Death risk other than from suicide is raised in self harmBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7387.499 (Published 01 March 2003) Cite this as: BMJ 2003;326:499
- Cameron Stark, honorary senior lecturer (, )
- David Hall, consultant psychiatrist,
- Anthony Pelosi, consultant psychiatrist
- Highlands and Islands Health Research Institute, Inverness IV2 3ED
- Dumfries and Galloway Primary Care NHS Trust, Crichton Royal Hospital, Dumfries DG1 4TG
- Lanarkshire PC NHS Trust, Strathclyde Hospital, Motherwell ML1 3BW
EDITOR—Jenkins et al report on continuing suicide risk after deliberate self harm.1 They use their findings to argue that clinicians should pay close attention to continuing risk of suicide in people with a history of deliberate self harm. Their findings, in a cohort from the late 1970s, are similar to findings from a 1981 Scottish discharge cohort.2
Using the Scottish linked dataset we followed up a cohort of 8304 people discharged over a 13 year period from Scottish general hospitals after deliberate self harm. We found that the greatest number of deaths from suicide or undetermined cause were in the five years after discharge. In the third five year period, however, the ratio of observed self harm to expected self harm was 5.33 (95% confidence interval 3.26 to 8.23) for men and 9.46 (5.61 to 14.95) for women. Homicides and accidental deaths were also raised.
We endorse the advice by Jenkins et al that clinicians should pay attention to suicide risk but think that their method may have concealed another important clinical implication. They note that people who had consumed alcohol at the time of the initial episode were less likely to be traced. They also censored the 13 deaths in their cohort that were not attributed to definite or probable suicide.
In the Scottish cohort, we examined deaths by suicide and undetermined cause, and deaths by other causes. Altogether 214 people died by suicide or undetermined cause during the follow up period, 196 more deaths than expected. Nine other categories of illness, however, accounted for 780 deaths, 344 more than would have been expected at general population rates. Natural causes, therefore, were responsible for more excess deaths than were suicides.
We identified a higher risk of digestive system disease, respiratory and circulatory disease, and cancers. The pattern indicates to us that alcohol, as well as unhealthy lifestyles and possibly impaired access to medical care, may be important in this group of people. Clinicians should pay attention to alcohol use and physical health as well as suicide risk in people with a history of deliberate self harm.