Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-18T00:13:15.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

Published online by Cambridge University Press:  22 September 2016

J. Birkbak ,
E. A. Stuart ,
B. D. Lind ,
P. Qin ,
E. Stenager ,
K. J. Larsen ,
A. G. Wang ,
A. C. Nielsen ,
C. M. Pedersen  and
J.-H. Winsløv
...Show all authors
J. Birkbak
Affiliation:
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Capital Region of Denmark, Denmark
E. A. Stuart
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
B. D. Lind
Affiliation:
Department of Psychiatry, Clinic of Suicide Prevention and Treatment for Adults, Region of Southern Denmark, Denmark
P. Qin
Affiliation:
National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
E. Stenager
Affiliation:
Psychiatric Research Unit, Aabenraa, University of Southern Denmark, Odense, Denmark
K. J. Larsen
Affiliation:
Department of Child and Adolescent Psychiatry, Clinic of Suicide Prevention and Treatment for Children and Adolescents, Region of Southern Denmark, Denmark
A. G. Wang
Affiliation:
Competence Centre for Suicide Prevention, Amager, Capital Region of Denmark, Denmark
A. C. Nielsen
Affiliation:
Competence Centre for Suicide Prevention, Copenhagen, Capital Region of Denmark, Denmark
C. M. Pedersen
Affiliation:
Clinic for Suicide Prevention, Aarhus University Hospital Risskov, Aarhus, Central Denmark Region, Denmark
J.-H. Winsløv
Affiliation:
Unit for Suicide Prevention, Aalborg University Hospital, North Denmark Region, Denmark
C. Langhoff
Affiliation:
Clinic for Suicide Prevention, Herning, Central Denmark Region, Denmark
C. Mühlmann
Affiliation:
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Capital Region of Denmark, Denmark Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
M. Nordentoft
Affiliation:
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Capital Region of Denmark, Denmark Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark
A. Erlangsen*
Affiliation:
Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Capital Region of Denmark, Denmark Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
*
*Address for correspondence: A. Erlangsen, Ph.D., Research Unit, Mental Health Centre Copenhagen, Kildegårdsvej 28, Opg. 15, 4, DK-2900 Hellerup, Denmark. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death.

Method

In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period.

Results

At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37–0.79], alcohol-related causes (0.63, 95% CI 0.50–0.80) and other diseases and medical conditions (0.61, 95% CI 0.49–0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5–448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2–210.5) for alcohol-related causes and 96.8 (95% CI 69.1–161.8) for other diseases and medical conditions.

Conclusions

Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.

