title: Suicide after nonfatal self-harm.
abstract: BACKGROUND
  Nonfatal self-harm is the strongest predictor of suicide, with some of the risk factors for subsequent suicide after nonfatal self-harm being similar to those for suicide in general. However, we do not have sufficient information regarding the medical care provided to nonfatal self-harm episodes preceding suicide.
  
  
  OBJECTIVE
  Our study sought to explore hospital care and predictive characteristics of the risk of suicide after nonfatal self-harm.
  
  
  METHODS
  Individuals with history of nonfatal self-harm who died by suicide were compared with those who had a nonfatal self-harm episode but did not later die by suicide. Cases were identified by cross-linking data collected through a self-harm monitoring project, 2000-2007, and comprehensive local data on suicides for the same period.
  
  
  RESULTS
  Dying by suicide after nonfatal self-harm was more common for male subjects than for female subjects (OR = 3.3, 95% CI = 1.7-6.6). Self-injury as the method of nonfatal self-harm was associated with higher risk of subsequent suicide than was self-poisoning (OR = 2.0, 95% CI = 1.04-3.9). More urgent care at the emergency department (OR = 2.7, 95% CI = 1.1-6.3) and admission to hospital (OR = 2.0, 95% CI = 1.0-4.0) at the index episode were related to a heightened risk of suicide.
  
  
  CONCLUSIONS
  The findings of our study could help services to form assessment and aftercare policies.
authors.affiliation: <location>Institute of Digital Healthcare, University of Warwick, UK</location>
authors.forename: Eleni
authors.initials: E
authors.lastname: Karasouli
authors.affiliation: <location>Leeds Institute of Health Sciences, University of Leeds, UK</location>
authors.forename: David
authors.initials: D
authors.lastname: Owens
authors.affiliation: <location>Leeds Institute of Health Sciences, University of Leeds, UK</location>
authors.forename: Gary
authors.initials: G
authors.lastname: Latchford
authors.affiliation: <location>Leeds Institute of Health Sciences, University of Leeds, UK</location>
authors.forename: Rachael
authors.initials: R
authors.lastname: Kelley
mesh_terms: D000328:Adult; D000359:Aftercare; D016022:Case-Control Studies; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
keywords: hospital care; patient characteristics; risk factors; self-harm; suicide