Self-inflicted Stabbings as Nonfatal Suicide Attempts: A Systematic Review and Case Series

Suicide by cutting or piercing is a rare and often nonlethal method. Self-stabbings are a subset of these cases, which can lead to significant injuries. Current literature does not adequately summarize the psychiatric characteristics of this population.

To examine the psychiatric presentations of adults with nonfatal self-inflicted stabbing suicide attempts to better inform the evidence-based care provided by the psychiatric consult service.

We searched Embase, Ovid MEDLINE, APA Psych INFO, and CINAHL for studies published within the last 15 years. All full-article case reports, case series, cohort studies, and systematic literature reviews in English were included. Studies not specific to adult (only those >18 years old were included) patients with self-inflicted stabbing wounds were excluded. Included studies were separated into 2 groups: case reports and cohort studies. Simple summative statistical analyses were performed. The quality of evidence was assessed using a modified version of the Joanna Briggs Institute Critical Appraisal Tools.

Thirty-four case reports, 3 cohort studies, and zero systematic literature reviews met the inclusion and quality assessment criteria. A total of 184 cases of self-stabbing were identified, 66% of which included male patients. The mean age of cohort patients was 44 years. The mean age of case report patients was 47 years. The most common tool for stabbing was a knife. Common stabbing locations included the neck, chest, and abdomen. Commonly reported psychiatric diagnoses included mood disorders and schizophrenia spectrum disorders. Self-stabbing characteristics important to psychiatry were inconsistently reported across studies.

This literature review found that self-stabbing appears to be a male-preferred method and may be associated with mood disorders. Inconsistent reporting of relevant psychiatric data such as psychiatric diagnosis, previous psychiatric history, suicidal intent, and intoxication is present in our review and is potentially due to a lack of reports from the psychiatric perspective. This limits our understanding of psychiatric issues in adults who made nonfatal self-inflicted stabbing suicide attempts. A further study into the presentations of this population is needed to better understand this distinct group of patients.