Suicide after nonfatal self-harm: A population case-control study examining hospital care and patient characteristics

Background: Nonfatal self-harm is the strongest predictor of suicide, with some of the risk factors for subsequent suicide after nonfatal self-harm being similar to those for suicide in general. However, we do not have sufficient information regarding the medical care provided to nonfatal self-harm episodes preceding suicide. Aims: Our study sought to explore hospital care and predictive characteristics of the risk of suicide after nonfatal self-harm. Method: Individuals with history of nonfatal self-harm who died by suicide were compared with those who had a nonfatal self-harm episode but did not later die by suicide. Cases were identified by cross-linking data collected through a self-harm monitoring project, 2000-2007, and comprehensive local data on suicides for the same period. Results: Dying by suicide after nonfatal self-harm was more common for male subjects than for female subjects (OR = 3.3, 95% CI = 1.7-6.6). Self-injury as the method of nonfatal self-harm was associated with higher risk of subsequent suicide than was self-poisoning (OR = 2.0, 95% CI = 1.04-3.9). More urgent care at the emergency department (OR = 2.7, 95% CI = 1.1-6.3) and admission to hospital (OR = 2.0, 95% CI = 1.0-4.0) at the index episode were related to a heightened risk of suicide. Conclusion: The findings of our study could help services to form assessment and aftercare policies.