From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York; the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers, State University of New Jersey, New Brunswick; the Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, N.J.; and the Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Md.
Am J Psychiatry. 2017 Aug 1;174(8):765-774. doi: 10.1176/appi.ajp.2017.16111288. Epub 2017 Mar 21.
The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm.
A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.
During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days.
Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.
作者旨在确定成年人蓄意自我伤害后一年内再次自我伤害和完成自杀的风险因素。
一项由医疗补助计划资助的全国性成年人临床诊断为蓄意自我伤害的队列研究（N=61297），随访时间长达 1 年。每千人年的重复自我伤害率和每 10 万人年的自杀率（基于国家死亡指数的死因信息）确定。通过 Cox 比例风险模型估计重复自我伤害和自杀的风险比。
在非致命性自我伤害后的 12 个月内，重复自我伤害的发生率为 263.2/1000 人年，完成自杀的发生率为 439.1/100000 人年，是匹配的一般人群队列的 37.2 倍。与初始自我伤害事件中涉及非暴力方法相比，涉及暴力方法的自杀风险更高（风险比=7.5，95%CI=5.5-10.1），尤其是枪支（风险比=15.86，95%CI=10.7-23.4；与中毒相比），并且在最近接受门诊心理健康护理的患者的事件中风险较低（风险比=1.6，95%CI=1.2-2.0）。与使用非暴力方法的自我伤害患者相比，首次事件后 30 天内使用暴力方法的患者自杀风险显著增加（风险比=17.5，95%CI=11.2-27.3），但在随后的 335 天内则没有。
接受蓄意自我伤害治疗的成年人在接下来的一年中经常重复自我伤害。初次自我伤害使用暴力方法的患者，特别是枪支，自杀风险极高，特别是在初次事件后立即，这突出了仔细评估和密切随访该群体的重要性。
