SELF HARM, REPEATED SELF HARM AND THE ROLE OF PREVENTION PROGRAMS. COMPARATIVE ANALYSIS OVER THE PERIODS 1983-1990 AND 2000-2007 IN THE TRIESTE PROVINCE.

 

 

Francesca Bertossi¹, Alessandra Oretti², Paola Berchialla³, Elisabetta Pascolo Fabrici⁴, Chiara Bertossi⁵

 

¹Department of Mental Health of Udine, Italy, ² Department of Mental Health of Trieste, Italy,  ³Department of Public Health and Microbiology, University of Torino, Italy ,⁴ Department of Mental Health, University of Trieste, Italy, ⁵ University of Udine, Italy.

 

Corresponding author:

Francesca Bertossi,MD

Department of Mental Healt, Udine, Italy

Via Pozzuolo 330, 33100 Udine, Italy.

Summary

 

Introduction: Self harm is the main predictor of suicide. In the 80s, the province of Trieste showed the highest suicide and self harm rates in Italy, with values similar to those of central Europe. In the 90s, the Department of Metnal Health of Trieste promoted a program for the prevention of suicidal behaviours, acquiring the WHO recommendations.

Aims: to analyse the trend of self harm and repeated self harm in the province of Trieste prior to and subsequent to the prevention program.

Methods: cross-sectional, retrospective registration study over the periods 1983-1990 and 2000-2007

Results: self harm phenomena are significantly decreasing in the province of Trieste, especially among adolescents and elderly people, while the mean age of subjects undertaking self-harm acts is increasing.

Self harm used to be more frequent among male subjects, but the difference between genders softened over the years. Repeated self harm, which is more frequent among young males, appears stable over time. A significant increase in the use of alcohol and drugs has been witnessed as a method of self-harm.

Limitations: Registration studies tend to underestimate the phenomenon. The design of the cross-sectional retrospective study does not allow for establishing a causality link between the prevention strategies adopted and the decrease in the self harm behaviours, as it is impossible to assess the contribute given to such a decrease by many factors such as, for example, the social and cultural changes.

The results may not be generalised widely for they refer only to Trieste province and to a specific prevention program and a peculiar community service organisation.

Conclusion: the prevention program and the community health program contributed to reducing the suicide and self harm phenomenon, especially among adolescents and elderly people. Repeated self harm seems to be a separate phenomenon, which requires more specific prevention strategies.

 

 

Keywords: self harm, repeated self harm, methods, gender difference

INTRODUCTION

 

For a long time, the WHO has been committed to the fight against suicidal behaviours, implementing programs about epidemiological studies and drawing up updated strategies for primary and secondary prevention of such a complex and polymorphic phenomenon (Bille-Brahe, 1999; Guo & Harstall, 2004; Schmidtke, et al., 1996; WHO, 2002) .

Self harm is the main predictor of suicide (Cooper, et al., 2005; Owens, Horrocks, & House, 2002; Sakinofsky, 2000; Suominen, et al., 2004).

Subjects carrying out self-harm acts show a risk of fatal repetition of 7-10%, approximately 40 times higher in comparison with the general population (Harris & Barraclough, 1998; Owens, et al., 2002) and it is believed that such a behaviour is linked to a psychiatric comorbidity of approximately 90% at the moment of the event (Haw, Hawton, Houston, & Townsend, 2001; Suominen, et al., 1996). Subjects carrying out repeated self harm are a particular at-risk population (Bille-Brahe, et al., 1996).  Repetitions are the main predictive factor for fatality in the short and above all in the long term (suicidal risk is 4,9% at 15 years for repetitors in comparison with 1.9% of non-repetitors) (Zahl & Hawton, 2004) and they are strongly associated to the presence of a severe and cronic psycopathology (Colman, Newman, Schopflocher, Bland, & Dyck, 2004). Such a phenomenon is increasing, although a global decreasing in self harm has been witnessed (Kerkhof, Schmidtke, Bille-Brahe, De Leo, & Lonnqvist, 1994).

