Deliberate Self-Harm and Repetition - Findings from the Irish National Registry of Deliberate Self-Harm

Since 2002, the Registry has collected data on all cases of deliberate self-harm (DSH) presenting to almost all emergency departments in Ireland.

Each year during 2002-2005 about 11,000 DSH presentations were made to hospital by approximately 8,600 persons. Based on the four-year data, 8.2% of the DSH patients made a repeat presentation within 3 months of their index presentation, 11.9% repeated within 6 months and 16.3% within 12 months. Thus, risk of repetition was highest in the first months after a DSH presentation.

Repetition rates were higher among patients aged 35-44 years, among men and among patients who had presented following self-cutting. In general, self-cutting was more common among male DSH presentations and this explained why men were observed to have a higher repetition rate than women.

Repeated DSH represents a significant challenge to the health services in general and to the professionals involved in the assessment and treatment of patients in particular. Identifying those at greatest risk of repetition is a core element of the psychosocial needs assessment carried out at emergency departments.

Consideration should be given to the fact that the risk is higher in the short term and particularly so among those whose DSH involved self-cutting.
The association between deliberate self harm, deprivation and social fragmentation in Ireland

International research has shown that deprived and socially fragmented areas generally have high suicide rates. A recently published study based on data from the National Registry of Deliberate Self-Harm examined whether this was true for deliberate self-harm.

During the period 2002-2004, 32,777 deliberate self-harm presentations to emergency departments were made by 25,797 individuals. The total, male and female annual rates of persons presenting following self-harm were 204, 171 and 237 per 100,000, respectively. Striking geographic differences were observed. Rates in Dublin, other cities (Cork, Galway, Limerick and Waterford) and urban districts were 10%, 48% and 62% higher than the national rate, respectively, while the rural district population had a 32% lower rate. These differences largely reflected the differences between these areas in terms of deprivation and social fragmentation.

Considering the country as a whole, increased deprivation and social fragmentation were associated with increased rates of deliberate self-harm, with deprivation having the stronger independent effect. However, the effect of deprivation was far more pronounced in Dublin and the other cities than in the urban or rural districts. Independent of deprivation, social fragmentation was only associated with increased rates of deliberate self-harm in rural districts.

Based on the study findings, we recommend that deprived urban areas be given priority when implementing community-based interventions aimed at reducing suicidal behaviour.

Source and more information: Ella Arensman, (ella.nsrf@iol.ie)Director of Research at the National Suicide Research Foundation in Ireland and EuroSafe Task Force leader on Suicide and Self-harm. The information in this article was taken from: Corcoran P, Arensman E, Perry IJ. (2007). The area–level association between hospital-treated deliberate self-harm, deprivation and social fragmentation in Ireland. Journal of Epidemiology and Community Health, 61: 1050-1055.