Hawton Keith, Bergen Helen, Cooper Jayne, Turnbull Pauline, Waters Keith, Ness Jennifer, Kapur Nav
Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
J Affect Disord. 2015 Apr 1;175:147-51. doi: 10.1016/j.jad.2014.12.062. Epub 2015 Jan 8.
Self-harm is a key risk factor for suicide and it is important to have contemporary information on the extent of risk.
Mortality follow-up to 2012 of 40,346 self-harm patients identified in the three centres of the Multicentre Study of Self-harm in England between 2000 and 2010.
Nineteen per cent of deaths during the study period (N=2704) were by suicide, which occurred in 1.6% of patients (2.6% of males and 0.9% of females), during which time the risk was 49 times greater than the general population risk. Overall, 0.5% of individuals died by suicide in the first year, including 0.82% of males and 0.27% of females. While the absolute risk of suicide was greater in males, the risk relative to that in the general population was higher in females. Risk of suicide increased with age. While self-poisoning had been the most frequent method of self-harm, hanging was the most common method of subsequent suicide, particularly in males. The number of suicides was probably a considerable underestimate as there were also a large number of deaths recorded as accidents, the majority of which were poisonings, these often involving psychotropic drugs.
The study was focussed entirely on hospital-presenting self-harm.
The findings underline the importance of prevention initiatives focused on the self-harm population, especially during the initial months following an episode of self-harm. Estimates using suicide and open verdicts may underestimate the true risk of suicide following self-harm; inclusion of accidental poisonings may be warranted in future risk estimates.
自我伤害是自杀的关键风险因素，掌握有关风险程度的最新信息很重要。
对2000年至2010年期间在英格兰自我伤害多中心研究的三个中心确定的40346名自我伤害患者进行至2012年的死亡率随访。
研究期间19%的死亡（N = 2704）是自杀，发生在1.6%的患者中（男性为2.6%，女性为0.9%），在此期间风险比一般人群风险高49倍。总体而言，0.5%的个体在第一年死于自杀，包括0.82%的男性和0.27%的女性。虽然男性自杀的绝对风险更大，但相对于一般人群，女性的风险更高。自杀风险随年龄增加。虽然自我中毒曾是最常见的自我伤害方式，但上吊是随后自杀最常见的方式，尤其是在男性中。自杀人数可能被大幅低估，因为也有大量死亡被记录为意外事故，其中大多数是中毒，这些中毒事件往往涉及精神药物。
该研究完全聚焦于在医院就诊的自我伤害。
研究结果强调了针对自我伤害人群开展预防举措的重要性，尤其是在自我伤害事件后的最初几个月。使用自杀和死因不明裁决进行的估计可能低估了自我伤害后自杀的真实风险；在未来的风险估计中纳入意外中毒情况可能是必要的。
