David Owens1, Rachael Kelley2, Theresa Munyombwe2, Helen Bergen3, Keith Hawton3, Jayne Cooper4, Jennifer Ness5, Keith Waters5, Robert West2, Navneet Kapur4. 1. Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK. Electronic address: d.w.owens@leeds.ac.uk. 2. Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK. 3. Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK. 4. Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK. 5. Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
Abstract
BACKGROUND: Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. METHODS: The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. RESULTS: Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching. LIMITATIONS: Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. CONCLUSIONS: Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm. Crown
BACKGROUND: Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. METHODS: The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. RESULTS: Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching. LIMITATIONS: Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. CONCLUSIONS: Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm. Crown
Authors: Keith Hawton; Katrina G Witt; Tatiana L Taylor Salisbury; Ella Arensman; David Gunnell; Philip Hazell; Ellen Townsend; Kees van Heeringen Journal: Cochrane Database Syst Rev Date: 2016-05-12
Authors: Leah Quinlivan; Jayne Cooper; Declan Meehan; Damien Longson; John Potokar; Tom Hulme; Jennifer Marsden; Fiona Brand; Kezia Lange; Elena Riseborough; Lisa Page; Chris Metcalfe; Linda Davies; Rory O'Connor; Keith Hawton; David Gunnell; Nav Kapur Journal: Br J Psychiatry Date: 2017-03-16 Impact factor: 9.319