Self harm is ubiquitously widespread. A sistematic study of this phenomenon is limited by the difficulties in sharing a clear definition of self harm (De Leo, Burgis, Bertolote, Kerkhof, & Bille-Brahe, 2006; Welch, 2001),  by the absence of specific national registers and by the difference of methods applied to carry out multicentric or local studies (Skegg, 2005).

In Europe, the WHO multicentric study provided comparable and standardized data, while many other local studies contributed to photograph the phenomenon and to highlight the geographic variability over the different observation periods (Bille-Brahe, et al., 1996; Kerkhof, et al., 1994; Schmidtke, et al., 1996).

In Italy, the most recent data is provided by some local studies that do not allow for a results generalization at national level, as different registration methods have been applied (Majori, et al., 2004; Michelotti, Tridenti, Guareschi, & De Risio, 1985; Poma, Magno, Belletti, & Toniolo, 2007; Raja & Azzoni, 2004; Torre, et al., 2003).

In the 80s, the province of Trieste showed the highest suicide and self harm rates (average rate respectively 21,6/100.000 inhabitants and 106,1/100.000) in Italy, with values similar to those recorded in central Europe (De Maria, Pascolo, Bertoli, & Costantinides, 1988).

In the 90s, the Trieste Department of Mental Heath promoted a program for the prevention of suicidal behaviours, acquiringthe WHO recommendations.

It’s an articulated project that led to establishing the Osservatorio Triestino (Trieste Observatory) on Suicide, to launching new programs and activating two green numbers called “Special Telephone” dedicated to the general population and “Amalia”, dedicated to the elderly. These programs allow for gathering the questions asked by citizens and providing answers by using the services already available on the territory. Several periodic information and media campaigns for journalists, family doctors, operators, teachers and police forces have been launched. After the prevention campaign, in the years 2000 a significant decrease in suicides has been recorded (17 cases out of 100.000 inhabitants) (Dell'Acqua, Belviso, Crusiz, & Oretti, 2003).This study aims at describing the trend of self harm over time, prior to and subsequent to the program “Suicide Prevention” in the province of Trieste, with the aim to better understand this phenomenon at local level and to identify more effective prevention and handling strategies.

 

METHODS AND AIMS

 

The phenomenon of self harm has been analysed through a cross-sectional retrospective registration study carried out on the population in the province of Trieste over two balanced periods of time: from January 1st, 1983 to December 31st, 1990 and from January 1st, 2000 to December 31st 2007.

The definition of self harm commonly utilised is that given by the WHO: “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 which the subject desired via the actual or expected physical consequences”.

The study has been deliberately restricted to self-harm acts that required a medical intervention in hospital. To this end, records of the accesses to first aid services in the two hospitals in the Trieste province have been considered. Records codified as “Self-harm” and “Intoxication” have been taken into consideration. The latter have been analysed individually with the aim to indentify only those carrying the key words “attempted suicide” and “voluntary intoxication", in order to rule out cases of non-intentional intoxication. Data about gender, age and self harm methods have been extrapolated from the reports. Two assessment criteria have been adopted: the first regarding self harm events and their repetitions, and the second regarding the subjects committing them. A comparison was made between the sample and the values provided for by the Italian National Institute of Statistics (ISTAT) on the population living in the province of Trieste, divided by gender and age, for the time period taken into consideration in the study. Data was gathered and treated in compliance with the current privacy laws.

 

Statistical Analysis

Data was described by analysing prevalences on the population living in the Trieste province in the period concerned, with absolute frequencies and percentages, where appropriate. The difference between the incidence of self harm and suicides over the two periods of time was assessed through the Chi-square test. The comparison between the distribution trends of both periods was made through a t-test, whereas the comparison within the two groups was carried out through a test on the trend proportions; p-values lower than 5% were considered significant.

