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Deliberate Self-Harm in Young People: Characteristics and Subsequent Mortality in a 20-Year Cohort of Patients Presenting to Hospital
Keith Hawton, D.Sc., and Louise Harriss, M.Sc.
Objectives: To investigate the characteristics of young deliberate self-harm (DSH) patients and determine outcome in terms of mortality and risk factors for suicide.
Method: Information was collected on consecutive DSH patients aged 15 through 24 years presenting to a general hospital during a 20-year period (1978-1997). Deaths to the end of 2000 were identified through national mortality registers.
Results: Of 5459 patients in the cohort, 62.9% were female and 37.1% male. Overdoses (90.5% of DSH episodes) most frequently involved acetaminophen (44.0%). Acetaminophen and antidepressant overdoses increased during the study period, whereas overdoses of minor tranquilizers decreased. More than one third of patients (36.1%) drank alcohol immediately before DSH. The most frequent problems faced by patients involved family members, partners, employment/studies, and friends. One quarter of patients (26.3%) had a history of prior DSH. Of 4843 patients followed up, 141 (2.9%) died (90 males [5.0%] and 51 females [1.7%]), the risk of death being 4 times greater than expected. More than half (81; 57.4%) of the deaths were from probable suicide, which was approximately 10 times more frequent than expected. Risk factors for suicide included male gender, previous DSH, prior psychiatric history (females), and high suicide intent. There were also more deaths than expected from respiratory disorders, circulatory disorders, and accidents that did not involve poisoning.
Conclusions: The range of characteristics of young DSH patients indicates the multifactional nature of aftercare required following DSH. The very high risk of suicide after DSH in young people highlights the need for preventive initiatives in this population.
(J Clin Psychiatry 2007;68:1574-1583)
Received June 22, 2006; accepted Jan. 23, 2007. From the Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford, United Kingdom.
This study was funded by Oxfordshire Health Services Research Committee, the National Health Service (NHS) Executive for England Department of Health, and the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust.
The authors thank the members of the psychiatric service in the general hospital in Oxford. We also thank Liz Bale, Anna Shepherd, and Daniel Zahl for assistance with data collection and Sue Simkin for her help with the preparation of the manuscript; none of these individuals report any financial or other relationships relevant to the subject of this article.
In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Dr. Hawton and Ms. Harriss have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services consumed by, or used on, patients to disclose relative to the article.
Corresponding author and reprints: Keith Hawton, D.Sc., Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX United Kingdom (e-mail: firstname.lastname@example.org).