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Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors

Published online by Cambridge University Press:  13 September 2011

H. Bergen ,
K. Hawton ,
N. Kapur ,
J. Cooper ,
S. Steeg ,
J. Ness  and
K. Waters
H. Bergen
Affiliation:
Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
K. Hawton*
Affiliation:
Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
N. Kapur
Affiliation:
Centre for Suicide Prevention, University of Manchester, UK
J. Cooper
Affiliation:
Centre for Suicide Prevention, University of Manchester, UK
S. Steeg
Affiliation:
Centre for Suicide Prevention, University of Manchester, UK
J. Ness
Affiliation:
Derbyshire Healthcare NHS Foundation Trust, UK
K. Waters
Affiliation:
Derbyshire Healthcare NHS Foundation Trust, UK
*
*Address for correspondence: Professor K. Hawton, Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, UK. (Email: keith.hawton@psych.ox.ac.uk)
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Abstract

Background

Mortality, including suicide and accidents, is elevated in self-harm populations. Although risk factors for suicide following self-harm are often investigated, rarely have those for accidents been studied. Our aim was to compare risk factors for suicide and accidents.

Method

A prospective cohort (n=30 202) from the Multicentre Study of Self-harm in England, 2000–2007, was followed up to 2010 using national death registers. Risk factors for suicide (intentional self-harm and undetermined intent) and accidents (narcotic poisoning, non-narcotic poisoning, and non-poisoning) following the last hospital presentation for self-harm were estimated using Cox models.

Results

During follow-up, 1833 individuals died, 378 (20.6%) by suicide and 242 (13.2%) by accidents. Independent predictors of both suicide and accidents were: male gender, age ⩾35 years (except accidental narcotic poisoning) and psychiatric treatment (except accidental narcotic poisoning). Factors differentiating suicide from accident risk were previous self-harm, last method of self-harm (twofold increased risks for cutting and violent self-injury versus self-poisoning) and mental health problems. A risk factor specific to accidental narcotic poisoning was recreational/illicit drug problems, and a risk factor specific to accidental non-narcotic poisoning and non-poisoning accidents was alcohol involvement with self-harm.

Conclusions

The similarity of risk factors for suicide and accidents indicates common experiences of socio-economic disadvantage, life problems and psychopathology resulting in a variety of self-destructive behaviour. Of factors associated with the accidental death groups, those for non-narcotic poisoning and other accidents were most similar to suicide; differences seemed to be related to criteria coroners use in reaching verdicts. Our findings support the idea of a continuum of premature death.

Keywords

Accidental deathpoisoningrisk factorsself-harmsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 4 , April 2012 , pp. 727 - 741
Copyright
Copyright © Cambridge University Press 2011

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