Columbia University Medical Center (CUMC)
March 21, 2017
New findings suggest that American adults who survive deliberate self-harm are at increased risk of suicide in the first year after such an event, indicating a need to direct clinical interventions in the critical 12 months following such episodes. The suicide risk is greatest in the month immediately following a self-harm attempt using a firearm, according to a study from researchers at Columbia University Medical Center (CUMC), New York State Psychiatric Institute, and colleagues.
Results of the study were published today in American Journal of Psychiatry.
“This study supports our hypothesis that use of a firearm or other violent self-harm methods greatly increases the risk of suicide, especially in the short term,” said Mark Olfson, MD, MPH, professor of psychiatry at CUMC and senior author of the report.
Using Medicaid data from 45 states during 2001-2007, the researchers sought to determine the one-year risk of repeated self-harm and suicide in 61,297 people who had been clinically diagnosed with deliberate self-harm. The data were linked to the National Death Index, which provides information about dates and cause of death. The researchers analyzed a variety of possible risk factors, such as demographic characteristics, recent treatment for common mental disorders, and both the setting and method of self-harm. Firearm-related self-harm was of particular interest, since the rate of suicide from firearms is eight times greater in the United States than in other high-income countries.
Nearly 20 percent—mostly older, white people who had been recently treated for a mental disorder such as depression or alcohol use disorder—repeated nonfatal self-harm during the follow-up period. The one-year suicide rate in adults with deliberate self-harm was 37 times higher than in the general population. In this group, males were twice as likely to complete suicide than females; older, white adults had triple the suicide risk of younger, nonwhite adults.
Two-thirds of suicides during initial self-harm episodes were caused by violent methods, with more than 40 percent related to firearms. The risk of suicide was approximately 10 times greater in the first month after an initial episode of self-harm using a violent method compared with the following 11 months.
“The patterns seen in this study suggest that clinical efforts should focus on ensuring the safety of individuals who survive deliberate self-harm during the first few months after such attempts—particularly when a violent method such as a firearm has been used,” said Dr. Olfson. “For these patients, clinicians should strongly consider inpatient admission, intensive supervision, and interventions targeting underlying mental disorders to reduce suicide risk. In addition, clinicians can encourage family members to install trigger locks or temporarily store firearms outside the patient’s home.”
The study, titled “Suicide Following Deliberate Self-Harm,” was published in The American Journal of Psychiatry on March 21, 2017. The authors are Mark Olfson, MD, MPH, Melanie Wall, PhD, Shuai Wang, PhD, Stephen Crystal, PhD, Tobias Gerhard, PhD, and Carlos Blanco, MD, PhD.
Dr. Wang is an employee of Quartet Health. Dr. Gerhard has received research grant funding from Bristol-Myers Squibb. He serves on an external safety review committee for a Merck study, and has provided expert consultation to law firms on behalf of Roche and Pfizer. The additional authors report no financial conflicts of interest.
The study was supported by grant R01 MH107452 from the National Institute of Mental Health and grant U19 HS021112 from the Agency for Healthcare Research and Quality.