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Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury

Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds

Helen Bergen, BSc, PhD, Keith Hawton, DSc, DM, FRCPsych, Deborah Casey, BA, Sue Simkin, BA and Elizabeth Murphy, BSc

Centre for Suicide Research, University of Oxford, Oxford

Jayne Cooper, PhD, RMN and Navneet Kapur, MD, MRCPsych

Centre for Suicide Prevention, Division of Psychiatry, University of Manchester, Manchester, UK

Correspondence: Dr David Owens, Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Woodhouse, Leeds LS2 9LJ. Email: d.w.owens{at}leeds.ac.uk

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.

Aims

We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.

Method

Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10 498 consecutive episodes of self-harm at six English teaching hospitals.

Results

Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.

Conclusions

Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

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Highlights of this issue

Kimberlie Dean
BJP 2008 192: A22. [Full Text]