title: Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort.
abstract: Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.
  
  
  
  We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.
  
  
  
  Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.
  
  
  
  We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
authors.affiliation: Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Beckman
authors.affiliation: Department of Clinical Neuroscience,Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Mittendorfer-Rutz
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Larsson
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Almqvist
authors.affiliation: Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Runeson
authors.affiliation: Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Dahlin
mesh_terms: D000293:Adolescent; D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D011619:Psychotropic Drugs
keywords: Longitudinal studies; mental disorders; self-harm; suicide; young adult