The changing pattern of the clinical characteristics of self-harm across the life-span: how do hospital services respond?

Introduction
Self-harm is a substantial problem in the UK with significant human and economic costs. It is
one of the most common reasons for acute admission to hospital in the UK and is an important risk factor for suicide. Psychological theory and empirical studies indicate that the characteristics of self-harm may differ in people of different ages, and that these
characteristics may influence the care that people receive when they attend hospital after selfharm.

Method
The study data were collected as part of a UK multi-centre self-harm monitoring project. The data cover 11,243 consecutive attendances at hospital emergency departments in Leeds made by 6292 individuals between 1 October 2004 and 30 September 2007. The data were analysed across the age range using comparison of odds ratios, linear chi squared tests for trend and survival analysis.

Results
Characteristics of self-harm and hospital management differ for people of different ages. Severity of self-harm increases with increasing age, but service provision is not closely linked to severity. The youngest and oldest age groups receive the best service and the working age
adults, who conduct medically serious self-harm and are at high risk of repeating self-harm, receive the worst service. The oldest age group appear to be substantially different from the younger groups in terms of their history.

Discussion
The differences in the characteristics of self-harm across the age range are compatible with psychological theory relating to the reasons people may conduct self-harm at different ages. Adult mental health services could learn from the high standards of care provided to the youngest and oldest people who self-harm. Further research to explore self-harm in different age groups is recommended.