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

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

20
Clinical Care of Self-Harm Patients
An Evidence-Based Approach

Keith Hawton and Kate E. A. Saunders


Introduction

Self-harm is the term used in the United Kingdom, much of Europe, and several other parts of the world to describe intentional nonfatal self-poisoning (e.g., overdoses of prescribed drugs, swallowing of noningestible substances such as pesticides), and selfinjury (e.g., self-cutting, hanging, jumping from a height), involving any type of motive or intention (e.g., to communicate distress, to die). Rates of self-harm estimated on the basis of general hospital presentations vary from country to country. In Europe, particularly high rates of self-harm have been reported for England, Ireland (see Chapter 3 by Arensman, Griffin, and Corcoran), France, and Finland (Schmidtke et al., 1996), where self-harm is one of the most common reasons for hospital admission. Rates are generally higher in females than males, especially in teenagers (Hawton & Harriss, 2008; Madge et al., 2008), and younger adults (Bergen, Hawton, Waters, Cooper, & Kapur, 2010; Hawton et al., 2007). However, in some countries the overall gender gap has narrowed in recent years. Rates also tend to be higher in areas of socioeconomic deprivation and social fragmentation (i.e., characterized by poor social networks; Gunnell, Peters, Kammerling, & Brooks, 1995; Hawton, Harriss, Simkin, Bale, & Bond, 2001).

The majority of self-harm episodes among individuals presenting to hospitals involve self-poisoning (e.g., 72% in Schmidtke et al., 1996; 80% in Bergen et al., 2010). In the community, however, self-injury, especially self-cutting and other forms of self-mutilation, are more common, particularly in adolescents (e.g., 56% in Madge et al., 2008).

Self-harm is often related to interpersonal and social problems (e.g., difficulties in relationships, social isolation). Many patients presenting to hospital following selfharm have psychiatric disorders, for example, depression, anxiety, and personality disorders, often complicated by alcohol or drug misuse (Haw, Hawton, Houston, & Townsend, 2001; Hawton, Saunders, Topiwala, & Haw, 2013; Suominen et al., 1996). The majority of adolescents who present to hospital because of self-harm also have psychiatric disorders, especially depression, ADHD, and substance misuse (Hawton et al., 2013). Self-harm has been linked to certain psychological characteristics, including deficiencies in problem solving (Linehan, Camper, Chiles, Strohsahl, & Shearin, 1987; Pollock & Williams, 2004), low self-esteem and impulsivity (Mann, 2003),

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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