Young People Who Self-Harm Face Striking Increase in Suicide Risk

Self-harm or self-injury describes a behavior by which a person willingly injures himself or herself.  Self-harm is not a mental disorder, but rather, a maladaptive or negative coping mechanism as a reaction to emotional stress. It is a symptom to a larger problem, not the root cause of what ails the individual.
Coping mechanisms describe the actions we partake when we try to solve a stressful situation.  Those that employ constructive means, leading to a good outcome, are called positive coping mechanisms. These positive constructs usually entail being aware of the stressor and an attempt to deal with the same. Negative coping mechanisms tend to distract temporarily from the problem, but may end up making the stress or underlying problem worse. Self-harm is a negative coping mechanisms as it relieves stress temporarily without addressing the root cause of the same.  In this regard, it is similar to aggression and other avoidance behaviors like drinking or gambling. 
Maladaptive behaviors are common in autism spectrum disorder taking the form of repetitive/ritualistic acts, tantrums, aggression and/or self-injurious behaviors. These negative coping mechanisms are more common in autism that in matched populations of intellectually disabled individuals of other causation (Hartley et al., 2008).  I have to believe that their prevalence in autism spectrum disorder (ASD)  is somewhat driven by their inability to properly communicate their feeling and life circumstances.
Although not surprising, a new study has linked self-harm to suicide. In many of these cases, the victim did not necessarily aimed at taking their life but rather attempted to stop the hurting.  In this regard, suicide in itself is a negative coping mechanism. For caregivers and physicians who follow ASD individuals this is an important consideration as suicidal tendencies may be difficult to spot in many cases.
In the year following an attempt at self-harm, teens are nearly 50 times more likely to commit suicide as compared with their non-self-harming peers, a Pediatrics study finds. The abstract to the study reads as follows:

OBJECTIVES: Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year.

METHODS: A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls.

RESULTS: The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9–67.9) than young adults (19.2, 95% CI: 12.7–28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41–9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92–32.80), especially firearms (HR: 35.73, 95% CI: 15.42–82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18–1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42–1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49–1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55–0.69) or outpatient (1.00, reference) setting.

CONCLUSIONS: After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety.

 

The study rides the coattail of recent surveys showing a striking rise in self-injury, primarily among US girls.

References
Hartley SL, Sikora DM, McCoy R. Prevalence and risk factors of maladaptive behaviour in young children with autistic disorder. J Intellectual Disabil Res 52(10):819-829, 2008.

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