title: Self-cutting and risk of subsequent suicide.
abstract: BACKGROUND
  Some studies suggest that people who self-cut have a higher risk of suicide than those who self-poison. Self-cutting ranges from superficial wrist cutting to severe self-injury involving areas such as the chest, abdomen and neck which can be life threatening. This study aimed to investigate whether the site of self-cutting was associated with risk of subsequent suicide.
  
  
  METHODS
  We followed-up 3928 people who presented to hospital following self-harm between September 2010 and December 2013 in a prospective cohort study based on the Bristol Self-harm Surveillance Register. Demographic information from these presentations was linked with coroner's data to identify subsequent suicides.
  
  
  RESULTS
  People who presented with self-cutting to areas other than the arm/wrist were at increased risk of suicide compared to those who self-poisoned (HR 4.31, 95% CI 1.27-14.63, p=0.029) and this increased risk remained after controlling for age, sex, history of previous self-harm and psychiatric diagnosis (HR 4.46, 95% CI 1.50-13.25, p<0.001). We observed no such increased risk in people presenting with cutting to the arm/wrist.
  
  
  CONCLUSIONS
  These data represent the experience of one city in the UK and may not be generalisable outside of this context. Furthermore, as suicide is a rare outcome the precision of our estimates is limited.
  
  
  CONCLUSIONS
  Site of self-injury may be an important indicator of subsequent suicide risk.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: Robert.Carroll@bristol.ac.uk.
authors.forename: R
authors.initials: R
authors.lastname: Carroll
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: K H
authors.initials: KH
authors.lastname: Thomas
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Bramley
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.affiliation: Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: L
authors.initials: L
authors.lastname: Griffin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK; Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Potokar
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D011041:Poisoning / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D014950:Wounds, Penetrating / Q000523:psychology*; D014954:Wrist Injuries / Q000523:psychology; D055815:Young Adult
keywords: Attempted suicide; Methods of self-harm; Psychiatric epidemiology; Risk factors; Self-harm; Suicide