Self-Harm: Extent of the Problem and Prediction of Repetition

Self-harm is a major public health problem in many countries and it varies by age group, gender and ethnicity. Having engaged in an act of self-harm is the strongest predictor of future fatal and non-fatal suicidal behaviour. Development and implementation of effective assessment procedures for self-harm patients are required in order to determine risk of repetition and prevent repeated self-harm and suicide. In this chapter we present the outcomes of a review of studies addressing the extent of the problem of self-harm and the rates of repetition. We also describe factors associated with the prediction of repeated self-harm including age, gender, ethnic aspects, and assessment procedures for self-harm patients presenting to hospital emergency departments. The extent of the problem of self-harm varies across countries, with relatively high rates in the UK and Belgium and low rates found in Scandinavia. Self-harm rates are consistently higher in females compared to males. However, in terms of repetition, recent studies indicate that men are overrepresented among those who repeat following and index self-harm act. Factors predicting repeated self-harm vary by age (young, adults, older adults) although there is some overlap. A history of previous self-harm is an important predictor of repetition in both young people and adults. Even though most national suicide prevention programmes consider the implementation of uniform guidelines for the assessment of self-harm patients to be a key priority, there is still considerable variation within and across countries in the types of assessment and aftercare offered to self-harm patients.