The annual report from National Self-Harm Registry Ireland was published in 2020.1 The report contains information relating to every recorded presentation of deliberate self-harm to acute hospital emergency departments in Ireland in 2019 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 12,465 recorded presentations of deliberate self-harm in 2019, involving 9,705 individuals. Taking the population into account, the age-standardised rate of individuals presenting to hospital in the Republic of Ireland following self-harm was 206 per 100,000 population. This was a decrease of 2% compared with the rate recorded in 2018 (210 per 100,000) and 8% lower than the peak rate recorded by the registry in 2010 (223 per 100,000).

In 2019, the national male rate of self-harm was 187 per 100,000 population, 3% lower than in 2018. The female rate was 226 per 100,000 population, which was 1% lower than in 2018. With regard to age, the peak rate for men was in the 20-24 age group, at 485 per 100,000 population. The peak rate for women was among 15-19-year-olds, at 726 per 100,000 population.

Source: National Suicide Research Foundation (2020)

‘All’ in the legend refers to the rate for both men and women per 100,000 population.

Figure 1: Person-based rate of deliberate self-harm from 2002 to 2019 by gender

Self-harm and drug and alcohol use

Intentional drug overdose was the most common form of deliberate self-harm reported in 2019, occurring in 7,763 (62.3%) of episodes. As observed in 2018, overdose rates were higher among women (67.1%) than among men (56.3%). Minor tranquillisers and major tranquilisers were involved in 33% and 9% of drug overdose acts, respectively. In total, 34% of male and 48% of female overdose cases involved analgesic drugs, most commonly paracetamol, which was involved in 31% of all drug overdose acts. In 69% of cases, the total number of tablets taken was known, with an average of 28 tablets taken in episodes of self-harm that involved a drug overdose.

In 2019, there was an increase in the number of self-harm presentations to hospital involving street drugs by 17% (from 742 to 870). Since 2007, the rate per 100,000 of intentional drug overdose involving street drugs has increased by 79% (from 9.9 to 17.8 per 100,000 population). Cocaine and cannabis were the most common street drugs recorded by the registry in 2019, present in 7% and 3% of overdose acts, respectively. Cocaine was most common among men, involved in 19% of overdose acts by 25-34-year-olds. Cannabis was most common among men aged 15-24 years and was present in 10% of overdose acts. Alcohol was involved in 31% of all self-harm presentations in 2019 and was more often involved in male episodes of self-harm than female episodes (36% vs 28%, respectively).

Recommendations

In 2019, there was a significant increase in presentations among persons experiencing homelessness, which is in line with previous trends identified in the period 2010-2014. The report authors noted that this group of individuals represent a particularly vulnerable population - at high risk of repetition and mortality from all causes. Although further work which examines factors associated with self-harm among persons experiencing homelessness is required, the authors suggest these findings underline the need for targeted suicide prevention interventions among this group. 

1   Joyce M, Daly C, McTernan N, et al. (2020) National Self-Harm Registry Ireland annual report 2019. Cork: National Suicide Research Foundation. https://www.drugsandalcohol.ie/33511/