Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory

Abstract

Purpose: This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. Methods: Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Results: Just over half of the 4391 cohort members identified as Aboriginal ( n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. Conclusion: The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.

Long-term risk of repeat hospital admission involving self-harm by Aboriginal and non-Aboriginal people: A retrospective cohort study

“…For Aboriginal people, however, all methods of self-harm were associated with an increased risk of repetition. Since any form of self-harm repetition has been found to be associated with a higher risk of suicide [7], the findings from this study may point to overlaps between those at risk of repeat self-harm and suicide. Therefore, means restriction counselling to reduce the risk of repeat self-harm should be informed by comprehensive psychosocial assessment to ensure the effectiveness of such strategies are based on an understanding of the psychological and interpersonal contexts of intent and unmet needs.…”

“…Individuals in the study cohort were linked to hospital records in the NT Inpatient Activity collection containing records of admissions to all NT public hospitals and to mortality records from the National Death Index (NDI) and the NT Deaths Registry. Details of these mortality data sources and how they were linked are described in more detail elsewhere [7].…”

“…Additionally, the repetition of self-harm is associated with further increasing the risk of suicide [4][5][6]. This has also been investigated in the NT in a cohort of hospital admissions involving self-harm and suicidal ideation, where the risk of suicide was found to increase by up to 30% for each repeat hospital admission involving self-harm [7].…”

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy

“…We investigated a range of potential correlates of suicidal experiences, based on existing evidence (Franklin et al, 2017; Kessler et al, 2015; Knipe et al, 2022; Leckning et al, 2022; Nock et al, 2008; Pandeya et al, 2022; Roy et al, 2021; Schechter et al, 2022a; Simon et al, 2001), on theory (Gerisch, 2020; Glaesmer et al, 2020; Schechter et al, 2022a) and on our clinical experience. We also considered the nature of the data (i.e., no self‐reports) and the number of reports available while selecting the variables for the analysis.…”