Wednesday, March 22, 2017

Suicide Risk After Violent Attempt Found to Be Highest Within First 30 Days

An article published yesterday in AJP in Advance suggests that people who survive violent self-harm events, particularly those involving self-inflicted firearm injuries, are at the greatest risk of suicide in the 30 days following an initial self-harm event. 

“Adults who present for treatment after a deliberate self-harm event offer opportunities for suicide prevention,” Mark Olfson, M.D., M.P.H., and colleagues wrote. “[C]linical priority should be given to developing and implementing prompt interventions that help ensure the safety of these high-risk patients during this high-risk period.”

For the study, Olfson and colleagues extracted Medicaid data on adults aged 18 to 64 with clinical diagnoses of deliberate self-harm (n=61,297). The self-harm cohort was followed forward from the index date for 365 days, date of death from any cause, or end of available data, whichever came first. A total of 243 deaths by suicide took place during the follow-up period.

The researchers reported that during the first year following the index self-harm event, the suicide rate for the follow-up cohort was 439.1 per 100,000 person-years—37 times greater than the suicide rate of the U.S. general population (11.8 per 100,000 person-years). Additional analysis revealed that self-harm patients who survived previous violent self-harm events as well as those who were male and older were at an elevated risk of suicide. Self-harm patients who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event compared with those who used nonviolent methods (hazard ratio=17.5, 95%; CI=11.2–27.3), but not during the following 335 days.

“This risk pattern supports concerted efforts to protect patients who attempt suicide by highly lethal methods during the acute period after the self-harm event. During periods of extremely high risk, inpatient admission may facilitate crisis work, intensive supervision, and implementation of complex interventions, and it can help ensure patient safety,” the authors wrote. “For patients who own firearms or live in homes with firearms, distributing trigger locks and urging family members to temporarily store household firearms away from the patient’s home can be a lifesaving intervention.”

For related information, see the Psychiatric News article “Firearms and Suicide: Risk Assessment and Management” and The Return on Investment of Postdischarge Follow-Up Calls for Suicidal Ideation or Deliberate Self-Harm.

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