Published yesterday in the Lancet, the Multicentre Study of Self-harm in England is a large (30,950 patients) cohort study of people presenting to hospital emergency departments in Oxford, Manchester and Derby, with self-poisoning or self-injury during 2000-2007.

We know that people who self-harm have an increased risk of dying early, but this study tries to find out more about the causes of premature death, particularly factors that are linked to poverty.

The authors measured deprivation by using the Index of Multiple Deprivation 2007 in England and obtained mortality data from the NHS Medical Research Information Service.

Patients were followed up until the end of 2009; a median of 6 years.

Results were worked out using two criteria:

1. Age-standardised mortality ratios (SMRs)
2. Years of life lost (YLL)

Here’s what they found:

• 6.1% of patients died during follow-up
• People in the study were more likely to die than the general population (SMR 3.6, 95% CI 3.5-3.8)
• Death occurred more in men (4.1, 3.8-4.3) than women (3.2, 2.9-3.4)
• Death from natural causes were 2-7.5 times more frequent than was expected
• The mean years of life lost (YLL) for deaths from any cause were:
  • 31.4 years (95% CI 30.5-32.2) for men
  • 30.7 years (29.5-31.9) for women
• The mean YLL for deaths from natural causes were:
  • 25.9 years (25.7-26.0) for men
  • 25.5 years (25.2-25.8) for women
• The mean YLL for deaths from external causes were:
  • 40.2 years (40.0-40.3) for men
  • 40.0 years (39.7-40.5) for women
• All-cause mortality increased as socioeconomic deprivation increased:
  • Men (χ2 trend 39.6; p<0.0001)
  • Women (13.9; p=0.0002)
  • All (55.4; p<0.0001)

The authors concluded:

Physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population. In the management of self-harm, clinicians assessing patients’ psychosocial problems should also consider their physical needs.

Link

Bergen H, Hawton K, Waters K, Ness J, Cooper J, Steeg S, Kapur N. Premature death after self-harm: a multicentre cohort study. The Lancet, 18 September 2012, DOI: 10.1016/S0140-6736(12)61141-6 [Abstract]