Background and Hypothesis Recent research showed that young people who presented to hospital with self-harm in Finland had a significantly elevated risk of later psychosis. We investigated the prospective relationship between hospital presentation for self-harm and risk of psychosis in an unprecedentedly large national Swedish cohort. Study Design We used inpatient and outpatient healthcare registers to identify all individuals born between 1981 and 1993 who were alive and living in Sweden on their 12th birthday and who presented to hospital one or more times with self-harm. We compared them with a matched cohort, followed up for up to 20 years, and compared the cumulative incidence of psychotic disorders. Furthermore, we examined whether the strength of the relationship between hospital presentation for self-harm and later psychosis changed over time by examining for cohort effects. Study Results In total, 28 908 (2.0%) individuals presented to hospital with self-harm without prior psychosis diagnosis during the follow-up. For individuals who presented to hospital with self-harm, the cumulative incidence of diagnosed psychosis was 20.7% at 20 years follow-up (hazard radio = 13.9, 95% CI 13.3–14.6, P-value <5 × 10−308). There was no evidence of a dilution of the effect over time: while the incidence of hospital self-harm presentation increased, this did not result in an attenuation over time of the strength of the relationship between hospital self-harm presentation and subsequent psychosis. Conclusions Individuals who present to hospital with self-harm in their teens and 20s represent an important risk group for psychosis prediction and prevention.

中文翻译：

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因自残而到医院就诊的个人患精神病的风险：瑞典一项前瞻性全国登记研究

背景和假设 最近的研究表明，在芬兰因自残而到医院就诊的年轻人日后患精神病的风险显着升高。我们在史无前例的大规模瑞典全国队列中调查了因自残入院就诊与精神病风险之间的前瞻性关系。研究设计 我们使用住院和门诊医疗登记册来识别 1981 年至 1993 年间出生的所有个人，这些人在 12 岁生日时还活着并居住在瑞典，并且因自残而一次或多次到医院就诊。我们将他们与匹配的队列进行了比较，随访长达 20 年，并比较了精神障碍的累积发病率。此外，我们通过检查队列效应来检查自残医院表现与后来的精神病之间的关系强度是否随着时间的推移而变化。研究结果 随访期间，总共有 28 908 名 (2.0%) 人因自残而到医院就诊，但事先没有精神病诊断。对于因自残而入院的个体，20 年随访时诊断出精神病的累积发生率为 20.7%（危险系数 = 13.9，95% CI 13.3–14.6，P 值 <5 × 10−308） 。没有证据表明这种影响随着时间的推移而减弱：虽然医院自残表现的发生率有所增加，但这并没有导致医院自残表现与随后的精神病之间的关系强度随着时间的推移而减弱。结论 青少年和 20 多岁因自残而到医院就诊的个体是精神病预测和预防的重要风险群体。