By Their Own Young Hand: Deliberate Self-Harm and Suicidal Ideas in Adolescents

By Keith Hawton; Karen Rodham et al. | Go to book overview

During the 1970s and 1980s, reports of increasing numbers of adolescents presenting to hospitals after deliberate self-harm also started to appear from other countries, especially in Europe (Choquet et al., 1980), North America (Wexler et al., 1978) and Australia (Mills et al., 1974; Oliver et al., 1971). Particularly high rates of deliberate self-harm in adolescents resulting in hospital presentation (equivalent to those in the UK) have been identified in France (Batt et al., 2004), Ireland (Corcoran et al., 2004; National Suicide Research Foundation, 2004), Belgium (Van Heeringen and De Volder, 2002) and Australia (Reith et al., 2003).

Most acts of self-harm that result in a young person going to hospital involve overdoses rather than self-injuries (Hawton et al., 2003a; Hultén et al., 2001). In the UK, the drugs used most frequently in overdoses are analgesics, especially paracetamol (acetaminophen). In Oxford, in recent years approximately 60 per cent of overdoses by adolescents have involved paracetamol (Hawton et al., 2003a, b). This certainly reflects ease of availability – paracetamol is present in most households and can be bought over the counter in pharmacies and a wide range of other outlets. Other drugs used relatively commonly in overdoses include psychotropic agents, especially antidepressants and tranquillisers. Self-injury most frequently involves selfcutting, especially of the arm, but other methods include jumping from a height, running into traffic, hanging and self-battery.

What is the significance of deliberate self-harm in adolescents? Clearly it represents considerable current distress. In addition, long-term follow-up of adolescents who have self-harmed indicates a very high rate of suicide attempts in young adulthood (Fergusson et al., 2005b). Furthermore, deliberate self-harm is associated strongly with risk of future suicide, the risk of suicide in deliberate self-harm patients in general being elevated some 50–100 times that in the general population during the year after hospital presentation (Hawton and Fagg, 1988; Hawton et al., 2003d). Follow-up studies of adolescent patients have demonstrated that such people also have a greatly elevated risk of suicide (Goldacre and Hawton, 1985; Otto, 1972; Sellar et al., 1990). In a long-term follow-up study (mean follow-up period 11 years) of a very large sample of patients aged between 15 and 24 years, over half of all deaths were due to suicide or probable suicide (Hawton and Harriss, submitted). Studies of young people who have died by suicide also highlight the association between deliberate self-harm and suicide. For example, in an investigation of suicide in 174 young people aged between 15 and 24years, 44.8 per cent were knownto haveaprior history of deliber-

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