The British Journal of Psychiatry
Suicide attempts v. deliberate self-harm: a response
M. Lawlor, P. Corcoran, D. Chambers

Ogundipe (1999), citing Hawton et al (1997), states that deliberate self-harm is more common in females than males, although the difference is narrowing. In reply, Isometsä & Lönnqvist (1999) write that Finland is the only country in Europe where males seem to have a slightly higher incidence of parasuicide than females. In Ireland, the National Suicide Research Foundation monitors hospital-treated parasuicide in one-quarter of the country. Forty-seven per cent of those treated are male and the male: female ratio is even closer to parity in urban areas. It is somewhat surprising to find that the Irish situation corresponds more closely to that in Finland as opposed to our British neighbours.

Both the Irish and Finnish data originate from centres of the WHO/EURO Multicentre Study of Parasuicide. The following standardised definition of parasuicide is utilised in all centres participating in this study. “An act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage and which is aimed at realising changes which the subject desired via the actual or expected physical consequences” (Kerkhof et al, 1994). It is noteworthy that suicidal intent is not referred to in this definition. However, Isometsä & Lönnqvist indicated that some degree of suicidal intent was required in their study. It is possible for Finnish males to have a slightly higher incidence of parasuicide, as defined by the WHO/EURO Study, and for females to have higher rates when the presence of suicidal intent is required. If this were the case, it might help to explain how Isometsä & Lönnqvist found a higher proportion of female suicides with previous suicide attempts.

Unfortunately, the issue of definition in suicidology continues to provoke controversy. The lack of standardisation limits our ability to make comparisons and generalisations based on the research findings of others, whether from the same jurisdiction or not.