Premature death among primary care patients with a history of self-harm

Purpose: To examine premature mortality in a nationally representative cohort of primary care patients who have harmed themselves.
Methods: During 2001-2013, 385 general practices in England contributed data to the Clinical Practice Research Datalink (CPRD) with linkage to Office for National Statistics (ONS) mortality records. We identified 30,017 persons aged 15-64 years with a recorded self-harm episode. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort, matched on age, gender and general practice.
Results: We found elevated risk of dying prematurely from any cause among the self-harm cohort, particularly during the first follow-up year: adjusted hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.1-4.2. The elevation in suicide risk within a year was especially great: adjusted HR 54.4, CI 34.4-86.3. Beyond the first year, suicide risk declined sharply but remained much higher than in the comparison cohort. Large risk elevations throughout the follow-up period were also observed for accidental, alcohol-related and drug poisoning deaths. At 10 years of follow up, cumulative incidence values were 6.5% (CI 6.0-7.1) for all-cause mortality and 1.3% (CI 1.2-1.5) for suicide.
Conclusions: Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially so within a year of a first episode. These individuals consult at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad co-morbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multi-pronged, multidisciplinary collaborative care approaches.