Minhyuk Kang, Hyejin Kim

Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Keywords: Biomarkers, emergency service, hospital, self-injurious behavior, suicide


OBJECTIVE: The objective was to investigate the characteristics of suicide attempters as distinguished from nonsuicidal self-injury (NSSI) among those who are admitted to the emergency department (ED) following self-harm behavior using psychological scales and biochemical markers.

MATERIALS AND METHODS: The initial assessment forms and medical records of patients referred to the ED after self-harm behavior between March 2017 and December 2019 were retrospectively reviewed. Based on the patients' statements, two groups were formed: the NSSI group and the suicide attempt (SA) group.

RESULTS: This study included 578 patients, 76.6% (n = 443) in the SA group and 23.4% (n = 135) in the NSSI group. A univariate analysis comparing the SA and NSSI groups revealed that the SA group was statistically significantly associated with male sex, chronic disease, history of depression, unemployment, not seeking help after the attempt, reduced consciousness, and psychiatric consultation. Further, the SA group was older and showed higher Risk-Rescue Rating Scale (RRRS) value and white blood cell value compared to the NSSI group. However, multivariate logistic analysis did not produce statistically significant results for RRRS and any of the biological markers, with one exception for the accessibility to rescue item in the RRRS, where the NSSI group showed a statistically higher “ask for help” score compared to the SA group (P < 0.01).

CONCLUSIONS: Among patients who were admitted to the ED following self-harm behaviors, the risk factors for SA as opposed to NSSI were chronic disease and not seeking help after the attempt. In addition, suicide attempters tended to be more cooperative in psychiatric consultation following ED admission. In clinical practice, patients admitted due to NSSI should be administered treatment equivalent to that for suicide attempters if they exhibit the characteristics of suicide attempters.

Ethics Committee Approval

Sanggye Paik Hospital, Inje University College of Medicine, Institutional Review Board (IRB date and no.: 2019-12-011-001).

Author Contributions

Conceived and designed the experiments: Hye Jin Kim and Min Hyuk Kang Performed the experiments: Min Hyuk Kang Analyzed and interpreted the data: Hye Jin Kim and Min Hyuk Kang Contributed reagents, materials, analysis tools, or data: Hye Jin Kim and Min Hyuk Kang Wrote the paper: Hye Jin Kim and Min Hyuk Kang.

Conflict of Interest

None declared.

Financial Disclosure

None declared.


We sincerely thank staff (Young ho Shin, Ji yeoung Lee) of the case management service of Sanggye Paik Hospital for helping with data collection (preformatted standardized form).