title: Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors.
abstract: BACKGROUND
  Mortality, including suicide and accidents, is elevated in self-harm populations. Although risk factors for suicide following self-harm are often investigated, rarely have those for accidents been studied. Our aim was to compare risk factors for suicide and accidents.
  
  
  METHODS
  A prospective cohort (n=30 202) from the Multicentre Study of Self-harm in England, 2000-2007, was followed up to 2010 using national death registers. Risk factors for suicide (intentional self-harm and undetermined intent) and accidents (narcotic poisoning, non-narcotic poisoning, and non-poisoning) following the last hospital presentation for self-harm were estimated using Cox models.
  
  
  RESULTS
  During follow-up, 1833 individuals died, 378 (20.6%) by suicide and 242 (13.2%) by accidents. Independent predictors of both suicide and accidents were: male gender, age 35 years (except accidental narcotic poisoning) and psychiatric treatment (except accidental narcotic poisoning). Factors differentiating suicide from accident risk were previous self-harm, last method of self-harm (twofold increased risks for cutting and violent self-injury versus self-poisoning) and mental health problems. A risk factor specific to accidental narcotic poisoning was recreational/illicit drug problems, and a risk factor specific to accidental non-narcotic poisoning and non-poisoning accidents was alcohol involvement with self-harm.
  
  
  CONCLUSIONS
  The similarity of risk factors for suicide and accidents indicates common experiences of socio-economic disadvantage, life problems and psychopathology resulting in a variety of self-destructive behaviour. Of factors associated with the accidental death groups, those for non-narcotic poisoning and other accidents were most similar to suicide; differences seemed to be related to criteria coroners use in reaching verdicts. Our findings support the idea of a continuum of premature death.
authors.affiliation: Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.
authors.forename: H
authors.initials: H
authors.lastname: Bergen
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.forename: J
authors.initials: J
authors.lastname: Cooper
authors.forename: S
authors.initials: S
authors.lastname: Steeg
authors.forename: J
authors.initials: J
authors.lastname: Ness
authors.forename: K
authors.initials: K
authors.lastname: Waters
mesh_terms: D000059:Accidents / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009294:Narcotics / Q000506:poisoning; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000145:classification / Q000401:mortality*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000401:mortality*; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult
chemical_list: D009294:Narcotics