Risk factors of Skegg for suicide in a patient with a history of self-harm:
(1) male gender
(2) older age
(3) past history of a psychiatric disorder
(4) recent psychological distress
(5) social isolation
(6) history of multiple episodes of self-harm
(7) avoiding discovery at the time of self-harm
(8) physically severe self-harm
(9) strong suicidal intent
(10) concurrent substance abuse
(11) hopelessness and despair
(12) poor or deteriorating physical health
where:
• Whitlock and Knox noted a significant increase in risk with > 10 lifetime incidents of self-harm.
• The opposite of avoiding discovery would include acting out.
Additional risk factors reported by Whitlock and Knox:
(1) history of sexual and/or emotional abuse
(2) bisexual orientation
(3) eating disorder
(4) absence of protective factors (help-seeking, love of life)
A patient with a history of repetitive self-harm needs to be evaluated for the risk of committing suicide. It is important not to dismiss an attempt as just another example of past behaviors.
If a person with a history of self-harm does commit suicide, then it may not have been intentional.
