Summary: One in four adolescents and young adults who present to hospital following self-harm go on to engage in self-harm more than once. The highest risk for repetition occurs within the first year after the initial hospital episode, with the first month being the most critical.
Source: University of New South Wales
The risk of repeat self-harm in young people is highest in the first month after an initial hospital presentation for self-harm.
Self-harm and suicidal behaviour are occurring in younger age groups, with some children as young as 10 presenting to emergency departments after self-harm—sometimes more than once. New research highlights how frequently these repeat presentations occur and when the risk is greatest.
Researchers from the Black Dog Institute and UNSW Medicine & Health examined linked hospital and emergency department records in New South Wales from 2014 to 2019. They identified more than 81,000 hospital-presenting self-harm episodes among 48,547 individuals aged 10–29 years.
Among adolescents aged 10–14, the study found 6,055 emergency department visits for self-harm over five years; of these, 2,276 were repeat presentations. Overall, roughly one-quarter of those who presented to hospital for self-harm did so on more than one occasion.
The greatest likelihood of repeat self-harm was concentrated in the year following the index episode, with the highest level of risk occurring within the first month after presentation.
“Teachers have reported hearing discussions of self-harm and suicide among primary school children,” says Dr. Michelle Tye, senior author of the study and a researcher at the Black Dog Institute and UNSW Medicine & Health. “Our findings support the view that children and adolescents are a high-risk group for self-harm and repeated episodes.”
The analysis showed particularly elevated risk among young people whose first recorded episode occurred between ages 10 and 19, and among those whose presentations were severe enough to require hospital admission. The study also found that individuals with two or more self-harm presentations faced a higher risk of later dying by suicide.
Although this study could not establish intent in each case, repeat self-harm is a known predictor of suicide. Suicide is the leading cause of death for Australians aged 15–44, and non-fatal suicide attempts are more common than completed suicide, with some estimates suggesting many more attempts occur than deaths.
“Adolescence is already a challenging time, and young people today face added pressures—such as the COVID-19 pandemic, climate anxiety and economic uncertainty,” Dr. Tye explains. “These stresses can reduce coping capacity and increase the likelihood that some young people will use self-harm as a way to manage distress.”
Lead author Dr. Jiahui Qian, also from the Black Dog Institute and UNSW Medicine & Health, notes that the study likely underestimates the true extent of self-harm among young people because it only captures episodes that result in emergency department or hospital presentation. Many young people who self-harm do not seek hospital care and therefore are not included in these records.
The study observed that males aged 15–29 who were admitted to hospital following a self-harm episode had a higher risk of repeating self-harm and of subsequent suicide death compared with females. This aligns with previous research showing higher suicide mortality among males, even though hospital presentations for self-harm are more common among females.
Dr. Tye suggests one possibility is that males may use more lethal means when they self-harm, which could help explain higher suicide mortality, but she emphasizes that further research is needed to understand these patterns.
Developing youth-specific self-harm interventions
Completely eliminating self-harm may not be realistic, but reducing its frequency—especially among young people—is an achievable and urgent goal. Early, youth-focused intervention is essential to prevent future episodes.
“Self-harm is fundamentally a maladaptive coping strategy,” says Dr. Tye. “We need effective ways to prevent young people from reaching the point of suicidal behaviour and to help them learn adaptive coping skills.”
The researchers recommend more evidence-based programs in schools to teach adaptive coping strategies, increase awareness of the warning signs of self-harm and suicide, and encourage help-seeking. School-based initiatives can reach large numbers of young people and help them recognise when they or their peers need support.
Improving clinical assessment and follow-up in frontline health services is also critical. Experiences of care in emergency departments vary, and post-discharge support is not always adequate. Routine psychosocial assessment and coordinated follow-up can help reduce the risk of repeat self-harm and suicide over time, but the very high risk in the first month after presentation highlights the need for immediate and sustained contact during that period.
“Ideally, all young people should have access to ongoing support through coordinated aftercare, particularly in the weeks following a hospital presentation, to reduce the chance of repeat self-harm,” Dr. Tye says.
Dr. Qian adds that hospital records provide a valuable opportunity to identify young people who are self-harming and to engage them in research and prevention efforts. Better understanding the needs and experiences of these young people can inform service design, guide clinical care and reveal opportunities for timely intervention.
About this self-harm and psychology research news
Author: Ben Knight
Source: University of New South Wales
Contact: Ben Knight – University of New South Wales
Image: The image is in the public domain
Original Research: Closed access. “Risk of repeat self-harm and suicide death following an episode of hospital self-harm presentation among adolescents and young adults” by Jiahui Qian et al., Journal of Affective Disorders.
Abstract
Risk of repeat self-harm and suicide death following an episode of hospital self-harm presentation among adolescents and young adults
Background
Self-harm is a major concern for young people and can lead to repeat episodes and suicide. This study aimed to estimate the short-term and long-term risks of repeat self-harm and subsequent suicide death after hospital presentations for self-harm among adolescents and young adults.
Methods
The research used linked data from New South Wales hospital and emergency department collections and cause-of-death records to capture self-harm presentations and suicide deaths between 2012 and 2019. Survival analysis models were used to estimate incidence rates of repeat self-harm and suicide by time since the index episode and to compare risks by sex, type of hospital presentation, and number of self-harm records.
Results
The study identified 81,133 self-harm episodes among 48,547 individuals aged 10–29 years. Of those indexed during the study period, 39.5% were aged 15–19. Incidence rates for repeat self-harm and suicide were highest in the year after the index presentation (repeat self-harm: 188.84 per 1,000 person-years; suicide: 3.30 per 1,000 person-years) and declined over five years. Among those aged 15–29 at index, males and those admitted to hospital had higher risks of repeat self-harm and suicide, and individuals with two or more presentations faced greater risk of suicide death.
Conclusion
Adolescents and young adults who present to hospital for self-harm are at substantial risk for repeat self-harm and suicide, especially during the first year and particularly the first month after presentation. The findings underscore the need for youth-specific early intervention, coordinated aftercare and long-term management, with particular attention to younger adolescents and those with severe presentations.