DELIBERATE SELF HARM is the single most important risk factor for suicide across the world but few countries other than Ireland have reliable data on it.

A new paper which looked at figures collected by the Irish National Registry of Deliberate Self Harm found there were 75,119 presentations of deliberate self harm (DSH) at Ireland’s 40 emergency departments (EDs) between the years of 2003 and 2009.

Although some people attended hospital more than once, there were still more than 48,000 individuals presenting with DSH in the seven year period. More than 10,000 of those visited EDs at least twice.

About 453 people presented at least ten times, accounting for more than 8,000 incidences of self harm.

Despite the high figures, it is believed that only a minority of adolescents and adults who self harm actually present to hospital.

Suicide up to 50 times more likely

The report’s authors concluded that it is important to note the links between self harming and suicide. Research has shown that if a person presents to hospital after an act of DSH, they are 30 to 50 times more likely than other members of the general population to risk suicide in the year after.

The research, which was funded by the HSE’s National Office for Suicide Prevention, found that there was an increased rate of DSH in Irish men in 2008 and 2009. The study noted that the 10 per cent jump coincided with the advent of the economic recession and an increased incidence of suicide amongst men.

Although the number of men presenting has risen significantly, more women still present to hospital per 100,000 population. There was a “clear peak” in 15 to 19-year-old women, while the highest rate in men was observed in the 20-24 year-old age group.

Overall, the highest DSH rates were observed in 17-year-old girls.

Used in 68 per cent of cases, drug overdose is by far the most common method of self harm. Minor tranquillisers, medication containing paracetamol and anti-depressants or mood stabilisers were the usual drugs used.

Self-cutting is also a common method of DSH. Most of the cuts recorded by the database were minor and did not need sutres. However, 6 per cent of cases were referred to plastic surgeons.

Alcohol was involved in more than 40 per cent of DSH incidences.

There were a small number of cases of more lethal methods, including attempted hanging and drowning. Those surviving such acts have shown their risk of fatal repeat acts to be relatively high.

Effective treatment is available

Although reliable information is scarce, the higher rate in women, the peak in early adult life and the predominance of drug overdose as a method of self harm seems to be consistent across difference cultures. However, rates of self-cutting particularly in men are higher in Ireland than in most other regions in Europe. Irish men also inflict more severe damage when self-cutting.

Self-inflicted injuries are the sixth leading cause of ill-health worldwide and about one million people die by suicide every year across the globe. The findings from the Irish National Registry of Deliberate Self Harm in relation to repetition underline the importance of linking deliberate self harm with suicide mortality data.

The authors also found that population-based data on hospital-treated DSH represents an important index of the burden of mental illness and suicide risk in the community.

They called for suitably-trained health professionals to assess both the risk of repeated suicidal behaviour and broader psychosocial needs of patients so appropriate referral and follow-ups can be carried out.

Effective treatment to reduce the risk of repeated self harm is available and there is growing evidence to support the efficacy of cognitive behaviour therapy, problem-solving terapy and interpersonal psychotherapy.

You can contact Samaritans on 1850 60 9090, or contact them via email at jo@samaritans.org.

You can contact Pieta House on 01 601 000 or email mary@pieta.ie