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Young people who self-harm

  • Robert Young (a1), Michael van Beinum (a1), Helen Sweeting (a1) and Patrick West (a1)

Abstract

Background

Self-harm among young people in the UK is possibly increasing but little is known about the reasons young people give for cessation and their link with gender or employment status.

Aims

To investigate self-harm in young people, prevalence, methods used, motivations for starting and ceasing, service use, and how these are related to gender, parental social class and current labour market position.

Method

Population-based survey of 1258 18-to 20-year-olds living in the Central Clydeside Conurbation, Scotland.

Results

Both past and current rates of self-harm were highest among those outside the labour market. This group was most likely to want to kill themselves and did not cite specialist mental health services as helpful in ceasing self-harm. Those in full-time education more often self-harmed for a brief time, mainly to reduce anxiety.

Conclusions

Current labour market position was a stronger predictor than parental social class or gender for self-harm, and was linked to level of severity, motivation for starting and ceasing, and service utilisation.

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Copyright

Corresponding author

Mr Robert Young, MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK. Email: robert@msoc.mrc.gla.ac.uk

Footnotes

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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes

References

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Young people who self-harm

  • Robert Young (a1), Michael van Beinum (a1), Helen Sweeting (a1) and Patrick West (a1)

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Young people who self-harm

  • Robert Young (a1), Michael van Beinum (a1), Helen Sweeting (a1) and Patrick West (a1)
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eLetters

Authors' Reply: Request for sub-group analysis.

Robert Young, Research Associate
24 August 2007

Kripalani, Badanapuram and Gash, raise an important issue, suggestingthat repeated self-harmers may constitute a distinctive clinical sub-group. We initially avoided including repeated self-harm in our study because there remains considerable uncertainty about an appropriate definition. However, following discussion with Kripalani (personal communication, 2007), we agreed a three-way classification of repeated self-harm among young people: Repeated self-harmers (19 out of 89 cases), self-harm both in the past and currently or using several (3+) methods, (since it is unlikely that multiple methods of self-injury refers to a single incident); Single-incident (17/89), explicit statement of transientincident; Unsure (53/89), the remainder. The crude repetition rate of 20% is typical for self-harm (Bennewith, et al. 2002). We proceeded to re-run virtually all of the analyses presented in our original paper (Young et al., 2007) for repeat self-harmers (available on request/online).

In summary, we can confirm that repeated self-harm was unrelated to sex, or social class of origin, but was related to current labour market position, with youth outside the labour market more likely self-harm repeatedly. Repeaters were more likely to self-harm via all methods with the exception of taking pills/tablets and more violent methods, which werecommon to all groups. Repeaters were far more likely to self-harm in orderto relieve negative emotions (anger, anxiety or to punish themselves), while self-harm in order to kill oneself was common to all groups. Taken together this confirms that repeated self-harmers are more likely to use self-injury as a coping mechanism. With regard to service use, repeaters were nearly twice as likely to have used casualty (emergency services) andover three times more likely to have used psychological services since age-11.

This suggests that young people and adults who repeatedly self-harm are heavy users of both health services in general and psychiatric health services in particular and this is compatible with Kripalani, Badanapuram and Gash’s, assertion that a small proportion of clients may account for alarge percentage of resources. Distinguishing between repeated and other forms of self-harm could provide useful clinical information, provided both researchers and clinicians can agree a clear definition.

Bennewith O, Stocks N, Gunnell D, Peters TJ, Evans MO & Sharp DJ.(2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British MedicalJournal, 324, 1254-1257.

Young R, van Beinum M, Sweeting H & West P. (2007) Young people who self-harm. British Journal of Psychiatry, 191, 44-49.
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Conflict of interest: None Declared

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Request for Sub-Group Analysis

Mukesh Kripalani, SpR Liaison psychiatry
01 August 2007

We read with interest the article “Young people who self harm” in theJuly edition of BJPsych 2007 but feel the outcome of factors considered could have been more viable if a further sub-group analysis was done in those patients who repeat self harm. We believe that a significant amount of our time is taken up by people who self harm repeatedly. This subset ofclients are often entrenched in their behavior patterns and use services disproportionately. Existing data has not analyzed factors responsible forrepetition adequately and we feel that the study mentioned above missed out on an excellent opportunity, albeit in a younger age group, for the same.

An analysis of our data from the Integrated Care Pathway (ICP), (Rajwal & Gash, 2006) show repetition rates of 40% for 2004, 42% for 2005 and 43% 2006 of all our referrals each year. This means that 18% of our patients in 2004, 18.9% in 2005 and 19.2% in 2006 were responsible forthe above statistics year on year. This is data is of course from adults of working age and only includes repetition in the same calendar year. About 13% of our referrals are below the age of 21 of which 18% are repetitions. Hence we can see that a small proportion of our clients are responsible for a large percentage of our work.

Our data also backs up the study mentioned above on the lack of a gender bias to the prevalence of self-harm. Females comprised of 50.2% of our referrals in 2006 but only 49.0% of repeaters. This means that the oldmyth of higher proportion of females self-harming has not been borne out by our statistics, albeit in the entire adult age group.

We would be interested to discover from the authors data if results would be different in the sub-group who had repeated self-harm.

Acknowledgements: Sue Morris, Senior Nurse, Self-Harm Team Middlesborough and Liaison Team St. Luke’s Hospital, M'bro.

Reference: MADHURI, R. & GASH, A., (2006) Risk assessment in self-harm. Psychiatric Bulletin, 30, 436.

Declaration of Interest: Nil

Authors: Dr. Mukesh Kripalani, Dr. Ramanand Badanapuram and Dr. Amanda Gash

Corresponding Author: Dr. Mukesh Kripalani, SpR, Bath Villa Annex, St. Luke's Hospital, M'bro. Tel: 01642516160 Fax: 01642516161

Dr. Ramanand Badanapuram, SHO, St. Luke's Hospital, M'bro

Dr. Amanda Gash, Consultant Liaison Psychiatrist, St. Luke's Hospital, M'bro.
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Conflict of interest: None Declared

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