Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions was missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality.

The research team analyzed the health data of individuals in Denmark who had attempted deliberate self-harm during 1992—2010. In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992—2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm

Over a 20-year follow-up period, the team surveyed the outcomes of 5,678 people who had received psychological counseling, and compared them with the outcomes of individuals with no psychosocial therapy.

It was found that in the first year after psychosocial therapy, individuals who received the therapy were 27% less likely to repeat deliberate self-harm and were at 38% lower risk of death from all causes than those who did not receive the therapy. 5 years after short-term psychological counseling, repeated suicide attempts were 26% lower among the recipients of psychological therapy.   

Long-term effects of psychological therapy were identified for repeated self-harm, absolute risk reduction, numbers needed to treat, deaths by suicide, and death by any cause, implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented.

 The findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favor the use of psychosocial therapy interventions after deliberate self-harm.

The findings are highly important as earlier on 4 September 2014, WHO called for coordinated action to reduce suicides worldwide.

According to the first WHO global report on suicide prevention that was released on 4 September 2014, more that 800000 people die by suicide every year-around one person every 40 seconds and some 75% of suicides occur in low- and middle-income countries. 

Suicide is a global phenomenon

Suicide occurs all over the world and can take place at almost any age. Globally, suicide rates are highest in people aged 70 years and over. In some countries, however, the highest rates are found among the young. Notably, suicide is the second leading cause of death in 15-29 year-olds globally.

“This report is a call for action to address a large public health problem which has been shrouded in taboo for far too long” said Dr Margaret Chan, Director-General of WHO.

Generally, more men die by suicide than women. In richer countries, three times as many men die by suicide than women. Men aged 50 years and over are particularly vulnerable.

In low- and middle-income countries, young adults and elderly women have higher rates of suicide than their counterparts in high-income countries. Women over 70 years old are more than twice as likely to die by suicide as women aged 15-29 years

Suicides are preventable

Reducing access to means of suicide is one way to reduce deaths. Other effective measures include responsible reporting of suicide in the media, such as avoiding language that sensationalizes suicide and avoiding explicit description of methods used, and early identification and management of mental and substance use disorders in communities and by health workers in particular.

Follow-up care by health workers through regular contact, including by phone or home visits, for people who have attempted suicide, together with provision of community support, are essential, because people who have already attempted suicide are at the greatest risk of trying again.

WHO recommends countries involve a range of government departments in developing a comprehensive coordinated response. High-level commitment is needed not just within the health sector, but also within education, employment, social welfare and judicial departments.

Dr. Shima Naghavi, Director of International Affairs