Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

Psychological Medicine, Cambridge University Press (CUP), ISSN 1469-8978

Volume 46, 16, 2016

DOI:10.1017/s0033291716001872, Dimensions: pub.1016168768, PMID: 27654845,



  1. (1) University of Copenhagen, grid.5254.6, KU
  2. (2) Johns Hopkins University, grid.21107.35
  3. (3) Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark.
  4. (4) National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway.
  5. (5) Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark.
  6. (6) Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark.
  7. (7) Capital Region of Denmark, grid.425848.7
  8. (8) Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark.
  9. (9) Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark.
  10. (10) Aalborg Hospital, grid.27530.33, North Denmark Region
  11. (11) Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark.


BACKGROUND: Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD: In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS: At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS: Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.


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