Suicide Following Deliberate Self-Harm

Am J Psychiatry. 2017 Aug 1;174(8):765-774. doi: 10.1176/appi.ajp.2017.16111288. Epub 2017 Mar 21.


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.

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.

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.

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.

Keywords: Emergency Psychiatry; Epidemiology; Suicide.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Cause of Death
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mental Disorders / mortality
  • Mental Disorders / psychology
  • Middle Aged
  • Risk Factors
  • Self-Injurious Behavior / mortality
  • Self-Injurious Behavior / psychology*
  • Sex Factors
  • Statistics as Topic
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data
  • United States
  • Violence / psychology
  • Violence / statistics & numerical data
  • Young Adult