Self-harm linked to higher risk of early death from many causes

People who have a history of self-harm are more than three times as likely to die prematurely as the general population, a study led by researchers at Oxford University has suggested.

While accidental poisoning and suicide were the most common causes of death, the number of deaths due to heart disease, alcohol-related conditions and other health problems were also substantially higher than in the general population.

‘It must be remembered that it is only a minority of people who self-harm that can go on to die at these tragically young ages – in our study, it was 6% of those who had come through an A&E department after self-harming. We are looking at the far end of a scale,’ says Professor Keith Hawton of the Department of Psychiatry at Oxford University, who led the study.

‘From other work by our group and other researchers we know that for many people – probably the large majority – self-harming can happen at one period in their life, but eventually they get through it and things tend to turn out OK.’

The researchers from the University of Oxford, with colleagues from the Royal Derby Hospital and University of Manchester, looked at over 30 000 individuals who were seen in emergency departments in Oxford, Manchester, and Derby after self-harm between 2000 and 2007.

Roughly 6% (1832) of these people died over an average follow-up period of 6 years. The causes of any premature deaths were assessed and compared with the general population. The findings are published in the medical journal The Lancet.

Death from both ‘natural’ and ‘external’ causes (suicides, accidental poisonings and accidents other than poisoning) was substantially increased for both men and women, equating to an average of at least 30 years of life lost by each individual.

Accidental poisoning was the most common cause of premature death, followed by suicide. However, the researchers found that deaths due to natural causes were 2 to 7.5 times greater than expected.

Professor Hawton says: ‘We have known for some time that there is an elevated risk of suicide among people who self-harm compared to the general population.

‘What is new is the size of the elevated risk we have found for other causes of death, including heart disease, alcohol-related conditions, misuse of illicit drugs, and other physical health problems.

‘It suggests that when people who self-harm pass through general hospitals, there is an opportunity to look more widely at their health and potentially intervene. It will often be the first time alcohol misuse could be identified, for example – something we’re not very good at spotting in hospitals.’

Professor Hawton suggests the lessons may be in the provision of appropriate healthcare: ‘People who self-harm can also show other risky behaviours, such as alcohol and substance misuse, and these may have common origins such as experiences in childhood or socioeconomic problems. Healthcare professionals could begin to treat arriving at an emergency department after self-harm as a possible indicator for other health problems and behaviours,’ he says.

Dr Paul Moran of the Institute of Psychiatry, King’s College London – who was not involved in the study – said: ‘In this study, compared to the general population, all-cause mortality was three times higher among those who self-harmed ... These figures alone highlight the devastating impact of self-harm on individuals and their families.'

He adds: ‘Such findings highlight how crucial it is to properly assess the physical health of people who self-harm. The paper shows that they are clearly a vulnerable population of individuals with multiple health needs. 

‘It should be noted that the use of a clinical cohort in this study does limit the generalisability of findings. By definition, hospital samples are weighted towards sicker individuals and so we cannot assume that the mortality findings will be applicable to the ‘average’ person who self-harms in the community (the majority of whom never seek hospital treatment).’

The study was funded by the Department of Health Policy Research Programme.