Clinical Pearl

The Paradox of Aftercare: Increased Self-Harm Repetition but Reduced Suicide Risk

Endpoint Editorial · May 22, 2026

In this seriesClinical Pearl5

Why Was This Research Needed?

How does aftercare following self-harm hospital presentations impact the rates of self-harm repetition and suicide?

Bottom Line

Aftercare services following self-harm episodes are associated with an increased risk of repeat self-harm presentations but a significant decrease in suicide risk, suggesting improved help-seeking behavior.

Study at a Glance

Study Design
Cohort study
Population
Patients aged 10+ years who presented to hospitals with self-harm episodes from 2012-2016 in Taiwan
Intervention
Aftercare provided through Taiwan's National Suicide Surveillance System including follow-up calls and assessments
Comparator
Patients with no aftercare
Primary Outcome
Rates of self-harm repetition and suicide within one year of index episode

Key Findings

  1. Aftercare is associated with a 17% increase in the risk of self-harm repetition (aHR=1.17) but a 20% reduction in suicide risk (aHR=0.80).
  2. Young patients aged 10-24 showed the most significant decrease in suicide risk (aHR=0.64), whereas middle-aged patients (45-64) had a higher increase in self-harm repetition risk (aHR=1.34).
  3. Patients without a history of psychiatric disorders displayed an increased reduction in suicide risk with aftercare compared to those with such history (aHR=0.76).
  4. The program appears to enhance help-seeking behaviors post-self-harm, indicated by higher repeat hospital presentations.

Implications for Practice

Clinicians should view repeat self-harm presentations after intervention as opportunities for further engagement and support, rather than treatment failures. Emphasis on follow-up and psychological support is critical for reducing long-term suicide risk.

Caveats & Limitations

The study's observational nature limits causality conclusions, and the increased self-harm risk may reflect greater engagement in mental health services.

This summary was AI-assisted and reviewed by an editor. It does not constitute medical advice. Always consult the original publication and your clinical judgment.