Tuesday, 30 April 2013

People who Present with Self-Harm to Hospital have a Much Higher Tate of Premature Death at Follow-Up

Lancet 380, 1568-1574 2012

One of the reasons why self-harm is important is because people who present to hospital after self-harm have a high rate of death from other causes beside suicide. So over ten years at least 10% of any cohort will die – about half of these deaths will be due to suicide and the other half to premature death for other reasons. And this is in a group of people whose average age of presentation is late 20’s early 30’s. 

I can’t think of another disorder presenting in this age group with such a high mortality. So it is good to see a paper in the Lancet in the last month by Keith Hawton’s group in Oxford describing the overall mortality following presentation to hospital emergency departments with self harm.

They followed up nearly 31000 people who had presented with self-harm in various centers in the UK for a median of 6 years. They found about 6% of the cohort died before the end of follow up with deaths due to natural causes 2-7.5 times greater than expected. 

The importance of this paper is that this is the largest cohort study on this topic to date. This makes me think that treating self-harm as solely a mental health problem is not that useful and that we should be paying more attention to health promotion and physical needs in this population. Clearly an issue in Ottawa is this group of people getting access to good primary care treatment.

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