Method choice in nonfatal self-harm as a predictor of subsequent episodes of self-harm and suicide: Implications for clinical practice

M. Miller, K. Hempstead, T. Nguyen, C. Barber, S. Rosenberg-Wohl and D. Azrael

American Journal of Public Health, 2013, vol. 103, issue 6, e61-e68

Abstract: Objectives. We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide. Methods. We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers. Results. Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode. Conclusions. Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried.

Keywords: adolescent; adult; article; automutilation; cohort analysis; decision making; drug overdose; female; follow up; hospital discharge; human; male; medical record; middle aged; register; risk factor; statistics; suicide; time; United States, Adolescent; Adult; Choice Behavior; Cohort Studies; Drug Overdose; Female; Follow-Up Studies; Humans; Male; Medical Records; Middle Aged; New Jersey; Patient Discharge; Registries; Risk Factors; Self-Injurious Behavior; Suicide; Time Factors; Young Adult (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2013.301326_3

DOI: 10.2105/AJPH.2013.301326

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