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Suicide risk significantly heightened first month, year after self-harm discharge

Patients who present to a hospital for self-harm are at a high risk for suicide in the first year after presentation, and particularly in the first month, according to results of an observational study conducted in England and published in Lancet Psychiatry.

“The peak in risk for suicide which follows immediately after discharge from hospital underscores the need for provision of early and effective follow-up care,” Galit Geulayov, PhD, of the Centre for Suicide Research at University of Oxford, said in a press release. “Presentation to hospital for self-harm offers an opportunity for intervention, yet people are often discharged from the hospital having not received a formal assessment of their problems and needs, and without specific aftercare arrangements. As specified in national guidance, a comprehensive assessment of the patients’ mental state, needs and risks is essential to devise an effective plan for follow-up care.”

In their study ⁠— the Multicentre Study of Self-harm in England ⁠— Geulayov and colleagues included data for 90,614 presentations to the study hospitals between January 2000 and December 2013 by 49,783 individuals aged 15 years or older. The mortality follow-up was up to Dec. 31, 2015, which allowed for up to 16 years of follow-up.

The researchers reported that within the follow-up period, 703 people died by suicide with the incidence being 163 (95% CI, 151.5-175.6) per 100,000 person-years. More than one-third of all suicides occurred within a year of patient discharge from a hospital for nonfatal self-harm. The incidence of suicide in the year following hospital discharge was 511 suicides per 100,000 person-years, which the researchers noted is more than 50 times the rate of suicide of the general population in England. Risk was particularly elevated in the first month following discharge, with 1,787 per 100,000 person-years. 

Of this patient population, men were more likely than women to die by suicide following hospital presentation for self-harm. Further, people who were admitted to a hospital more than once for nonfatal self-harm were more likely to die by suicide than those with single presentation. Age also was associated with risk, with each year of age increasing risk by 3%.

“While awareness of characteristics which increase the risk of subsequent suicide can assist as part of this assessment, previous studies indicate that individual factors related to self-harm are a poor means to evaluate the risk of future suicide,” Keith Hawton, FMedSci, of the Centre for Suicide Research at University of Oxford, said in the release. – by Joe Gramigna

Disclosures: Geulayov and Hawton report grants from the United Kingdom Department of Health and Social Care. Hawton reports sitting on the National Suicide Prevention Strategy Advisory Group of the U.K. Department of Health and Social Care, as well as on a committee related to developing clinical and public health guidelines for the National Institute for Health and Care Excellence.