Young people face a sharply higher risk of suicide in the months following a deliberate self-harm attempt, according to a new study led by Columbia University Irving Medical Center (CUIMC). After a nonfatal self-harm event, males are four times more likely to die of suicide than females and Native Americans are five times more likely than white non-Hispanics.
The findings, published in the journal Pediatrics, highlight the need to have clinical interventions during this critical period for youth who survive such attempts.
“Our latest study shows that time is of the essence in preventing a nonfatal self-harm event from leading to a fatality,” said Mark Olfson, M.D., M.P.H., professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons and lead author of the study.
“Although young adults compared to adolescents had a higher risk of suicide over the year after self-harm, adolescents had a particularly high risk during the first few weeks.”
Nonfatal self-harm, such as cutting or poisoning oneself with or without suicidal intent, is common among young people. Research has shown that approximately one-third of young people who die of suicide engage in nonfatal self-harm events in the last three months of life; however, it has remained unclear which young people with self-harm are at the highest short-term risk of suicide.
The researchers looked at Medicaid data from 45 states to determine the 1-year suicide risk in 32,395 adolescents and young adults (age 12 to 24 years) who had been clinically diagnosed with deliberate self-harm. The information was linked to the U.S. National Death Index to confirm dates and cause of death.
The researchers analyzed several risk factors, including demographic characteristics, recent treatment for a psychiatric disorder, and method of self-harm. Among young people with self-harm, the researchers compared the risk of repeated nonfatal self-harm and suicide. They also compared the risk of suicide in the self-harm group to the general population of similar age and demographic characteristics.
The findings show that about 17 percent had a repeated nonfatal self-harm episode in the first year, and 0.15 percent percent died of suicide. Adolescents in the self-harm group were 46 times more likely than the controls to die of suicide in the 12 months after a nonfatal self-harm attempt. The risk of suicide was especially high after self-harm events using violent methods such as firearms or hanging.
Although only around 4 percent of young people in the self-harm group used violent methods, they accounted for approximately 40 percent of the suicide deaths. In previous research, Olfson found that adults also had a greater risk of suicide in the year after a self-harm episode, particularly after a self-harm incident involving violent methods.
“For many people, young and old, the same problems that led them to harm themselves in the first place — such as depression, substance use, and anxiety disorders — may continue to put them at risk of suicide,” said Olfson.
Following nonfatal self-harm, males were four times more likely to die of suicide than females, and Native Americans were five times more likely than white non-Hispanic individuals.
Learn more: Suicide resources for those in need.
“We suspect that lower use of mental health services among males and Native Americans may partially explain the higher suicide rates in these groups,” said Olfson.
The study suggests that clinical priority should be given to ensuring the safety of young people after a self-harm event. This may include treating underlying psychiatric disorders, restricting access to lethal means of self-harm, strengthening supportive relationships, and close monitoring for emerging suicidal symptoms.
Dr. Jeffrey Lieberman, chair of Columbia Psychiatry and former president of the American Psychiatric Association, added that “this report is a wake-up call to a public mental health problem that has been neglected for too long. It’s time to act on these results to provide services that can prevent self-inflicted harm to mentally distressed youth.”