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Individual- and population-level associations of mental disorders with intentional self-harm
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DOI：10.1192/j.eurpsy.2026.10182.png)
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Abstract
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BackgroundRegistry-based studies can inform suicide prevention by identifying mental disorders with the highest risk. Previous studies focused on severe disorders and suicide; with limited data on non-lethal self-harm or population impact. We quantified individual- and population-level associations of 32 mental disorders with non-lethal intentional self-harm (NLISH) and suicide.MethodsRegistry-based cohort study representative for all residents of Catalonia (Spain) aged ≥10 years (2014–2019; n = 645; 571). Cause-specific Cox models estimated individual (hazard ratios [HRs]) and population-level (population attributable fractions [PAFs]) associations with NLISH and suicide; stratified by sex and adjusted for age; socioeconomic status; and nationality.ResultsIndividual-level associations with NLISH were strongest for borderline personality disorder (BPD; females HR = 26.9 [95%CI 24.9–29.0]; males HR = 18.9 [95%CI 16.7–21.4]). Associations with suicide were strongest for BPD in females (HR = 40.9 [95%CI 28.5–58.8]) and obsessive-compulsive disorder in males (HR = 17.4 [95%CI 5.3–56.5]). Associations with suicide were stronger among females; and those aged 10–44 across mood; substance use; dissociative; borderline personality; and psychotic disorders. Substantial proportions of outcomes were associated with common disorders: depressive episodes (PAFs 29.8–49.8%); substance use disorders (PAFs 25.1–48.7%); mixed anxiety-depressive disorders (PAFs 19.7–53.2%); and adjustment disorders (PAFs 10.6–44.6%).ConclusionsDepressive; anxiety; adjustment; and substance use disorders are associated with large shares of self-harm and suicide; whereas BPD confers particularly high individual risk. Our findings support multilevel prevention strategies; especially among young people; including improved risk assessment; collaborative care; and timely access to specialized interventions.
Keywords:
cohort studies
mental disorders
population attributable fraction
self-injurious behaviour
suicide
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