title: Method choice in nonfatal self-harm as a predictor of subsequent episodes of self-harm and suicide: implications for clinical practice.
abstract: OBJECTIVE
  We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide.
  
  
  METHODS
  We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers.
  
  
  RESULTS
  Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode.
  
  
  CONCLUSIONS
  Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried.
authors.affiliation: Department of Health Policy and Management, Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA. mmiller@hsph.harvard.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.forename: Katherine
authors.initials: K
authors.lastname: Hempstead
authors.forename: Tuan
authors.initials: T
authors.lastname: Nguyen
authors.forename: Catherine
authors.initials: C
authors.lastname: Barber
authors.forename: Sarah
authors.initials: S
authors.lastname: Rosenberg-Wohl
authors.forename: Deborah
authors.initials: D
authors.lastname: Azrael
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D015331:Cohort Studies; D062787:Drug Overdose / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult