People who self-harm have an increased risk of premature death. The aim of this study
was to investigate cause-specific premature death in individuals who self-harm, including
associations with socioeconomic deprivation.
We undertook a cohort study of patients of all ages presenting to emergency departments
in Oxford, Manchester, and Derby, UK, after self-poisoning or self-injury between
Jan 1, 2000, and Dec 31, 2007. Postcodes of individuals' place of residence were linked
to the Index of Multiple Deprivation 2007 in England. Mortality information was supplied
by the Medical Research Information Service of the National Health Service. Patients
were followed up to the end of 2009. We calculated age-standardised mortality ratios
(SMRs) and years of life lost (YLL), and we tested for associations with socioeconomic
deprivation.
30 950 individuals presented with self-harm and were followed up for a median of 6·0
years (IQR 3·9-7·9). 1832 (6·1%) patients died before the end of follow-up. Death
was more likely in patients than in the general population (SMR 3·6, 95% CI 3·5-3·8),
and occurred more in males (4·1, 3·8-4·3) than females (3·2, 2·9-3·4). Deaths due
to natural causes were 2-7·5 times more frequent than was expected. For individuals
who died of any cause, mean YLL was 31·4 years (95% CI 30·5-32·2) for male patients
and 30·7 years (29·5-31·9) for female patients. Mean YLL for natural-cause deaths
was 25·9 years (25·7-26·0) for male patients and 25·5 years (25·2-25·8) for female
patients, and for external-cause deaths was 40·2 years (40·0-40·3) and 40·0 years
(39·7-40·5), respectively. Disease of the circulatory (13·1% in males; 13·0% in females)
and digestive (11·7% in males; 17·8% in females) systems were major contributors to
YLL from natural causes. All-cause mortality increased with each quartile of socioeconomic
deprivation in male patients (χ(2) trend 39·6; p<0·0001), female patients (13·9; p=0·0002),
and both sexes combined (55·4; p<0·0001). Socioeconomic deprivation was related to
mortality in both sexes combined from natural causes (51·0; p<0·0001) but not from
external causes (0·30; p=0·58). Alcohol problems were associated with death from digestive-system
disease, drug misuse with mental and behavioural disorders, and physical health problems
with circulatory-system disease.
Physical health and life expectancy are severely compromised in individuals who self-harm
compared with the general population. In the management of self-harm, clinicians assessing
patients' psychosocial problems should also consider their physical needs.
Department of Health Policy Research Programme.
Copyright © 2012 Elsevier Ltd. All rights reserved.