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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: Annette.Erlangsen@regionh.dk)
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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 

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