Self-harm (regardless of suicidal
intent) entails high costs to individuals and society in terms of suicide risk
and healthcare expenditure. This review identified risk factors for self-harm
repetition among those utilising emergency services. A systematic procedure
located, quality-assessed and synthesised 111 relevant prospective studies.
Strong predictors of repetition were: being aged 25-54, higher hopelessness;
previous psychiatric treatment; personality disorder; alcohol misuse; previous
self-harm; and self-injury involvement in the index episode. Emerging risk
factors were: poorer problem-solving; history of violence/criminality; lower
self-efficacy; lower sense of coherence; lower serotonergic functioning; family
dysfunction; sociopathy; homelessness; epilepsy; suicidal ideation; and
Manchester Self-Harm Rule score. Despite extensive study, familial suicide,
education level, depression scores, and lethality of the index episode fail to
reliably predict repetition.