title: Deliberate self-harm before psychiatric admission and risk of suicide: survival in a Danish national cohort.
abstract: OBJECTIVE
  Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15% of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high-risk cohort consisting of hospitalized psychiatric patients with recent DSH.
  
  
  METHODS
  This national prospective register-based study examined all hospitalized psychiatric patients who self-harmed within a year before admission. All admitted patients, in the time period 1998-2006, were followed and survival analyses techniques were used to identify predictors of suicide.
  
  
  RESULTS
  The study population consisted of 17,257 patients; 520 (3%) died by suicide during follow-up; 50% of the suicides occurred within a year from the index admission. A rate of 1,645 suicides per 100,000 person-years in the first year after psychiatric admission was found. Adjusted analyses showed that a higher degree of education, having DSH within a month before psychiatric admission and contact with a private psychiatrist increased the risk of suicide.
  
  
  CONCLUSIONS
  Psychiatric hospitalized patients with recent DSH revealed high suicide rates, even during hospitalization. When discharging psychiatric patients with recent DSH careful arrangement of follow-up treatment in the outpatient setting is recommendable.
authors.affiliation: Psychiatric Center Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, Building 13A, 2400, Copenhagen, Denmark. trine.madsen@regionh.dk
authors.forename: Trine
authors.initials: T
authors.lastname: Madsen
authors.forename: Esben
authors.initials: E
authors.lastname: Agerbo
authors.forename: Preben B
authors.initials: PB
authors.lastname: Mortensen
authors.forename: Merete
authors.initials: M
authors.lastname: Nordentoft
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D012737:Sex Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D014754:Violence