Deliberate self-harm before psychiatric admission and risk of suicide: survival in a Danish national cohort

Soc Psychiatry Psychiatr Epidemiol. 2013 Sep;48(9):1481-9. doi: 10.1007/s00127-013-0690-2. Epub 2013 Apr 23.


Purpose: Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15% of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high-risk cohort consisting of hospitalized psychiatric patients with recent DSH.

Methods: This national prospective register-based study examined all hospitalized psychiatric patients who self-harmed within a year before admission. All admitted patients, in the time period 1998-2006, were followed and survival analyses techniques were used to identify predictors of suicide.

Results: The study population consisted of 17,257 patients; 520 (3%) died by suicide during follow-up; 50% of the suicides occurred within a year from the index admission. A rate of 1,645 suicides per 100,000 person-years in the first year after psychiatric admission was found. Adjusted analyses showed that a higher degree of education, having DSH within a month before psychiatric admission and contact with a private psychiatrist increased the risk of suicide.

Conclusions: Psychiatric hospitalized patients with recent DSH revealed high suicide rates, even during hospitalization. When discharging psychiatric patients with recent DSH careful arrangement of follow-up treatment in the outpatient setting is recommendable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Denmark / epidemiology
  • Female
  • Hospitals, Psychiatric / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Patient Admission / statistics & numerical data*
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Sex Factors
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • Survival Analysis
  • Time Factors
  • Violence