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Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder

BACKGROUND: Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE: To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorder...

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Autores principales: Sariaslan, Amir, Larsson, Henrik, Hawton, Keith, Pitkänen, Joonas, Lichtenstein, Paul, Martikainen, Pekka, Fazel, Seena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577735/
https://www.ncbi.nlm.nih.gov/pubmed/37380367
http://dx.doi.org/10.1136/bmjment-2023-300758
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author Sariaslan, Amir
Larsson, Henrik
Hawton, Keith
Pitkänen, Joonas
Lichtenstein, Paul
Martikainen, Pekka
Fazel, Seena
author_facet Sariaslan, Amir
Larsson, Henrik
Hawton, Keith
Pitkänen, Joonas
Lichtenstein, Paul
Martikainen, Pekka
Fazel, Seena
author_sort Sariaslan, Amir
collection PubMed
description BACKGROUND: Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE: To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. METHODS: 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. FINDINGS: 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. CONCLUSIONS: Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. CLINICAL IMPLICATIONS: 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.
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spelling pubmed-105777352023-10-17 Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder Sariaslan, Amir Larsson, Henrik Hawton, Keith Pitkänen, Joonas Lichtenstein, Paul Martikainen, Pekka Fazel, Seena BMJ Ment Health Adult Mental Health BACKGROUND: Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE: To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. METHODS: 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. FINDINGS: 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. CONCLUSIONS: Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. CLINICAL IMPLICATIONS: 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. BMJ Publishing Group 2023-06-28 /pmc/articles/PMC10577735/ /pubmed/37380367 http://dx.doi.org/10.1136/bmjment-2023-300758 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Adult Mental Health
Sariaslan, Amir
Larsson, Henrik
Hawton, Keith
Pitkänen, Joonas
Lichtenstein, Paul
Martikainen, Pekka
Fazel, Seena
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
topic Adult Mental Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577735/
https://www.ncbi.nlm.nih.gov/pubmed/37380367
http://dx.doi.org/10.1136/bmjment-2023-300758
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