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Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study

  • Chi-Leung Kwok (a1), Paul S. F. Yip (a1), David Gunnell (a2), Chian-Jue Kuo (a3) and Ying-Yeh Chen (a4)...

Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia.


To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan.


Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004–December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm.


In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7–10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05–1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm.


The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.

Corresponding author
Dr Ying-Yeh Chen, 309 Songde Road, Taipei City Psychiatric Center, XinYi District, Taipei, Taiwan. Email:
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The study was supported by Department of Health, Taipei City Government. The funding agency has no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. Y-Y.C. was supported by the National Science Council, Taiwan (grant number 101-2314-B-532-005-MY2) and the National Health Research Institute, Taiwan (grant number NHRI-EX100-10024PC). C-L.K. and P.S.F.Y. were supported by a GRF grant of Research Grant Council (HKU-784210).

Declaration of interest


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1 Owens, D, Horrocks, J, House, A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 2002; 181: 193–9.
2 Arensman, E, Corcoran, P, Fitzgerald, AP. Deliberate self-harm: extent of the problem and prediction of repetition. In International Handbook of Suicide Prevention: Research, Policy and Practice (eds O'Connor, RC, Platt, S, Gordon, J): 119–32. Wiley-Blackwell, 2011.
3 Windfuhr, K, Kapur, N. International perspectives on the epidemiology and aetiology of suicide and self-harm. In International Handbook of Suicide Prevention: Research, Policy and Practice (eds O'Connor, RC, Platt, S, Gordon, J): 2758. Wiley-Blackwell, 2011.
4 Yip, PSF, Chen, YY, Yousuf, S, Lee, CK, Kawano, K, Routley, V, et al. Towards a reassessment of the role of divorce in suicide outcomes: evidence from five Pacific Rim populations. Soc Sci Med 2012; 75: 358–66.
5 Yip, PSF. Towards evidence-based suicide prevention programs. Crisis 2011; 32: 117–20.
6 Mohamed, F, Perera, A, Wijayaweera, K, Kularatne, K, Jayamanne, S, Eddleston, M, et al. The prevalence of previous self-harm amongst self-poisoning patients in Sri Lanka. Soc Psychiatry Psychiatr Epidemiol 2011; 46: 517–20.
7 Chen, VCH, Tan, HKL, Cheng, ATA, Chen, C-Y, Liao, L-R, Stewart, R, et al. Non-fatal repetition of self-harm: population-based prospective cohort study in Taiwan. Br J Psychiatry 2010; 196: 31–5.
8 Bertolote, JM, Fleischmann, A, De Leo, D, Phillips, MR, Botega, NJ, Vijayakumar, L, et al. Repetition of suicide attempts: data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study. Crisis 2010; 31: 194201.
9 Yip, PSF, Callanan, C, Yuen, HP. Urban/rural and gender differentials in suicide rates: east and west. J Affect Disord 2000; 57: 99106.
10 Phillips, MR, Li, X, Zhang, Y. Suicide rates in China, 1995–99. Lancet 2002; 359: 835–40.
11 Chen, YY, Wu, KCC, Yousuf, S, Yip, PSF. Suicide in Asia: opportunities and challenges. Epidemiol Rev 2012; 34: 129–44.
12 Wu, KCC, Chen, YY, Yip, PSF. Suicide methods in Asia: implications in suicide prevention. Int J Environ Res Public Health 2012; 9: 1135–58.
13 Yip, PSF, Hawton, K, Liu, K, Liu, KS, Ng, PW, Kam, PM, et al. A study of deliberate self-harm and its repetition among patients presenting to an emergency department. Crisis 2011; 32: 217–24.
14 Chung, CH, Lai, CH, Chu, CM, Pai, L, Kao, S, Chien, WC. A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan. BMC Public Health 2012; 12: 744.
15 Kuo, C-J, Gunnell, D, Chen, C-C, Yip, PSF, Chen, Y-Y. Suicide and non-suicide mortality after self-harm in Taipei City, Taiwan. Br J Psychiatry 2012; 200: 405–11.
16 Kapur, N, Cooper, J, King-Hele, S, Webb, R, Lawlor, M, Rodway, C, et al. The repetition of suicidal behavior: a multicenter cohort study. J Clin Psychiatry 2006; 67: 1599–609.
