Switching methods of self-harm at repeat episodes: Findings from a multicentre cohort study

Abstract

BackgroundSelf-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. MethodsThe pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. ResultsOver an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had selfharmed previously. Self-poisoning was far less likely than other methods to lead on to switching. LimitationsSelf-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. ConclusionsMethod of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people's risks or needs based simply on method of harm.

Combination of self-harm methods and fatal and non-fatal repetition: A cohort study

“…The proportions of people that we allocated to our four categories of self-harm method are similar to those we reported previously together with data from Manchester and Oxford (Lilley et al, 2008). In particular, the proportion of people who had self-harmed using combined methods is in keeping with that seen in multicentre monitoring (Lilley et al, 2008;Owens et al, 2015).…”

“…Two acts (say self-poisoning followed by self-injury) will be classified as rapid repetition if each leads to a separate hospital attendance but as one combined episode if they occurred very rapidly and presentation was deferred until after the second act. Since repetition very often involves a change of method (Owens et al, 2015) it is not implausible that this overlap between the definitions of the two presentations is matched by some more general overlap between the phenomena (use of more than one method, early repetition), which may account in part for their similar outcomes.…”

“…Consequently, although the analysis takes index episodes as a starting point and refers to subsequent episodes as repetitions, these index episodes are arbitrary start points in what may be a succession of episodes beginning years earlier (Owens et al, 2015). This difficulty cannot adequately be corrected using data about earlier episodes because ED records do not contain reliable past information and patients are too often not asked in the ED (or it is asked about but not recorded) whether the present episode is their first hospital attendance.…”

Dealing with difficult days: Functional coping dynamics in self-harm ideation and enactment

“…Firstly, the sample size may, in part, be a product of the definition of 'recent' employed. Research evidence suggests that, if repeated, there is often a very short time period between self-harm episodes (Owens et al, 2015). Therefore, it could be suggested that the 3 month timeframe increases the probability of capturing enactment.…”

Are neurocognitive factors associated with repetition of self-harm? A systematic review

“…However, recent cohort analysis indicates that many individuals switch self-harm methods in subsequent episodes, and so division of participants by methods alone for prediction of repetition may not be appropriate (Owens et al, 2015).…”