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Risk of suicide in patients who present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England

Published online by Cambridge University Press:  04 August 2021

Galit Geulayov ,
Deborah Casey ,
Elizabeth Bale ,
Fiona Brand ,
Caroline Clements ,
Bushra Farooq ,
Nav Kapur ,
Jennifer Ness ,
Keith Waters  and
Anita Patel
...Show all authors
Galit Geulayov*
Affiliation:
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
Deborah Casey
Affiliation:
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
Elizabeth Bale
Affiliation:
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
Fiona Brand
Affiliation:
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
Caroline Clements
Affiliation:
Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
Bushra Farooq
Affiliation:
Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
Nav Kapur
Affiliation:
Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
Jennifer Ness
Affiliation:
Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
Keith Waters
Affiliation:
Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
Anita Patel
Affiliation:
Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
Keith Hawton
Affiliation:
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK Oxford Health NHS Foundation Trust, Oxford, UK
*
Author for correspondence: Galit Geulayov, E-mail: Galit.geulayov@psych.ox.ac.uk
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Abstract

Background

We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab.

Method

We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004–31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models.

Results

In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03–2.96, p = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80–9.30, p = 0.001).

Conclusions

Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck.

Keywords

Self-harmself-cuttingsite of self-cutself-poisoningsuicide
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 4 , March 2023 , pp. 1400 - 1408
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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