A 20-year review of trends in deliberate self-harm in a British town, 1981-2000.

BACKGROUND: It is important to identify trends in deliberate self-harm because of potential links both with complex mental health problems and with suicide itself, and because of its significant impact on resources in both mental health and acute health services.
METHOD: Patients presenting at the A&E department at Kidderminster General Hospital following an act of deliberate self-harm between the years 1981 and 2000 were assessed by the Parasuicide Counselling Group. These data were used to examine trends in deliberate self-harm and patient characteristics.
RESULTS: The 20-year study examined 4,474 episodes of deliberate self-harm in the Kidderminster district. Rates of deliberate self-harm were higher in females throughout, although the difference between the genders narrowed in the second half of the 1990s. In both males and females, the rate of deliberate self-harm was highest in those aged 15-24. Since the mid-1990s, there have been increases in the rate of deliberate self-harm in males aged 45-54 and in females aged 25-44. Rates were highest in males and females who were separated. Although the most common method of deliberate self-harm in both males and females was overdose, males used cutting and other methods of deliberate self-harm proportionally more than females. There was a relentless rise in paracetamol use until a decline at the end of the study period following the introduction of a restriction on sales. Alcohol use at the time of deliberate self-harm rose markedly in both genders. There was a significant increase in deliberate self-harm repetition in both males and females over the study period. In males and females, psychiatric involvement or admission increased in the 1990s compared to the 1980s.
CONCLUSIONS: Higher levels of deliberate self-harm repetition and psychiatric involvement suggest increasing pressures on health services and a continuing need to develop understanding of deliberate self-harm.