title: Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.
abstract: Background Psychiatric illnesses are known risk factors for self-harm but associations between self-harm and physical illnesses are less well established. We aimed to stratify selected chronic physical and psychiatric illnesses according to their relative risk of self-harm. Design Retrospective cohort studies using a linked dataset of Hospital Episode Statistics (HES) for 1999-2011. Participants Individuals with selected psychiatric or physical conditions were compared with a reference cohort constructed from patients admitted for a variety of other conditions and procedures. Setting All admissions and day cases in National Health Service (NHS) hospitals in England. Main outcome measures Hospital episodes of self-harm. Rate ratios (RRs) were derived by comparing admission for self-harm between cohorts. Results The psychiatric illnesses studied (depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse) all had very high RRs (> 5) for self-harm. Of the physical illnesses studied, an increased risk of self-harm was associated with epilepsy (RR = 2.9, 95% confidence interval [CI] 2.8-2.9), asthma (1.8, 1.8-1.9), migraine (1.8, 1.7-1.8), psoriasis (1.6, 1.5-1.7), diabetes mellitus (1.6, 1.5-1.6), eczema (1.4, 1.3-1.5) and inflammatory polyarthropathies (1.4, 1.3-1.4). RRs were significantly low for cancers (0.95, 0.93-0.97), congenital heart disease (0.9, 0.8-0.9), ulcerative colitis (0.8, 0.7-0.8), sickle cell anaemia (0.7, 0.6-0.8) and Down's syndrome (0.1, 0.1-0.2). Conclusions Psychiatric illnesses carry a greatly increased risk of self-harm as well as of suicide. Many chronic physical illnesses are also associated with an increased risk of both self-harm and suicide. Identifying those at risk will allow provision of appropriate monitoring and support.
authors: 1 University of Oxford Medical School, Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK.
authors: Arvind
authors: A
authors: Singhal
authors: 1 University of Oxford Medical School, Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK.
authors: Jack
authors: J
authors: Ross
authors: 2 Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
authors: Olena
authors: O
authors: Seminog
authors: 3 Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
authors: Keith
authors: K
authors: Hawton
authors: 2 Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
authors: Michael J
authors: MJ
authors: Goldacre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology; D004739:England; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000209:etiology*; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: chronic illness; cohort study; physical illness; psychiatric illness; risk; self-harm; suicidality; suicide