The Interaction Effect Between Low Income and Severe Illness on the Risk of Death by Suicide After Self-Harm
Abstract
Background: Previous Western studies have reported that the prevalence of death by suicide within 1 year after self-harm was 0.5–2%; however, no studies have focused on the Far East. Aims: To calculate the prevalence of death by suicide after self-harm over different lengths of follow-up time and to determine the predictors of death by suicide after self-harm. Method: Our study was based on 3,388 inpatients hospitalized between 2000 and 2007 in any of the 1,230 hospitals in Taiwan. Death by suicide after self-harm among the members of this cohort was tracked after 3 months, 6 months, and 1–8 years. The tracking continued until December 31, 2008. We analyzed the prevalence and risk factors of death by suicide after self-harm using Cox’s regression model. Results: Of the 3,388 individuals with a history of self-harm included in the study, 48 (1.4%) died by suicide after self-harm within 3 months and 97 (2.9%) within 1 year. In all, 144 (4.3%) died by suicide after self-harm within 8 years. The predictors of death by suicide were violent methods (such as hanging, drowning, firearms, and jumping), low income, and severe illness. Moreover, an interaction effect was noted between low income and severe illness on the outcome (death by suicide). Conclusion: It seems that effective healthcare for individuals who engage in self-harming behavior would benefit from supplementing medical care with social assistance, such as the support of a social worker.
References
(2002). A global perspective in the epidemiology of suicide. Suicidologi, 7, 6–8.
(2010). Repetition of suicide attempts: Data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study. Crisis, 31, 194–201.
(2007). Rates, risk factors & methods of self-harm among minority ethnic groups in the UK: A systematic review. BMC Public Health, 7, 336.
(1999). Repetition of deliberate self-poisoning in an Australian hospital-treated population. The Medical Journal of Australia, 170(7), 307–311.
(2007). Predictors of repeat suicidal attempts after first-everattempt: A two-year follow-up study. Hong Kong Journal of Psychiatry, 18, 131–135.
(2010). ”Hidden” suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan. Social Psychiatry and Psychiatric Epidemiology, 45, 143–152.
(1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383.
(2010). Non-fatal repetition of self-harm: Population-based prospective cohort study in Taiwan. The British Journal of Psychiatry, 196, 31–35.
(2012). Suicide in Asia: Opportunities and challenges. Epidemiologic Reviews, 34, 129–144.
(2010). Characteristics of hospitalizations caused by injury by different levels of family income in Taiwan, 2006–2007. Taiwan Journal of Family Medicine, 20, 153–167.
(1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stage of change. Journal of Consulting and Clinical Psychology, 59, 295–304.
(2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. The British Journal of Psychiatry, 182, 537–542.
(2010). Long-term suicide mortality rates decrease in men and increase in women after the Niigata-Chuetsu earthquake in Japan. The Tohoku Journal of Experimental Medicine, 220, 149–155.
(2012). Daily hassles, physical illness, and sleep problems in older adults with wishes to die. International Psychogeriatrics, 24, 243–252.
. (2012). National Health Insurance Research Database – Introduction. Retrieved from w3.nhri.org.tw/nhird/brief_01.htm
(1995). Survival analysis of suicide risk after attempted suicide. Acta Psychiatrica Scandinavica, 91, 336–340.
(2002). Fatal and non-fatal repetition of self-harm. Systematic review. The British Journal of Psychiatry, 181, 193–199.
(2007). The epidemiology and costs of unintentional and violent injuries. In , Handbook of injury and violence prevention (pp. 3–20). New York, NY: Springer Science+Business Media, LLC.
(2000). Suicide: A 15-year review of the sociological literature: Part 1: Culture and economic factors. Suicide and Life-Threatening Behavior, 30, 145–162.
. (2002). World report on violence and health. Retrieved from whqlibdoc.who.int/hq/2002/9241545615.pdf