17 Lin, DY, Wei, LJ, Yang, I, Ying, Z. Semiparametric regression for the mean and rate functions of recurrent events. J R Stat Soc Series B Stat Methodol 2000; 62: 711–30.
18 Cox, DR. Regression models and life-tables. J R Stat Soc Series B Stat Methodol 1972; 34: 187220.
19 SAS Institute. SAS/STAT 9.3 User's Guide: Survival Analysis, Book Excerpt. SAS Publishing, 2011.
20 Colman, I, Newman, SC, Schopflocher, D, Bland, RC, Dyck, RJ. A multivariate study of predictors of repeat parasuicide. Acta Psychiatr Scand 2004; 109: 306–12.
21 Hsueh, LM, Tseng, HP, Hsieh, YW. Factors affect relocation behavior in Taiwan in recent years – the model of household joint decision on moving and destination choice. J Popul Stud 2007; 34: 69107.
22 Perry, IJ, Corcoran, P, Fitzgerald, AP, Keeley, HS, Reulbach, U, Arensman, E. The incidence and repetition of hospital-treated deliberate self harm: findings from the world's first national registry. PLoS One 2012; 7: e31663.
23 Harriss, L, Hawton, K. Deliberate self-harm in rural and urban regions: a comparative study of prevalence and patient characteristics. Soc Sci Med 2011; 73: 274–81.
24 Gunnell, D, Eddleston, M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003; 32: 902–9.
25 Yip, PSF, Caine, ED, Kwok, RCL, Chen, YY. A decompositional analysis of the relative contribution of age, sex and methods of suicide to the changing patterns of suicide in Taipei City, 2004–2006. Inj Prev 2012; 18: 187–92.
26 Lee, HL, Lin, HJ, Yeh, ST, Chi, CH, Guo, HR. Presentations of patients of poisoning and predictors of poisoning-related fatality: findings from a hospital-based prospective study. BMC Public Health 2008; 8: 7.
27 Bergen, H, Hawton, K, Waters, K, Cooper, J, Kapur, N. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007. Br J Psychiatry 2010; 197: 493–8.
28 Kapur, N, Murphy, E, Cooper, J, Bergen, H, Hawton, K, Simkin, S, et al. Psychosocial assessment following self-harm: results from the multi-centre monitoring of self-harm project. J Affect Disord 2008; 106: 285–93.
29 Hawton, K, Bergen, H, Kapur, N, Cooper, J, Steeg, S, Ness, J, et al. Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. J Child Psychol Psychiatry 2012; 53: 1212–9.
30 Bergen, H, Hawton, K, Kapur, N, Cooper, J, Steeg, S, Ness, J, et al. Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors. Psychol Med 2012; 42: 727–41.
31 Bennewith, O, Gunnell, D, Peters, T, Hawton, K, House, A. Variations in the hospital management of self harm in adults in England: observational study. BMJ 2004; 328: 1108–9.
32 Kapur, N, Steeg, S, Webb, R, Haigh, M, Bergen, H, Hawton, K, et al. Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England. PloS One 2013; 8: e70434.
33 Pan, YJ, Chang, WH, Lee, MB, Chen, CH, Liao, SC, Caine, ED. Effectiveness of a nationwide aftercare program for suicide attempters. Psychol Med 2013; 43: 1447–54.
34 Joiner, TE. Why People Die by Suicide. Harvard University Press, 2005.
35 Hawton, K, Zahl, D, Weatherall, R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. Br J Psychiatry 2003; 182: 537–42.
36 Nordstrom, P, Samuelsson, M, Asberg, M. Survival analysis of suicide risk after attempted suicide. Acta Psychiatr Scand 1995; 91: 336–40.
37 Suokas, J, Suominen, K, Isometsa, E, Ostamo, A, Lonnqvist, J. Long-term risk factors for suicide mortality after attempted suicide – findings of a 14-year follow-up study. Acta Psychiatr Scand 2001; 104: 117–21.
38 Runeson, B, Tidemalm, D, Dahlin, M, Lichtenstein, P, Langstrom, N. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ 2010; 341: c3222.
39 Chen, VCH, Tan, HKL, Chen, C-Y, Chen, THH, Liao, L-R, Lee, CTC, et al. Mortality and suicide after self-harm: community cohort study in Taiwan. Br J Psychiatry 2011; 198: 31–6.
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Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study

  • Chi-Leung Kwok (a1), Paul S. F. Yip (a1), David Gunnell (a2), Chian-Jue Kuo (a3) and Ying-Yeh Chen (a4)...
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