European Child & Adolescent Psychiatry

, Volume 21, Issue 7, pp 369–377 | Cite as

Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England

  • Keith Hawton
  • Helen Bergen
  • Keith Waters
  • Jennifer Ness
  • Jayne Cooper
  • Sarah Steeg
  • Navneet Kapur
Original Contribution


We examined epidemiology and characteristics of self-harm in adolescents and impact of national guidance on management. Data were collected in six hospitals in three centres between 2000 and 2007 in the Multicentre Study of Self-harm in England. Of 5,205 individuals (7,150 episodes of self-harm), three-quarters were female. The female:male ratio in 10–14 year-olds was 5.0 and 2.7 in 15–18 year-olds. Rates of self-harm varied somewhat between the centres. In females they averaged 302 per 100,000 (95 % CI 269–335) in 10–14 year-olds and 1,423 (95 % CI 1,346–1,501) in 15–18 year-olds, and were 67 (95 % CI 52–82) and 466 (95 % CI 422–510), respectively, in males. Self-poisoning was the most common method, involving paracetamol in 58.2 % of episodes. Presentations, especially those involving alcohol, peaked at night. Repetition of self-harm was frequent (53.3 % had a history of prior self-harm and 17.7 % repeated within a year). Relationship problems were the predominant difficulties associated with self-harm. Specialist assessment occurred in 57 % of episodes. Self-harm in children and adolescents in England is common, especially in older adolescents, and paracetamol overdose is the predominant method. National guidance on provision of psychosocial assessment in all cases of self-harm requires further implementation.


Children Adolescents Self-harm Epidemiology Alcohol Paracetamol 



For assistance with data collection we thank Deborah Casey, Elizabeth Bale and Anna Shepherd in Oxford, Elizabeth Murphy, Iain Donaldson, Maria Healey and Stella Dickson in Manchester, and Carol Stalker in Derby, and members of the general hospital psychiatric and other clinical services, and hospital administration staff in all three centres. KH is a National Institute for Health Research Senior Investigator. NK is also supported by the Manchester Mental Health and Social Care Trust. We acknowledge financial support from the Department of Health under the NHS R&D Programme (DH/DSH2008). The Department of Health had no role in study design, the collection, analysis and interpretation of data, the writing of the report, and the decision to submit the paper for publication. The views and opinions expressed herein do not necessarily reflect those of the Department of Health.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Hawton K, Rodham K (2006) By their own young hand: deliberate self-harm and suicidal ideas in adolescents. Jessica Kingsley Publishers, LondonGoogle Scholar
  2. 2.
    Hultén A, Jiang GX, Wasserman D, Hawton K, Hjelmeland H, De Leo D, Ostamo A, Salander-Renberg E, Schmidtke A (2001) Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. Eur Child Adolesc Psychiatry 10:161–169PubMedCrossRefGoogle Scholar
  3. 3.
    Hawton K, Rodham K, Evans E, Weatherall R (2002) Deliberate self-harm in adolescents: self report survey in schools in England. BMJ 325:1207–1211PubMedCrossRefGoogle Scholar
  4. 4.
    Madge N, Hewitt A, Hawton K, de Wilde EJ, Corcoran P, Fekete S, Van Heeringen K, De Leo D, Ystgaard M (2008) Deliberate self-harm within an international community sample of young people: comparative findings from the Child and Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry 49:667–677PubMedCrossRefGoogle Scholar
  5. 5.
    Ystgaard M, Arensman E, Hawton K, Madge N, Van Heeringen K, Hewitt A, de Wilde EJ, De Leo D, Fekete S (2009) Deliberate self harm in adolescents: comparison between those who receive help following self harm and those who do not. J Adolesc 32:875–891. doi: 10.1016/j.adolescence.2008.10.010 PubMedCrossRefGoogle Scholar
  6. 6.
    Hawton K, Hall S, Simkin S, Bale E, Bond A, Codd S, Stewart A (2003) Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990–2000. J Child Psychol Psychiatry 44:1191–1198PubMedCrossRefGoogle Scholar
  7. 7.
    Cassidy C, McNicholas F, Lennon R, Tobin B, Doherty M, Adamson N (2009) Deliberate self-harm (DSH): A follow-up study of Irish children. Ir Med J 102(4)Google Scholar
  8. 8.
    National Collaborating Centre for Mental Health (2004) Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (full guideline) Clinical Guideline 16. National Institute for Clinical Excellence, LondonGoogle Scholar
  9. 9.
    National Collaborating Centre for Mental Health (2011) Self-harm (longer term management) (Clinical Guideline 133). National Institute for Clinical Excellence, LondonGoogle Scholar
  10. 10.
    Australian College for Emergency Medicine (ACEM) and The Royal Australian and New Zealand College of Psychiatrists (RANZCP) (2000) Guidelines for the management of deliberate self harm in young people. Australasian College for Emergency Medicine (ACEM) and The Royal Australian and New Zealand College of Psychiatrists (RANZCP), MelbourneGoogle Scholar
  11. 11.
    Department of Health (2002) National suicide prevention strategy for England. Department of Health, LondonGoogle Scholar
  12. 12.
    Health Service Executive the National Suicide Review Group and Department of Health and Children (2005) Reach Out: National Strategy for Action on Suicide Prevention 2005–2014. Health Service Executive DublinGoogle Scholar
  13. 13.
    U. S. Department of Health and Human Services (2001) National Strategy for Suicide Prevention: Goals and Objectives for Action. U.S. Department of Health and Human Services, Public Health Service, RockvilleGoogle Scholar
  14. 14.
    Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 181:193–199PubMedCrossRefGoogle Scholar
  15. 15.
    Hawton K, Harriss L (2007) Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. J Clin Psychiatry 68:1574–1583PubMedCrossRefGoogle Scholar
  16. 16.
    Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, Kapur N, Horrocks J, House A, Lilley R, Noble R, Owens D (2007) Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol 42:513–521. doi: 10.1007/s00127-007-0199-7 PubMedCrossRefGoogle Scholar
  17. 17.
    Bergen H, Hawton K, Waters K, Cooper J, Kapur N (2010) Epidemiology and trends in non-fatal self-harm in three centres in England, 2000 to 2007. Br J Psychiatry 197:493–498. doi: 10.1192/bjp.bp.110.077651 PubMedCrossRefGoogle Scholar
  18. 18.
    Hawton K, Harriss L, Hall S, Simkin S, Bale E, Bond A (2003) Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med 33:987–996PubMedCrossRefGoogle Scholar
  19. 19.
    Schmidtke A, Bille Brahe U, De Leo D, Kerkhof A, Bjerke T, Crepet P, Haring C, Hawton K, Lönnqvist J, Michel K, Pommereau X, Querejeta I, Phillipe I, Salander Renberg E, Temesvary B, Wasserman D, Fricke S, Weinacker B, Sampaio Faria JG (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 93:327–338PubMedCrossRefGoogle Scholar
  20. 20.
