American adults who survive deliberate self–harm are at increased risk of suicide in the first year after such an event, indicating a need to direct clinical interventions in the critical 12 months following such episodes. The suicide risk is greatest in the month immediately following a self–harm attempt using a firearm, according to a study from researchers at Columbia University’s Mailman School of Public Health, Columbia University Medical Center, New York Psychiatric Institute, and colleagues.

Results of the study were published in American Journal of Psychiatry.

Using Medicaid data from 45 states during 2001–2007, the researchers sought to determine the 1–year risk of repeated self–harm and suicide in 61,297 people who had been clinically diagnosed with deliberate self–harm. The data were linked to the National Death Index, which provides information about dates and cause of death. The researchers analyzed a variety of possible risk factors, such as demographic characteristics, recent treatment for common mental disorders, and both the setting and method of self–harm. Firearm–related self–harm was of particular interest, since the rate of suicide from firearms is eight times greater in the U.S. than in other high–income countries.

“This study supports our hypothesis that use of a firearm or other violent self–harm methods greatly increases the risk of suicide, especially in the short term,” said Mark Olfson, MD, MPH, senior author of the report.

Co–investigator Melanie Wall, PhD, professor of Biostatistics in Psychiatry, and colleagues reported that nearly 20 percent—mostly older, white people who had been recently treated for a mental disorder such as depression or alcohol use disorder—repeated nonfatal self–harm during the follow–up period. The 1–year suicide rate in adults with deliberate self–harm was 37 times higher than in the general population. In this group, males were twice as likely to complete suicide than females; older, white adults had triple the suicide risk than younger, non–white adults.

Two–thirds of suicides during initial self–harm episodes were caused by violent methods, with over 40 percent related to firearms. The risk of suicide was approximately 10 times greater in the first month after an initial episode of self–harm using a violent method compared with the following 11 months.

The patterns seen in this study suggest that clinical efforts should focus on ensuring the safety of individuals who survive deliberate self–harm during the first few months after such attempts – particularly when a violent method such as a firearm has been used, according to the research team. For these patients, clinicians should strongly consider inpatient admission, intensive supervision, and interventions targeting underlying mental disorders to reduce suicide risk. In addition, clinicians can encourage family members to install trigger locks or temporarily store firearms outside the patient’s home.”