Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care, Emergency Department Patients

Hayley Chartrand, Joanna Bhaskaran, Jitender Sareen, Laurence Y Katz, James M Bolton
Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 2015, 60 (6): 276-83

OBJECTIVE: In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

METHODS: Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

RESULTS: NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

CONCLUSIONS: NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.

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