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Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden.
Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6851-3297
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2016 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 16, 3397-3405 p.Article in journal (Refereed) Published
Abstract [en]

Background: Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.

Method: We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.

Results: Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.

Conclusion: We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

Place, publisher, year, edition, pages
Nww York, USA: Cambridge University Press, 2016. Vol. 46, no 16, 3397-3405 p.
Keyword [en]
Longitudinal studies, mental disorders, self-harm, suicide, young adult
National Category
Medical and Health Sciences Psychiatry Psychology
Identifiers
URN: urn:nbn:se:oru:diva-54648DOI: 10.1017/S0033291716002282ISI: 000389705400012PubMedID: 27644850Scopus ID: 2-s2.0-84988358591OAI: oai:DiVA.org:oru-54648DiVA: diva2:1064497
Note

Funding Agencies:

Swedish Council for Working Life and Social Research (FAS) 

Bror Gadelius Foundation 

Swedish Research Council [Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework] 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-01-31Bibliographically approved

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CiteExportLink to record
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Citation style
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