Time until Self-Inflicted Injury Recurrence Among Wisconsin Youth

BACKGROUND:  Among Wisconsin youth, rates of self-inflicted injuries are high, and suicide is the second leading cause of years of potential life lost. Several studies have examined the prevalence of fatal and non-fatal recurrence of self-harm among adolescents; however, none have determined the critical period between the occurrence of a self-inflicted injury and a subsequent self-injury or suicide. Knowing how long this window for prevention lasts is critical for timely intervention. The current study investigates this among Wisconsin youth and examines differences between subpopulations.

METHODS:  The authors utilized a 5-year linked inpatient hospitalization and death certificate dataset (2007-2011) to investigate self-inflicted injuries and suicide deaths among Wisconsin youth aged 10-22. The dataset captured multiple hospitalizations and death events over time for the same individuals. The authors estimated survival curves and hazard functions which modeled the time from a self-injury hospitalization until the next self-injury hospitalization or suicide. Differences in hazard functions between males and females were also estimated.

RESULTS:  Overall, the hazard for a subsequent self-inflicted injury (whether it resulted in hospitalization or death) was highest between 0-1 months after the initial self-injury hospitalization. Approximately 6.0% of the sample experienced a recurrence within one month. The hazard declined rapidly between 0-6 months, by which 9.1% of youth experienced a recurrence, and declined more slowly until the end of the study (60 months), by which 14.4% of youth experienced a recurrence. The hazard functions of males and females were not significantly different, with both groups having their highest hazard in the 0-1 month period.

CONCLUSIONS:  A substantial proportion of Wisconsin youth experience a subsequent self-injury event following a hospitalization for a self-injury. Nearly half of recurrent self-injury events take place within the first month following the initial hospitalization. For both males and females, the critical period for intervention is quite short – hospitals, mental health practitioners, and others should consider implementing strategies that better equip youth and their families to prevent suicide and self-harm through means restriction and other evidence-based approaches following a self-injury hospitalization. For many youth, scheduling a follow-up appointment with a mental health care professional 6-8 weeks after the event is too late. In particular, hospitals located within mental health professional shortage areas may need to identify more readily accessible support services for these at-risk youth.