Conference Agenda

BACKGROUND: Many people presenting to emergency departments (EDs) after self-harm do not receive adequate follow–up care, even in well-resourced systems. Little is known about patterns of health service engagement before, during, and after these presentations, and how they relate to subsequent mortality, including suicide.
OBJECTIVES: To identify distinct trajectories of health service use up to 1 year before, during, and after an index ED presentation for self-harm, and examine associations with all-cause and suicide mortality.
METHODS: We conducted a retrospective cohort study of 4,668 individuals presenting to the Royal Melbourne Hospital ED for self-harm. Linked administrative data captured over 1.3 million treatment contacts across primary care, pharmacy, specialist mental health, alcohol and other drug (AOD), and physical health services. Sequential pattern mining and hierarchical clustering identified service use trajectories in three periods: (1) 1 year before, (2) during the acute episode, and (3) up to 1 year after the index ED presentation. Cox and Fine-Gray models estimated associations with all-cause and suicide mortality.
RESULTS: Before the index presentation, 3 service use clusters emerged: mixed (60%), pharmacy-only (28%), and specialist mental health (12%). During the acute episode, service use was dynamic, with the index presentation triggering short-term increases in multi–sector contacts, particularly with AOD (34%) and specialist physical health (25%). In the year following, most (68·7%) reverted to the same cluster observed pre-presentation. Cluster membership was not associated with all-cause mortality, but assignment to the specialist mental health cluster was linked to higher suicide risk within 1 year.

CONCLUSIONS: Health service responses to self-harm are dynamic but short-lived, leaving many high-risk individuals disconnected from care. Sustained, integrated engagement across mental health, AOD, primary care, and community services—particularly in the first year post-ED—is critical to reduce repeat self-harm and suicide. Structural reforms targeting service integration, continuity, and access are urgently needed.

Introduction: Self-harm and suicide are global health issues. Prevention strategies in the Republic of Ireland and Northern Ireland have highlighted hospital-presenting self-harm as a target priority area. This study describes rates of self-harm in the Republic and the North during 2013-2022.

Methods: Data from the National Self-Harm Registry Ireland and the Northern Ireland Registry of Self-Harm were utilised in this study. Both registries record information on self-harm presentations to all hospital Emergency Departments across the Republic and the North. Self-harm rates were calculated based on the number of persons who presented to a hospital Emergency Department following self-harm in that calendar year. Crude and age-specific rates per 100,000 population were calculated.

Results: There was an average of 9023 people who presented with self-harm in the Republic and 5472 in the North annually. The national rate of self-harm in the Republic in 2013 (199 per 100,000) was almost identical to 2022 (197 per 100,000). In the North, the rate reduced from 322 per 100,000 in 2013 to 272 per 100,000 in 2022. A similar trend over the 10-year timeframe was observed for men in both countries with a decrease of 8% in the Republic and 22% in the North. The female rate increased by 5% in the Republic and decreased by 9% in the North. In both countries, younger age groups showed an increasing trend in self-harm rates with larger increases observed for girls.

Conclusion: The monitoring of trends in this study detected country-level differences in trends over a 10-year timeframe.

Background: Method of self-harm has been identified as a factor influencing whether patients are admitted to hospital after presentation to Emergency Departments (EDs), but admission status has not been analysed by method of self-harm in detail. This study examines hospital admission patterns over time for patients presenting to EDs with self-harm in the Republic of Ireland over the 12-year period 2013–2024.

Method: The study uses data from the National Self-Harm Registry Ireland. Descriptive statistics, including frequencies and proportions, are used to examine annual and overall patterns over the 12-year timeframe.

Results: There were 137,475 ED presentations involving self-harm in the study period. Over that time, the percentage of presentations involving admission to general hospital wards remained stable at ca. 25%, whilst psychiatric inpatient admissions declined from 9% in 2013 to ca. 5% in 2022–24. Among presentations involving intentional drug overdose (IDO) and self-cutting, the percentage of presentations resulting in a medical admission increased from 29% to 32% and from 11% to 13% respectively. Psychiatric admission following attempted hanging decreased from 22% to 10%.

Conclusion: The proportion of presentations resulting in a medical admission slightly increased over the study period, primarily as a result of the increase in medical admission following presentations involving IDO and self-cutting. The percentage of presentations resulting in a psychiatric admission substantially decreased, driven by presentations involving attempted hanging. These changes may reflect changes in the severity of self-harm, with presentations involving self-cutting, for example, becoming more medically serious over the time period and presentations involving attempted hanging becoming less psychiatrically urgent; or they may reflect changes in recommended care or hospitals’ available resources. The presentation will canvas these possibilities.

Introduction: Approximately 69% of self-harm presentations to hospital Emergency Departments (EDs) in the Republic of Ireland involve drug use. For presentations where a recreational drug such as cocaine is present with another self-harm method, the drug use may be recreational rather than an intentional drug overdose (IDO). This study seeks to quantify the extent of this.

