2019 November–December

Here we are with the selection of articles published in the months of November and December 2019, about suicide, self harm and suicidal related topics from the major scientific journals.

Three articles are presented with a small comment by Raffaella Calati and Martina Rignanese.

Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study
Geulayov, G., Casey, D., Bale, L., Brand, F., Clements, C., Farooq, B., … & Hawton, K. 
The Lancet Psychiatry, 2019, 6(12), 1021-1030.

In this ongoing Multicentre Study of Self-harm in England, the study population consisted of individuals aged at least 15 years who had attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. The resulting study sample consisted of 90 614 hospital presentations by 49 783 individuals. By the end of follow-up on Dec 31, 2015, 703 patients had died by suicide. Based on all presentations to hospital, men were three times more likely than women to die by suicide after self-harm. Age was positively related to suicide risk in both genders, with a 3% increase in risk for every one-year increase in age at hospital presentation. Relative to hospital presentations after self-poisoning alone, presentations involving both self-injury and self-poisoning were associated with higher suicide risk, as were presentations after self-injury alone. Compared with those patients living in the most deprived areas, those who lived in the least deprived areas had a greater risk of dying by suicide. However, while specific risk factors can be usefully integrated into the assessment process, individual factors have poor utility in predicting suicide, so the needs and risks of all patients should be assessed to develop appropriate aftercare plan, including early follow-up.

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Association of Suicide and Other Mortality With Emergency Department Presentation
Goldman-Mellor S, Olfson M, Lidon-Moyano C, Schoenbaum M.
JAMA Netw Open. 2019;2(12):e1917571. doi:10.1001/jamanetworkopen.2019.17571

The aim of this retrospective cohort study was to examine 1-year incidence of suicide and other mortality among emergency departments (EDs) patients who presented with non fatal deliberate self-harm, suicidal ideation, or any other chief concern, and to examine sociodemographic and clinical factors associated with suicide mortality risk. Among 648 646 individuals who visited an ED in California from 2009 to 2011, the rates of suicide deaths per 100 000 person years in the year after index ED presentation were 693.4 deaths among 83 507 individuals presenting with deliberate self-harm and 23.4 deaths among 497 760 reference patients. Also, the rates of suicide mortality were higher among men, people 65 years or older and non-Hispanic white patients. These findings suggest that broad implementation of suicide risk screening and intervention is needed in emergency department settings, and the scope of interventions should also consider suicidal individuals’ risk for unintentional injury and other premature mortality.

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Pre-conception self-harm, maternal mental health and mother-infant bonding problems: a 20-year prospective cohort study
Borschmann, R., Molyneaux, E., Spry, E., Moran, P., Howard, L. M., Macdonald, J. A., … & Patton, G. C. 
Psychological medicine, 2019, 49(16), 2727-2735.

In this paper is illustrated the Victorian Intergenerational Health Cohort Study (VIHCS), a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3–9. Five hundred sixty-four pregnancies from 384 women were included. Women who reported self-harming in young adulthood (ages 20–29) reported higher levels of perinatal depressive symptoms and mother–infant bonding problems. There was no evidence that self-harm in adolescence (ages 15–17) was associated with either perinatal outcome. 

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