Comparison of suicide risk and other outcomes among boys and girls who self-harm
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ORIGINAL CONTRIBUTION
Comparison of suicide risk and other outcomes among boys and girls who self‑harm Anna Ohlis1,2 · Johan Bjureberg1,2,3 · Paul Lichtenstein3 · Brian M. D’Onofrio3,4 · Alan E. Fruzzetti5 · Martin Cederlöf1,2 · Clara Hellner1,2 Received: 24 September 2019 / Accepted: 2 February 2020 © The Author(s) 2020
Abstract Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0–17 years) enrolled at the child- and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/ substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9–12.7) compared with exposed males (HR 6.5, 95% 5.2–8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socio-economic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes. Keywords Self-injurious behaviour · Suicide · Sex characteristics · Follow-up studies · Mental health services
Introduction Self-harm refers to all self-directed harmful acts, regardless of suicidal intent (e.g., self-cutting and self-poisoning) [1, 2], and is a major public health concern among young people worldwide [2]. Self-harm is slightly more commonly * Anna Ohlis [email protected] 1
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
2
Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
3
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
4
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
5
Department of Psychiatry, Harvard Medical School, Boston, MA, USA
reported in females, has a peak in prevalence rates at age 15–17 (onset age usually 12–14 years of age) and declines in early adulthood [1–3]. During adolescence, self-harm is associated with impuls
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