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Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort

Published online by Cambridge University Press:  20 September 2016

K. Beckman ,
E. Mittendorfer-Rutz ,
P. Lichtenstein ,
H. Larsson ,
C. Almqvist ,
B. Runeson  and
M. Dahlin
K. Beckman*
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
E. Mittendorfer-Rutz
Affiliation:
Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Medical Sciences, Örebro University, Örebro, Sweden
C. Almqvist
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
B. Runeson
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
M. Dahlin
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
*
*Address for correspondence: Dr K. Beckman, Department of Clinical Neuroscience/Stockholm County Council, Centre for Psychiatric Research and Education, Karolinska Institutet, St Goran, Sweden. (Email: karin.beckman@ki.se)
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Abstract

Background

Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.

Method

We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.

Results

Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.

Conclusion

We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

Keywords

Longitudinal studiesmental disordersself-harmsuicideyoung adult
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3397 - 3405
Copyright
Copyright © Cambridge University Press 2016 

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References

Agerbo, E, Nordentoft, M, Mortensen, PB (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. British Medical Journal 325, 74.Google Scholar
Bridge, JA, Goldstein, TR, Brent, DA (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry and Allied Disciplines 47, 372–394.Google Scholar
Briere, FN, Rohde, P, Seeley, JR, Klein, D, Lewinsohn, PM (2015). Adolescent suicide attempts and adult adjustment. Depression and Anxiety 32, 270–276.Google Scholar
Cooper, J, Kapur, N, Webb, R, Lawlor, M, Guthrie, E, Mackway-Jones, K, Appleby, L (2005). Suicide after deliberate self-harm: a 4-year cohort study. American Journal of Psychiatry 162, 297–303.Google Scholar
Ekbom, A (2011). The Swedish multi-generation register. Methods in Molecular Biology 675, 215–220.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL (2005). Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychological Medicine 35, 983–993.Google Scholar
Fox, KR, Franklin, JC, Ribeiro, JD, Kleiman, EM, Bentley, KH, Nock, MK (2015). Meta-analysis of risk factors for nonsuicidal self-injury. Clinical Psychology Review 42, 156–167.Google Scholar
Goldman-Mellor, SJ, Caspi, A, Harrington, H, Hogan, S, Nada-Raja, S, Poulton, R, Moffitt, TE (2014). Suicide attempt in young people: a signal for long-term Health Care and Social Needs. JAMA Psychiatry 71, 119–127.Google Scholar
Groholt, B, Ekeberg, O (2009). Prognosis after adolescent suicide attempt: mental health, psychiatric treatment, and suicide attempts in a nine-year follow-up study. Suicide and Life-Threatening Behavior 39, 125–136.Google Scholar
Harrington, R, Pickles, A, Aglan, A, Harrington, V, Burroughs, H, Kerfoot, M (2006). Early adult outcomes of adolescents who deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry 45, 337–345.Google Scholar
Haukka, J, Suominen, K, Partonen, T, Lonnqvist, J (2008). Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996–2003. American Journal of Epidemiology 167, 1155–1163.Google Scholar
Haw, CM, Hawton, K (2011). Problem drug use, drug misuse and deliberate self-harm: trends and patient characteristics, with a focus on young people, Oxford, 1993–2006. Social Psychiatry and Psychiatric Epidemiology 46, 85–93.CrossRefGoogle Scholar
Hawton, K, Bergen, H, Kapur, N, Cooper, J, Steeg, S, Ness, J, Waters, K (2012 a). Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. Journal of Child Psychology and Psychiatry and Allied Disciplines 53, 1212–1219.Google Scholar
Hawton, K, Fagg, J, Platt, S, Hawkins, M (1993). Factors associated with suicide after parasuicide in young people. British Medical Journal 306, 1641–1644.Google Scholar
