خطر خودآسیبی در بیماران از لحاظ جسمی بیمار در مراقبت های اولیه در بریتانیا

Objective To examine self-harm risk across the adult age range in patients diagnosed with various physical illnesses using the General Practice Research Database — a broadly representative sample of all people registered with a family practice in the United Kingdom. Methods We conducted a large nested case–control study sampled from the whole primary care cohort. During 2001–2008 we studied 2306 cases of self-harm and 46,120 age and gender-matched controls without such an episode recorded. Relative risks were estimated against reference patients with none of the examined physical illnesses. Additionally, we assessed confounding by recorded depression, effect modification by gender and multi-morbidity effects.

Introduction In recent years there has been heightened interest in investigating the links between physical illness, mental illness, and suicidal behaviour [1]. However, the exact nature of these associations remains unclear from previous research, due to methodological limitations; for example, inadequate sample sizes, reliance on self-reported morbidity data, and incomplete adjustment for psychiatric disorder [2] and [3]. Higher risk of completed suicide in physically ill elderly people has been studied extensively [4], [5], [6], [7] and [8], but there have been far fewer investigations of suicide among younger people affected by physical ill health [9]. This is pertinent because physical illness of some kind is present in most suicide cases that occur at age 50 years and older [10]. It is, however, also important to examine non-fatal suicidal outcomes separately in younger adults [11]. As well as being far more common overall than completed suicide, self-harm occurs more frequently at younger age and with a higher female to male ratio [12]. It is also an especially strong predictor of completed suicide [13], and so suicide prevention initiatives require a profound understanding of the whole suicidal process. In this paper, we seek to answer the following research questions: 1. What is the relative risk of self-harm linked with physical illness per se? 2. How does relative risk vary between different types of major physical illnesses experienced by primary care patients across the whole adult age range? 3. How do the effect sizes vary according to gender, age and number of physical illnesses diagnosed? 4. How much of any increased risks observed can be explained by clinical depression as detected by healthcare services? We expected to find elevated risks in physically ill patients across the broad range of physical illnesses examined. More specifically, and in line with the findings of our recent study of completed suicide risk in the same study population [14], we anticipated that relative risk would be higher in women than in men, and that there would be a gradient in rising risk with a greater number of physical illnesses.

Conclusion Risk of self-harm is raised across a wide variety of physical illnesses in both genders, and particularly so in women, indicating a clear need for developing far-reaching initiatives to tackle this problem across the medical specialties. Much of the current literature on the link between physical illness and suicidality has been conducted in older patient samples. Our novel findings indicate the importance of tackling psychological distress and self-harm in physically ill patients who are not elderly. Because self-harm is a relatively common antecedent to future completed suicide, researchers should aim to uncover the mechanisms that explain the association between major physical illness and self-harm in younger and middle aged adults. The following are the supplementary data related to this article.