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Fatal and non-fatal repetition of self-harm: Systematic review

  • David Owens (a1), Judith Horrocks (a1) and Allan House (a1)

Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions.


To estimate rates of fatal and non-fatal repetition of self-harm.


A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria.


Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide.


After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

Corresponding author
David Owens, Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK
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Declaration of interest

J.H.'s salary is paid by the mental health charity Leeds Mind from a research grant awarded by the UK National Lottery Charities Board.

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Fatal and non-fatal repetition of self-harm: Systematic review

  • David Owens (a1), Judith Horrocks (a1) and Allan House (a1)
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