@article{ref1,
title="Association between deliberate self-harm and violent criminality",
journal="JAMA Psychiatry",
year="2017",
author="Sahlin, Hanna and Kuja-Halkola, Ralf and Bjureberg, Johan and Lichtenstein, Paul and Molero, Yasmina and Rydell, Mina and Hedman, Erik and Runeson, Bo and Jokinen, Jussi and Ljótsson, Brjánn and Hellner, Clara",
volume="74",
number="6",
pages="615-621",
abstract="Importance:  Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. Objective:  To investigate the association between nonfatal self-harm and violent crime.  Design, Setting, and Participants:  This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, <2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016.  Exposures:  Receipt of self-harm-associated clinical care.  Main Outcomes and Measures:  Conviction of a violent crime according to the Swedish penal code.  Results:  The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9).  Conclusions and Relevance:  Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.<p /> <p>Language: en</p>",
language="en",
issn="2168-622X",
doi="10.1001/jamapsychiatry.2017.0338",
url="http://dx.doi.org/10.1001/jamapsychiatry.2017.0338"
}