Methods: Data on all self-harm presentations to EDs in the Republic of Ireland between 2007 and 2024 were obtained from the National Self-Harm Registry Ireland, a national self-harm monitoring system. A new variable for self-harm presentations involving drugs was created for this analysis: IDO included drug use involving any non-recreational drug and recreational drug involvement where no other method of self-harm was recorded. Presentations with recreational drug involvement alongside another self-harm method were categorised as possible IDO. The data were analysed by sex and five-year age group.

Results: Of the 208,481 self-harm presentations recorded over the study period, 137,310 involved drug use. Overall, 2.2% of presentations involving drug use (1.4% of all self-harm presentations) may have involved drugs only recreationally. The proportion was similar from 2007 to 2014 with around 1% of presentations involving drug use; this increased to 6.6% by 2024. The proportion was more pronounced for men than women: in 2007, 1.8% of presentations involving drug use by men may have involved drugs only recreationally compared to 0.2% by women that year; in 2024, the equivalent figure for men was 11.0% and 3.4% for women. The rate of possible recreational drug use became increasingly pronounced among younger persons from 2014 onwards—especially those aged 20–34, for whom the rate in 2024 was 11.9% of all presentations involving drug use.

Conclusions: The increase in recreational drug involvement in self-harm presentations warrants further investigation, particularly in terms of treatment and appropriate onward referrals.

Background: Attempted hanging and attempted drowning are highly lethal methods of self-harm and constitute an increasing proportion of self-harm acts in recent years. This study investigates trends in hospital-presenting self-harm for attempted hanging and attempted drowning over an 18-year period and identifies at-risk age groups.

Methods: Data on self-harm presentations to hospital Emergency Departments (EDs) in the Republic of Ireland from 2007 to 2024 were obtained from the National Self-Harm Registry Ireland, a national monitoring system of hospital-presenting self-harm. Percentages, crude and age-standardised incidence rates, and trends were calculated. Population data were obtained from the Central Statistics Office (CSO) in Ireland.

Results: The total number of self-harm presentations during the study period was 208,472. Attempted hanging and attempted drowning accounted for 10% (n = 20,900) of presentations (14,297 and 6,603 presentations respectively). A greater proportion of these presentations were by men (64%).20–24-year-olds had the highest number of presentations for both methods.

The incidence rate of attempted hanging increased by 72% (from 9.3 to 16 per 100,000) from 2007 to 2024. The largest increase was in the 25–29-year-old age group (180%), but there were also substantial increases among younger age groups including 10–14-year-olds.

The incidence rate of attempted drowning increased by 9% (from 6.6 to 7.2 per 100,000). The largest increase was in the 15–19-year-old age group (54%). Attempted drowning rates generally increased among younger age groups only and declined among older age groups.

Conclusion: Attempted hanging and attempted drowning are significant public health concerns in Ireland. This study identifies that those aged between 10 and 29 years old had the highest incidence rates, with rates among this age group increasing. Higher rates among younger age groups indicate the need to address the determinants of highly lethal methods of self-harm and provide interventions for younger persons.

Introduction: Over the past few decades, the prevalence of self-harming behaviors among adolescents has shown a significant upward trend. This study aims to examine the prevalence of self-harm among Lithuanian school students and explore its associations with psycho-emotional difficulties.

Methods: The study was conducted between October and December 2023 across 12 secondary and 14 high schools in Lithuania. The target population comprised students aged 12 to 17 years. Data were collected using a researcher-developed questionnaire encompassing demographic information, self-reported history of self-harm, and the Strengths and Difficulties Questionnaire (SDQ) to assess psycho-emotional functioning.

Results: The study included 4,124 adolescents (49.0% female), with a mean age of 14.48 ± 1.15 years. A total of 13.6% of adolescents had engaged in self-harm at least once in their lifetime, and 14.3% had self-harmed more than once. Repeated self-harm was reported by 6.0% of boys and 22.0% of girls (p < 0.001, φ = 0.289). The adolescents’ mean SDQ total difficulties score was 13.64 ± 5.78. Respondents who had engaged in self-harm had higher SDQ total difficulties scores (15.70 ± 4.98) compared to those who had not (12.23 ± 5.22) (p < 0.001, d = 0.668). Regression analysis indicated that emotional problems and hyperactivity were the most important factors associated with self-harm among girls (β = 0.281; β = 0.140), while emotional problems and peer problems were the most important factors associated with self-harm among boys (β = 0.272; β = 0.098).

Conclusions: Nearly one in four Lithuanian adolescents reported having self-harmed at least once. Emotional difficulties, peer-related problems, and hyperactivity emerged as the most significant psychosocial factors associated with self-harming behavior. These findings emphasize the need for comprehensive school- and community-based mental health strategies aimed at fostering emotional regulation, improving peer relationships, and managing behavioral difficulties to mitigate self-harm risk among adolescents.