Risk of Fatal Self-harm Repetition Among Individuals Registered with the National Self-harm Registry and Concurrently with Other Health and Social Care Registries in Taiwan

• Main Authors: Guan-Wei Chang, 張冠偉
• Other Authors: Shu-Sen Chang
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/xyg6dq

碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 107 === Background: A past history of self-harm or suicide attempt is one of the key risk factors of suicide. This study was aimed to i) investigate the risk of suicide among people who were registered in the national self-harm/suicide attempt surveillance system established by Taiwan’s Ministry of Health and Welfare and ii) to examine its association with demographic factors, self-harm methods, and being concurrently registered in other health and social care registries, in order to identify the high-risk groups of fatal self-harm repetition. Methods: Data were extracted for all people registered in the national self-harm/suicide attempt surveillance system in 2012 to 2017, with linkage to registers of patients with mental illness receiving post-discharge aftercare, offenders and victims of children and adolescent abuse, offenders and victims of domestic violence, victims of sexual abuse, people who used illicit drugs, and people who received opioids replacement therapy. Fatal self-harm repetition was identified thru linkage to the national suicide mortality data files. Standardized mortality ratio (SMR) for suicide was calculated to investigate suicide risk relative to the general population. Poisson regression analysis was conducted to calculate rate ratios for suicide in the sample of people who were registered to the national self-harm/suicide attempt surveillance system. Results: There were 123,354 reported cases of self-harm. Among them 3,330 (2.7%) died by self-harm repetition. The overall SMR for suicide was 146. In subgroup analyses, SMRs were higher in females, the younger groups, people who self-harmed using self-mutilation compared to their counterparts. SMRs were highest in people who were in the registries of people who received opioids replacement therapy, patients with mental illness receiving post-discharge aftercare, and those who were registered in multiple registers. The SMR was highest during the first 7-30 days post-registry (SMR = 340), followed by 125 in the 2nd to 3rd months, 70 in the 4th to 6th months, and became stable afterward. Poisson regression analysis showed that rate ratio of suicide was higher in males, older people, people who self-harmed using self-mutilation, charcoal burning, hanging, drowning, and pesticide poisoning, and people registered as those receiving opioids replacement therapy and patients with mental illness receiving post-discharge aftercare than their counterparts. Conclusion: High risk groups for fatal self-harm repetition were identified. The findings have implications for Taiwan’s national self-harm aftercare services.