Clinical Summary: The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and Suicide: A Cohort Study

Patients who present to hospital after self-harm face high short-term and longer-term risks of both repeat self-harm and suicide, yet the real-world impact of routine aftercare at national scale has remained uncertain. This study addresses the question clinicians face after discharge: whether systematic follow-up changes what happens next.

Design a cohort study

N 90,413 index nonfatal self-harm episodes presenting to hospitals by Taiwanese citizens aged 10+ years

Population Taiwanese citizens aged 10+ years

Duration 2012–2016

Key Findings

After controlling for all covariates, aftercare intervention was associated with a 20% decrease in suicide risk (HR=0.80, 95% CI 0.74–0.86).
After controlling for all covariates, aftercare intervention was associated with a 17% increase in self-harm repetition risk (HR =1.17, 95% CI 1.14–1.21).
During a mean follow-up of 3.3 years, 3,317 (3.7%) died by suicide; the incidence rate of suicide was 738.1 per 100,000 person-years in the exposed group versus 1,650.1 per 100,000 person-years in the nonexposed group.
During a mean follow-up of 2.8 years, 17,280 (19.1%) patients repeated self-harm; the incidence rate of self-harm repetition was 10,132.0 per 100,000 person-years in the exposed group versus 4,398.3 per 100,000 person-years in the nonexposed group.
The reduction in suicide risk with aftercare was strongest in those aged 10–24 years (HR= 0.64, 95% CI 0.48–0.86), while the increase in self-harm repetition was more marked in patients with a history of psychiatric disorders (HR =1.26, 95% CI 1.21–1.31).

Clinical Bottom Line

Systematic aftercare after hospital-presenting self-harm was associated with lower subsequent suicide risk but higher repeat self-harm hospital presentation. In practice, repeat presentation after follow-up should be treated as an expected point of re-engagement, not as evidence that aftercare failed.

Practice Implications

Prioritize early follow-up after a self-harm presentation, as the national program was associated with lower suicide risk overall (HR=0.80, 95% CI 0.74–0.86).
Interpret repeat self-harm presentations during aftercare as opportunities for intervention and continued engagement, given the higher adjusted repetition risk (HR =1.17, 95% CI 1.14–1.21).
Consider more tailored and intensive management for patients with psychiatric disorders, who showed a more marked increase in repeat self-harm with aftercare (HR =1.26, 95% CI 1.21–1.31).
Give particular attention to younger patients, especially those aged 10–24 years, because this subgroup had the most marked reduction in suicide risk with aftercare (HR= 0.64, 95% CI 0.48–0.86).