Fatal and non-fatal repetition of self-harm. Systematic review.
BACKGROUND
Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions.


OBJECTIVE
To estimate rates of fatal and non-fatal repetition of self-harm.


METHODS
A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria.


RESULTS
Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide.


CONCLUSIONS
After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.
Owens
David
D
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK.
Horrocks
Judith
J
House
Allan
A
D006801:Humans; D012008:Recurrence; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000150:complications*; D013405:Suicide; D013997:Time Factors; D006113:United Kingdom