Suicide and self-harm in adult survivors of critical illness: population based cohort study.

To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Population based cohort study using linked and validated provincial databases. Ontario, Canada between January 2009 and December 2017 (inclusive). Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Institut du Savoir Montfort, Hôpital Montfort, Ontario MOHLTC, CIHI for the submitted work; MMS reports Continuing Medical Education funding from AstraZeneca, and is supported by the Jindal Research Chair in the Prevention of Kidney Disease at the University of Ottawa; DMN reports financial or in-kind support for consultancy or research (outside the scope of this research) from Haisco-USA Pharmaceuticals, GlaxoSmithKline (UK), Novartis Pharma (Switzerland), Baxter Healthcare Corporation, and Reck Medical Devices; BR is supported by a Hamilton Health Sciences new investigator grant; DJC is supported by a Canada Research Chair in Critical Care Knowledge Translation; HW is supported by a Canada Research Chair in Critical Care Organisation and Outcomes; RAF is the H Barrie Fairley Professor of Critical Care at the University Health Network and University of Toronto Interdepartmental Division of Critical Care Medicine; PT is supported by a Physician Services Incorporated Graham Farquharson Knowledge Translation Fellowship; all other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.