Prior hospitalisations a leading indicator of suicide: New research on self-harm and mortality

9 August 2017

  • Individuals who were admitted to hospital for self-harm experienced a higher mortality rate at nearly 10 times the general population (2.9 per cent versus 0.3 per cent).
  • The study of 11,597 individuals found hospital readmission rates were highest for females and individuals aged 18-44 years.
  • More than one-third of deaths occurred in the first two weeks following discharge from hospital.

Prior hospital admissions for self-harm is an indicator for subsequent self-harm attempts and suicide, with the riskiest time period within one month post-admission, a new study assessing hospital and mortality data has found.

The study of 11,597 individuals hospitalised after attempted self-harm, published in the Australian & New Zealand Journal of Psychiatry, found those who were admitted to hospital for self-harm had a higher rate of hospital admissions – 21 per cent when compared to the matched individuals from the general population – in the 12 months pre- and post-admission for self-harm.

Hospital readmission rates were highest for females and individuals aged 18-44 years.

Those who were admitted to hospital for self-harm also had worse survival at 12 months after their admission: they experienced a higher mortality rate than the general population – 2.9 per cent versus 0.3 per cent.

More than one-third of deaths occurred in the first two weeks following discharge from hospital, with two-thirds of these deaths recorded as self-harm, unintentional poisoning or of undetermined intent.

“Examining repeated self-harm episodes can assist in clarifying patterns of self-harm behaviour over time, identifying opportunities for intervention and post-discharge after care, including continuity of care,” said study author Associate Professor Rebecca Mitchell from the Australian Institute of Health Innovation.

“Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing conditions and prior hospital use when assessing the impact of self-harm,” said Associate Professor Mitchell.

No prior population-based studies of repeat health service use after a self-harm hospitalisation have included comparisons with the general population or examined hospital use in the 12 months prior to the self-harm hospitalisation.

“Improved understanding of the extent of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed,” concluded Associate Professor Mitchell.

Mitchell RJ and Cameron CM. Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design. Australian & New Zealand Journal of Psychiatry. July 2017. doi:10.1177/0004867417717797

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