Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital.

OBJECTIVES: To investigate the characteristics of young deliberate self-harm (DSH) patients and determine outcome in terms of mortality and risk factors for suicide.
METHOD: Information was collected on consecutive DSH patients aged 15 through 24 years presenting to a general hospital during a 20-year period (1978-1997). Deaths to the end of 2000 were identified through national mortality registers.
RESULTS: Of 5459 patients in the cohort, 62.9% were female and 37.1% male. Overdoses (90.5% of DSH episodes) most frequently involved acetaminophen (44.0%). Acetaminophen and antidepressant overdoses increased during the study period, whereas overdoses of minor tranquilizers decreased. More than one third of patients (36.1%) drank alcohol immediately before DSH. The most frequent problems faced by patients involved family members, partners, employment/ studies, and friends. One quarter of patients (26.3%) had a history of prior DSH. Of 4843 patients followed up, 141 (2.9%) died (90 males [5.0%] and 51 females [1.7%]), the risk of death being 4 times greater than expected. More than half (81; 57.4%) of the deaths were from probable suicide, which was approximately 10 times more frequent than expected. Risk factors for suicide included male gender, previous DSH, prior psychiatric history (females), and high suicide intent. There were also more deaths than expected from respiratory disorders, circulatory disorders, and accidents that did not involve poisoning.
CONCLUSIONS: The range of characteristics of young DSH patients indicates the multifactional nature of aftercare required following DSH. The very high risk of suicide after DSH in young people highlights the need for preventive initiatives in this population.