Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage

Francis Mitrou,Sven R Silburn,Fiona J Stanley,David Lawrence,Stephen R Zubrick,Jennifer Gaudie

doi:10.1186/1471-244x-10-82

Francis Mitrou, Sven R Silburn + Show 4 more

Open Access

https://doi.org/10.1186/1471-244x-10-82

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Abstract

BackgroundA prior episode of deliberate self-harm (DSH) is one of the strongest predictors of future completed suicide. Identifying antecedents of DSH may inform strategies designed to reduce suicide rates. This study aimed to determine whether individual and socio-ecological factors collected in childhood and adolescence were associated with later hospitalisation for DSH.MethodsLongitudinal follow-up of a Western Australian population-wide random sample of 2,736 children aged 4-16 years, and their carers, from 1993 until 2007 using administrative record linkage. Children were aged between 18 and 31 years at end of follow-up. Proportional hazards regression was used to examine the relationship between child, parent, family, school and community factors measured in 1993, and subsequent hospitalisation for DSH.ResultsThere were six factors measured in 1993 that increased a child's risk of future hospitalisation with DSH: female sex; primary carer being a smoker; being in a step/blended family; having more emotional or behavioural problems than other children; living in a family with inconsistent parenting style; and having a teenage mother. Factors found to be not significant included birth weight, combined carer income, carer's lifetime treatment for a mental health problem, and carer education.ConclusionsThe persistence of carer smoking as an independent risk factor for later DSH, after adjusting for child, carer, family, school and community level socio-ecological factors, adds to the known risk domains for DSH, and invites further investigation into the underlying mechanisms of this relationship. This study has also confirmed the association of five previously known risk factors for DSH.

Highlights

A prior episode of deliberate self-harm (DSH) is one of the strongest predictors of future completed suicide
This study sought to address some of these concerns by utilising a quasi-longitudinal design within a socioecological framework, as used in the 1993 Western Australian Child Health Survey (WACHS) [6,7,8], to identify factors measured in childhood that predict future episodes of DSH
We hypothesised that socioecological factors measured earlier in life, in the WACHS, would be predictive of later episodes of DSH identified in linked hospital data over the follow-up period

Summary

Introduction

A prior episode of deliberate self-harm (DSH) is one of the strongest predictors of future completed suicide. A prior episode of deliberate self-harm (DSH) is one of the strongest predictors of future completed suicide [1], identifying antecedents of DSH may inform strategies aimed at reducing suicide rates. This study sought to address some of these concerns by utilising a quasi-longitudinal design within a socioecological framework, as used in the 1993 Western Australian Child Health Survey (WACHS) [6,7,8], to identify factors measured in childhood that predict future episodes of DSH. Data collected on 2,736 children aged 4-16 years in the WACHS, a cross sectional survey of health and wellbeing conducted in 1993, were linked to administrative hospital records over the ensuing 14 years until December 2007. While our study’s ability to replicate Klomek et al’s bullying analysis is beyond the scope of our questionnaire, it was designed to test the association of a wide range of other factors with hospital admissions for DSH

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