Background Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions.

Aims To estimate rates of fatal and non-fatal repetition of self-harm.

Method A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria.

Results Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide.

Conclusions After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

/pdf/fatal-and-non-fatal-repetition-of-self-harm-systematic-3u31ysyh0l.pdf

Fatal and non-fatal repetition of self-harm. Systematic review.

Self poisoning is the most common form ofdeliberate self harm. Most cases of deliberateself poisoning present to general hospitals; inthe UK there are more than 150 000 suchattendances annually. The most common sub-stances ingested are analgesics, particularlyparacetamol and paracetamol containingcompounds.

https://qualitysafety.bmj.com/content/qhc/8/2/137.full.pdf

Deliberate self harm.

https://www.journal-of-hepatology.eu/article/S0168-8278(88)80475-6/pdf

Transplantation of the liver in adults and children with fulminant hepatic failure.

Suicides in prison have been increasing at a rate that is faster than the rate of increase in the size of the prison population. The causes of this increase, and the particular nature of the prison suicide problem, have been poorly understood in previous studies. Most of these studies have been based on recorded information alone. Talking openly and systematically to prisoners and staff involved in suicide attempts in prison provides new and important insights into the development of suicidal feelings in custody. A group of young prisoners who show a marked vulnerability to suicide and suicide attempts can be differentiated from the general young prisoner population by the extent of the background deprivation they report, and by their inability to cope with or make any constructive use of their sentence. It is shown that the most vulnerable inmates can often be found in the worst situations, many having no job or activity in prison, and receiving very little contact from their families. They make...

Suicides in young prisoners: A summary

Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department. This group was then randomly allocated to hospital admission (38 cases) or discharge home (39 cases). One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms, and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. This lends support to recent government recommendations, but caution should be exercised before such a result is generalised.

General hospital admission in the management of parasuicide. A randomised controlled trial.

The outcome in 115 consecutive patients with mild self-poisoning seen by junior medical staff and discharged from the accident department was compared with that of 98 similar patients admitted to the medical wards. Psychiatrists saw only four patients in the accident department and 25 admissions. In making their assessments the junior medical staff considered psychosocial factors as well as the patients9 physical condition. Most patients recommended for further care, and discharged from the accident department, subsequently received it. Repetition rates were similar in the two groups and there had been no suicides when patients were followed up at one year. It is feasible for junior staff in an accident department to decide whether patients with self-poisoning need admission or may be discharged with or without subsequent referral for psychiatric or social work help.

J. M. Allon-Smith

Papers

Psychological and social evaluation in cases of deliberate self-poisoning seen in an accident department