Self-Harm Can Be a Harbinger of Suicide

Adults who self-harm appear to be at increased risk for suicide over the next year, a new study suggests.

"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 senior study author Dr. Mark Olfson. He's a professor of psychiatry at Columbia University Medical Center in New York City.

"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," Olfson said in a university news release.

The researchers examined Medicaid data on more than 62,000 people in 45 states diagnosed with an initial self-harm episode between 2001 and 2007.

The study found that nearly 20 percent -- mostly older whites who had been recently treated for a mental disorder such as depression or alcohol use disorder -- repeated self-harm in the following year.

The researchers also found that the one-year suicide rate among self-harm patients was 37 times higher than in the general population. Men were two times more likely to die by suicide than women, and older white adults were three times more likely to die by suicide than younger, nonwhite adults.

Just last week, Princeton University researchers reported that older whites without college degrees were particularly vulnerable to early deaths.

While blacks and Latinos have seen steady improvement in mortality rates, the opposite has been true for whites without college degrees, the Princeton team found. Most of that jump in early death rates has been attributed to high rates of drug overdoses, alcoholism and suicides, along with an increase in heart disease cases.

In the new report on suicide, two-thirds of suicides during initial self-harm episodes were violent, with more than 40 percent involving guns. The risk of suicide was about 10 times greater in the first month after an initial episode of self-harm using a violent method than during 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," Olfson said.

The study was published March 21 in the American Journal of Psychiatry.