Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
J Child Psychol Psychiatry. 2018 Sep;59(9):948-956. doi: 10.1111/jcpp.12883. Epub 2018 Mar 5.
Self-harm is common in youth and an important risk factor for suicide. Certain self-harm methods might indicate a higher risk of suicide. The main aim of this study was to determine whether some methods of self-harm in adolescents (10-17 years) and young adults (18-24 years) are associated with a particularly high risk of suicide. A secondary aim was to ascertain how different self-harm methods might affect the probability of psychiatric follow-up.
Five Swedish registers were linked in a national population-based cohort study. All nonfatal self-harm events recorded in specialist health care, excluding psychiatry and primary care services, among 10-24 year olds between 2000 and 2009 were included. Methods were classified as poisoning, cutting/piercing, violent method (gassing, hanging, strangulation/suffocation, drowning, jumping and firearms), other and multiple methods. Hazard Ratios (HR) for suicide were calculated in Cox regression models for each method with poisoning as the reference. Odds Ratios (OR) for psychiatric inpatient care were determined in logistic regression models. Analyses were adjusted for important covariates and stratified by age group and treatment setting (inpatient/outpatient).
Among adolescents with initial medical hospitalisation, use of a violent method was associated with a near eightfold increase in HR for suicide compared to self-poisoning in the adjusted analysis [HR 7.8; 95% confidence interval (CI) 3.2-19.0]. Among hospitalised young adult women, adjusted HRs were elevated fourfold for both cutting [4.0 (1.9-8.8)] and violent methods [3.9 (1.5-10.6)]. Method of self-harm did not affect suicide risk in young adult men. Adolescents using violent methods had an increased probability of psychiatric inpatient care following initial treatment for self-harm.
Violent self-harm requiring medical hospitalisation may signal particularly high risk of future suicide in adolescents (both sexes) and in young adult women. For the latter group this is the case for cutting requiring hospitalisation as well.
自残在年轻人中很常见，是自杀的重要危险因素。某些自残方法可能表明自杀风险更高。本研究的主要目的是确定青少年（10-17 岁）和年轻成年人（18-24 岁）中某些自残方法是否与特别高的自杀风险相关。次要目的是确定不同的自残方法如何影响精神科随访的可能性。
在一项全国性基于人群的队列研究中，将五个瑞典登记处进行了关联。纳入了 2000 年至 2009 年期间 10-24 岁之间在专科保健中心记录的所有非致命性自残事件，不包括精神病学和初级保健服务。方法分为中毒、切割/刺穿、暴力方法（毒气、上吊、绞杀/窒息、溺水、跳楼和枪支）、其他和多种方法。将中毒作为参考，用 Cox 回归模型计算每种方法的自杀风险比（HR）。在逻辑回归模型中确定了精神科住院治疗的优势比（OR）。分析调整了重要协变量，并按年龄组和治疗场所（住院/门诊）进行分层。
在最初接受医疗住院治疗的青少年中，与自我中毒相比，使用暴力方法与自杀风险增加近八倍相关，调整后分析的 HR 为 7.8（95%置信区间 [CI] 3.2-19.0）。在住院的年轻成年女性中，调整后的 HR 均升高四倍，切割 [4.0（1.9-8.8）]和暴力方法 [3.9（1.5-10.6）]。自残方法并不影响年轻成年男性的自杀风险。使用暴力方法的青少年在最初接受自残治疗后，接受精神科住院治疗的可能性增加。
需要医疗住院治疗的暴力自残可能预示着青少年（男女）和年轻成年女性未来自杀风险特别高。对于后者群体，住院治疗的切割也属于这种情况。
