title: Alcohol-related mortality following self-harm: a multicentre cohort study.
abstract: OBJECTIVE
  To assess alcohol-related premature death in people who self-harm compared to the general population, including variation by socioeconomic deprivation.
  
  
  METHODS
  A retrospective longitudinal cohort analysis from the Multicentre Study of self-harm in England, 1 January 2000 to 31 December 2010, with cause-specific mortality follow-up through to 31 December 2012.
  
  
  METHODS
  Six emergency departments in Oxford, Manchester and Derby.
  
  
  METHODS
  All individuals aged 15 years or more who presented with self-harm (n = 39,014) to general hospital emergency departments, together with follow-up mortality information from the Data Linkage Service of the Health and Social Care Information Centre.
  
  
  METHODS
  STANDARDISED MORTALITY RATIOS (OBSERVED/EXPECTED NUMBER OF DEATHS: SMRs) and mean number of years of life lost (YLL) were estimated for alcohol-related mortality. Patients' characteristics and clinical management following self-harm were also examined.
  
  
  RESULTS
  After 7.5 years' (median) follow-up, 2695 individuals (6.9%) had died, significantly more males (9.5%) than females (5.0%), including 307 (11.4%) from alcohol-related causes. Alcohol-related death was more frequent than expected in both males (SMR 8.5, 95% CI 7.3 to 9.8) and females (11.6, 9.8 to 13.7), equating to 33.7 YLL (95% CI 32.4 to 35.0) in males and 38.1 YLL (36.6 to 39.6) in females. It was not associated with area-level socioeconomic deprivation. Alcohol-related death was associated with unemployed/sick/disabled status, alcohol use during self-harm, referral to drug/alcohol services and lack of psychosocial assessment following self-harm.
  
  
  CONCLUSIONS
  Hospital-presenting self-harm patients should receive assessment following self-ham according to national guidance to enable early identification and treatment of alcohol problems.
authors.affiliation: Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bergen
authors.affiliation: Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Webb
authors.affiliation: Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.affiliation: Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK ; Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Haigh
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ness
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.affiliation: Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
keywords: alcohol; alcohol misuse; mortality follow-up; self-harm; socio-economic deprivation