The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and Suicide: A Cohort Study

Abstract

Objective: Aftercare interventions following self-harm may prevent subsequent self-harm and suicide deaths. However, previous research into the effectiveness of aftercare services on self-harm repetition and suicide mostly comprised a small sample size and showed inconsistent findings. We investigated the effectiveness of Taiwan’s national self-harm aftercare program on self-harm repetition and suicide among self-harm patients. Methods: A cohort study of 90,413 index self-harm episodes (ie, the first episode during the study period) presented to hospitals and registered in the National Suicide Surveillance System (2012–2016) was performed. Cox regression models were used to evaluate the risk of self-harm repetition or suicide after receiving the aftercare, which was modeled as a time-varying variable. Results: The aftercare was associated with a 17% (adjusted hazard ratio [aHR]= 1.17, 95% confidence interval [CI] 1.14– 1.21) increase in self-harm repetition risk and a 20% (aHR= 0.80, 95% CI 0.74–0.86) decrease in suicide risk. The association of the aftercare with increased self-harm repetition risk was most marked in patients aged 45–64 years (aHR= 1.34) and more marked in those with a history of psychiatric disorders (aHR= 1.26). The association of aftercare with decreased suicide risk was most marked in patients aged 10–24 years (aHR= 0.64) and more marked in those without a history of psychiatric disorders (aHR= 0.76) than their counterparts. Conclusion: The aftercare following self-harm was associated with an increased risk of repeat self-harm hospital presentation and decreased risk of suicide. The findings suggest that the aftercare intervention may increase help-seeking behaviors after self-harm and decrease suicide deaths, especially in specific subgroups.