The 2003 annual report of the National Parasuicide Registry defines parasuicide 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 dose and which is aimed at realising changes that the person desires via actual or expected physical consequences’.1  Internationally, according to the report, the term parasuicide is being superseded by the term ‘deliberate self-harm’.

Since 2001, the National Suicide Research Foundation has collected data on deliberate self-harm in Ireland through its National Parasuicide Registry. Each accident and emergency unit and prison provides data on every episode of self-harm that they attend. Up to 2004, there was complete coverage in all HSE areas outside the Eastern Region. Three hospitals in the Eastern Region did not make returns until 2004; the rates given in the 2003 report were adjusted to take account of this.

According to the report, there were 11,200 presentations in 2003 as a result of deliberate self-harm, involving 8,800 individuals, whereas in 2002 there were 10,500 presentations involving 8,400 individuals. In 2003 the age-standardised rate of self-harm was 209 per 100,000, while in 2002 the rate was 202 per 100,000; this represents an increase of almost 4%. Every year, a number of individuals present more than once in the twelve-month period; 21% of cases presented more than once in 2003, while 19% of cases presented more than once in 2002. The rate of deliberate self-harm was higher among males (177 per 100,000) than among females (241 per 100,000) in 2003, though the difference in 2003 was smaller than the rates in 2002, 36% versus 42% respectively. Just under 47% of presentations were aged under 30 years. The peak age for women was 15–19 years, while for men it was 20–24 years.

Drug overdose was the commonest method of self-harm, representing almost 79% of all such acts registered in 2003. Half of all overdose acts involved at least 25 tablets. In general, men took more tablets than women. For example, at least 50 tablets were taken by 21% of men compared to 15% of women. It was common for cases to take more than one drug. The most common drugs used in deliberate self-harm were minor tranquillisers (41%), paracetamol (31%) and antidepressants (24%).

Self-cutting was the second most common method of self-harm, representing 18% of all acts registered in 2003. Cutting was more common in men (23%) than in women (14%). This finding reflects those in the United Kingdom but not internationally.

The report highlights the challenge the deliberate self-harm poses for Irish health services and for society. Deliberate self-harm is a predictor of both non-fatal and fatal suicidal behaviour. It is a symptom of mental health problems and distress in our society, and a major cause of suffering for individuals and their families. There is a need to understand the reasons for self-harm in society and to prevent repeat episodes among individuals. The open discussion in general society, which commenced in recent years, needs to continue but it should be informed and sensitive.

1. National Parasuicide Registry Ireland (2004) Annual Report 2003. Cork: National Suicide Research Foundation.