The standardized rates by age and the specific age rates have been calculated in both periods of time taken into consideration. The former have been calculated in order to consider how the population structure has changed over the time. A direct method was applied and the standard European population was used to obtain the standardization. 95% confidence intervals have been used to compare the rates of the two periods (1983-1990 vs. 2000-2007). Specific age rates have been calculated by dividing the number of self harm accounted for within each age group by the corresponding population.

The statistical software R was used to carry out such analysis (R Development Core Team, 2007).

 

RESULTS

The frequency of self harm in the Trieste province is presented in table 1. Self harm events, say the number of accesses to first aid facilities for self harm, significantly diminished by 17.97%, while repeated events increased by 9.36% (n.s.)

Analysing the data by subjects, a significant 31.46% decrease has been experienced. Individuals with only one self harm episode decreased by 34.51%, while the 14.52% reduction of subjects repeating the gesture was not significant.

Self harm is much more frequent among males between 1983 and 1990, while over the period 2000-2007 the difference between genders reduces. Repetitions are more frequent among males and this rate keeps constantly high over time (table 1).

The mean age of subjects undertaking self-harm gestures is 40.6 years in the period 1983-1990 and 45.8 years in 2000-2007 (p<0.001). The subjects with repeated self harm presented a mean age at the first attempt on 33.7 years in the first period of time and 38.1 years in the second period of time, and a mean age at the second attempt of 34.9 years in the 1983-1990 and 39.5 years in 2000-2007.Both differences are significant (p<0.001).

Table 2 show the specific rates by age groups.

Between 2000 and 2007 a significant decrease in individuals undertaking self harm acts in the age groups from 15 to 49 years and in the population with more than 60 years was witnessed. The most important reduction was recorded among adolescents (decrease by 68.3%) and among people with more than 70 years (decrease by 37.1%). The number of subjects undertaking repeated self harm decreased significantly among adolescents and people aged more than 70, while data concerning the other age groups remains unchanged.

The age group in which more frequently individuals undertake either single and multiple self-harm gestures is the one between 20 and 29 years. This value keeps constant over time.

Table 3 and table 4 show the methods used to commit self harm acts.

An increasing tendency to use alcohol together with a different method (from 10.4% to 15.8%, with an increase by 51.9%) as well as the use of drugs (from 2.9% to 9.7%, with an increase by 234%) has been witnessed. A decreasing trend in the use of psychotropic drugs (from 49.4% to 32.5%, with a decrease by 34.2%), self-cutting (from 31.19% to 13.1%, with a decrease by 59%) and suicide by falling (from 6% to 1.8%, with a decrease by 70%) has been shown.

If we consider the methods used for committing repeated self harm acts, psychotropic overdoses remain the main method (from 29.1% to 34%), accounting for an increase in frequency by 16.8%), while self-cutting significantly decreased (from 26.1% to 15%, with a decrease by 42.5%). The frequency in the use of drugs and alcohol shows an increasing trend over time (the former from 0.6% to 7.9%, increasing by 1217%, and the latter from 3.6% to 11.1%, increasing by 208%).

The tendency to resort to multiple methods for committing self harm acts has increased over time (table 5). 

 

 

DISCUSSION

 

The phenomenon of self harm showed peculiar changes between 1983 and 2007, say the period of time prior to and subsequent to implementing the complex prevention program of suicidal behaviours starting from the 90s.

Considered on their whole, self harm behaviours strongly diminished: the standardized rate of indivuduals committing self harm gestures went from 80.5 to 55.18 out of 100.000 inhabitants, with a decrease by 31.46%. Self harm events decreased by 17.97%, going from 106.11 cases out of 100,000 inhabitants between 1983 and 1990 to 87.04 cases out of 100,000 inhabitants between 2000 and 2007. By contrast, the phenomenon of repeated self harm acts does not show important changes over time (from 12.88 to 11.01 out of 100,000 inhabitants).

Data has been analysed either by subjects committing self harm and by event, with the aim to define a clearer and wider picture of the self harm phenomenon and to compare the data with other national studies that investigated the phenomenon either by subjects and by events.

