Deliberate self-harm can signal suicide risk

NEW YORK (Reuters Health) - The characteristics of young patients who commit acts of deliberate self-harm vary widely, but the risk of suicide is very high in this population, UK investigators report.

"Deliberate self-harm and suicide are both major problems in young people," Drs. Keith Hawton and Louise Harriss, of the University of Oxford, point out.

"Rates of deliberate self-harm, the term used for the intentional self-poisoning or self-injury in many European countries because of the mixed motivation that is often involved, are highest in young persons," the researchers write in Journal of Clinical Psychiatry.

The researchers collected information on consecutive deliberate self-harm patients between the ages of 15 and 24 years who were seen at a general hospital over a 20-year period (1978 to 1997). National mortality registers were used to identify deaths recorded up to the end of 2000.

A total of 5,459 subjects were included in the study: 3,432 females and 2,027 males. Overdoses accounted for the majority of deliberate self-harm episodes (90.5 percent). Most of the overdoses - 44 percent -- involved acetaminophen (Tylenol). Increases in acetaminophen overdoses (from 33.3 percent to 53.4 percent) and antidepressant overdoses (9.3 percent to 11.9 percent) were observed over the course of the study.

Overdoses of minor tranquilizers and sedatives decreased (18.8 percent to 7.7 percent) decreased during the study. Of the 708 self-injuries, cutting (88.5 percent) accounted for the majority of them. Overall, 36.1 percent of subjects drank alcohol immediately before the deliberate self-harm incident.

The most common problems faced by patients at the time of deliberate self-harm included family difficulties (50.9 percent), problems in a relationship with a partner (45.7 percent), employment problems or problems with studies (41.9 percent), and difficulties with friends (22.5 percent). A prior history of deliberate self-harm was observed in 26.3 percent of patients.

A total of 4,843 subjects were followed-up until the year 2000. Of these, 141 patients (2.9 percent) had died -- 90 males (5.0 percent) and 51 females (1.7 percent). The overall risk of death was 4.1 times greater than expected in the general population.

Of the 141 deaths, 81 (57.4 percent) were categorized as probable suicides, a rate 10- times greater than expected. Risk factors for suicide included male sex, previous deliberate self-harm, psychiatric history (for females), and a high suicide intent. There was also an excess number of deaths from respiratory disorders, circulatory disorders, and accidents that did not involve poisoning.

"Assessment of young deliberate self-harm patients must include close attention to interpersonal problems, previous self-harm, previous and current psychiatric problems, alcohol and drug misuse, history of violence and criminality, and suicidal intent," the investigators conclude.

Treatment programs for young patients who commit acts of deliberate self-harm should focus on improving interpersonal difficulties using strategies such as problem-solving therapy and treating substance abuse and psychiatric disorders, they recommend.

SOURCE: Journal of Clinical Psychiatry, October 2007.