Evidence map›Paper›PMID 33952509›Full record

Observational studyBMJ (Clinical research ed.)2021

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

Shannon M Fernando, Danial Qureshi, Manish M Sood, Michael Pugliese, Robert Talarico, Daniel T Myran, Margaret S Herridge, Dale M Needham, Bram Rochwerg, Deborah J Cook and 9 more

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed
7.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 65 citations in OpenAlex.

  1. Trial
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  8. Increased risk of suicide after stroke: A population-based matched cohort study.International journal of stroke : official journal of the International Stroke Society · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 9 institutions in 3 countries.

Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada sfernando@qmed.ca.ORCID 0000-0003-4549-4289
Danial QureshiICES, Toronto, ON, Canada.
Manish M SoodICES, Toronto, ON, Canada.
Michael PuglieseICES, Toronto, ON, Canada.
Robert TalaricoICES, Toronto, ON, Canada.
Daniel T MyranICES, Toronto, ON, Canada.
Margaret S HerridgeInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Dale M NeedhamDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Bram RochwergDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Deborah J CookDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Hannah WunschICES, Toronto, ON, Canada.
Robert A FowlerICES, Toronto, ON, Canada.
Damon C ScalesICES, Toronto, ON, Canada.
O Joseph BienvenuDepartment of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kathryn M RowanIntensive Care National Audit and Research Centre, Napier House, London, UK.
Magdalena KisilewiczDepartment of Critical Care, Queensway Carleton Hospital, Ottawa, ON, Canada.
Laura H ThompsonClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Peter TanuseputroICES, Toronto, ON, Canada.
Kwadwo KyeremantengDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
University of Ottawa · CAOttawa Hospital · CAImpact · CAJohns Hopkins University · USSunnybrook Health Science Centre · CAIntensive Care National Audit & Research Centre · GBQueensway-Carleton Hospital · CASt. Michael's Hospital · CAUniversity Health Network · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo analyse the association between survival from critical illness and suicide or self-harm after hospital discharge.

designPopulation based cohort study using linked and validated provincial databases.

settingOntario, Canada between January 2009 and December 2017 (inclusive).

participantsConsecutive 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.

main outcome measuresThe 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.

results423 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 (

conclusionsSurvivors 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.

Indexed as

AdolescentAdultAgedAged, 80 and overCase-Control StudiesCritical CareCritical IllnessFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedOntarioProportional Hazards ModelsRetrospective Studies

Identifiers

PMID33952509
PMCPMC8097311
OpenAlexW3157079348

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.