Method of self-harm and risk of self-harm repetition: findings from a national self-harm registry

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Background: Risk of self-harm repetition has consistently been shown to be higher following self-cutting compared to intentional drug overdose (IDO) and other self-harm methods. The utility of previous evidence is limited due to the large heterogeneous method categories studied. This study examined risk of hospital presented self-harm repetition according to specific characteristics of self-harm methods. Methods: Data on consecutive self-harm presentations to hospital emergency departments (2010–2016) were obtained from the National Self-Harm Registry Ireland. Associations between self-harm method and repetition were analysed using survival analyses. Results: Overall, 65,690 self-harm presentations were made involving 46,661 individuals. Self-harm methods associated with increased repetition risk included minor self-cutting, severe self-cutting, multiple drug IDOs involving psychotropic drugs and self-harm by blunt object. Minor self-cutting was the method associated with highest repetition risk (adjusted hazard ratio (AHR) 1.38, 95% CI 1.31–1.45). Risk of repetition was comparable following IDOs of four or more drugs involving psychotropic drugs (AHR = 1.29, 95% CI 1.20–1.39), severe self-cutting (AHR 1.25, 95% CI 1.16–1.34) and blunt object (AHR = 1.23, 95% CI 1.07–1.42). Limitations: Information was not available on suicide or other causes of mortality. Conclusions: Self-harm method and the associated risk of repetition should form a core part of biopsychosocial assessments and should inform follow-up care for self-harm patients. The observed differences in repetition associated with specific characteristics of IDO underline the importance of safety planning and monitoring prescribing for people who have engaged in IDO.




Cully, G., Corcoran, P., Leahy, D., Griffin, E., Dillon, C., Cassidy, E., … Arensman, E. (2019). Method of self-harm and risk of self-harm repetition: findings from a national self-harm registry. Journal of Affective Disorders, 246, 843–850.

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