Citation

Clements C, Farooq B, Bickley H, Kapur N. J. Affect. Disord. 2019; 262: 77-82.

Affiliation

Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, UK.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jad.2019.10.052

PMID

31710932

Abstract

BACKGROUND: As a risk factor for future self-harm and suicide, questions about past self-harm are typically included in assessments that help inform management of people who self-harm. However, little is known about people with a history of self-harm who do not report it. This study aimed to describe and compare (i) characteristics of people who did or did not accurately report previous self-harm, and (ii) 12-month repetition of self-harm.

METHODS: Data on all self-harm presentations to three hospital emergency departments in England were collected from 2003 to 2015. A 1:5 matched case-control design included 374 cases where previous self-harm was not reported and 1,870 controls where previous self-harm was reported. Data were analysed using conditional logistic regression and survival analysis.

RESULTS: Cases were more likely to be male (OR 1.42; 95% CI 1.13-1.77), middle-aged (OR 1.41; 95% CI 1.08-1.83), employed (OR 1.51; 95% CI 1.15-1.98), and less likely be referred to psychiatric services (OR 0.53; 95% CI 0.35-0.80). Twelve-month repetition was similar in cases and controls (30% vs 31%). LIMITATIONS: Self-harm not resulting in a hospital presentation could not be verified and individuals with a single episode in the study database were therefore excluded.

CONCLUSIONS: Previous self-harm is an important risk factor for repetition in people who accurately recall and report it and those who fail to report it. Those who do not report previous self-harm are less likely to be referred to psychiatric services, emphasising the need for careful assessment of every self-harm presentation to emergency departments.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

Case-control; Psychiatric assessment; Self-harm; Suicidal behavior