Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada

Key Points Question How common is nonfatal self-injury (NFSI) after a cancer diagnosis, and what are the associated risk factors? Findings In this cohort study of 806 910 adults with cancer, 0.3% of the population had an NFSI event within 5 years of diagnosis. Age, history of severe psychiatric illness, and prior self-injury were the factors most strongly associated with NFSI. Meaning These findings suggest that age, prior severe psychiatric illness, and prior self-injury could be used to identify patients with cancer at risk of NFSI events.
This cohort study examines the risk of nonfatal self-injury following a cancer diagnosis.
Importance Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. Objective To examine the risk of NFSI after a cancer diagnosis. Design, Setting, and Participants This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. Exposures Demographic and clinical factors. Main Outcomes and Measures Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. Results In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (