Cybulski, L. et al | 2021 | Risk factors for nonfatal self-harm and suicide among adolescents: two nested case–control studies conducted in the UK Clinical Practice Research Datalink | The Journal of Child Psychology and Psychiatry | https://doi.org/10.1111/jcpp.13552
A new longitudinal study finds that the majority (80 per cent) of young people who self-harmed or died by suicide had been in contact with a GP or a practice nurse in the year before. The study followed adolescents between 2003 and 2018, using two delineated case control studies, using data derived from two health databases: Clinical Practice Research Datalink (CPRD) Aurum and GOLD datasets. From these the researchers identified 56 008 adolescents with a nonfatal self-harm episode for the self-harm case control and 324 Individuals who had died by suicide, of which two thirds (67 per cent) were boys in the suicide case control.
Ultimately, comparing adolescents who have harmed themselves nonfatally with those who died by suicide is inherently complicated because future suicides will be preponderant among those individuals who harm themselves nonfatally (Hawton et al., 2012). Whereas most individuals who die by suicide have a history of self-harm (Rodway et al., 2016), the majority of individuals who harm themselves nonfatally do not die from suicide at a later date (Hawton et al., 2015; Hawton & Harriss, 2008).
The authors argue primary care services are in position to intervene as most adolescents who self-harm or die from suicide have contact with services in the year preceding the initial self-harm episode. Ensuring timely access to effective treatment is a priority as psychiatric illnesses increase the risks of nonfatal self-harm and suicide (Source:
Abstract
Background
The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown.
Method
We delineated two nested case–control studies of patients aged 10–19 years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N = 324) – study 1; experienced their first self-harm episode (N = 56,008) – study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation.
Results
Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8–8.2; suicide: OR 7.4; 95% CI 5.5–9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not.
Conclusions
We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention.
Risk factors for nonfatal self-harm and suicide among adolescents: two nested case–control studies conducted in the UK Clinical Practice Research Datalink [primary paper]
See also: University of Manchester Most adolescents dying by suicide or harming themselves known to health services [
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