A1 Refereed original research article in a scientific journal
Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns
Authors: Bolhuis Koen, Lång Ulla, Gyllenberg David, Kääriälä Antti, Veijola Juha, Gissler Mika, Kelleher Ian
Publisher: OXFORD UNIV PRESS
Publication year: 2021
Journal: Schizophrenia Bulletin
Journal name in source: SCHIZOPHRENIA BULLETIN
Journal acronym: SCHIZOPHRENIA BULL
Volume: 47
Issue: 6
First page : 1685
Last page: 1694
Number of pages: 10
ISSN: 0586-7614
DOI: https://doi.org/10.1093/schbul/sbab061
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/67997173
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.
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