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Risk factors for repeat self-harm hospitalisation following hospital admissions for suicidal ideation and self-harm

Bernard Leckning^1,2, Rohan Borschmann^3,4,5,6,7, Tanja Hirvonen⁸

¹Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. bernard.leckning@menzies.edu.au.

Social Psychiatry and Psychiatric Epidemiology

|February 27, 2026

Abstract

Purpose:

The Northern Territory (NT) experiences the highest rates of hospitalisations involving self-harm in Australia, especially amongst Aboriginal people. Given self-harm is a strong predictor of suicide risk, it is important to identify the distinct risk factors for a repeat hospitalisation involving self-harm amongst Aboriginal and non-Aboriginal people in the NT hospitalised for suicidal ideation and self-harm.

Methods:

A retrospective cohort study was designed to follow-up patients with a first hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013. Survival analysis techniques were used to estimate probability of and risk factors for repeat hospitalisation involving self-harm up to 31 December 2018 for Aboriginal and non-Aboriginal people separately.

Results:

The risk of repeat hospitalisation involving self-harm was higher (HR 1.39; 95% CI: 1.22-1.59) amongst Aboriginal (n = 2,304) than non-Aboriginal people (n = 2,087). Compared to suicidal ideation only at first hospital admission, a higher risk of repetition was observed for any self-harm method (aHR: 1.71; 95% CI: 1.37-2.12) amongst Aboriginal people and self-poisoning only (aHR: 1.45; 95% CI: 1.13-1.85) amongst non-Aboriginal people. Previous substance misuse was associated with a higher risk of repeat hospitalisation involving self-harm for Aboriginal (aHR: 1.7; 95% CI: 1.38-2.1) and non-Aboriginal (aHR: 1.6; 95% CI: 1.14-2.25) people. For non-Aboriginal people, several mental health diagnoses were associated with higher risks of repetition.

Conclusion:

The distinct risk factors for repeat hospitalisation involving self-harm between Aboriginal and non-Aboriginal people emphasises the importance of comprehensive psychosocial assessment and culturally tailored clinical interventions and community-based solutions to properly understand and address risk factors for each group.

Keywords:

Administrative data Hospital Indigenous Self-harm Suicidal ideation

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