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All-cause mortality after non-fatal self-poisoning: a cohort study

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Suicide has been repeatedly shown to have greatly increased incidence after non-fatal self-harm but far less is known about early death from other causes. The present study’s aim was to describe mortality and risk factors concerning all causes of death after non-fatal self-poisoning.

Methods

A prospective cohort study of 976 patients who attended the Emergency Department in Nottingham, UK during a 9-month period in 1985–1986. Information on deaths was obtained for 16 years following an episode of self-poisoning, from the records of the Office for National Statistics.

Results

The observed:expected ratio for all-cause mortality was 2.2. Deaths due to diseases of the digestive and respiratory systems were, respectively, 4.4 and 2.9 times more frequent than expected. The risk for accidents was sixfold and for probable suicides 17-fold when compared with the risk in the general population. The main risk factor for subsequent deaths from natural causes was increasing age.

Conclusions

The findings of this study suggest that patients who survive self-poisoning have an increased risk of death from natural and unnatural causes. The findings point towards the need for more effective clinical management and preventive initiatives.

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References

  1. Antretter E, Dunkel D, Haring C (2009) Cause-specific excess mortality in suicidal patients: gender differences in mortality patterns. Gen Hosp Psychiat 31:67–74

    Article  Google Scholar 

  2. Carter G, Reith DM, Whyte IM, McPherson M (2005) Non-suicidal deaths following hospital-treated self-poisoning. Aust NZ J Psychiat 39:101–107

    Google Scholar 

  3. Chang SS, Sterne JAC, Lu T-H, Gunnell D (2010) ‘Hidden’ suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan. Soc Psychiatry Psychiatr Epidemiol 45:143–152

    Article  PubMed  Google Scholar 

  4. Charlton J, Kelly S, Dunnell K, Evans B, Jenkins R, Wallis R (1992) Trends in suicide deaths in England and Wales. Popul Trends 69:10–16

    Google Scholar 

  5. De Leo D, Scocco P, Marietta P, Schmidtke A, Bille-Brahe U, Kerkhof AJFM, Lönnqvist J, Crepet P, Salander-Renberg E, Wasserman D, Michel K, Bjerke T (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO). Int J Psychiat Med 29:149–163

    Article  Google Scholar 

  6. Dennis M, Read S, Andrews H, Wakefield P, Zafar R, Kavi S (2001) Suicide in a single health district: epidemiology and audit of the involvement of psychiatric services. J Ment Health 6:673–682

    Google Scholar 

  7. Dennis M, Baillon S, Brugha T, Lindesay J, Stewart R, Meltzer H (2007) The spectrum of suicidal ideation in Great Britain: comparisons across a 16–74 age range. Psychol Med 37:795–805

    Article  PubMed  Google Scholar 

  8. Ekeberg O, Ellingsen O, Jacobsen D (1991) Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo. Acta Psychiat Scand 83:432–437

    Article  PubMed  CAS  Google Scholar 

  9. Ekeberg O, Ellingsen O, Jacobsen D (1994) Mortality and causes of death in a 10-year follow-up of patients treated for self-poisonings in Oslo. Suicide Life Threat Behav 24:398–405

    PubMed  CAS  Google Scholar 

  10. Hall DJ, O’Brien F, Stark C, Pelosi A, Smith H (1998) Thirteen-year follow-up of deliberate self-harm, using linked data. Br J Psychiatry 172:239–242

    Article  PubMed  CAS  Google Scholar 

  11. Harris EC, Barraclough BM (1994) Suicide as an outcome for medical disorders. Medicine 73:281–296

    Article  PubMed  CAS  Google Scholar 

  12. Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, House A, van Heeringen K (1999) Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Db Syst Rev (4):CD001764. doi:10.1002/14651858.CD001764

  13. Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, Kapur N, Horrocks J, House A, Lilley R, Noble R, Owens D (2007) Self-harm in England: a tale of three cities. Soc Psychiatry Psychiatr Epidemiol 42:513–521

    Article  PubMed  Google Scholar 

  14. Hawton K, Harriss L (2007) Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. J Clin Psychiatry 68:1574–1583

    Article  PubMed  Google Scholar 

  15. Hawton K, Harriss L, Hall S, Simkin S, Bale E, Bond A (2003) Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med 33:987–996

    Article  PubMed  CAS  Google Scholar 

  16. Hawton K, Harriss L, Zahl D (2006) Death from all causes in a long-term follow-up study of 11 583 deliberate self-harm patients. Psychol Med 36:397–405

