title: How do methods of non-fatal self-harm relate to eventual suicide?
abstract: BACKGROUND
  Methods used at an index episode of non-fatal self-harm may predict risk of future suicide. Little is known of suicide risk associated with most recent non-fatal method, and whether or not change in method is important.
  
  
  METHODS
  A prospective cohort of 30,202 patients from the Multicentre Study of Self-harm in England presenting to six hospitals with self-harm, 2000-2007, was followed up to 2010 using national death registers. Risks of suicide (by self-poisoning, self-injury, and all methods) associated with recent method(s) of non-fatal self-harm were estimated using Cox models.
  
  
  RESULTS
  Suicide occurred in 378 individuals. Cutting, hanging/asphyxiation, CO/other gas, traffic-related and other self-injury at the last episode of self-harm were associated with 1.8 to 5-fold increased risks (vs. self-poisoning) of subsequent suicide, particularly suicide involving self-injury. All methods of self-harm had similar risks of suicide by self-poisoning. One-third who died by suicide used the same method for their last self-harm and for suicide, including 41% who self-poisoned. No specific sequences of self-poisoning, cutting or other self-injury in the last two non-fatal episodes were associated with suicide in individuals with repeated self-harm.
  
  
  CONCLUSIONS
  Data were for hospital presentations only, and lacked a suicide intent measure.
  
  
  CONCLUSIONS
  Method of self-harm may aid identification of individuals at high risk of suicide. Individuals using more dangerous methods (e.g. hanging, CO/other gas) should receive intensive follow-up. Method changes in repeated self-harm were not associated with suicide. Our findings reinforce national guidance that all patients presenting with self-harm, regardless of method, should receive a psychosocial assessment.
authors: Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom.
authors: Helen
authors: H
authors: Bergen
authors: Keith
authors: K
authors: Hawton
authors: Keith
authors: K
authors: Waters
authors: Jennifer
authors: J
authors: Ness
authors: Jayne
authors: J
authors: Cooper
authors: Sarah
authors: S
authors: Steeg
authors: Navneet
authors: N
authors: Kapur
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000401:mortality / Q000523:psychology*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult