title: Descriptive epidemiology and underlying psychiatric disorders among hospitalizations with self-directed violence.
abstract: BACKGROUND
  Suicide claims over one million lives worldwide each year. In the United States, 1 per 10,000 persons dies from suicide every year, and these rates have remained relatively constant over the last 20 years. There are nearly 25 suicide attempts for each suicide, and previous self-directed violence is a strong predictor of death from suicide. While many studies have focused on suicides, the epidemiology of non-fatal self-directed violence is not well-defined.
  
  
  OBJECTIVE
  We used a nationally representative survey to examine demographics and underlying psychiatric disorders in United States (US) hospitalizations with non-fatal self-directed violence (SDV).
  
  
  METHODS
  International Classification of Disease, 9(th) Revision (ICD-9) discharge diagnosis data from the National Hospital Discharge Survey (NHDS) were examined from 1997 to 2006 using frequency measures and adjusted logistic regression.
  
  
  RESULTS
  The rate of discharges with SDV remained relatively stable over the study time period with 4.5 to 5.7 hospitalizations per 10,000 persons per year. Excess SDV was documented for females, adolescents, whites, and those from the Midwest or West. While females had a higher likelihood of self-poisoning, both genders had comparable proportions of hospitalizations with SDV resulting in injury. Over 86% of the records listing SDV also included psychiatric disorders, with the most frequent being affective (57.8%) and substance abuse (37.1%) disorders. The association between psychiatric disorders and self-injury was strongest for personality disorders for both males (OR = 2.1; 95% CI = 1.3-3.4) and females (OR = 3.8; 95% CI = 2.7-5.3).
  
  
  CONCLUSIONS
  The NHDS provides new insights into the demographics and psychiatric morbidity of those hospitalized with SDV. Classification of SDV as self-injury or self-poisoning provides an additional parameter useful to epidemiologic studies.
authors.affiliation: Preventive Medicine Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America. Natalya.Weber@us.army.mil
authors.forename: Natalya S
authors.initials: NS
authors.lastname: Weber
authors.forename: Jared A
authors.initials: JA
authors.lastname: Fisher
authors.forename: David N
authors.initials: DN
authors.lastname: Cowan
authors.forename: Teodor T
authors.initials: TT
authors.lastname: Postolache
authors.forename: Rakel A
authors.initials: RA
authors.lastname: Larsen
authors.forename: David W
authors.initials: DW
authors.lastname: Niebuhr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D011041:Poisoning; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014754:Violence; D055815:Young Adult; D000092864:Suicide Prevention
references.citation: Br J Psychiatry. 2005 Jan;186:60-6
references.pmid: 15630125
references.citation: J Affect Disord. 2001 Mar;63(1-3):159-70
references.pmid: 11246092
references.citation: Suicide Life Threat Behav. 2010 Oct;40(5):421-4
references.pmid: 21034205
references.citation: Am J Public Health. 2010 Dec;100(12):2473-80
references.pmid: 21068419
references.citation: Am J Psychiatry. 2005 Feb;162(2):297-303
references.pmid: 15677594
references.citation: Ann Emerg Med. 2005 Oct;46(4):369-75
references.pmid: 16183394
references.citation: J Affect Disord. 2012 Feb;136(3):526-33
references.pmid: 22127391
references.citation: Ann Intern Med. 2002 Feb 19;136(4):302-11
references.pmid: 11848728
references.citation: J Clin Psychiatry. 2003 Sep;64(9):1031-8
references.pmid: 14628978
references.citation: Curr Psychiatry Rep. 2000 Feb;2(1):56-61
references.pmid: 11122933
references.citation: Am J Psychiatry. 1992 Jan;149(1):41-4
references.pmid: 1728183
references.citation: Pharmacoepidemiol Drug Saf. 2010 Dec;19(12):1263-75
references.pmid: 20922709
references.citation: Int Clin Psychopharmacol. 2001 Mar;16 Suppl 2:S25-30
references.pmid: 11349758
references.citation: Epidemiology. 2002 Sep;13(5):517-24
references.pmid: 12192220
references.citation: Vital Health Stat 1. 2000 Dec;(39):1-42
references.pmid: 11261241
references.citation: MMWR Surveill Summ. 2011 Oct 21;60(13):1-22
references.pmid: 22012169
references.citation: Acta Psychiatr Scand. 1989 May;79(5):490-7
references.pmid: 2750550
references.citation: Br J Psychiatry. 1998 Jan;172:35-7
references.pmid: 9534829
references.citation: J Psychother Pract Res. 2000 Winter;9(1):1-6
references.pmid: 10608903
references.citation: J Psychosom Res. 2009 Jun;66(6):477-93
references.pmid: 19446707
references.citation: Ann Epidemiol. 1994 Mar;4(2):152-8
references.pmid: 8205283
references.citation: Arch Gen Psychiatry. 1988 Jun;45(6):589-92
references.pmid: 3377646
references.citation: Am J Geriatr Psychiatry. 2008 Nov;16(11):905-13
references.pmid: 18978251
references.citation: Crisis. 2004;25(4):147-55
references.pmid: 15580849
references.citation: Eur Child Adolesc Psychiatry. 2011 Feb;20(2):103-8
references.pmid: 21222215
references.citation: JAMA. 2004 Sep 15;292(11):1333-40
references.pmid: 15367555
references.citation: J Natl Med Assoc. 2011 Jul;103(7):614-7
references.pmid: 21999037
references.citation: Acta Psychiatr Scand. 2011 Dec;124(6):454-61
references.pmid: 21838739
references.citation: Suicide Life Threat Behav. 2003 Winter;33(4):353-64
references.pmid: 14695050
references.citation: Bipolar Disord. 2010 Feb;12(1):1-9
references.pmid: 20148862
references.citation: Chronic Dis Can. 2002 Fall;23(4):139-45
references.pmid: 12517321
references.citation: Int J Geriatr Psychiatry. 2001 Mar;16(3):300-10
references.pmid: 11288165
references.citation: Consult Pharm. 2010 Feb;25(2):93-102
references.pmid: 20211822