l

The content of this website is intended for healthcare professionals only

Better support after self-harm will reduce suicide-risk

Study shows risk of suicide particularly acute in the month after hospital discharge

Mark Gould

Thursday, 07 November 2019

A major new report spanning 16 years and including case studies of almost 50,000 people highlights the acute risk of suicide in the immediate aftermath of hospital discharge following treatment for self-harm.

The study* published today in The Lancet Psychiatry emphasises the need for provision of early follow-up care and attention to risk reduction strategies.


It examined care at five English hospitals and concludes that to reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

The study compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and socioeconomic deprivation. It also estimated the incidence of suicide by time after hospital attendance, adjusting for gender, age, previous self-harm and psychiatric treatment.

The study included 49,783 people aged over 15 years who presented to hospital after non-fatal self-harm a total of 90,614 times between 2000-2013. The authors followed these patients for 16 years until the end of 2015. The study included five hospitals, one in Oxford, three in Manchester and one in Derby.

Within the 16 year follow-up, 703 out of 49,783 people died by suicide – with the incidence of suicide being 163 per 100,000 people per year.

Around a third of these deaths occurred within a year of the patient attending hospital for non-fatal self-harm (36%, 252/703 deaths), and the study confirmed the high risk of suicide in the first year after presentation to hospital for self-harm (the incidence of suicide in the year following discharge from hospital was 511 suicides per 100,000 people per year – 55.5 times higher than that of the general population).

The authors found that the incidence of suicide in the month following discharge from hospital was 1,787 per 100,000 people per year – close to 200 times higher than in the general population – with 74 out of 703 people in the study dying by suicide within a month.

“The peak in risk of suicide which follows immediately after discharge from hospital underscores the need for provision of early and effective follow-up care. Presentation to hospital for self-harm offers an opportunity for intervention, yet people in are often discharged from hospital having not received a formal assessment of their problems and needs, and without specific aftercare arrangements.

“As specified in national guidance, a comprehensive assessment of the patients’ mental state, needs, and risks is essential to devise an effective plan for their follow-up care,” says study author Dr Galit Geulayov, from the Centre for Suicide Research, Department of Psychiatry, University of Oxford.

It has been estimated that every year there are approximately 200,000 presentations to emergency departments in hospitals across England following acts of non-fatal self-harm. Self-harm is associated with increased mortality, especially by suicide. Approximately 50% of individuals who die by suicide have a history of self-harm, with hospital presentation for self-harm often occurring shortly before suicide.

The authors note that men were more likely to die by suicide following hospital presentation of self-harm than women, people who attended hospital more than once for non-fatal self-harm were more likely to die by suicide than those with a single presentation, and age was associated with risk (with risk increasing 3% with each year of age).

In addition, those who lived in less deprived areas had a higher risk of death by suicide than those who lived in the most deprived areas, but this contrasts with a large body of evidence and might be explained by higher rates of psychiatric disorders in this group in this study, although more research is needed. The authors also note that some forms of self-harm were more strongly linked to subsequent suicide, but advise against including detail of this kind in media reporting.


*Geulayov G, Casey D, Bale L, et al. Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study. The Lancet Psychiatry. Published: November 06, 2019. DOI:10.1016/S2215-0366(19)30402-X

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470