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Multicenter Study
. 2023 Mar;53(4):1400-1408.
doi: 10.1017/S0033291721002956. Epub 2021 Aug 4.

Risk of suicide in patients who present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England

Galit Geulayov  1 , Deborah Casey  1 , Elizabeth Bale  1 , Fiona Brand  1 , Caroline Clements  2 , Bushra Farooq  2 , Nav Kapur  2   3   4 , Jennifer Ness  5 , Keith Waters  5 , Anita Patel  5 , Keith Hawton  1   6
Affiliations
Multicenter Study

Risk of suicide in patients who present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England

Galit Geulayov et al. Psychol Med. 2023 Mar.

Abstract

Background: We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab.

Method: We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004-31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models.

Results: In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03-2.96, p = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80-9.30, p = 0.001).

Conclusions: Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck.

Keywords: Self-harm; self-cutting; self-poisoning; site of self-cut; suicide.

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