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Cited by 1,241Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseOpioid Use Disorder Treatment

Fatal and non-fatal repetition of self-harm: Systematic review

Open access
Owens, David, Horrocks, Judith, House, Allan·2002·British Journal of Psychiatry
DOI 10.1192/bjp.181.3.193
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Abstract

Background: Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. Aims: To estimate rates of fatal and non-fatal repetition of self-harm. Method: A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. Results: Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. Conclusions: After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

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Crossref · 10.1192/bjp.181.3.193

Cites

105 of 105 references verified0 citation errors · 0 not checkable

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  • These results are slightly lower than those from meta-analyses in the existing literature, but are consistent with population-based samples.

    “These results are slightly lower than those from meta-analyses in the existing literature,7,33 but are consistent with population-based samples”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [33]

    The Results report a median 1-year non-fatal self-harm repetition rate of 16%, providing a literature estimate for comparison. But ‘Combining the studies into a summary’ says the studies were too heterogeneous for meta-analysis and reports medians instead. The cited paper therefore supports a comparison with a systematic review, not the description of its estimates as coming from a meta-analysis; the citing paper’s own results are not given here, so ‘slightly lower’ cannot be checked. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Deliberate self harm is a global health problem and is one of the strongest predictors of completed suicide.

    “Deliberate self harm is a global health problem 15 16 and is one of the strongest predictors of completed suicide.17”

    From Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis (2013) · cites this paper as [16]

  • Self-harm is a powerful predictor of completed suicide.

    “Self-harm is a powerful predictor of completed suicide.5”

    From Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial (2014) · cites this paper as [5]

  • Suicide is the cause of death that is most elevated in individuals with bipolar disorder and schizophrenia compared with the general population.

    “Suicide is the cause of death that is most elevated in individuals with bipolar disorder and schizophrenia compared with the general population.33,34”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [33]

    The Abstract reports that suicide risk after self-harm is much higher than in the general population. Searches for bipolar disorder, schizophrenia, and comparative causes of death found no passage addressing whether suicide is the most elevated cause of death in those diagnostic groups. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Forcing individuals to use a less lethal method may work because over 80% of suicide attempt survivors do not end up dying by suicide.

    “Forcing individuals to use a less lethal method may work because over 80% of suicide attempt survivors do not end up dying by suicide (249).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [249]

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Authors
Owens, D., Horrocks, J., & House, A.
Affiliations
University of Leeds (GB)
Corresponding author
Owens, David
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2002-09
Volume
181
Issue
3
Pages
193-199
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.181.3.193
OpenAlex
W2169361101
Cited by
1,241
References
106
Citations by year
2026: 31 · 2025: 41 · 2024: 45 · 2023: 53 · 2022: 53 · 2021: 62 · 2020: 78 · 2019: 53 · 2018: 62 · 2017: 92 · 2016: 78 · 2015: 74 · 2014: 80 · 2013: 67 · 2012: 69
FWCI
2.68
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 5602 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
University of Leeds
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
self-harm, suicide, non-fatal self-harm, suicide risk, follow-up outcomes
MeSH terms
United Kingdom, Humans, Recurrence, Risk Factors, Suicide, Time Factors, Self-Injurious Behavior

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