We read with great interest the Article by Yi Chai and colleagues1 in The Lancet Psychiatry, in which the authors investigated the risk of self-harm after diagnosis of psychiatric disorders in Hong Kong over the period 2000–10. The study focused on the incidence of self-harm in groups diagnosed with different psychiatric disorders and the subsequent risk of self-harm associated with each disorder. Variation in risk was also assessed across subgroups stratified by gender and age. Significant differences in self-harm incidence were identified between cases and controls in all diagnostic groups, with the greatest difference in the substance misuse or dependence group, and the smallest difference in the anxiety disorders group. We would like to discuss several aspects of the study that could have influenced these findings. First, in their inclusion criteria, the authors do not state the reason for using the ICD-9 diagnostic criteria for each disorder, and not the more recent ICD-10 classifications, which were already in place at the time of study initiation. Second, the reason for including only six comorbid physical disorders in their analysis, and no other physical disorders associated with risk of self-harm, is not clear. The available literature shows that a wide range of physical disorders are associated with a markedly increased risk of self-harm.3 Third, whether the diagnosis was made by a mental health professional or a general physician is not clear. Variance in the specialty of clinicians making the diagnoses would have influenced the prevalence of the psychiatric disorders of interest and the subsequent findings of the study ...
Language: en
LA - en SN - 2215-0374 UR - http://dx.doi.org/10.1016/S2215-0366(20)30088-2 ID - ref1 ER -