The decreased self harm rate and the unchanged repetition rate are in line with the data presented in the international literature (Bille-Brahe 1999, Schmidtke 1996). This aspect seems to underline the efficacy of prevention programs in curbing the self harm phenomenon, especially if first attempters are considered. At the same time, the prevention programs do not seem to affect repeated self harm, which constitute a specific subgroup of the self harm phenomenon.

Self harm between 1983 and 1990 were more frequent among males, while between the years 2000 and 2007 the male/female ratio among subjects committing a single gesture reversed, with a slightly higher rate among females. Individuals undertaking more than one self-harm act were more frequent among males and this data keeps constant over time. The difference between genders appears in countertendency if compared to the international literature (Bille-Brahe 1999, Schmidtke 1996), in which self harm acts are more frequent among females and suicides among males. In order to better understand such a difference, a social, economical and cultural study of the population considered would be necessary.

The most represented age group among individuals committing either single and multiple self-harm acts is between 20 and 29 years, with a specific rate by age of 29.76 out of 100,000 inhabitants over the first period and 23.29 over the second one. According to the international literature, young adults are the population segment committing the greatest number of self harm acts.

The mean age of subjects undertaking only one self harm act increased significantly over the period considered, going from 40.56 years to 45.78 years. A rise in the mean age is evident also for individuals with repeated self harm (from 33.68 to 38.12 years). Such a rise could be associated to the data showing that young adults continue their studies over a period longer than in the past, thus delaying their entry into the labour market and their achieving an independent life.

Repeated self harm is more frequent among younger subjects, who repeat their suicide attempt a little more than one year later.

By analysing the distribution by age groups, a decrease in the number of subjects committing a self harm act between the age of 15 and 19 (from 143.26 to 45.44 out of 100,000 inhabitants) and in the population with more than 70 years (from 55.18 to 34.72 subjects out of 100,000) emerges.

As to individuals undertaking repeated self harm, a decrease was accounted for only among adolescents (from 15.32 to 3.03 cases out of 100,000 inhabitants) and among elderly people with more than 70 years (from 2.32 to 0.27 cases out of 100,000 inhabitants). As to the other population age groups, data remains basically unchanged. A decrease in the number of self harm acts occurred only among adolescents (from 15.32 to 3.03 cases out of 100,000 inhabitants) and among elderly people with more than 70 years (from 2.32 to 0.27 cases out of 100,000 inhabitants). For all the other population age groups, data remain basically unchanged.

The reduced number of self harm behaviours either for single events and for repetitions among the extreme segments of the population could be associated to the efficacy of specific measures within the prevention program (education in schools, the Amalia project for the elderly) as well as to the development of proximity services aimed at the young and the elderly - which are the most numerous population subgroup in the Trieste province - starting from the 80s. The efficacy and the duration of the prevention program are linked to the service capillarity on the territory as well as to the community health programs. Self harm appears strongly linked to suicide, representing its main risk factor. Measures aimed at reducing suicidal behaviours can positively influence both phenomena. Our study shows a parallel reduction in self harm over time in the province of Trieste. This fact could be linked to the efforts made to improve primary and secondary prevention, starting from the 90s.

The program seems to have effectively achieved the adult as well, reducing the number of first attempts. By contrast, repeated self harm, which are usually associated to a chronic and severe psychopathology, are not affected by a prevention program aimed at the general population, and probably require specific interventions.

The International literature shows that the methods used to commit self harm acts follow temporal and geographical fluctuations. Over the time spans considered, the main method used in all the events in their whole is psychotropic overdose, although a decrease by 34.2% is reported over time (from 49.4% to 32.5%). Self-cutting was the second method in terms of frequency between 1983 and 1990 (31.2%), but it was overcome by the use of alcohol between 2000 and 2007 (15.8% in 2000-2007), accounting for an increase by 93.9%. It is always used in association with other methods. Drugs report a significant increase by 234% (from 2.9% to 9.7%) and they are often used in association with other methods. Therefore, over the time spans considered, a drastic increase in the use of alcohol and drugs as self-harm methods is accounted for.   

