Key Takeaways
Extended Takeaways
- This study reflects routine practice at scale: 90,413 index nonfatal hospital-presenting self-harm episodes were analyzed, and 59.8%; n=54,092 of patients received aftercare within 90 days, supporting the feasibility of a national follow-up model in usual care.
- Program delivery often fell outside the intended timeline. Although the guideline specified first contact within three days and service for three months with a minimum of two contacts per month, the observed median interval to first aftercare contact was 12 days (range 0–364 days), suggesting implementation delays that clinicians and systems should address.
- Baseline case mix differed between groups, which matters when interpreting outcomes. Patients who received aftercare within 90 days were more likely to have depressive disorders and anxiety disorders but less likely to have schizophrenia, substance use disorders, comorbid physical conditions, or prior psychiatric or nonpsychiatric hospitalizations.
- Absolute event burden after a self-harm presentation was high despite follow-up services: during a mean follow-up of 2.8 years, 17,280 (19.1%) patients repeated self-harm, and during a mean follow-up of 3.3 years, 3,317 (3.7%) died by suicide.
- Younger patients and those with prior psychiatric disorders may need more intensive management after discharge. The association between aftercare and repeat self-harm was strongest in patients aged <65 years (HR ranged from 1.13 to 1.34) and in those with a history of psychiatric disorders (HR =1.26, 95% CI 1.21–1.31).
- Suicide prevention benefit was not uniform across subgroups. The largest reduction was seen in those aged 10–24 years (HR= 0.64, 95% CI 0.48–0.86), and the association was also more marked in patients without a history of psychiatric disorders (HR =0.76, 95% CI 0.67–0.86), highlighting groups in whom outreach may have the greatest impact.