Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder

BMJ Ment Health. 2023 Jun;26(1):e300758. doi: 10.1136/bmjment-2023-300758.


Background: Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown.

Objective: To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders.

Methods: By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments.

Findings: A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals.

Conclusions: Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders.

Clinical implications: Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.

Keywords: Depression & mood disorders; Schizophrenia & psychotic disorders; Suicide & self-harm.

MeSH terms

  • Bipolar Disorder*
  • Brain Injuries, Traumatic* / epidemiology
  • Humans
  • Mental Disorders* / epidemiology
  • Precipitating Factors
  • Self-Injurious Behavior* / epidemiology