Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder
<strong>Background </strong>Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. <br><strong> Objective </strong>To examine whether specific physical injuries are ass...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023
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| _version_ | 1797110063930802176 |
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| author | Sariaslan, A Larsson, H Hawton, K Pitkanen, J Lichtenstein, P Martikainen, P Fazel, S |
| author_facet | Sariaslan, A Larsson, H Hawton, K Pitkanen, J Lichtenstein, P Martikainen, P Fazel, S |
| author_sort | Sariaslan, A |
| collection | OXFORD |
| description | <strong>Background </strong>Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown.
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Objective </strong>To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders.
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Methods </strong>By using population and secondary care registers, we identified all people born in Finland (1955–2000) and Sweden (1948–1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments.
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Findings </strong>A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4–37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0–2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals.
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Conclusions </strong>Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders.
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Clinical implications </strong>Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies. |
| first_indexed | 2024-03-07T07:50:00Z |
| format | Journal article |
| id | oxford-uuid:73b32793-6993-4974-b69e-c17c241b3308 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:50:00Z |
| publishDate | 2023 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:73b32793-6993-4974-b69e-c17c241b33082023-07-04T10:32:38ZPhysical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorderJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:73b32793-6993-4974-b69e-c17c241b3308EnglishSymplectic ElementsBMJ Publishing Group2023Sariaslan, ALarsson, HHawton, KPitkanen, JLichtenstein, PMartikainen, PFazel, S<strong>Background </strong>Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. <br><strong> Objective </strong>To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. <br><strong> Methods </strong>By using population and secondary care registers, we identified all people born in Finland (1955–2000) and Sweden (1948–1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments. <br><strong> Findings </strong>A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4–37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0–2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals. <br><strong> Conclusions </strong>Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. <br><strong> Clinical implications </strong>Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies. |
| spellingShingle | Sariaslan, A Larsson, H Hawton, K Pitkanen, J Lichtenstein, P Martikainen, P Fazel, S Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title | Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title_full | Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title_fullStr | Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title_full_unstemmed | Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title_short | Physical injuries as triggers for self-harm: a within-individual study of nearly 250,000 injured people with a major psychiatric disorder |
| title_sort | physical injuries as triggers for self harm a within individual study of nearly 250 000 injured people with a major psychiatric disorder |
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