The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

3
Self-Harm
Extent of the Problem and
Prediction of Repetition

Ella Arensman, Eve Griffin, and Paul Corcoran


Introduction

Engaging in self-harm is the strongest predictor of future suicidal behavior, both nonfatal and fatal (Gilbody, House, & Owens, 1997; Gunnell et al., 2008; Kerkhof & Arensman, 2001; Zahl & Hawton, 2004). Self-harm frequently leads to nonfatal repetition with an estimated median risk of repetition of 16% within 1 year and 23% over 4 years, on the basis of the findings of systematic reviews (Carroll, Metcalfe, & Gunnell, 2014; Owens, Horrocks, & House, 2014). However, other estimates from a U.K. multicenter study suggest even higher rates of repeated self-harm (33%) in the 12 months following an index case (Lilley et al., 2008). Subsequent repeated selfharm often occurs within days and weeks of an index self-harm act (Cedereke & Ojehagen, 2005; Kapur et al., 2006; Perry et al., 2012).

Worldwide, few countries have reliable data on self-harm. There is a broad spectrum of self-harming behaviors, ranging from deliberate recklessness to highly lethal attempts at suicide, and only a minority of persons who self-harm present to hospital (Skegg, 2005). However, hospital presentations due to self-harm provide a potentially important indicator of the impact of psychiatric and psychological morbidity in the population. They also provide an important opportunity for the health and social care system to provide targeted interventions to reduce the risk of suicide in a welldelineated group of patients at high risk of suicide.

An internationally agreed definition of self-harm has been endorsed by the World Health Organization (WHO) and will be used to define self-harm in this chapter: “an act with non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour, that without intervention from others will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes that the person desires via the actual or expected physical consequences” (Platt et al., 1992). This definition facilitated international comparisons of self-harm incidence and trends in a European multicenter study (Schmidtke, Bille-Brahe, Kerkhof, & De Leo, 2004) that demonstrated a more than 10-fold variation in self-harm rates across more than 20 regions. These rates were based on single centers as reliable estimates of national rates are not available.

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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