Self cutting and risk of subsequent suicide.
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. LIMITATIONS 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.
Journal of affective disorders