Research Article J Clin Psychiatry September 2026

The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and Suicide: A Cohort Study

Research Article

Chien-Yu Lin, PhD, PhD; Yi-Han Chang, PhD, PhD; Chia-Yueh Hsu, PhD, PhD; Ying-Yeh Chen, ScD, ScD; Chi-Shin Wu, PhD, PhD; Chau-Shoun Lee, PhD, PhD; Shu-Sen Chang, PhD, PhD

Clinical Nuggets

The Paradox of Aftercare: Increased Self-Harm Repetition but Reduced Suicide Risk

Aftercare services following self-harm episodes are associated with an increased risk of repeat self-harm presentations but a significant decrease in suicide risk, suggesting improved help-seeking behavior.

Self-Harm Management

New Insights on Aftercare Programs

Investigations into aftercare programs reveal paradoxical effects on self-harm and suicide.

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Understanding Self-Harm Dynamics

Understanding Help-Seeking in Self-Harm

Exploring the nuances of help-seeking behaviors after self-harm presentations highlights the role of targeted aftercare interventions.

Guidelines

Understanding the Mixed Outcomes of Aftercare Programs for Self-Harm Patients

Aftercare programs intended for individuals who have experienced self-harm often yield mixed results regarding their effectiveness. Understanding the contributing factors may guide clinicians in tailoring interventions.

Patient Summary

Patient Guide: Understanding Aftercare After Self-Harm

Clinical Checklist

Clinical Practice Checklist: Implementing Aftercare for Self-Harm

This checklist serves as a guide for clinicians to enhance aftercare services post self-harm episodes, ensuring patients receive comprehensive support and follow-up care.

Authors

Research Article

The Effect of a Nationwide Aftercare Program for Self-Harm Presentations on the Risk of Self-Harm Repetition and Suicide: A Cohort Study

Objective: Aftercare interventions following self-harm may prevent subsequent self-harm and suicide deaths. However, previous research into the effectiveness of aftercare services on self-harm repetition and suicide mostly comprised a small sample size and showed inconsistent findings. We investigated the effectiveness of Taiwan’s national self-harm aftercare program on self-harm repetition and suicide among self-harm patients. Methods: A cohort study of 90,413 index self-harm episodes (ie, the first episode during the study period) presented to hospitals and registered in the National Suicide Surveillance System (2012–2016) was performed. Cox regression models were used to evaluate the risk of self-harm repetition or suicide after receiving the aftercare, which was modeled as a time-varying variable. Results: The aftercare was associated with a 17% (adjusted hazard ratio [aHR]= 1.17, 95% confidence interval [CI] 1.14– 1.21) increase in self-harm repetition risk and a 20% (aHR= 0.80, 95% CI 0.74–0.86) decrease in suicide risk. The association of the aftercare with increased self-harm repetition risk was most marked in patients aged 45–64 years (aHR= 1.34) and more marked in those with a history of psychiatric disorders (aHR= 1.26). The association of aftercare with decreased suicide risk was most marked in patients aged 10–24 years (aHR= 0.64) and more marked in those without a history of psychiatric disorders (aHR= 0.76) than their counterparts. Conclusion: The aftercare following self-harm was associated with an increased risk of repeat self-harm hospital presentation and decreased risk of suicide. The findings suggest that the aftercare intervention may increase help-seeking behaviors after self-harm and decrease suicide deaths, especially in specific subgroups.

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