Geulayov Galit, Casey Deborah, Bale Elizabeth, Brand Fiona, Clements Caroline, Farooq Bushra, Kapur Nav, Ness Jennifer, Waters Keith, Patel Anita, Hawton Keith
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK.
Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Psychol Med. 2023 Mar;53(4):1400-1408. doi: 10.1017/S0033291721002956. Epub 2021 Aug 4.
We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab.
We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004-31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models.
In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03-2.96, = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80-9.30, = 0.001).
Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck.
我们根据自残/刺伤的部位，比较了因自残而住院后自杀死亡的风险。
我们纳入了英格兰自残多中心研究（2004年1月1日至2014年12月31日）中54999例自残住院病例（涉及31419名个体），随访至2019年12月31日的死亡率。自残方法的信息通过医院监测获得。死亡信息通过与英国国家医疗服务体系数字化部门的关联获得。我们使用混合效应模型评估自残部位与自杀死亡之间的关联。
总共10790例（19.6%）住院病例涉及自残/刺伤，其中7489例（69.4%）仅因手臂/手腕撕裂伤，1846例（17.1%）涉及身体其他部位切割伤，1455例（13.5%）因撕裂伤部位不明。在控制混杂因素后，与仅因中毒住院相比，因手腕/手臂以外身体部位自残/刺伤而住院的患者随后自杀的可能性更大[调整后的优势比（aOR）为1.75，95%置信区间（CI）为1.03 - 2.96，P = 0.038]。仅因手腕/手臂切割/刺伤住院后自杀的可能性与仅因中毒住院的患者相当。涉及颈部撕裂伤的住院病例与因中毒住院相比，随后自杀的可能性高四倍（aOR为4.09，95%CI为1.80 - 9.30，P = 0.001）。
自残/刺伤后住院的患者在特征、自残/刺伤方法和随后自杀风险方面是一个异质性群体。自残/刺伤身体手腕或手臂以外部位的个体自杀风险更大，尤其是颈部。
