Young Adults Who Self-Harm May Be More at Risk of Psychosis Diagnosis

Young adults and teenagers who presented to the hospital with self-harm were found to be more likely to receive a psychotic disorder diagnosis later in life, according to recent findings from a cohort study published in the journal Schizophrenia Bulletin. 

“These findings highlight important opportunities for earlier identification of risk for severe mental disorders and open new avenues for research into psychosis prevention,” researchers noted, emphasizing that people in their teens and 20s “represent an important risk group” in particular. 

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Using health care registers, individuals born between 1981 and 1993 in Sweden who exhibited self-harm by their 12th birthday were identified and compared to a matched cohort over a 20-year period to assess the incidence of psychotic disorders. Additionally, cohort effects were analyzed to determine any changes in the association between self-harm and later psychosis over time.

Among the study population, 28,908 individuals (2.0%) presented to the hospital with self-harm but no prior psychosis diagnosis during follow-up, with a cumulative incidence of diagnosed psychosis reaching 20.7% at 20 years (hazard ratio [HR] = 13.9, 95% CI 13.3–14.6, P-value <5 × 10−308). Researchers noted that, despite an increase in hospital self-harm admissions, there was no observed reduction in the relationship between hospital self-harm presentation and subsequent psychosis over time.

“Future research to further improve personalized risk prediction for psychosis following hospital presentation with self-harm will need to take additional factors into account, such as contact with child and adolescent mental health services, minority stress and social disadvantage, [and] family history of mental disorders,” authors concluded. “Additional clinical, demographic, cognitive, and biological markers may also help to stratify risk for psychosis in this group.”

Reference
Bolhuis K, Ghirardi L, Kuja-Halkola R, et al. Risk of psychosis among individuals who have presented to hospital with self-harm: a prospective nationwide register study in Sweden. Schizophrenia Bulletin. Published online January 19, 2024. doi.org/10.1093/