Deliberate self-harm (DSH) is a major public health problem in many countries and varies by age group, gender, and ethnicity. Having engaged in an act of DSH is the strongest predictor of future suicidal behaviour, both non-fatal and fatal. Development and implementation of effective assessment procedures for DSH patients are required in order to assess risk of repetition and prevent repeated suicidal behaviour. In this chapter we present the outcomes of a review of studies addressing the extent of the problem of DSH and repetition, prediction of factors associated with repeated DSH including age, gender, ethnicity, and assessment procedures for DSH patients presenting to hospital emergency departments.
The extent of the problem of DSH varies across countries, with relatively high rates in the United Kingdom and Belgium and low rates in Scandinavia. DSH rates are consistently higher in females compared to males. However, recent studies in Ireland indicate that rates of repeated DSH are similar for men and women. Factors predicting repeated DSH vary by age (young, adults, older adults) with some overlap. A history of previous DSH is a predictor for repetition in both young people and adults. Even though most national suicide prevention programmes prioritize the implementation of uniform guidelines for the assessment of DSH patients, there is still considerable variation within and across countries with regard to the types of assessment and aftercare offered to DSH patients. A four-question tool (Manchester Self-Harm Rule) is an example of an evidence-based screening tool for identifying risk of repeated suicidal behaviour (non-fatal and fatal) and is recommended for wider implementation.