Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis
Top Cited Papers
Open Access
- 28 February 2014
- journal article
- review article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (2), e89944
- https://doi.org/10.1371/journal.pone.0089944
Abstract
Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.Keywords
This publication has 25 references indexed in Scilit:
- A nationwide, population-based, long-term follow-up study of repeated self-harm in TaiwanBMC Public Health, 2012
- Repeated suicide attempts among suicidal cases: Outcome of one‐year follow‐upAsia-Pacific Psychiatry, 2012
- Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort studyBMJ, 2010
- The prevalence of previous self-harm amongst self-poisoning patients in Sri LankaSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2010
- Non-fatal repetition of self-harm: population-based prospective cohort study in TaiwanThe British Journal of Psychiatry, 2010
- Undue reliance on I 2 in assessing heterogeneity may misleadBMC Medical Research Methodology, 2008
- The epidemiology and management of self-harm amongst adults in EnglandPublished by Oxford University Press (OUP) ,2004
- Controlling the risk of spurious findings from meta‐regressionStatistics in Medicine, 2004
- Variations in the hospital management of self harm in adults in England: observational studyBMJ, 2004
- Risk factors for suicide independent of DSM–III–R Axis I disorderThe British Journal of Psychiatry, 1999