Deliberate self harm.

Introduction This paper summarises the research evidence presented in a recent issue of EVective Health Care on deliberate self harm. Deliberate self harm is one of the top five reasons for acute medical admissions in the UK. The term deliberate self harm includes intentional self poisoning or self injury (such as cutting), irrespective of the apparent purpose of the act. Self poisoning is the most common form of deliberate self harm. Most cases of deliberate self poisoning present to general hospitals; in the UK there are more than 150 000 such attendances annually. The most common substances ingested are analgesics, particularly paracetamol and paracetamol containing compounds. Prevalence rates for self harm have been rising continuously since the mid-1980s to an estimated 400 per 100 000 population each year. 5 This incidence is higher than most others recorded in Europe. EVective intervention after an episode of self harm is important because these individuals are at high risk of suicide. Repetition of self harm is common, especially in the weeks immediately after an episode; and the suicide rate over the following year is 100 times greater than among the general population. In the year before they die, about a quarter of all suicides are seen in hospital after a non-fatal act of self harm. 9 EVective intervention after deliberate self harm, if it were available, could therefore be an important means of achieving the targets for reduction of the suicide rate which are outlined in the Health of the Nation and in the green paper, Our Healthier Nation. Once there were two or three times as many episodes in women as men, now there is near equality. 4 12 Some general hospitals now deal with more referrals of men than women. This trend is worth noting because the suicide rate has been increasing among young men in the past 10 years. The mean age of the self harm population is in the early 30s for both sexes, the peak age for presentation being 15–24 years for women and 25–34 years for men. 15 Most people report that they take overdoses in response to social problems including, difficulties with housing, unemployment, debt, illness, and conflict or loss in personal relationships. Evidence exists that repetition of self harm may occur despite resolution of personal problems. 19 After an episode of deliberate self harm, about a third of general hospital attenders may be given a psychiatric diagnosis (usually depression), and a similar proportion have had previous contact with the psychiatric services. About 10% are alcohol dependent. Fewer than 10% have mental illnesses such as schizophrenia or bipolar disorder. Box 1 shows features associated with an increased risk of repetition or eventual suicide. 26–35 Risk of repetition is not uniformly distributed, and some people repeat self harm on numerous occasions. Although it is often assumed that those who repeat self harm frequently are predominantly women, the excess of women among chronic repeaters is probably no greater than among the self harming population as a whole. Little is known about multiple repeaters, except for a subgroup of women who meet criteria for borderline personality disorder, many of whom have been subject to abuse (not always sexual) in childhood.