Deliberate Self-Harm and Suicide: Gender-Specific Trends in Eight European Regions

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Abstract

Objective: The Network for International Collaboration on Evidence in Suicide Prevention (NICE???SP) has conducted an international comparative study to examine time trends in deliberate self harm (DSH) and suicide in eight different European regions and how rates of DSH at the regional level and national suicide rates co-vary in each region.Design: Prospective study. Across the regions, the monitoring period ranged from 6 (1998???2003) to 14 years (1989???2003). Standard registration forms were used to collect information on demographic variables and self-harm characteristics.Setting: Eight regions in six European countries.Participants: Patients aged 15 years and over presenting to general hospitals following DSH in defined catchment areas. Data on suicides were obtained from national statistics offices in the individual countries.Results: The international database comprised over 44 000 DSH episodes. Trends in DSH rates over time varied considerably across the different European regions and by gender. Based on rolling averages, DSH rates per 100 000 for women were consistently higher than for men, with the highest rates in Manchester (580.9), Oxford (416.0) and Gent (305.7), and the lowest rates in Sor-Trondelag (148.4), Umea (128.6) and Ljubljana (71.9). The two Irish regions showed intermediate DSH rates, with 266.2 in Limerick and 216.5 per 100 000 in Cork. With the exception of Ljubljana, similar trends over time were found for female and male DSH rates. Based on average annual DSH rates at the regional level and average annual suicide rates at the national level, a similar ranking was found for female and male DSH rates across the European regions. Looking across countries, a significant correlation (Spearman???s rank correlation) was found between the rate of change in suicide rates nationally and DSH rates over time for men (r ???=??? 0.71, p<0.05).Conclusions: Although DSH rates vary considerably between European countries, regional DSH rates and national suicide rates follow similar trends over time in both men and women. An increase in DSH may thus be accompanied by an increase in suicide, in particular among men. Based on the study outcomes, it is recommended that prevention programmes target both forms of suicidal behaviour.

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