How primary care nurses can identify and manage self-harm

Primary care nurses need to be able to identify and manage self-harm. This research focus explores high risk groups and management strategies

Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study

Young people who had tried different self-injury methods, especially self-poisoning, were 30 times more likely to die by suicide than peers who had not self-harmed, research into those at greatest risk of death following self-harm found.

Data from the Multicentre Study of Self-harm and NHS Digital in England provided a sample of 9,173 people aged 10-18 years who had presented to five hospitals with self-harm between 2000 and 2013.

Follow-up took place until the end of 2015, by which time 1% of the cohort had died: 44% by suicide, 22% by accidental death and 34% from other causes. Of the deaths by suicide, 82% involved self-injury and 76% were in those aged 18 or over. A change in method was common, especially from self-poisoning to a more lethal method.

The greatest indicators of death were being male, being an older adolescent at the time of presentation, repeated self-harm, the use of self-injury, especially hanging or asphyxiation, and higher risk of self-poisoning, including misusing illicit drugs.

Hawton K, Bale L, Brand F et al (2020) The Lancet Child and Adolescent Health. 4, 2, 111-120. doi: https://doi.org/10.1016/S2352-4642(19)30373-6

Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death

The risk of suicide among older people who self-harm found suicidal intent is greater in the younger age group, and attempts are more often fatal, despite a lower incidence of self-harm overall, this research shows.

Primary and secondary care electronic records for 2001-2014 found 4,124 reported self-harm episodes in adults aged 65 years and over; 59.6% of women self-harmed compared to 40.4% of men.

This group was 20 times more likely to die than general population peers in the 12 months following self-harm and consistently at higher risk subsequently. Men aged 60 years or over are the highest risk age group.

The highest risk group had physical and mental ill health. The loss of functional ability, experience of bereavement and social isolation are known risk factors for self-harm.

Only 11.7% were referred to secondary services, while 59.3% were prescribed an antidepressant, including tricyclic antidepressants which are highly toxic in overdose.

Recommended management includes enhancing social connections, engaging in social and physical activity and safety planning.

Morgan C, Webb R, Carr M et al (2018) The Lancet Psychiatry. 5, 11, 905-912. doi: https://doi.org/10.1016/S2215-0366(18)30348-1

Related articles

• Three minutes to save a life: the course designed to raise suicide awareness
• Leave judgement at the door when talking about self-harm
• Annessa Rebair: Why suicide prevention must be part of pre-registration nurse education

Compiled by Pam Hodge, lecturer in practice learning, Middlesex University, London