Drugs overdose remains the primary method also for repeated self harm (from 29.1% to 34%), while self-cutting decreased significantly by 42.5% (from 26.1% to 15%). The use of drugs and alcohol shows an increasing trend over time (the former going from 0.6% to 7.9% with a rise by 1217% and the latter from 3.6% to 11.1%, with a rise by 208%). 

Moreover, the tendency to resort to more than one method for committing self harm increases over time. Such an aspect seems to mirror a change in the use of psychotropic drugs, alcohol and drugs in general.

In line with the International literature, sporadic oppioid overdoses are classified as self-harm events while overdoses caused by too pure batches on the market are differently considered – although this classification is still controversial. The data emerging from our research about the tendency to resort to drugs as a self-harm method is higher than that reported in the WHO/EURO Multicentre Study on Self harm from 1989 to 1993, in which a European average of 5.6% for males and 2.6% for females was reported. However, the data emerging from the multicentre study appears comparable only with the period 1983-1990, while, as to the data referring to the years 2000, only comparisons with local epidemiological studies are possible, given the lack of internationally standardized data. It seems however that the increase in the use of alcohol and drugs as a self-harm method is a ubiquitary phenomenon, linked to the rise in the use of alcohol especially among women. Although several information and awareness campaigns have been recently carried out about a more conscious use of alcohol and drugs, their increasing use mirrors complex social and cultural changes that should be analysed more deeply.

To conclude, by analyzing the global trend of rates over time, self harm appears significantly diminishing among the population examined, while the most frequent repeated self-harm among young males remains basically unchanged over time. The two phenomena are therefore to be considered as two separate entities, requiring different prevention and handling strategies.

The research shows some methodological limits. Registration studies tend to underestimate the phenomenon, as an accurate description can be obtained only from self harm requiring a medical intervention. The event leading to accessing first aid services has been classified by the doctor as a self-harm event. Therefore, no psychiatric assessment has been carried out and cases difficult to be interpreted could have been classified as accidental or as forms of non-voluntary intoxication (De Leo, et al., 2006) .

The design of the cross-sectional retrospective study does not allow for establishing a causality link between the prevention strategies adopted and the decrease in the self harm behaviours, as it is impossible to assess the contribute given to such a decrease by many factors such as, for example, the social and cultural changes. Only a prospective cohort study could have allowed for drawing the above conclusions. The results obtained have thus to be considered as the product of possible associations between the phenomenon observed and the specific interventions implemented starting from the 90s.

Despite the limits above-described, the research presents different strong points. The analysis of all access reports to the first aid facilities in the two Trieste hospitals allows for defining a precise picture of the phenomenon trend in the province. The long observation period and the great number of samples allow for an adequate statistical and descriptive analysis of self harm. This study, moreover, enables us to assess the self harm trend in the Trieste province prior to and subsequent to the primary prevention program.

 

CONCLUSIONS

 

Between 2000 and 2007 self harm significantly decreased in the province of Trieste, especially among adolescents and elderly people. The mean ages of subjects committing self harm have increased of 5 years, both for non repeated and repeated self harm.

A gender difference, with a prevalence of self harm behaviours in young male, is present all over the periods considered, the reasons of this are not clear, but may be link with complex psychosocial and economic changes

Repeated self harm, which is more frequent among young males, appears stable over time and it seems to be a separate phenomenon, which requires more specific prevention strategies.

 

It has been observed an important increase in the use of alcohol and drugs, these methods have always been considered as associated methods of self harm, not as the only mean used.

The prevention program and the community health program can have contributed to reducing the suicide and self harm phenomenon, but more effort must be done in reaching people with repeated behaviours and paying attention to the changes in methods used.

The study describes a picture of self harm trends over the time in Trieste province, but may not be generalised widely for they refer to province with a peculiar history and socio-economic pattern and to a specific prevention program and a peculiar community service organisation.

 

Declaration of interest. None.

