ArticlesPremature death after self-harm: a multicentre cohort study
Introduction
People who self-harm have an increased risk of premature death: studies from the 1980s showed that risk of suicide was 25 times greater, accidental death seven times higher, and death from natural causes two times greater in individuals who self-harm than in the general population.1 Subsequent studies2, 3, 4, 5, 6, 7 established that all-cause and natural-cause mortality was increased in people who self-harm, although estimates varied widely across countries, perhaps due to differences in suicide or self-harm rates, periods investigated, and sample characteristics. Both self-harm8, 9 and suicide10 are associated with socioeconomic status. Yet, as far as we are aware only one study11 has investigated the association between socioeconomic deprivation and suicide after self-harm, and none has examined deprivation in relation to all-cause or natural-cause mortality after self-harm. The scarcity of data is surprising in view of the profound effect of deprivation on mortality in the general population10 and on premature mortality in the UK.12
Researchers have argued that studies of the association between premature mortality and psychological disorders should include all causes of death,13 and that primary prevention of suicide should focus on overall improvement of health by targeting vulnerabilities that increase risk of natural death.1 Physical health problems are often poorly treated in people with mental disorders, leading to reduced life expectancy.14, 15 As well as being at high risk for suicide, most patients who self-harm have psychiatric disorders.16, 17 It is important to know the extent of physical health problems in this population, and the study of mortality after self-harm is one approach. Patients' characteristics and health risk behaviour could inform clinical practice in relation to management of physical disorders in the context of self-harm.
The aims of this study were to investigate excess all-cause and cause-specific mortality and years of life lost (YLL) in individuals who self-harm compared with the general population. Additionally, we hoped to identify associations between mortality and socioeconomic deprivation and between problems with alcohol, illicit drugs, and physical health identified at the time of self-harm and subsequent mortality.
Section snippets
Study design and participants
A cohort study was undertaken in Oxford, Manchester, and Derby, UK, where centres are taking part in the Multicentre Study of Self-harm in England.18 Data were obtained for all individuals who presented with non-fatal self-harm to one general hospital emergency department in Oxford, three in Manchester, and two in Derby between Jan 1, 2000, and Dec 31, 2007. Non-fatal self-harm was defined as intentional self-poisoning or self-injury, irrespective of motivation.19 The sample,20 risks of suicide
Results
30 950 individuals presented with self-harm to the six hospitals and were followed up for a median of 6·0 years (IQR 3·9–7·9). 748 (2·4%) individuals were not traced by the MRIS, 29 (0·1%) were younger than 15 years at the end of follow-up, and 41 (0·1%) were of unknown age and so were excluded from the analyses. Of the remaining 30 132 individuals, 17 671 (58·6%) were female and 12 444 (41·3%) were male (17 individuals were of unknown sex). Age distributions by sex and centre are presented in
Discussion
We have shown that individuals who presented to emergency departments after self-harm between 2000 and 2007 had a greater risk of death from any cause than did the general population. Roughly 6% of our cohort died, many prematurely, such that at least 30 years of life was lost by each individual. Deaths were not only due to external causes—as might be expected in view of the high suicide risk in this population2, 3—but also to natural causes. These findings are higher than estimates of a loss
References (33)
- et al.
Predictors of suicide, accidental death, and premature natural death in a general-population birth cohort
Lancet
(1998) A continuum of premature death: meta-analysis of competing mortality in the psychosocially vulnerable
Int J Epidemiol
(2001)- et al.
Deaths from all causes in a long-term follow-up study of 11,583 deliberate self harm patients
Psychol Med
(2006) - et al.
All-cause mortality after non-fatal self-poisoning: a cohort study
Soc Psychiatry Psychiatr Epidemiol
(2011) - et al.
Non-suicidal deaths following hospital-treated self-poisoning
Aust N Z J Psychiatry
(2005) - et al.
Excess mortality of suicide attempters
Soc Psychiatry Psychiatr Epidemiol
(2001) - et al.
Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia
Aust N Z J Psychiatry
(2004) - et al.
Suicide, and other causes of death, following attempted suicide
Br J Psychiatry
(1988) - et al.
Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered
Soc Psychiatry Psychiatr Epidemiol
(2001) - et al.
Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation
BMJ
(1995)
Mortality by deprivation and cause of death in England and Wales, 1999–2003
Health Stat Q
Thirteen-year follow-up of deliberate self-harm, using linked data
Br J Psychiatry
Inequalities in premature mortality in Britain: observational study from 1921 to 2007
BMJ
Physical health disparities and mental illness: the scandal of premature mortality
Br J Psychiatry
Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders
Br J Psychiatry
Psychiatric and personality disorders in deliberate self-harm patients
Br J Psychiatry
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