Lynn, Ena
(2008)
National Registry of Deliberate Self Harm annual report 2006-2007.
Drugnet Ireland,
Issue 28, Winter 2008,
p. 14.
The sixth annual report from the National Registry of Deliberate Self Harm was published in September 2008.1 The report contains information relating to every presentation of deliberate self-harm to general hospital and paediatric hospital A&E departments in Ireland in 2006 and 2007, giving complete national coverage of hospital-treated deliberate self-harm. The Registry defines deliberate self-harm as ‘an act with non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour, that without intervention from others will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes that the person desires via the actual or physical consequences’.
According to the report there were 10,700 presentations of deliberate self-harm, involving 8,200 individuals, to hospital A&E departments in 2006. There were 11,100 presentations by 8,600 individuals in 2007, a rate 2% higher than in 2006. Reviewing data collected by the Registry for the six-year period 2002–2007, the report indicates that the rate of presentation of deliberate self-harm is relatively stable.
The national rate of deliberate self-harm in both 2006 and 2007 was one-third (32% and 33%) higher among females than among males. Concordant with previous reports, deliberate self-harm was largely confined to the younger age groups. Almost half of all presentations (46% in 2006 and 47% in 2007) were by people aged under 30, and 88% were by people aged under 50.
The peak age range for females presenting was 15–19 years, at 600 per 100,000. This indicates that one in every 165 Irish adolescent girls was treated in hospital each reporting year as a result of deliberate self-harm. The peak age range for males presenting was 20–24 years, at 392 per 100,000.
Increased deprivation and social fragmentation were associated with increased rates of deliberate self-harm. Rates were higher in urban settings, with the highest rate reported in HSE Dublin/North East Region.
Repetition of deliberate self-harm accounted for almost one in four (23.1% in 2006 and 22.4% in 2007) of all presentations, with men more at risk of repeated self-harm.
Drug overdose was the most common form of deliberate self-harm, representing 74% of all such episodes reported in 2006–2007. Overdose rates were higher among females (80%) than among males (65%). On average, 31 tablets were taken in episodes of drug overdose. The total number of tablets taken was known in 78% of cases. Forty-two per cent of all drug overdoses involved a minor tranquilliser, 30% involved paracetamol-containing medicines and 22% involved anti-depressants/mood stabilisers. According to the report, the withdrawal of the analgesic, Distalgesic, in January 2005 has had a positive effect. Distalgesic was involved in approximately forty cases of self-harm in 2007 compared to approximately four hundred cases reported annually between 2002 and 2005.
There was evidence of alcohol consumption in 41% of all episodes of deliberate self-harm, emphasising the strong association between alcohol consumption and suicidal behaviour.
Self-cutting was the second most common method of deliberate self-harm, representing 21% of all episodes, and was more common among males than among females.
The emergency department was the only treatment setting for more than half (53%) of all deliberate self-harm patients, that is, they did not proceed to further treatment.
The report recommends the following measures to reduce the incidence of deliberate self-harm:
- continued support of the national mental health awareness campaign and related mental health promotion initiatives to reduce levels of psychiatric and psychological morbidity in the population;
- additional resources to support mental health promotion, and specialist mental health services for adolescents aged 15–19 years;
- evidence-based interventions targeting people who repeatedly self-harm, with a focus on high risk groups;
- restriction of the availability of minor tranquillisers;
- development of a mechanism for linking data collected by the Registry with data on suicide mortality to improve understanding of the relationship between deliberate self-harm and the risk of suicide in the future; and
- extension of the core Registry dataset to support evaluation of progress on actions in the strategy document on suicide prevention, Reach out,2 and increase our understanding of deliberate self-harm.
1. National Registry of Deliberate Self Harm Ireland (2008) Annual report 2006–2007. Cork: National Suicide Research Foundation.
2. HSE, National Suicide Review Group and Department of Health and Children (2005) Reach out: national strategy for action on suicide prevention 2005–2014. Dublin: Health Service Executive.