 

 

REFERENCES

 

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Bille-Brahe, U., Kerkhof, A., De Leo, D., Schmidtke, A., Crepet, P., Lonnqvist, J., et al. (1996). A repetition-prediction study on European self harm populations. Part II of the WHO/Euro Multicentre Study on Self harm in cooperation with the EC Concerted Action on Attempted Suicide. Crisis, 17(1), 22-31.

Colman, I., Newman, S. C., Schopflocher, D., Bland, R. C., & Dyck, R. J. (2004). A multivariate study of predictors of repeat self harm. Acta Psychiatr Scand, 109(4), 306-312.

Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., et al. (2005). Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry, 162(2), 297-303.

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Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry, 181, 193-199.

Poma, S. Z., Magno, N., Belletti, S., & Toniolo, E. (2007). Self harm in Rovigo (North of Italy) during the period 2000-2005. J Prev Med Hyg, 48(3), 79-82.

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Sakinofsky, I. (2000). Repetition of suicidal behaviour. In K. Hawton & K. v. Heeringen (Eds.), The international handbook of suicide and attempted suicide (pp. xviii, 755). Chichester: Wiley.

Schmidtke, A., Bille-Brahe, U., DeLeo, D., Kerkhof, A., Bjerke, T., Crepet, P., et al. (1996). Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Self harm. Acta Psychiatr Scand, 93(5), 327-338.

Skegg, K. (2005). Self-harm. Lancet, 366(9495), 1471-1483.

Suominen, K., Henriksson, M., Suokas, J., Isometsa, E., Ostamo, A., & Lonnqvist, J. (1996). Mental disorders and comorbidity in attempted suicide. Acta Psychiatr Scand, 94(4), 234-240.

Suominen, K., Isometsa, E., Suokas, J., Haukka, J., Achte, K., & Lonnqvist, J. (2004). Completed suicide after a suicide attempt: a 37-year follow-up study. Am J Psychiatry, 161(3), 562-563.

Torre, E., Zeppegno, P., Usai, C., Rudoni, M., Ammirata, G., de Donatis, O., et al. (2003). [Suicidal behaviour in young people. An epidemiological study in the Verbano-Cusio-Ossola Province (years 1988-2000)]. Minerva Pediatr, 55(2), 157-162.

Welch, S. S. (2001). A review of the literature on the epidemiology of self harm in the general population. Psychiatr Serv, 52(3), 368-375.

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 TABLES

 

 

 

 

Table 1. Standardized rates and corresponding confidence intervals of Self harm in the Trieste province.

	1983 - 1990			2000 - 2007			Variation % 2000-2007 vs 1983-1990
	N	Standardized rate  x 100.000	IC 95%	N	Standardized rate  x 100.000	IC 95%
Self harm events
Males	1187	112.3	(105.95; 119.02)	843	91.81	(85.46; 98.59)	-18.25%
Females	1120	98.97	(93.03;105.28)	809	81.56	(75.62; 87.95)	-17.59%
Total	1781	106.11	(101.73; 110.67)	1.652	87.04	(82.66; 91.64)	-17.97%
Repeated events
Males	303	29.45	(26.22; 33.06)	285	31.46	(27.81; 35.56)	6.83%
Females	212	20.26	(17.58; 23.33)	206	23.19	(20.02; 26.84)	12.74%
Total	515	25.12	(22.98; 27.45)	491	27.47	(25.01; 30.15)	9.36%
Subjects
Males	879	82.45	(77.03; 88.24)	508	55.47	(50.52; 60.88)	-32.72%
Females	902	78.14	(72.91; 83.76)	561	54.53	(49.71; 59.81)	-30.22%
Total	1.781	80.51	(76.72; 84.49)	1069	55.18	(51.69; 58.89)	-31.46%
Subjects with single self harm
Males	745	69.5	(64.55; 74.84)	407	43.82	(39.44; 48.65)	-36.96%
Females	768	65.47	(60.7; 70.62)	469	44.44	(40.12; 49.23)	-32.12%
Total	1.513	67.58	(64.12; 71.23)	876	44.26	(41.15; 47.59)	-34.51%
Subjects with repeated self harm
Males	134	12.95	(10.84; 15.45)	101	11.84	(9.58; 14.58)	-8.57%
Females	134	12.61	(10.53; 15.09)	92	10.04	(8.02; 12.56)	-20.38%
Total	268	12.88	(11.37; 14.58)	193	11.01	(9.46; 12.8)	-14.52%

 

Table 2. Specific age rates. The differences statistically important (p<0,05) between the two periods are marked by *, (p<0,001) by **.