    Article  PubMed  CAS  Google Scholar 

  17. Holley HL, Fick G, Love EJ (1998) Suicide following an inpatient hospitalization for a suicide attempt. Soc Psychiatry Psychiatr Epidemiol 33:543–551

    Article  PubMed  CAS  Google Scholar 

  18. Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P (2002) Suicide rate 22 years after parasuicide: cohort study. BMJ 325:1155

    Article  PubMed  Google Scholar 

  19. Neeleman J (2001) A continuum of premature death. Meta-analysis of competing mortality in the psychologically vulnerable. Int J Epidemiol 30:154–162

    Article  PubMed  CAS  Google Scholar 

  20. National Institute for Clinical Excellence (2004) Short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. NICE, London

    Google Scholar 

  21. Nordentoft M, Breum L, Munck LK, Nordestgaard AG, Hunding A, Laursen Bjaeldager PA (1993) High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempt. BMJ 306:1637–1641

    Article  PubMed  CAS  Google Scholar 

  22. Ostamo A, Lönnqvist J (2001) Excess mortality of suicide attempters. Soc Psychiatry Psychiatr Epidemiol 36:29–35

    Article  PubMed  CAS  Google Scholar 

  23. Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm: a systematic review. Br J Psychiatry 181:193–199

    Article  PubMed  Google Scholar 

  24. Owens D, Dennis M, Jones S, Dove A, Dave S (1991) Self-poisoning patients discharged from accident and emergency: risk factors and outcome. J Roy Coll Phys Lond 25:218–222

    CAS  Google Scholar 

  25. Owens D, Wood C, Greenwood D, Hughes T, Dennis M (2005) Mortality and suicide after non-fatal self-poisoning: a 16-year outcome study of patients attending accident and emergency. Br J Psychiatry 187:470–475

    Article  PubMed  Google Scholar 

  26. Rygnestad T (1997) Mortality after deliberate self-poisoning. A prospective follow-up study of 587 persons observed for 5279 person years: risk factors and causes of death. Soc Psychiatry Psychiatr Epidemiol 32:443–450

    PubMed  CAS  Google Scholar 

  27. Sakinofsky I (2000) Repetition of suicidal behaviour. In: Hawton K, van Heeringen K (eds) The international handbook of suicide and attempted suicide. Wiley, Chichester, pp 385–404

    Chapter  Google Scholar 

  28. Sinclair JMA, Gray A, Rivero-Arias O, Saunders KEA, Hawton K. (2010) Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-010-0183-5

  29. Start R, Delargy-Aziz Y, Dorries C, Silcocks P, Cotton D (1993) Clinicians and the coronial system: ability of clinicians to recognise reportable deaths. BMJ 306:1038–1041

    Article  PubMed  CAS  Google Scholar 

  30. Stenager EN, Stenager E (2000) Physical illness and suicidal behaviour. In: Hawton K, van Heeringen K (eds) The international handbook of suicide and attempted suicide. Wiley, Chichester, pp 405–420

    Chapter  Google Scholar 

  31. Suominen K, Isomestä E, Haukka J, Lönnqvist J (2004) Substance use and male gender as risk factors for deaths and suicide. A 5-year follow-up study after deliberate self-harm. Soc Psychiatry Psychiatr Epidemiol 39:720–724

    Article  PubMed  Google Scholar 

  32. World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. WHO, Geneva

    Google Scholar 

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Acknowledgments

We thank the Office for National Statistics for provision of data. Tracing of the patients by the Office for National Statistics was supported by a research grant from the former NHS Northern and Yorkshire Region.

Conflict of interest statement

None.

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Authors and Affiliations

  1. Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, Leeds, LS2 9LJ, UK

    Eleni Karasouli & David Owens

  2. Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK

    Rachel L. Abbott & Keith M. Hurst

  3. School of Medicine, Swansea University, Swansea, UK

    Michael Dennis

Authors
  1. Eleni Karasouli
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  2. David Owens
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  3. Rachel L. Abbott
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  4. Keith M. Hurst
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  5. Michael Dennis
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Corresponding author

Correspondence to Eleni Karasouli.

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Karasouli, E., Owens, D., Abbott, R.L. et al. All-cause mortality after non-fatal self-poisoning: a cohort study. Soc Psychiatry Psychiatr Epidemiol 46, 455–462 (2011). https://doi.org/10.1007/s00127-010-0213-3

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  • DOI: https://doi.org/10.1007/s00127-010-0213-3

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