Incidence and prognostic factors of self-harm and subsequent unnatural death in South Africa: A cohort study

作者：Veronika Skrivankova, Stephan Rabie, Mpho Tlali, Naomi Folb, Chido Chinogurei, Sarah A. Bennett, Aimee Wesso, Yann Ruffieux, Morna Cornell, Soraya Seedat, Matthias Egger, Mary‐Ann Davies, Gary Maartens, John A. Joska, Andreas D. Haas · 发表于：PLoS Medicine · 年份：2025 · DOI：10.1371/journal.pmed.1004765 · 被引用次数：6 · 研究领域：Suicide and Self-Harm Studies、COVID-19 and Mental Health、Gun Ownership and Violence Research

BACKGROUND: Self-harm is a major public health concern globally and in South Africa. Individuals with a history of self-harm are at increased risk of unnatural death, including suicide and fatal accidents. This study investigates the incidence and predictors of self-harm and its role as a predictor for subsequent unnatural death. METHODS AND FINDINGS: We conducted a cohort study using insurance claims and vital registration data from beneficiaries of South African medical insurance schemes (2011-2022), aged 10 years or older. We estimated the cause-specific cumulative incidences of healthcare encounters for intentional self-harm (International Classification of Diseases 10th Revision [ICD-10] codes X60-X84) and unnatural deaths (ICD-10 codes V01-Y98), using the Aalen-Johansen method. We assessed predictors of both outcomes using Cox regression. We followed 1,356,119 beneficiaries (median age 33 years, 52.2% female) for a median of 3 years, during which 7,510 (0.6%) had a healthcare encounter for self-harm. The 5-year cumulative incidence of self-harm ranged from 0.2% in males aged 10-14 to 2.1% in females aged 15-24. Sex, age, and mental disorders were strong predictors for self-harm, while HIV was a modest predictor. Among individuals who survived a self-harm event, the five-year cumulative incidence of subsequent unnatural death was 3.43% (95% CI [2.38, 4.76]) for males and 0.77% (95% CI [0.48, 1.19]) for females. Non-fatal self-harm was a strong predictor of subsequent unn...