Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns

• Published in: Schizophrenia bulletin 2021-10, Vol.47 (6), p.1685-1694
• Main Authors: Bolhuis, Koen, Lång, Ulla, Gyllenberg, David, Kääriälä, Antti, Veijola, Juha, Gissler, Mika, Kelleher, Ian
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bipolar Disorder - epidemiology; Emergency Service, Hospital - statistics & numerical data; Female; Finland - epidemiology; Humans; Longitudinal Studies; Male; Psychotic Disorders - epidemiology; Registries - statistics & numerical data; Regular; Risk Factors; Schizophrenia - epidemiology; Self-Injurious Behavior - epidemiology; Young Adult
• ISSN: 0586-7614; 1745-1701
• DOI: 10.1093/schbul/sbab061

Abstract Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness.