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Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 12, pp 1929–1935 | Cite as

The iceberg of suicide and self-harm in Irish adolescents: a population-based study

  • Elaine M. McMahonEmail author
  • Helen Keeley
  • Mary Cannon
  • Ella Arensman
  • Ivan J. Perry
  • Mary Clarke
  • Derek Chambers
  • Paul Corcoran
Original Paper

Abstract

Purpose

Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community.

Methods

Annual suicide rates were calculated for 15–17 year-old in the Cork and Kerry region in Ireland based on data from the Central Statistics Office. Rates of hospital-treated self-harm were collected by the Irish National Registry of Deliberate Self-Harm. Rates of self-harm in the community were assessed using a survey of 3,881 adolescents, the Child and Adolescent Self-harm in Europe study.

Results

The annual suicide rate was 10/100,000. Suicide was six times more common among boys than girls. The annual incidence rate of hospital-treated self-harm was approximately 344/100,000, with the female rate almost twice the male rate. The rate of self-harm in the community was 5,551/100,000, and girls were almost four times more likely to report self-harm. For every boy who died by suicide, 16 presented to hospital with self-harm and 146 reported self-harm in the community. For every female suicide, 162 girls presented to hospital with self-harm and 3,296 reported self-harm.

Conclusions

Gender differences in relative rates of self-harm and suicide are very large, with boys who have harmed themselves at particularly high risk of suicide. Knowledge of the relative incidence of self-harm and suicide in adolescents can inform prevention programmes and services.

Keywords

Suicide Self-harm Adolescent 

Notes

Acknowledgments

We would like to acknowledge all those who contributed to the development of the Irish National Registry of Deliberate Self Harm, in particular Ms Eileen Williamson (Executive Director), Dr Eve Griffin (Registry Co-ordinator), the data managers and data registration officers.

Conflict of interest

On behalf of all authors, the corresponding author confirms that there are no conflicts of interest.

References

  1. 1.
    World Health Organisation. Public health action for the prevention of suicide. Geneva: World Health Organisation; 2012Google Scholar
  2. 2.
    Bertolote J, Fleischmann A (2002) Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry 1:181–185PubMedCentralPubMedGoogle Scholar
  3. 3.
    Wasserman D, Cheng Q, Jiang G (2005) Global suicide rates among young people aged 15–19. World Psychiatry 4:114–120PubMedCentralPubMedGoogle Scholar
  4. 4.
    Eurostat. Suicide death rate, by age group—total—crude death rate per 100 000 persons. In: Secondary Suicide death rate, by age group—total—crude death rate per 100 000 persons. 2009. http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&init=1&language=en&pcode=tsdph240&plugin=1
  5. 5.
    Hawton K, Saunders KE, O’Connor RC (2012) Self-harm and suicide in adolescents. Lancet 379(9834):2373–2382. doi: 10.1016/S0140-6736(12)60322-5 (published Online First: Epub Date]PubMedCrossRefGoogle Scholar
  6. 6.
    Whitlock J, Muehlenkamp J, Eckenrode J et al (2013) Nonsuicidal self-injury as a gateway to suicide in young adults. J Adolesc Health Off Publ Soc Adolesc Med 52(4):486–492. doi: 10.1016/j.jadohealth.2012.09.010 (published Online First: Epub Date)CrossRefGoogle Scholar
  7. 7.
    Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm. Systematic review. Brit J Psychiatry 181:193–199CrossRefGoogle Scholar
  8. 8.
    Scoliers G, Portzky G, Madge N et al (2009) Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help? Findings from the child and adolescent self-harm in Europe (CASE) study. Soc Psychiatry Psychiatr Epidemiol 44(8):601–607. doi: 10.1007/s00127-008-0469-z (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  9. 9.
    Sinclair JM, Hawton K, Gray A (2010) Six year follow-up of a clinical sample of self-harm patients. J Affect Disord 121(3):247–252. doi: 10.1016/j.jad.2009.05.027 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  10. 10.
    Schmidtke A, Bille-Brahe U, DeLeo D et al (1996) Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 93(5):327–338PubMedCrossRefGoogle Scholar
  11. 11.
    Hawton K, Rodham K, Evans E et al (2009) Adolescents who self harm. A comparison of those who go to hospital and those who do not. Child Adolesc Mental Health 14(1):24–30CrossRefGoogle Scholar
  12. 12.
    Madge N, Hewitt A, Hawton K et al (2008) Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry 49(6):667–677. doi: 10.1111/j.1469-7610.2008.01879.x (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  13. 13.
    Ystgaard M, Arensman E, Hawton K et al (2009) Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. J Adolesc 32(4):875–891. doi: 10.1016/j.adolescence.2008.10.010 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  14. 14.
    Morey C, Corcoran P, Arensman E et al (2008) The prevalence of self-reported deliberate self harm in Irish adolescents. BMC Publ Health 8:79 Pii: 1471-2458-8-79/1471-2458-8-79 (published Online First: Epub Date)CrossRefGoogle Scholar
  15. 15.
    World Health Organisation. Self-directed violence. World report on violence and health. Geneva: World HEalth Organisation; 2002. p. 185–212Google Scholar
  16. 16.
    Perry IJ, Corcoran P, Fitzgerald AP et al (2012) The incidence and repetition of hospital-treated deliberate self harm: findings from the world’s first national registry. PLoS ONE 7(2):e31663. doi: 10.1371/journal.pone.0031663 (published Online First: Epub Date)PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Olfson M, Gameroff M, Marcus S et al (2005) Emergency treatment of young people following deliberate self-harm. Arch Gen Psychiatry 62:1122–1128PubMedCrossRefGoogle Scholar
  18. 18.
    Foundation National Suicide Research (2013) National Registry of Deliberate Self Harm Annual Report 2012. National Suicide Research Foundation, CorkGoogle Scholar
  19. 19.
    Hawton K, Bergen H, Casey D et al (2007) Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol 42(7):513–521. doi: 10.1007/s00127-007-0199-7 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  20. 20.
    McMahon EM, Reulbach U, Corcoran P et al (2010) Factors associated with deliberate self-harm among Irish adolescents. Psychol Med 40(11):1811–1819. doi: 10.1017/S0033291709992145 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  21. 21.
    Hawton K, Bergen H, Waters K et al (2012) Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England. Eur Child Adolesc Psychiatry 21(7):369–377. doi: 10.1007/s00787-012-0269-6 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  22. 22.
    Canetto SS, Sakinofsky I (1998) The gender paradox in suicide. Suicide Life Threat Behav 28(1):1–23PubMedGoogle Scholar
  23. 23.
    Gunnell D, Platt S, Hawton K (2009) The economic crisis and suicide. BMJ 338:b1891. doi: 10.1136/bmj.b1891 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  24. 24.
    Kaess M, Parzer P, Haffner J et al (2011) Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study. BMC Publ Health 11:597. doi: 10.1186/1471-2458-11-597 (published Online First: Epub Date)CrossRefGoogle Scholar
  25. 25.
    Moran P, Coffey C, Romaniuk H et al (2012) The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet 379(9812):236–243. doi: 10.1016/S0140-6736(11)61141-0 (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  26. 26.
    Walinder J, Rutzt W (2001) Male depression and suicide. Int J Clin Psychopharmacol 16(Suppl 2):S21–S24CrossRefGoogle Scholar
  27. 27.
    Hawton K, Bergen H, Kapur N et al (2012) Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. J Child Psychol Psychiatry 53(12):1212–1219. doi: 10.1111/j.1469-7610.2012.02559.x (published Online First: Epub Date)PubMedCrossRefGoogle Scholar
  28. 28.
    Wasserman C, Hoven CW, Wasserman D et al (2012) Suicide prevention for youth—a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Publ Health 12:776. doi: 10.1186/1471-2458-12-776 (published Online First: Epub Date)CrossRefGoogle Scholar
  29. 29.
    Tollefsen IM, Hem E, Ekeberg O (2012) The reliability of suicide statistics: a systematic review. BMC Psychiatry 12:9. doi: 10.1186/1471-244X-12-9 (published Online First: Epub Date)PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Elaine M. McMahon
    • 1
    Email author
  • Helen Keeley
    • 2
  • Mary Cannon
    • 3
  • Ella Arensman
    • 1
  • Ivan J. Perry
    • 4
  • Mary Clarke
    • 3
  • Derek Chambers
    • 5
  • Paul Corcoran
    • 1
  1. 1.National Suicide Research FoundationUniversity College CorkCorkIreland
  2. 2.Child and Adolescent Mental Health ServicesHealth Service ExecutiveCo. CorkIreland
  3. 3.Department of PsychiatryRoyal College of Surgeons in IrelandDublinIreland
  4. 4.Department of Epidemiology and Public HealthUniversity College CorkCorkIreland
  5. 5.Inspire Ireland FoundationDublinIreland

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