Congenital Heart Disease and Risk of Suicide and Self‐Harm: A Danish Nationwide Cohort Study

Background In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self‐harm in patients with congenital heart disease (CHD ).Methods and Results We identified all Danish citizens receiving a diagnosis ofCHD between 1977 and 2007. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide and self‐harm, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self‐harm in patients withCHD with the reference cohort. We identified 14 433 patients withCHD . Mean follow‐up was 21.3 years, with a maximum follow‐up of 42 years. Since the time of diagnosis, 2659 patients had died, with a median age of death of 23 years. A total of 15 patients had died by suicide, compared with 232 suicides in the reference cohort. Patients withCHD had a low and similar risk of dying by suicide when compared with the reference cohort (cause‐specific hazard ratio, 0.81; 95%CI , 0.48–1.37; and subhazard ratio, 0.68; 95% CI, 0.41–1.16). We identified 336 events of self‐harm among patients withCHD , and 3484 events in the reference group. The overall risk of deliberate self‐harm was not increased in patients withCHD when compared with the reference group (subhazard ratio, 0.95; 95% CI, 0.85–1.06).Conclusions This is the first study to estimate the risk of suicide and deliberate self‐harm in patients withCHD . We found that patients withCHD do not have an increased risk of suicide or deliberate self‐harm when compared with a large reference cohort.