The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and...

Objective: Aftercare interventions following self-harm may prevent subsequent self-harm and suicide deaths. However, previous research into the effectiveness of aftercare services on self-harm repetition and suicide mostly comprised a small sample size and showed inconsistent findings. We investigated the effectiveness of Taiwan's national self-harm aftercare program on self-harm repetition and suicide among self-harm patients.

Methods: A cohort study of 90,413 index self-harm episodes (ie, the first episode during the study period) presented to hospitals and registered in the National Suicide Surveillance System (2012-2016) was performed. Cox regression models were used to evaluate the risk of self-harm repetition or suicide after receiving the aftercare, which was modeled as a time-varying variable.

Results: The aftercare was associated with a 17% (adjusted hazard ratio [aHR]=1.17, 95% confidence interval [CI] 1.14-1.21) increase in self-harm repetition risk and a 20% (aHR=0.80, 95% CI 0.74-0.86) decrease in suicide risk. The association of the aftercare with increased self-harm repetition risk was most marked in patients aged 45-64 years (aHR=1.34) and more marked in those with a history of psychiatric disorders (aHR=1.26). The association of aftercare with decreased suicide risk was most marked in patients aged 10-24 years (aHR=0.64) and more marked in those without a history of psychiatric disorders (aHR=0.76) than their counterparts.

Conclusion: The aftercare following self-harm was associated with an increased risk of repeat self-harm hospital presentation and decreased risk of suicide. The findings suggest that the aftercare intervention may increase help-seeking behaviors after self-harm and decrease suicide deaths, especially in specific subgroups.