Hawton, K, Hall, S, Simkin, S, Bale, L, Bond, A, Codd, S, Stewart, A (2003 a). Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990–2000. Journal of Child Psychology and Psychiatry and Allied Disciplines 44, 1191–1198.Google Scholar
Hawton, K, Harriss, L (2007). Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. Journal of Clinical Psychiatry 68, 1574–1583.Google Scholar
Hawton, K, Saunders, KEA, O'Connor, RC (2012 b). Self-harm and suicide in adolescents. Lancet 379, 2373–2382.CrossRefGoogle ScholarPubMed
Hawton, K, Zahl, D, Weatherhall, R (2003 b). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry 182, 537–542.Google Scholar
Kokkevi, A, Rotsika, V, Arapaki, A, Richardson, C (2011). Increasing self-reported suicide attempts by adolescents in Greece between 1984 and 2007. Social Psychiatry and Psychiatric Epidemiology 46, 231–237.CrossRefGoogle ScholarPubMed
Kokkevi, A, Rotsika, V, Arapaki, A, Richardson, C (2012). Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. Journal of Child Psychology and Psychiatry 53, 381–389.Google Scholar
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.Google Scholar
Madge, N, Hewitt, A, Hawton, K, de Wilde, EJ, Corcoran, P, Fekete, S, van Heeringen, K, De Leo, D, Ystgaard, M (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of Child Psychology and Psychiatry and Allied Disciplines 49, 667–677.Google Scholar
Mars, B, Heron, J, Crane, C, Hawton, K, Lewis, G, Macleod, J, Tilling, K, Gunnell, D (2014). Clinical and social outcomes of adolescent self harm: population based birth cohort study. British Medical Journal 349, g5954.Google Scholar
Moran, P, Coffey, C, Romaniuk, H, Degenhardt, L, Borschmann, R, Patton, GC (2015). Substance use in adulthood following adolescent self-harm: a population-based cohort study. Acta Psychiatrica Scandinavica 131, 61–68.Google Scholar
Moran, P, Coffey, C, Romaniuk, H, Olsson, C, Borschmann, R, Carlin, JB, Patton, GC (2012). The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet 379, 236–243.Google Scholar
National Board of Health and Welfare (2010). Causes of death 2008. Official Statistics of Sweden. Statistics - Health and Medical care.Google Scholar
Neeleman, J, Wessely, S (1997). Changes in classification of suicide in England and Wales: time trends and associations with coroners’ professional backgrounds. Psychological Medicine 27, 467–472.Google Scholar
Niederkrotenthaler, T, Tinghog, P, Alexanderson, K, Dahlin, M, Wang, M, Beckman, K, Gould, M, Mittendorfer-Rutz, E (2014). Future risk of labour market marginalization in young suicide attempters-a population-based prospective cohort study. International Journal of Epidemiology 43, 1520–1530.Google Scholar
Nigg, JT (2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical Psychology Review 33, 215–228.Google Scholar
Patel, V, Flisher, AJ, Hetrick, S, McGorry, P (2007). Mental health of young people: a global public-health challenge. Lancet 369, 1302–1313.Google Scholar
Patton, GC, Coffey, C, Sawyer, SM, Viner, RM, Haller, DM, Bose, K, Vos, T, Ferguson, J, Mathers, CD (2009). Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 374, 881–892.Google Scholar
Reith, DM, Whyte, I, Carter, G, McPherson, M (2003). Adolescent self-poisoning: a cohort study of subsequent suicide and premature deaths. Crisis 24, 79–84.Google Scholar
Suokas, JT, Suominen, K, Heila, H, Ostamo, A, Aalto-Setala, T, Perala, J, Saarni, S, Lonnqvist, J, Suvisaari, JM (2011). Attempted suicide in mental disorders in young adulthood. Social Psychiatry and Psychiatric Epidemiology 46, 965–974.Google Scholar
Tidemalm, D, Beckman, K, Dahlin, M, Vaez, M, Lichtenstein, P, Langstrom, N, Runeson, B (2014). Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden. Psychological Medicine 45, 1699–1707.Google Scholar
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, a2205.Google Scholar
Wettermark, B, Hammar, N, Fored, CM, Leimanis, A, Otterblad Olausson, P, Bergman, U, Persson, I, Sundstrom, A, Westerholm, B, Rosen, M (2007). The new Swedish Prescribed Drug Register – opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiology and Drug Safety 16, 726–735.Google Scholar