Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?

This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm.

This register study included 16,235 cases in the ages 16-24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome.

In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.

This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.