Severity of hospital-treated self-cutting and risk of future self-harm: a national registry study.

BACKGROUND Risk assessment forms a key component in self-harm management. Among self-harm presentations generally, lethality of an index act is a poor predictor of future non-fatal repetition. However, no study has examined whether severity of an index self-cutting episode is associated with prospective repetition. AIMS To examine factors associated with severity of self-cutting and in particular the association between severity of self-cutting and prospective repetition of self-harm. METHODS All index self-cutting presentations to emergency departments in Ireland over 5 years were grouped by treatment received and compared on the basis of demographic and clinical characteristics. RESULTS Receiving more extensive medical treatment was associated with male gender, being aged more than 15 years, and not combining self-harm methods. Receiving less extensive treatment conferred a higher risk of prospective 12-month repetition, even after controlling for demographic and clinical characteristics. Repeat self-harm presentations by those with more severe self-cutting in an index act were less prevalent but were more likely to involve high-lethality methods of self-harm. DISCUSSION The results indicate that the already-elevated repetition risk among self-cutting patients is further increased for those receiving less extensive wound closure treatment. Severity of self-cutting might also affect suicide risk but such an association has yet to be examined.