    Kapur N, Murphy E, Cooper J, Bergen H, Hawton K, Simkin S, Casey D, Horrocks J, Lilley R, Noble R, Owens D (2008) Psychosocial assessment following self-harm: results from the multi-centre monitoring of self-harm project. J Affect Disord 106:285–293. doi: 10.1016/j.jad.2007.07.010 PubMedCrossRefGoogle Scholar
  21. 21.
    Sellar C, Goldacre MJ, Hawton K (1990) Reliability of routine hospital data on poisoning as measures of deliberate self poisoning in adolescents. J Epidemiol Community Health 44:313–315PubMedCrossRefGoogle Scholar
  22. 22.
    Population estimates for UK, England and Wales, Scotland and Northern Ireland—current datasets (2008) Accessed 19/05/2011
  23. 23.
    SPSS Inc (2007) SPSS for Windows Release Scholar
  24. 24.
    Stata Corporation (2007) Stata Statistical Software: Release 10. Stata Corporation, College Station, TXGoogle Scholar
  25. 25.
    Patton GC, Hemphill SA, Beyers JM, Bond L, Toumbourou JW, McMorris BJ, Catalano RF (2007) Pubertal stage and deliberate self-harm in adolescents. J Am Acad Child Adolesc Psychiatry 46:508–514PubMedCrossRefGoogle Scholar
  26. 26.
    Hawton K, Harriss L (2008) The changing gender ratio in occurrence of deliberate self-harm across the life-cycle. Crisis 29:4–10PubMedCrossRefGoogle Scholar
  27. 27.
    Royal College of Psychiatrists (2004) Assessment following self-harm in adults. Council Report CR122. Royal College of Psychiatrists, LondonGoogle Scholar
  28. 28.
    Hawton K, Simkin S, Deeks J, Cooper J, Johnston A, Waters K, Arundel M, Bernal W, Gunson B, Hudson M, Suri D, Simpson K (2004) UK legislation on analgesic packs: before and after study of long term effect on poisonings. BMJ 329:1076–1079PubMedCrossRefGoogle Scholar
  29. 29.
    Hawton K, Bergen H, Simkin S, Brock A, Griffiths C, Romeri E, Smith KL, Kapur N, Gunnell D (2009) Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis. BMJ 338:b2270PubMedCrossRefGoogle Scholar
  30. 30.
    Hawton K, Rodham K, Evans E, Harriss L (2009) Adolescents who self harm: a comparison of those go to general hospital and those who do not. Child Adolesc Mental Health 14:24–30CrossRefGoogle Scholar
  31. 31.
    World Health Organisation (2010) mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings.
  32. 32.
    Hawton K, Fagg J, Simkin S, Bale E, Bond A (2000) Deliberate self-harm in adolescents in Oxford, 1985–1995. J Adolesc 23:47–55PubMedCrossRefGoogle Scholar
  33. 33.
    Dieserud G, Gerhardsen RM, Van den Weghe H, Corbett K (2010) Adolescent suicide attempts in Bærum, Norway, 1984–2006: trends, triggers, and underlying reasons. Crisis 31:255–264PubMedCrossRefGoogle Scholar
  34. 34.
    Webb L (2002) Deliberate self-harm in adolescence: a systematic review of psychological and psychosocial factors. J Adv Nurs 38:235–244PubMedCrossRefGoogle Scholar
  35. 35.
    Burgess S, Hawton K, Loveday G (1998) Adolescents who take overdoses: outcome in terms of changes in psychopathology and the adolescents’ attitudes to their care and to their overdoses. J Adolesc 21:209–218PubMedCrossRefGoogle Scholar
  36. 36.
    Carter GL, Issakidis C, Clover K (2003) Correlates of youth suicide attempters in Australian community and clinical samples. Aust N Z J Psychiatry 37:286–293PubMedCrossRefGoogle Scholar
  37. 37.
    Harrington R, Kerfoot M, Dyer E, McNiven F, Gill J, Harrington V, Woodham A, Byford S (1998) Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. J Am Acad Child Adolesc Psychiatry 37:512–518PubMedCrossRefGoogle Scholar
  38. 38.
    Green JM, Wood AJ, Kerfoot MJ, Trainor G, Roberts C, Rothwell J, Woodham A, Ayodeji E, Barrett B, Byford S, Harrington R (2011) Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 342:d682Google Scholar
  39. 39.
    Hazell PL, Martin G, McGill K, Wood TK, Trainor G, Harrington R (2009) Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial. J Am Acad Child Adolesc Psychiatry 48:662–670PubMedGoogle Scholar
  40. 40.
    Bergen H, Hawton K, Waters K, Cooper J, Kapur N (2010) Psychosocial assessment and repetition of self-harm: The significance of single and multiple repeat episode analyses. J Affect Disord 123:95–101. doi: 10.1016/j.jad.2010.05.001 PubMedCrossRefGoogle Scholar
  41. 41.
    Hultén A, Wasserman D, Hawton K, Jiang GX, Salander-Renberg E, Schmidtke A, Bille-Brahe U, Bjerke T, Kerkhof A, Michel K, Querejeta I (2000) Recommended care for young people (15–19 years) after suicide attempts in certain European countries. Eur Child Adolesc Psychiatry 9:100–108PubMedCrossRefGoogle Scholar
  42. 42.
    Bergen H, Hawton K, Murphy E, Cooper J, Kapur N, Stalker C, Waters K (2009) Trends in prescribing and self-poisoning in relation to UK regulatory authority warnings against use of SSRI antidepressants in under-18 year-olds. Br J Clin Pharmacol 68:618–629. doi: 10.1111/j.1365-2125.2009.03481.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Keith Hawton
    • 1
  • Helen Bergen
    • 1
  • Keith Waters
    • 2
  • Jennifer Ness
    • 2
  • Jayne Cooper
    • 3
  • Sarah Steeg
    • 3
  • Navneet Kapur
    • 3
  1. 1.Department of Psychiatry, Centre for Suicide Research, Warneford HospitalUniversity of OxfordOxfordUK
  2. 2.Derbyshire Healthcare NHS Foundation TrustDerbyEngland
  3. 3.Centre for Suicide PreventionUniversity of ManchesterManchesterUK

Personalised recommendations