title: Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching.
abstract: Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death.
  
  
  
  In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period.
  
  
  
  At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions.
  
  
  
  Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
authors.affiliation: Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Birkbak
authors.affiliation: Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark.
authors.forename: B D
authors.initials: BD
authors.lastname: Lind
authors.affiliation: National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway.
authors.forename: P
authors.initials: P
authors.lastname: Qin
authors.affiliation: Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Stenager
authors.affiliation: Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark.
authors.forename: K J
authors.initials: KJ
authors.lastname: Larsen
authors.affiliation: Competence Centre for Suicide Prevention,Amager,Capital Region of Denmark,Denmark.
authors.forename: A G
authors.initials: AG
authors.lastname: Wang
authors.affiliation: Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark.
authors.forename: A C
authors.initials: AC
authors.lastname: Nielsen
authors.affiliation: Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark.
authors.forename: C M
authors.initials: CM
authors.lastname: Pedersen
authors.affiliation: Unit for Suicide Prevention,Aalborg University Hospital,North Denmark Region,Denmark.
authors.forename: J-H
authors.initials: JH
authors.lastname: Winsløv
authors.affiliation: Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Langhoff
authors.affiliation: Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Mühlmann
authors.affiliation: Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Nordentoft
authors.affiliation: Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Erlangsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D011613:Psychotherapy; D012042:Registries; D016728:Self-Injurious Behavior / Q000628:therapy*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Deliberate self-harm; mortality; preventive medicine; psychosocial therapy; suicide