Adults who have engaged in self-harm are 37 times more likely to commit suicide during the 12 months following such an episode, and intensive intervention is needed, according to a new study at Columbia University Medical Center (CUMC), New York Psychiatric Institute.
Suicide risk is highest in the month immediately following a self-harm attempt using a firearm.
“The patterns seen in this study suggest that clinical efforts should focus on ensuring the safety of individuals who survive deliberate self-harm during the first few months after such attempts — particularly when a violent method such as a firearm has been used,” said Mark Olfson, M.D., M.P.H., professor of psychiatry at CUMC and senior author of the report.
“For these patients, clinicians should strongly consider inpatient admission, intensive supervision, and interventions targeting underlying mental disorders to reduce suicide risk. In addition, clinicians can encourage family members to install trigger locks or temporarily store firearms outside the patient’s home.”
Using data pulled from Medicaid records from 2001 to 2007, the researchers set out to determine the one year risk of repeated self-harm and suicide in 61,297 people who had been clinically diagnosed with deliberate self-harm.
The data were linked to the National Death Index, which provides information on dates and causes of death. The study analyzed a variety of potential risk factors, such as demographic characteristics, recent treatment for common mental disorders, as well as the setting and method of self-harm.
The researchers were particularly interested in firearm-related self-harm, since the rate of suicide from firearms is eight times greater in the U.S. than in other high-income countries.
They found that nearly 20 percent — mostly older, white people who had been recently treated for a mental disorder such as depression or alcohol use disorder — repeated nonfatal self-harm during the follow-up period.
The one-year suicide rate among adults who had engaged in deliberate self-harm was 37 times higher than in the general population. In this group, males were twice as likely to complete suicide than females; older, white adults had triple the suicide risk compared to younger, non-white adults.
Two-thirds of suicides during initial self-harm episodes were caused by violent methods, with over 40 percent related to firearms. The risk of suicide was approximately 10 times greater in the first month after an initial episode of self-harm using a violent method compared with the following 11 months.
“This study supports our hypothesis that use of a firearm or other violent self-harm methods greatly increases the risk of suicide, especially in the short term,” said Olfson.
The study is published in the American Journal of Psychiatry.