The 16th annual report from National Self-Harm Registry Ireland was published in 2018.1 The report contains information relating to every recorded presentation of deliberate self-harm to acute hospital emergency departments in Ireland in 2017 and complete national coverage of cases treated. All individuals who were alive on admission to hospital following deliberate self-harm were included, along with the methods of deliberate self-harm that were used. Accidental overdoses of medication, street drugs or alcohol were not included.

Rates of self-harm

There were 11,600 recorded presentations of deliberate self-harm in 2017, involving 9,103 individuals. Taking the population into account, the age-standardised rate of individuals presenting to hospital in the Republic of Ireland following self-harm was 199 per 100,000 population. This was 3% lower than the rate recorded in 2016 (206 per 100,000 population). In recent years, between 2011 and 2013, there have been successive decreases in the self-harm rate. Nevertheless, the rate in 2017 was still 6% higher than in 2007, the year before the economic recession (see Figure 1).

In 2017, the national male rate of self-harm was 181 per 100,000 population, 2% lower than in 2016. The female rate was 218 per 100,000 population, which was 4% lower than in 2016. With regard to age, the peak rate for men was in the 20–24-age group, at 505 per 100,000 population. The peak rate for women was among 15–19-year-olds, at 758 per 100,000 population.

Self-harm and drug and alcohol use

Intentional drug overdose was the most common form of deliberate self-harm reported in 2017, occurring in 7,531 (64.9%) of episodes. As observed in 2016, overdose rates were higher among women (70.3%) than among men (58.1%). Minor tranquillisers and major tranquilisers were involved in 34% and 9% of drug overdose acts, respectively. In total, 33% of male and 47% of female overdose cases involved analgesic drugs, most commonly paracetamol, which was involved in 29% of all drug overdose acts. In 67% of cases, the total number of tablets taken was known, with an average of 29 tablets taken in episodes of self-harm that involved a drug overdose.

There was a 7% increase (n=583) in the number of presentations involving street drugs (cannabis, ecstasy, and cocaine) compared with 2016 (n=547). The 2017 levels are the highest recorded since 2008 and the second-highest ever recorded by the registry. Alcohol was involved in 31% of all self-harm presentations, and was significantly more often involved in male episodes of self-harm than females (33% vs 29%, respectively). The authors reported that, as in previous years, alcohol continued to be one of the factors associated with the higher rate of self-harm presentations on Sundays, Mondays and public holidays, and in the hours around midnight.

Conclusions

• The authors concluded that these findings underline the need for ongoing efforts:
• To reduce access to minor tranquillisers and other frequently used drugs, including paracetamol
• To intensify national strategies to increase awareness of mental health issues
• To intensify further strategies to reduce access to alcohol.

   

1                  Griffin E, Dillon CB, McTernan N, Arensman E, Williamson E, Perry IJ et al. (2018) National Self-Harm Registry Ireland annual report 2017. Cork: National Suicide Research Foundation. https://www.drugsandalcohol.ie/29774/