Contribution of psychiatric disorders in suicide is well known with 90% having a diagnosable disorder.(This proportion is less in asian countries).Non fatal self harm is far common and is a key risk factor for completed suicide. Life events and problems, alcohol misuse and specific psychological characteristics and personality disorders are considered causal factors in self harm. Less is known about the contribution of psychiatric disorders in self harm.
Keith Hawton , Kate Saunders , Anya Topiwala and Camilla Haw did a systematic review of the contribution of psychiatric disorders in self harm presenting in general hospitals. They included only prospective studies that used either research diagnostic criteria or clinical diagnosis.
50 studies from 24 countries reported in 53 papers were identified.The overall prevalence of Axis I psychiatric disorders was 84% (95% CI 74.7–91.3%) in adult/mixed age samples. Heterogeniety was extremely high. Rates were similar among genders. Rates were not different by diagnostic method ( by research criteria or clinical diagnosis). Rates were higher in western studies (90%) than non western (70%),but difference did not reach statistical significance.
Mood disorders were diagnosed in up to 60%. 35% had anxiety disorders. 35% had substance misuse. 25% had adjustment disorder. Personality disorder were identified in 25%. 6% had psychotic disorders.
Proportion and pattern of psychiatric disorders in self harm as shown in this review is similar to data from suicide studies. 84% of adults or mixed sample patients presenting with self harm had a psychiatric diagnosis. This is close to 91% (median proportion of psychiatric disorders) found in studies of adults dying by suicide. The pattern of mode disorders, alcohol misuse, anxiety disorders as dominating in self harm is similar to that in suicide.
These findings question the commonly held view that majority of self-harm patients either do not have psychiatric disorders, or if they do then this is most likely to be a personality disorder or adjustment disorder.
Limitations: Authors did not specifically search for studies of personality disorders in self-harm, but just extracted data on these where it was recorded (eight studies).proportions in repeated self harm is not available as this group might have different pathology. Only english language studies were included.Analysis was restricted to patients presenting in general hospitals.High heterogeneity limit the robustness of the findings. Definitions of self harm differed among studies.
Conclusion: Psychiatric disorders are found in over 80% of self-harm patients presenting to general hospitals, with depression, anxiety disorders and alcohol misuse being particularly common.
Summary of the article:
Hawton K, Saunders K, Topiwala A, Haw C. J Affect Disord. 2013 Dec;151(3):821-30