Self-cutting and risk of subsequent suicide

Abstract

BackgroundSome studies suggest that people who self-cut have a higher risk of suicide than those who self-poison. Self-cutting ranges from superficial wrist cutting to severe self-injury involving areas such as the chest, abdomen and neck which can be life threatening. This study aimed to investigate whether the site of self-cutting was associated with risk of subsequent suicide. MethodsWe followed-up 3928 people who presented to hospital following self-harm between September 2010 and December 2013 in a prospective cohort study based on the Bristol Self-harm Surveillance Register. Demographic information from these presentations was linked with coroner’s data to identify subsequent suicides. ResultsPeople who presented with self-cutting to areas other than the arm/wrist were at increased risk of suicide compared to those who self-poisoned (HR 4.31, 95% CI 1.27–14.63, p=0.029) and this increased risk remained after controlling for age, sex, history of previous self-harm and psychiatric diagnosis (HR 4.46, 95% CI 1.50–13.25, p<0.001). We observed no such increased risk in people presenting with cutting to the arm/wrist. LimitationsThese data represent the experience of one city in the UK and may not be generalisable outside of this context. Furthermore, as suicide is a rare outcome the precision of our estimates is limited. ConclusionsSite of self-injury may be an important indicator of subsequent suicide risk.