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Prior self-harm in teens, young adults increases risk of suicide nearly 27 times
Teenagers and young adults who participated in the Medicaid program were at 26.7 times higher risk of suicide following nonfatal self-harm, with an increased risk observed specifically in American Indians, Alaskan natives and those who used violent methods for self-harm, according to findings published in Pediatrics.
“Age-related changes in cognitive, affective, social, behavioral and biological vulnerabilities may influence initiation and persistence of psychopathology through adolescence and young adulthood,” Mark Olfson, MD, MPH, from the department of psychiatry in the College of Physicians and Surgeons within Columbia University and the New York State Psychiatric Institute, and colleagues wrote. “However, little is known about whether and how adolescents and young adults vary in their risks of repeated self-harm.”
To examine the risk factors associated with repetitive nonfatal self-harm in adolescents and young adults and death caused by suicide within the year, the researchers analyzed data concerning patients aged 12 to 24 years who were insured through Medicaid. One year after self-harm was reported, the researchers followed up on their status. Information regarding cause of death was collected from the National Death Index.
After information was gathered, Olfson and colleagues calculated repeat self-harm per 1,000 person-years and deaths caused by suicide per 100,000 person-years. Additionally, the researchers estimated hazard ratios of repeat self-harm and suicide by using Cox proportional hazard models, and the ratios of standard suicide-related mortality rates were attained through comparison with demographically matched general population controls.
Within the cohort, which included 32,395 patients, the suicide standardized mortality rate ratio (SMR) following self-harm was 26.7 (95% CI, 19.9-35.1) when compared with controls. The suicide SMR was significantly greater for adolescents than for young adults (teens: 46.0; 95% CI, 29.9-67.9; young adults: 19.2; 95% CI, 12.7-28.0). Those who were American Indian or Alaskan natives were at increased risk of suicide following self-harm when compared with non-Hispanic white patients (HR = 4.69; 95% CI, 2.41-9.13).
Those who used violent methods for self-harm were also at an increased risk of later suicide when compared with those who did not use violent methods for self-harm (violent: HR = 18.04; 95% CI, 9.92-32.80; nonviolent: HR = 1.00), especially with firearms (HR = 35.73; 95% CI, 15.42-82.79).
Repeat self-harm was most likely to be seen in female patients when compared with male patients (HR = 1.25; 95% CI, 1.18-1.33) and those with personality disorders (HR = 1.55; 95% CI, 1.42-1.69). Additionally, the researchers observed an increased risk of suicide in those who were treated in an inpatient setting for self-harm (HR = 1.65; 95% CI, 1.49-1.83) when compared with those who were treated in ED or outpatient settings (ED: HR = 0.62; 95% CI, 0.55-0.69; outpatient: HR = 1.00).
“Adolescents and young adults who survive self-harm are at high risk for repeated self-harm and suicide over the following year,” Olfson and colleagues wrote. “… 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.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
