Tuesday, March 20, 2018

Survivors of Self-Harm at High Risk of Repeat, Suicide Over Following Year

Teenagers and young adults who deliberately hurt themselves are at markedly increased risk of suicide within one year, especially if the original self-harm incident involved violent methods such as using firearms, according to a report published Monday in Pediatrics.

According to lead author Mark Olfson, M.D., M.P.H. (pictured left), and colleagues, the results speak to the need for urgent clinical attention to young people who self-harm. “Clinical priority should be given to ensuring the safety of young people after self-harm, which may include treating underlying psychiatric disorders, restricting access to lethal means, fortifying psychosocial supports, and close monitoring for emerging suicidal symptoms,” they wrote.

Olfson and colleagues analyzed a cohort of 32,395 Medicaid patients aged 12 to 24 who had been diagnosed with deliberate self-harm. The cohort was followed from their index self-harm until the end of a 365-day follow-up period, date of death, or end of available data, whichever came first. The primary outcomes of interest were repeat, nonfatal self-harm and suicide.

Within a year after the initial self-harming incident, teenagers and young adults were at 26.7 times higher risk of suicide than those in the general population matched for age, sex, or race and/or ethnicity. Approximately 17% of the self-harm patients (n=5,545) had another incident of non-fatal self-harm during the follow-up year.

For self-harm patients who initially used firearms, the risk of suicide during the following year was 35 times greater than for those who harmed themselves by nonviolent means. Additionally, the odds of suicide were more than five times higher for American Indian and Alaskan native patients than for white non-Hispanic patients.

“For high-risk young people with access to firearms, distributing trigger locks and urging family members to store firearms away from the patient’s home can be a lifesaving precautionary measure,” Olfson and colleagues wrote.

For more information on self-harm, see the Psychiatric News article “Upping Our Game to Prevent Suicide,” by APA President Anita Everett, M.D., and the Psychiatric Services article “Denial of Suicide Attempt Among Hospitalized Survivors of a Self-Inflicted Gunshot Wound.”



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