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Individual- and area-level predictors of self-harm repetition

Centre for Suicide Prevention, University of Manchester, UK

ROGER WEBB, MSc

Centre for Women’s Mental Health, University of Manchester, UK

NAVNEET KAPUR, MD, MRCPsych

Centre for Suicide Prevention, University of Manchester, UK

Correspondence: Dr N. Kapur, Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Tel: +44 (0)161 275 0733; fax: +44 (0)161 275 0716; email: nav.kapur{at}manchester.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background No ecological studies have examined the relationship between area characteristics, individual characteristics and self-harm repetition.

Aims To investigate the association between area-level factors and incidence and repetition of self-harm, and to identify which area-level factors are independently associated with repetition after adjustment for individual factors.

Method Prospective cohort study using the Manchester Self-Harm database. Adults who were resident in Manchester and presented to an emergency department following self-harm between 1997 and 2002 were included (n = 4743). The main outcome measure was repeat self-harm within 6 months of the index episode.

Results Four individual factors (previous self-harm, previous psychiatric treatment, employment status, marital status) and one area-based factor (proportion of individuals who were of White ethnicity) were independently associated with repetition.

Conclusions Repetition of self-harm may be more strongly related to individual factors than to area characteristics. We need to better understand the processes underlying ecological associations with suicidal behaviour before embarking on area-based interventions.

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