Suicide in the 18 years after deliberate self-harm - A prospective study

Background. Clinical and demographic information on patients seen as a result of deliberate self-harm (DSH) was collected in an attempt to identify factors in the index episode of DSH predictive of subsequent suicide. Method. Specific data were prospectively collected on all DSH patients who lived in Blacktown Municipality, Sydney, Australia, and seen from October 1975 to September 1976. Follow-up at 18 years was by evaluation of coroners' records and identification of probable suicide. Results. Two hundred and twenty-three patients harmed themselves on one or more occasions. Follow-up at 18 years showed that 15 of the 223 (6.7%) had completed suicide. The proportion at five and eight years was 4.0% and at 10 years was 4.5%. Identified predictors of suicide were: narcotic overdose; more than one episode of DSH in the year of the study: planned episode; and mental illness. Teenage narcotic-abusing males were at greatest risk, and in females a planned episode was the most powerful predictor. Conclusions. Suicides continued to occur over 18 years. One of the striking differences between this and other studies is the finding of teenage male DSH, associated with narcotic abuse, as a strong predictor of subsequent suicide. These findings are particularly relevant to the issue of young male suicide, which increased from the 1970s onwards in Australia and elsewhere.