A longitudinal study of risk factors, correlates, course, and outcomes of adults who engage in non-suicidal self-injury

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Chartrand, Hayley
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With the release of DSM-5, the distinction between non-suicidal self-injury and suicide attempts is highlighted in the section of conditions for further study with non-suicidal self-injury and suicidal behavior disorder classified as distinct disorders. However, some have questioned the validity of distinguishing non-suicidal self-injury from suicide attempts and have instead advocated for the use of the term “self-harm” regardless of intent. The objective of this study was to examine the correlates, risk factors, course, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in non-suicidal self-injury and compared them to (a) adults who engage in suicide attempts and (b) adults with no self-harm or suicidal ideation, to determine whether non-suicidal self-injury and suicide attempts should be considered distinct groups. Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Manitoba between January 2009 and June 2012. Chart reviews were conducted for all presentations with non-suicidal self-injury (n=158), and a sample of those with suicide attempts (n=172) and no self-harm or suicidal ideation (n=173). Results showed that those who present to emergency services with self-harm regardless of intent, appear similar for the most past in terms of correlates and risk factors. The overlap between non-suicidal self-injury and suicidal behaviours demonstrates the problem with creating a separate disorder, because those who originally presented with non-suicidal self-injury that returned to hospital do not return with repeat non-suicidal self-injury, but instead the majority escalate to suicidal thoughts and behaviour. Further, those who re-presented with non-suicidal self-injury and suicide attempts are less likely to be hospitalized or receive a referral to mental health services, and more likely to be discharged to usual care. This study highlights the need for increased intervention in emergency services among those who present with self-harm regardless of intent.
Non-suicidal self-injury, Self-harm, Suicide attempt, Emergency services, Emergency department, Correlates, Longitudinal, Risk factors