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Psychiatric admission following self-harm associated with increased risk for suicide, all-cause mortality

Adults presenting to the ED for self-harm had a higher risk for suicide or all-cause mortality if they underwent psychiatric admission, according to study findings in Lancet Psychiatry.

“Results of a systematic review showed that around one in 25 people who presented to a hospital with self-harm died by suicide in the following 5 years. A clinical guideline that included a review of previous studies concluded that previous suicidal behavior, suicidal intent, and being male were the strongest risk factors for suicide following self-harm,” Nav Kapur, MD, FRCPsych, of the Centre for Suicide Prevention at the University of Manchester, United Kingdom, and colleagues wrote.

To determine the effect of routine hospital management on mortality, researchers prospectively assessed data for 38,415 adults who presented to five EDs in the United Kingdom for self-harm between 2000 and 2010. Researchers studied how psychosocial assessment, medical admission, psychiatric admission and referral for mental health follow-up interacted with risk for death by suicide or any cause within 12 months of presentation.

Overall, 0.7% of the study cohort died by suicide and 2.2% died from any cause within 12 months.

Most aspects of hospital management were associated with a higher risk for death, according to unadjusted analyses.

Psychiatric admission was associated with the highest risk for suicide (HR = 2.35; 95% CI, 1.59-3.45) and all-cause mortality (HR = 2.35; 95% CI, 2.04-2.72).

When adjusting for baseline variables, hazard ratios were generally smaller, particularly for psychiatric admission, according to researchers. Sex, age and history of self-harm significantly affected risk.

“The findings of this study show just how high the risk of suicide and other premature death can be for patients who attend the ED after self-harm. The risk is elevated further for people requiring the most intensive forms of clinical management, such as referral to outpatient mental health services and psychiatric hospital admission,” study researcher Sarah Steeg, BA, of the Centre for Suicide Prevention at the University of Manchester, told Healio.com/Psychiatry. “Encouragingly, these findings indicate clinicians are appropriately allocating treatment. Importantly, when we take into account some of the differences between patients, admission to inpatient psychiatry appears to have benefits in terms of reducing suicide and other early death in some subgroups, including older adults, men and those with a history of self-harm.” – by Amanda Oldt

Disclosure: Kapur reports serving as chair of the Guideline Development Group for the National Institute for Health and Care Excellence self-harm guidelines and as chair of the National Institute for Health and Care Excellence depression in adults guidelines. Please see the full study for a list of all other authors’ relevant financial disclosures.