1. Background
Risk of repeated self-harm and
associated factors
in children, adolescents and
young adults
Marco Bennardi¹
Co-authors: E. McMahon¹, P. Corcoran¹, E. Arensman¹’²
Aim
To identify risk factors for long-term repetition of
self-harm among children, adolescents and young
adults admitted to hospital emergency departments
in Ireland. The focus was on frequency of repetitions
and time between presentations
• Longitudinal study including all self-harm
presentations to 36 emergency departments in
Ireland between 2007 and 2014
• Database: Self-harm Registry Ireland
• 28,700 individuals - 42,642 presentations
• Variables: gender, date of birth, area of residence,
date and hour of attendance at hospital,
method(s) of self-harm, alcohol involved in the
act, and recommended next care
• Risk of long-term repetition was assessed using
survival analysis and time differences between the
first presentations using generalised estimating
equation analysis
3rd ESR
Conference
April 28th 2016
Oulu, Finland
¹National Suicide Research Foundation, ²Department of Epidemiology and Public Health, University College Cork
Methods
Results
• Higher proportion of females and of adolescents
and younger emerging adults, compared to
children and older emerging adults
• Intentional drug overdose was the most prevalent
method (57.9%)
In recommending
interventions for self-
harm, history of self-
harm and potential
risk of future
repetition should be
considered.
• Self-harm is a common phenomenon and a major
public health problem
• Repeated self-harm represents the strongest risk
factor for suicide and other premature deaths
Acknowledgements
The research leading to these results has received funding from the People Programme (Marie Curie Actions) of the European Union's Seventh Framework
Programme FP7/2007-2013/ under REA grant agreement n°316795.
• Time between 2nd and 3rd presentation
increased (on average 42 days) compared
to time between 1st and 2nd
presentation among low frequency
repeaters (patients with 3 presentations
only within one year following a first
presentation).
• The same time period decreased (on
average 47 days) among high frequency
repeaters (patients with at least 4 to
more than 30 presentations).
 15-19-year-old females and 20-24-year-old males are at the highest risk
for repeated self-harm
 Time between first self-harm presentations represents an indicator of
subsequent repetition
 Self-cutting, both combined and not combined with intentional drug
overdose is associated with the highest risk of self-harm
 Younger emerging adult males and older emerging adult females were
at lower risk of repetition when admitted at a hospital general ward
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Proportionofindividualsnotrepeating
0 30 60 90 120 150 180 210 240 270 300 330 360
Time to self-harm repetition (days)
10-14yrs 15-19yrs
20-24yrs 25-29yrs
0.60
0.65
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Proportionofindividualsnotrepeating
0 30 60 90 120 150 180 210 240 270 300 330 360
Time to self-harm repetition (days)
Drug overdose only Self-cutting only
Overdose & self-cutting Attempted hanging only
Attempted drowning only Other
Kaplan-Meier sur vival estimates
0.25
0.30
0.35
0.40
0.45
0.50
0.55
0.60
0.65
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Proportionofindividualsnotrepeating
0 30 60 90 120 150 180 210 240 270 300 330 360
Time to self-harm repetition (days)
None One
Two Three
Four Five
Kaplan-Meiersurvival estimates
Key findings Conclusion
• Overall, the risk of repeated self-harm was similar between males and females. However,
in the 20-24-year-old age group males were at higher risk than females
• Adolescent females are at higher risk for repetition than other age group females
• Those who used self-cutting were at higher risk for repetition than those who used any
other method
• Repeated self-harm risk increased significantly with the number of previous self-harm
episodes.
• Self-harm repetition occurred in 19.2% (N=2,630) of individuals
• The majority (62.7%) of individuals repeating self-harm, engaged in one repeated act
during the first year following a first presentation
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1
2
3
4
5
6
> 6
Total
Drug overdose only (N) Self-cutting only (N) Overdose & self-cutting (N)
Attempted hanging only (N) Attempted drowning only (N) Other (N)
0 50 100 150 200 250 300
Highfrequenty
repeaters
Lowfrequency
repeaters
Time between first and second presentation
Time between second and third presentation
0 50 100 150 200 250 300
Femalehigh
frequencyrepeaters
Femalelow
frequencyrepeaters
Figure 1 - Proportion of individuals who did not repeat within 1-year period according to age, self-harm method, and number of previous self-harm
Figure 2 – Comparison between time (days) from 1st to 2nd presentation and time
from 2nd to 3rd presentation in the whole sample (left) and among females (right)