Annette Erlangsen1, Bertel Dam Lind2, Elizabeth A Stuart3, Ping Qin4, Elsebeth Stenager5, Kim Juul Larsen6, August G Wang7, Marianne Hvid7, Ann Colleen Nielsen8, Christian Møller Pedersen9, Jan-Henrik Winsløv10, Charlotte Langhoff11, Charlotte Mühlmann9, Merete Nordentoft12. 1. Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: annette.Erlangsen@regionh.dk. 2. Clinic of Suicide Prevention and Treatment for Adults, Department of Psychiatry, Region of Southern Denmark, Denmark. 3. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway. 5. Department of Psychiatry, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark. 6. Department of Child and Adolescent Psychiatry, Clinic of Suicide Prevention and Treatment for Children and Adolescents, Region of Southern Denmark, Denmark. 7. Competence Centre for Suicide Prevention, Amager, Capital Region of Denmark, Denmark. 8. Competence Centre for Suicide Prevention, Copenhagen, Capital Region of Denmark, Denmark. 9. Clinic for Suicide Prevention, Aarhus University Hospital Risskov, Aarhus, Central Denmark Region, Denmark. 10. Unit for Suicide Prevention, Aalborg University Hospital, North Denmark Region, Denmark. 11. Clinic for Suicide Prevention, Herning, Central Denmark Region, Denmark. 12. Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark.
Abstract
BACKGROUND: Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. METHODS: In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992-2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. FINDINGS: 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17,034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65-0·82) and death by any cause (0·62, 0·47-0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77-0·91; absolute risk reduction [ARR] 2·6%, 1·5-3·7; numbers needed to treat [NNT] 39, 95% CI 27-69), deaths by suicide (OR 0·75, 0·60-0·94; ARR 0·5%, 0·1-0·9; NNT 188, 108-725), and death by any cause (OR 0·69, 0·62-0·78; ARR 2·7%, 2·0-3·5; NNT 37, 29-52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented. INTERPRETATION: Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm. FUNDING: Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.
BACKGROUND: Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. METHODS: In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992-2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. FINDINGS: 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17,034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65-0·82) and death by any cause (0·62, 0·47-0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77-0·91; absolute risk reduction [ARR] 2·6%, 1·5-3·7; numbers needed to treat [NNT] 39, 95% CI 27-69), deaths by suicide (OR 0·75, 0·60-0·94; ARR 0·5%, 0·1-0·9; NNT 188, 108-725), and death by any cause (OR 0·69, 0·62-0·78; ARR 2·7%, 2·0-3·5; NNT 37, 29-52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented. INTERPRETATION: Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm. FUNDING: Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.
Authors: Sarah Steeg; Matthew J Carr; Pearl L H Mok; Carsten B Pedersen; Sussie Antonsen; Darren M Ashcroft; Nav Kapur; Annette Erlangsen; Merete Nordentoft; Roger T Webb Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2019-10-25 Impact factor: 4.328
Authors: Keith Hawton; Katrina G Witt; Tatiana L Taylor Salisbury; Ella Arensman; David Gunnell; Philip Hazell; Ellen Townsend; Kees van Heeringen Journal: Cochrane Database Syst Rev Date: 2016-05-12
Authors: R Carroll; P Corcoran; E Griffin; I Perry; E Arensman; D Gunnell; C Metcalfe Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-06-14 Impact factor: 4.328