Other academic)
We aimed to test two hypotheses: 1. There is a higher proportion of suicides among those who have been admitted for self-harm compared with controls from the general population. 2. There is higher risk for suicide among cases with somatic inpatient admissions before self-harm than among cases with no such admissions.
For this nested case-control study we selected 16,235 cases with a first admission for self-harm during the period 1999–2009, at which time they were 16-24 years old. Next, 32,465 controls – matched for sex, age and home municipality – were randomly selected from the Total Population Register. From the Swedish National Inpatient Register, we registered all admissions and diagnoses from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study (end of 2013) and diagnoses from the Cause of Death Register for all deceased was noted. Group differences were analysed using survival analysis with death by suicide as primary outcome.
A higher proportion of cases (4.5%; women 2.6%, men 8.8%) died during the study period than controls (0.3%; women 0.2%, men 0.6%) (p<0.001). During the year before cases’ first admission for self-harm 6.0% of the cases and 2.3% of the controls had somatic admissions. For both cases and controls, a higher proportion of those with a previous somatic admission died from suicide during the study period than those without a somatic admission (cases: 4.2% vs. 2.8%, p<0.05). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.
This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people. At the same time their contact with healthcare due to their physical problems should provide an excellent opportunity to screen for psychiatric problems and risk for suicide.
Young people, Self-harm, Case-control, Register study, Somatic disorders, Suicide risk
Research subject Psychiatry
IdentifiersURN: urn:nbn:se:umu:diva-120696OAI: oai:DiVA.org:umu-120696DiVA: diva2:929435