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Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden

  • D. Tidemalm (a1), K. Beckman (a1), M. Dahlin (a1), M. Vaez (a2), P. Lichtenstein (a3), N. Långström (a3) and B. Runeson (a1)...
Abstract
Background.

Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm.

Method.

The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990–1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9–19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome.

Results.

The 1-year HR for suicide among younger males (10–19 years) was 14.6 [95% confidence interval (CI) 4.1–51.9] for violent method and 8.4 (95% CI 1.8–40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8–5.4) for males and 10.4 (95% CI 8.3–13.0) for females. HRs for repeated self-harm during years 2–9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0–7.8; females: HR 3.7, 95% CI 2.1–6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year.

Conclusions.

Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.

Copyright
Corresponding author
* Address for correspondence: Dr D. Tidemalm, Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Vårdvägen 1, St. Göran, SE-112 81 Stockholm, Sweden. (Email: dag.tidemalm@ki.se)
References
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Bergen, H, Hawton, K, Waters, K, Ness, J, Cooper, J, Steeg, S, Kapur, N (2012). How do methods of non-fatal self-harm relate to eventual suicide? Journal of Affective Disorders 136, 526533.
Charlton, J (1995). Trends and patterns in suicide in England and Wales. International Journal of Epidemiology 24 (Suppl. 1), S45S52.
Christiansen, E, Jensen, BF (2007). Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: a register-based survival analysis. Australian & New Zealand Journal of Psychiatry 41, 257265.
Cooper, J, Kapur, N, Webb, R, Lawlor, M, Guthrie, E, Mackway-Jones, K, Appleby, L (2005). Suicide after deliberate self-harm: a 4-year cohort study. American Journal of Psychiatry 162, 297303.
De Moore, GM, Robertson, AR (1996). Suicide in the 18 years after deliberate self-harm a prospective study. British Journal of Psychiatry 169, 489494.
Draper, B (1996). Attempted suicide in old age. International Journal of Geriatric Psychiatry 11, 577587.
Frierson, RL (1991). Suicide attempts by the old and the very old. Archives of Internal Medicine 151, 141144.
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205228.
Haukka, J, Suominen, K, Partonen, T, Lönnqvist, J (2008). Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996–2003. American Journal of Epidemiology 167, 11551163.
Hawton, K, Fagg, J (1988). Suicide, and other causes of death, following attempted suicide. British Journal of Psychiatry 152, 359366.
Hawton, K, Fagg, J, Simkin, S, Harriss, L, Malmberg, A (1998). Methods used for suicide by farmers in England and Wales. The contribution of availability and its relevance to prevention. British Journal of Psychiatry 173, 320324.
Hawton, K, Harriss, L (2006). Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. International Journal of Geriatric Psychiatry 21, 572581.
Hawton, K, Harriss, L (2008). How often does deliberate self-harm occur relative to each suicide? A study of variations by gender and age. Suicide and Life-Threatening Behavior 38, 650660.
Hawton, K, Saunders, KE, O'Connor, RC (2012). Self-harm and suicide in adolescents. Lancet 379, 23732382.
Hawton, K, Zahl, D, Weatherall, R (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry 182, 537542.
Jenkins, GR, Hale, R, Papanastassiou, M, Crawford, MJ, Tyrer, P (2002). Suicide rate 22 years after parasuicide: cohort study. British Medical Journal 325, 1155.
Linsley, KR, Schapira, K, Kelly, TP (2001). Open verdict v. suicide – importance to research. British Journal of Psychiatry 178, 465468.
Ludvigsson, JF, Otterblad-Olausson, P, Pettersson, BU, Ekbom, A (2009). The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. European Journal of Epidemiology 24, 659667.
Murphy, E, Kapur, N, Webb, R, Purandare, N, Hawton, K, Bergen, H, Waters, K, Cooper, J (2011). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry 200, 399404.
National Board of Health and Welfare (2010). Causes of death, 2008.
Neeleman, J, Wessely, S (1997). Changes in classification of suicide in England and Wales: time trends and associations with coroners’ professional backgrounds. Psychological Medicine 27, 467472.
Nordentoft, M, Breum, L, Munck, LK, Nordestgaard, AG, Hunding, A, Laursen Bjaeldager, PA (1993). High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. British Medical Journal 306, 16371641.
Nordström, P, Samuelsson, M, Åsberg, M (1995). Survival analysis of suicide risk after attempted suicide. Acta Psychiatrica Scandinavica 91, 336340.
Owens, D, Horrocks, J, House, A (2002). Fatal and non-fatal repetition of self-harm. Systematic review. British Journal of Psychiatry 181, 193199.
Patton, GC, Coffey, C, Sawyer, SM, Viner, RM, Haller, DM, Bose, K, Vos, T, Ferguson, J, Mathers, CD (2009). Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 374, 881892.
Runeson, B, Tidemalm, D, Dahlin, M, Lichtenstein, P, Långström, N (2010). Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. British Medical Journal 341, c3222.
Rygnestad, T (1988). A prospective 5-year follow-up study of self-poisoned patients. Acta Psychiatrica Scandinavica 77, 328331.
Sahai, H, Khurshid, A (1996). Statistics in Epidemiology: Methods, Techniques, and Applications. CRC Press: Boca Raton.
Skogman, K, Alsén, M, Öjehagen, A (2004). Sex differences in risk factors for suicide after attempted suicide – a follow-up study of 1052 suicide attempters. Social Psychiatry and Psychiatric Epidemiology 39, 113120.
Suokas, J, Lönnqvist, J (1991). Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five-year follow-up. Acta Psychiatrica Scandinavica 84, 545549.
Suokas, J, Suominen, K, Isometsa, E, Ostamo, A, Lonnqvist, J (2001). Long-term risk factors for suicide mortality after attempted suicide – findings of a 14-year follow-up study. Acta Psychiatrica Scandinavica 104, 117121.
Suominen, K, Isometsä, E, Suokas, J, Haukka, J, Achte, K, Lönnqvist, J (2004). Completed suicide after a suicide attempt: a 37-year follow-up study. American Journal of Psychiatry 161, 562563.
Tejedor, MC, Diaz, A, Castillon, JJ, Pericay, JM (1999). Attempted suicide: repetition and survival – findings of a follow-up study. Acta Psychiatrica Scandinavica 100, 205211.
Tidemalm, D, Långström, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, a2205.
WHO (2013). (http://www.who.int/mental_health/prevention/suicide_rates/en/). World Health Organization.
Zahl, DL, Hawton, K (2004). Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. British Journal of Psychiatry 185, 7075.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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