title: Substance use and male gender as risk factors for deaths and suicide--a 5-year follow-up study after deliberate self-harm.
abstract: OBJECTIVE
  The aim of this study was to determine the mortality by suicide and other causes of death in a cohort of suicide attempters and identify predictive factors, including contact to healthcare after the attempt.
  
  
  METHODS
  All consecutive 1198 deliberate self-harm patients treated in hospital emergency rooms in Helsinki during a 12-month period were identified. Data were gathered on healthcare contacts preceding and following the index attempt, and cause-specific mortality over a 5-year period.
  
  
  RESULTS
  By the end of the 5-year follow-up period, 171 (14%) of the patients had died. A total of 57 (5%) had committed suicide. The age- and sex-adjusted risk for suicide among deliberate self-harm patients was 40-fold, and for death overall tenfold, compared to general population during the 5-year follow-up period. Risk factors for subsequent suicide were a diagnosis of substance use disorder, male gender and previous suicide attempts. A diagnosis of substance use disorder and male gender predicted death. Furthermore, male gender and substance use disorders had a strong interaction for both classes of death.
  
  
  CONCLUSIONS
  The findings of this study suggest that deliberate self-harm patients have a high risk for both suicide and other causes of death. Male gender and substance use disorders are significant risk factors for both later suicide and other causes of death. Male suicide attempters with substance use disorders have remarkably high total and suicide mortality.
authors.affiliation: Dept. of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. kirsi.suominen@ktl.fi
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
authors.forename: Jari
authors.initials: J
authors.lastname: Haukka
authors.forename: Jouko
authors.initials: J
authors.lastname: Lönnqvist
mesh_terms: D000328:Adult; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D033182:Intention; D008297:Male; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000401:mortality*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*