Thursday, February 25, 2016

Young People Who Self-Harm: A Prospective 1-Year Follow-Up Study

To explore repetition, service provision and service engagement following presentation of young people to emergency services with self-harm.

969 patients who presented to accident and emergency services after self-harm were followed up prospectively for a period of 1 year. Data on rates, method, clinical history, initial service provision, engagement and repetition (defined as re-presenting to emergency services with further self-harm) were gathered from comprehensive electronic records.

Young people were less likely to repeat self-harm compared to those aged 25 and above. A psychiatric history and a history of childhood trauma were significant predictors of repetition. Young people were more likely to receive self-help as their initial service provision, and less likely to receive acute psychiatric care or a hospital admission. There were no differences in engagement with services between young people and those aged 25 and above.

Younger individuals may be less vulnerable to repetition, and are less likely to represent to services with repeated self-harm. All young people who present with self-harm should be screened for mental illness and asked about childhood trauma. Whilst young people are less likely to be referred to psychiatric services, they do attend when referred. This may indicate missed opportunity for intervention.

Method of self-harm and precipitating factors by age group
VariablesaAll ages16–24 years25+ years
n (%)n (%)n (%)
Method of SH (969)
 Self-poisoning704 (72.7)236 (76.4)468 (70.9)
 Self-injury214 (22.0)59 (19.1)155 (23.5)
 Both self-injury and self-poisoning51 (5.3)14 (4.5)37 (5.6)
Drugs in overdose
 Single drug in overdose (931)418 (44.9)144 (48.2)274 (43.4)
 Paracetamol127 (13.6)59 (20.3)68 (11.0)
 Opioid analgesic55 (5.9)18 (6.2)37 (6.0)
 Antidepressant51 (5.5)16 (5.5)35 (5.6)
 Multiple drugs in overdose (931)297 (31.9)94 (31.4)203 (32.1)
Self-injury (969)
 Self-cutting156 (16.1)48 (15.5)108 (16.4)
 Other self-injury109 (11.2)26 (8.4)83 (12.6)
Alcohol with SH (966)334 (34.5)69 (22.3)265 (40.1)
Precipitating factors to SH
 Alcohol misuse (957)289 (30.2)50 (16.4)239 (36.6)
 Drug misuse (956)145 (15.2)47 (15.5)98 (15.0)
 Child abuse (sexual/physical/emotional) (952)204 (21.4)80 (26.4)124 (19.1)
 Adult abuse (sexual/physical/emotional) (943)109 (11.4)33 (10.9)76 (11.7)
 Bereavement (955)145(15.2)30 (9.9)115 (17.6)
 Financial problems (956)113 (11.8)20 (6.6)93 (14.3)
 Housing problems (957)75 (7.8)16 (5.2)59 (9.0)
 Legal problems (959)29 (3.0)7 (2.3)22 (3.4)
 Relationship problems (958)445 (46.5)165 (54.1)280 (42.9)
 Physical health problems (960)278 (29.0)55 (18.0)223 (34.1)
 Self-harm in response to symptoms (961)36 (3.7)11 (3.6)25 (3.8)
aNumber of patient cases with available information varied between variables

Below:  Kaplan–Meier curve showing cumulative probability of self-harm repetition by age groups

Full article at:

College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
Warwick University, Coventry, UK
Department of Psychiatry, University of Oxford, Oxford, UK
Oxford Health NHS Foundation Trust, Oxford, UK
Rachel Upthegrove,
*Corresponding author.

No comments:

Post a Comment