	1983 - 1990			2000 - 2007
Age groups	N total	%	Specific age rate x 100.000	N total	%	Specific age rate x 100.000
Events
15-19 years	214	9.28	163.94**	33	2	49.99**
20-29 years	770	33.38	274.49**	359	21.73	199.05**
30-39 years	455	19.72	170.48*	436	26.39	149.31*
40-49 years	347	15.04	113.14	346	20.94	125.78
50-59 years	181	7.85	61.19**	222	13.44	81.89**
60-69 years	137	5.94	46.69	124	7.51	44.76
>70	200	8.67	58.09**	132	7.99	35.53**
Repeated  events
15-19 years	27	5.24	20.68**	3	0.61	4.54**
20-29 years	240	46.6	85.56	131	26.68	72.64
30-39 years	132	25.63	49.46	154	31.36	52.74
40-49 years	68	13.2	22.17**	121	24.64	43.99**
50-59 years	26	5.05	8.79**	51	10.39	18.81**
60-69 years	14	2.72	4.77**	30	6.11	10.83**
>70	8	1.55	2.32*	1	0.2	0.27*
Subjects
15-19 years	187	10.5	143.26**	30	2.81	45.44**
20-29 years	530	29.76	188.94**	227	21.23	125.86**
30-39 years	322	18.08	120.65**	249	23.29	85.27**
40-49 years	277	15.55	90.31**	195	18.24	70.89**
50-59 years	152	8.53	51.39	150	14.03	55.33
60-69 years	120	6.74	40.89*	89	8.33	32.13*
>70	190	10.67	55.18**	129	12.07	34.72**
Subjects with single self harm
15-19 years	159	10.53	121.81**	26	2.97	39.38**
20-29 years	426	28.21	151.86**	176	20.09	97.59**
30-39 years	261	17.28	97.79**	196	22.37	67.12**
40-49 years	237	15.7	77.27**	148	16.89	53.8**
50-59 years	136	9.01	45.98	125	14.27	46.11
60-69 years	108	7.15	36.8*	77	8.79	27.8*
>70	183	12.12	53.15**	128	14.61	34.45**
Subjects with single self harm
15-19 years	20	7.46	15.32**	2	1.04	3.03**
20-29 years	101	37.69	36.01	57	29.53	31.6
30-39 years	64	23.88	23.98	53	27.46	18.15
40-49 years	47	17.54	15.32	46	23.83	16.72
50-59 years	18	6.72	6.09	24	12.44	8.85
60-69 years	10	3.73	3.41	10	5.18	3.61
>70	8	2.99	2.32**	1	0.52	0.27**

Table 3. Methods used for self harm over the period of time 1983-1990.

 

