@article{ref1,
title="Suicide following deliberate self-harm",
journal="American journal of psychiatry",
year="2017",
author="Olfson, Mark and Wall, Melanie and Wang, Shuai and Crystal, Stephen and Gerhard, Tobias and Blanco, Carlos",
volume="174",
number="8",
pages="765-774",
abstract="OBJECTIVE: The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. <br><br>METHOD: A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models. <br><br>RESULTS: During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days. <br><br>CONCLUSIONS: Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.<p /> <p>Language: en</p>",
language="en",
issn="0002-953X",
doi="10.1176/appi.ajp.2017.16111288",
url="http://dx.doi.org/10.1176/appi.ajp.2017.16111288"
}