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Method choice in nonfatal self-harm as a predictor of subsequent episodes of self-harm and suicide: Implications for clinical practice

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  • Miller, M.
  • Hempstead, K.
  • Nguyen, T.
  • Barber, C.
  • Rosenberg-Wohl, S.
  • Azrael, D.

Abstract

Objectives. We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide. Methods. We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers. Results. Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode. Conclusions. Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried.

Suggested Citation

  • Miller, M. & Hempstead, K. & Nguyen, T. & Barber, C. & Rosenberg-Wohl, S. & Azrael, D., 2013. "Method choice in nonfatal self-harm as a predictor of subsequent episodes of self-harm and suicide: Implications for clinical practice," American Journal of Public Health, American Public Health Association, vol. 103(6), pages 61-68.
  • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2013.301326_3
    DOI: 10.2105/AJPH.2013.301326
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    Cited by:

    1. Braun, Michael T. & Adams, Nicole B. & O'Grady, Courtney E. & Miller, Deserai L. & Bystrinski, Jonathan, 2020. "An exploration of youth physically restrained in mental health residential treatment centers," Children and Youth Services Review, Elsevier, vol. 110(C).
    2. Caroline Daly & Eve Griffin & Elaine McMahon & Paul Corcoran & Roger T. Webb & Katrina Witt & Darren M. Ashcroft & Ella Arensman, 2020. "Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young Peopleā€”A National Registry Study," IJERPH, MDPI, vol. 17(17), pages 1-16, August.

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