	1983-1990
	METHOD						REPEATED METHOD
CODES ICD-10	M	% out of tot ev M	F	% out of tot ev F	M+F	% out of tot ev M+F	M	% out of tot ev M	F	% out of tot ev F	M+F	% out of tot ev M+F
X60, X63, X64 drugs	29	2.4	48	4.3	77	3.3	15	0.3	10	-	1	0.2
X61 psychotropic drugs	414	34.6	732	64.8	1,146	49.3	51	17.0	96	46.6	147	29.1
X62 drugs-overdose	52	4.3	16	1.4	68	2.9	1	0.3	2	1.0	3	0.6
X65 alcohol	165	13.8	78	6.9	243	10.5	14	4.7	4	1.9	18	3.6
X 66,X 69 toxic substances (acids-caustics-detergents)	33	2.8	69	6.1	102	4.4	-	-	6	2.9	6	1.2
X67 gas	29	2.4	27	2.4	56	2.4	-	-	1	0.5	1	0.2
X68 pesticides	-	-	-	-	-	-	-	-	-	-	-	-
X 70 hanging	12	1.0	7	0.6	19	0.8	-	-	-	-	-	-
X 71 drowning	15	1.3	15	1.3	30	1.3	-	-	-	-	-	-
X 72, X73, X74, X75 firearms	5	0.4	3	0.3	8	0.3	-	-	-	-	-	-
X76, X77 burning	15	1.3	11	1.0	26	1.1	-	-	1	0.5	1	0.2
X78, X79 cutting	537	44.9	190	16.8	727	31.3	115	38.3	17	8.3	132	26.1
X80 falling	72	6.0	65	5.8	137	5.9	1	0.3	2	1.0	3	0.6
X81, X82 intentional collision	2	0.2	-	-	2	0.1	-	-	-	-	-	-
X83 specified tools (es trauma, ingestion of extraneous material,...)	33	2.8	12	1.1	45	1.9	-	-	-	-	-	-
X84 not specified	3	0.3	-	-	3	0.1	-	-	-	-	-	-

 

Table 4. Methods used for self harm over the period of time 2000-2007

 

	2000-2007
	METHODS						REPEATED METHODS
CODES ICD-10	M	% out of tot ev M	F	% out of tot ev F	M+F	% out of tot ev M+F	M	% out of tot ev M	F	% out of tot ev F	M+F	% out of tot ev M+F
X60, X63, X64 drugs	31	3.7	78	9.6	109	6.6	1	0.3	5	2.4	6	1.2
X61 psychotropic drugs	304	36.1	458	56.5	762	46.1	83	27.7	89	43.2	172	34.0
X62 drugs-overdose	168	19.9	59	7.3	227	13.7	33	11.0	7	3.4	40	7.9
X65 alcoHol	217	25.7	154	19.0	371	22.4	32	10.7	24	11.7	56	11.1
X 66,X 69 toxic substances	33	3.9	48	5.9	81	4.9	1	0.3	-	-	1	0.2
X67 gas	22	2.6	10	1.2	32	1.9	6	2.0	1	0.5	7	1.4
X68 pesticides	1	0.1	1	0.1	2	0.1	-	-	-	-	-	-
X 70 hanging	6	0.7	4	0.5	10	0.6	-	-	-	-	-	-
X 71 drowning	2	0.2	8	1.0	10	0.6	-	-	-	-	-	-
X 72, X73, X74, X75 firearms	7	0.8	-	-	7	0.4	-	-	-	-	-	-
X76, X77 burning	4	0.5	2	0.2	6	0.4	-	-	-	-	-	-
X78, X79 cutting	196	23.3	120	14.8	316	19.1	51	17.0	25	12.1	76	15.0
X80 falling	17	2.0	27	3.3	44	2.7	-	-	-	-	-	-
X81, X82 intentional collision	1	0.1	3	0.4	4	0.2	-	-	-	-	-	-
X83 specified tools	49	5.8	38	4.7	87	5.3	8	2.7	1	0.5	9	1.8
X84 not specified	56	6.6	26	3.2	82	5.0	-	-	-	-	-	-

 

Table 5. Number of methods used for self harm

 

	1983-1990						2000-2007
Number of methods	M	% out of ev M	F	% out of ev F	M+F	% out of ev M+F	M	% out of tot ev M	F	% out of tot ev F	M+F	% out of tot ev M+F
1 method	1002	82.6	993	87.9	1995	85.1	590	70	600	74	1190	71.9
2 method	199	16.4	130	11.5	329	14	235	27.9	197	24.3	432	26.1
3 method	12	1	7	0.6	19	0.8	18	2.1	14	1.7	32	1.9
Total	1213	100	1130	100	2343	100	843	100	811	100	1654	100

 

 

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First Published March 2011

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