Keywords

Deliberate self-harmmortalitypreventive medicinepsychosocial therapysuicide
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3419 - 3427
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bergen, H, Hawton, K, Waters, K, Ness, J, Cooper, J, Steeg, S, Kapur, N (2012). Premature death after self-harm: a multicentre cohort study. Lancet 380, 1568–1574.Google Scholar
Bergstralh, E, Kosanke, J (2004). Gmatch macro for SAS (http://www.mayo.edu/research/departments-divisions/department-health-sciences-research/division-biomedical-statistics-informatics/software/locally-written-sas-macros). Accessed June 2015.Google Scholar
Boden, JM, Fergusson, DM, Horwood, LJ (2008). Cigarette smoking and suicidal behaviour: results from a 25-year longitudinal study. Psychological Medicine 38, 433–439.Google Scholar
Brown, GK, Green, KL (2014). A review of evidence-based follow-up care for suicide prevention: where do we go from here? American Journal of Preventive Medicine 47, S209–S215.Google Scholar
Brown, GK, Jager-Hyman, S (2014). Evidence-based psychotherapies for suicide prevention: future directions. American Journal of Preventive Medicine 47, S186–S194.Google Scholar
Erlangsen, A, Fedyszyn, I (2015). Danish nationwide registers for public health and health-related research. Scandinavian Journal of Public Health 43, 333–339.Google Scholar
Erlangsen, A, Lind, BD, Stuart, EA, Qin, P, Stenager, E, Larsen, KJ, Wang, AG, Hvid, M, Nielsen, AC, Pedersen, CM, Winsløv, JH, Langhoff, C, Mühlmann, C, Nordentoft, M (2014). Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Lancet Psychiatry 2, 49–58.Google Scholar
Fleischmann, A, Bertolote, JM, Wasserman, D, De, Leo D, Bolhari, J, Botega, NJ, De, Silva D, Phillips, M, Vijayakumar, L, Värnik, A, Schlebusch, L, Thanh, HT (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization 86, 703–709.Google Scholar
Hawton, K, Harriss, L, Zahl, D (2006). Deaths from all causes in a long-term follow-up study of 11,583 deliberate self-harm patients. Psychological Medicine 36, 397–405.CrossRefGoogle Scholar
Hawton, K, van Heeringen, K (2009). Suicide. Lancet 373, 1372–1381.CrossRefGoogle ScholarPubMed
Hawton, K, Witt, KG, Taylor Salisbury, TL, Arensman, E, Gunnell, D, Hazell, P, Townsend, E, van Heeringen, K (2016). Psychosocial interventions for self-harm in adults. Cochrane Database of Systematic Reviews 5, CD012189.Google Scholar
Hawton, K, Witt, KG, Taylor Salisbury, TL, Arensman, E, Gunnell, D, Townsend, E, van Heeringen, K, Hazell, P (2015). Interventions for self-harm in children and adolescents. Cochrane Database of Systematic Reviews 12, CD012013.Google Scholar
Jollant, F, Bellivier, F, Leboyer, M, Astruc, B, Torres, S, Verdier, R, Castelnau, D, Malafosse, A, Courtet, P (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry 162, 304–310.Google Scholar
Mann, JJ, Waternaux, C, Haas, GL, Malone, KM (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry 156, 181–189.CrossRefGoogle Scholar
Mellqvist, FM, Ostling, S, Braam, AW, Backman, K, Copeland, JR, Fichter, M, Kivela, SL, Lawlor, BA, Lobo, A, Magnusson, H, Prince, MJ, Reischies, FM, Turrina, C, Wilson, K, Skoog, I, Waern, M (2014). Functional disability and death wishes in older Europeans: results from the EURODEP concerted action. Social Psychiatry and Psychiatric Epidemiology 49, 1475–1482.Google Scholar
Nordentoft, M, Breum, L, Munck, LK, Nordestgaard, AG, Hunding, A, Laursen Bjaeldager, PA (1993). High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. British Medical Journal 306, 1637–1641.Google Scholar
O'Neil, ME, Peterson, K, Low, A, Carson, S, Denneson, LM, Haney, E, Shiroma, P, Kansagara, D (2012). Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review. Department of Veterans Affairs: Washington, DC.Google ScholarPubMed
Pan, YJ, Chang, WH, Lee, MB, Chen, CH, Liao, SC, Caine, ED (2013). Effectiveness of a nationwide aftercare program for suicide attempters. Psychological Medicine 43, 1447–1454.Google Scholar
Pavarin, RM, Fioritti, A, Fontana, F, Marani, S, Paparelli, A, Boncompagni, G (2014). Emergency department admission and mortality rate for suicidal behavior. A follow-up study on attempted suicides referred to the ED between January 2004 and December 2010. Crisis 35, 406–414.Google Scholar
Pedersen, W, von Soest, T (2009). Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study. Addiction 104, 129–137.Google Scholar
Pederson, AM, Tefft, BM, Babigian, HM (1975). Risks of mortality of suicide attempters compared with psychiatric and general populations. Suicide 5, 145–157.Google Scholar
SAS Institute (2003). SAS system for SunOP (9.3). SAS Institute Inc.: Cary, NC.Google Scholar
Tang, NK, Crane, C (2006). Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychological Medicine 36, 575–586.Google Scholar
Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M, Laursen, TM (2011). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 199, 453–458.Google Scholar
World Health Organization (1965). International Statistical Classification of Diseases and Related Health Problems, 8th revision edn. WHO: Geneva.Google Scholar
World Health Organization (2014). Preventing Suicide: A Global Imperative. WHO: Geneva.Google Scholar
World Health Organization (2015 a). The top ten causes of death (http://www.who.int/mediacentre/factsheets/fs310/en/). Accessed June 2015.Google Scholar
World Health Organization (2015 b). ICD-10 Online (http://www.apps.who.int/classifications/icd10). Accessed June 2015.Google Scholar
Supplementary material: Image

Birkbak supplementary material

Figure S1

Download Birkbak supplementary material(Image)
Image 2.6 MB
Supplementary material: File

Birkbak supplementary material

Appendix

Download Birkbak supplementary material(File)
File 47.6 KB