Editing Self-harm (section)

==Epidemiology==
[[File:Self-harm world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Deaths from self-harm per million people in 2012 {{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff20|3–23}}
{{legend|#ffe820|24–32}}
{{legend|#ffd820|33–49}}
{{legend|#ffc020|50–61}}
{{legend|#ffa020|62–76}}
{{legend|#ff9a20|77–95}}
{{legend|#f08015|96–121}}
{{legend|#e06815|122–146}}
{{legend|#d85010|147–193}}
{{legend|#d02010|194–395}}
{{Div col end}}]]
[[File:Self-inflicted injuries world map - DALY - WHO2004.svg|thumb|upright=1.3|World-map showing the [[disability-adjusted life year]], which is a measure of each country's disease burden, for self-inflicted injuries per 100,000&nbsp;inhabitants in 2004{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|less than 80}}
{{legend|#fff200|80–160}}
{{legend|#ffdc00|160–240}}
{{legend|#ffc600|240–320}}
{{legend|#ffb000|320–400}}
{{legend|#ff9a00|400–480}}
{{legend|#ff8400|480–560}}
{{legend|#ff6e00|560–640}}
{{legend|#ff5800|640–720}}
{{legend|#ff4200|720–800}}
{{legend|#ff2c00|800–850}}
{{legend|#cb0000|more than 850}}
{{Div col end}}]]
It is difficult to gain an accurate picture of incidence and prevalence of self-harm.<ref>{{harvnb|Bowen|John|2001|pp=360–361}}. {{harvnb|Claassen|Trivedi|Shimizu|Stewart|2006|p=193}}: "[N]ational rates of self-harm have not been well established in most countries, including the United States."</ref> Even with sufficient monitoring resources, self-harm is usually unreported, with instances taking place in private and wounds being treated by the self-harming individual.{{sfn|Bowen|John|2001|pp=360-361}} Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys.<ref name="Rodham05">{{cite journal |vauthors=Rodham K, Hawton K, Evans E |title=Deliberate Self-Harm in Adolescents: the Importance of Gender |journal=Psychiatric Times |volume=22 |issue=1 |year=2005}}</ref> A 2015 meta-analysis of reported self-harm among 600,000 adolescents found a lifetime prevalence of 11.4% for suicidal or non-suicidal self-harm (i.e. excluding self-poisoning) and 22.9% for non-suicidal self-injury (i.e. excluding suicidal acts), for an overall prevalence of 16.9%.{{sfn|Gillies|Christou|Dixon|Featherston|2018|p=4}} The difference in SH and NSSI rates, compared to figures of 16.1% and 18.0% found in a 2012 review, may be attributable to differences in methodology among the studies analyzed.<ref>{{harvnb|Gillies|Christou|Dixon|Featherston|2018|p=6}}, citing {{harvnb|Muehlenkamp|Claes|Havertape|Plener|2012}}.</ref>

The World Health Organization estimates that, as of 2010, 880,000 deaths occur as a result of self-harm (including suicides).<ref name=Loz2012>{{cite journal |vauthors=Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA |display-authors=6 |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=Lancet |volume=380 |issue=9859 |pages=2095–2128 |date=December 2012 |pmc=10790329 |hdl-access=free |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |url=http://www.cobiss.si/scripts/cobiss?command=DISPLAY&base=cobib&rid=1537267652&fmt=11 }}{{Dead link|date=August 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> About 10% of admissions to medical wards in the UK are as a result of self-harm, the majority of which are [[drug overdose]]s.<ref name=BBC>{{cite web |title=Self-harm |publisher=British Broadcasting Corporation |date=2004-12-06 |url=http://news.bbc.co.uk/1/hi/health/medical_notes/4067129.stm |access-date=2010-01-04 |url-status=dead |archive-url=https://web.archive.org/web/20090319065604/http://news.bbc.co.uk/1/hi/health/medical_notes/4067129.stm |archive-date=2009-03-19}}</ref> However, studies based only on hospital admissions may hide the larger group of self-harmers who do not need or seek hospital treatment for their injuries,<ref name="fox_hawton"/> instead treating themselves. Many adolescents who present to general hospitals with deliberate self-harm report previous episodes for which they did not receive medical attention.<ref name="Rodham05"/> In the United States up to 4% of adults self-harm with approximately 1% of the population engaging in chronic or severe self-harm.<ref name=kerr2010>{{cite journal |vauthors=Kerr PL, Muehlenkamp JJ, Turner JM |title=Nonsuicidal self-injury: a review of current research for family medicine and primary care physicians |journal=Journal of the American Board of Family Medicine |volume=23 |issue=2 |pages=240–259 |year=2010 |doi=10.3122/jabfm.2010.02.090110 |doi-access=free |pmid=20207935}}</ref>

The onset of self-harm tends to occur around [[puberty]], although scholarship is divided as to whether this is usually before puberty or later in adolescence. Meta-analyses have not supported some studies' conclusion that self-harm rates are increasing among adolescents. It is generally thought that self-harm rates increase over the course of adolescence, although this has not been studied thoroughly.{{sfn|Gillies|Christou|Dixon|Featherston|2018|pp=1-2}} The earliest reported incidents of self-harm are in children between 5 and 7 years old.<ref name="MHF"/> In addition there appears to be an increased risk of self-harm in college students than among the general population.{{sfn|Greydanus|Shek|2009}}{{Page needed|date=August 2023}}<ref name=kerr2010/> In a study of undergraduate students in the US, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-harm was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this.<ref>{{cite journal |vauthors=Vanderhoff H, Lynn SJ |title=The assessment of self-mutilation: Issues and clinical considerations |journal=Journal of Threat Assessment |volume=1 |pages=91–109 |year=2001 |doi=10.1300/J177v01n01_07}}</ref> In Ireland, a study found that instances of hospital-treated self-harm were much higher in city and urban districts, than in rural settings.<ref name="pmid20716390">{{cite journal |vauthors=Corcoran P, Reulbach U, Perry IJ, Arensman E |title=Suicide and deliberate self harm in older Irish adults |journal=International Psychogeriatrics |volume=22 |issue=8 |pages=1327–1336 |date=December 2010 |hdl=10468/2916 |s2cid=21390675 |hdl-access=free |doi=10.1017/S1041610210001377 |pmid=20716390}}</ref> The CASE (Child & Adolescent Self-harm in Europe) study suggests that the life-time risk of self-injury is ~1:7 for women and ~1:25 for men.<ref>{{cite journal |vauthors=Madge N, Hewitt A, Hawton K, de Wilde EJ, Corcoran P, Fekete S, van Heeringen K, De Leo D, Ystgaard M |display-authors=6 |title=Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=49 |issue=6 |pages=667–677 |date=June 2008 |doi=10.1111/j.1469-7610.2008.01879.x |pmid=18341543}}</ref>

===Gender differences===

Aggregated research has found no difference in the prevalence of self-harm between men and women.<ref name=kerr2010/> This contrasts with previous studies, which suggested that up to four times as many females as males have direct experience of self-harm,<ref name="fox_hawton"/> which many had argued was rather the result of data collection biases.{{sfn|Bowen|John|2001|p=361}}

The [[WHO]]/EURO Multicentre Study of Suicide, established in 1989, demonstrated that, for each age group, the female rate of self-harm exceeded that of the males, with the highest rate among females in the 13–24 age group and the highest rate among males in the 12–34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of self-harm in general.<ref>{{cite web |vauthors=O'Brien A |title=Women and Parasuicide: a Literature Review |publisher=Women's Health Council |url=http://www.whc.ie/publications/reports_parasuicide.html |access-date=2008-05-26 |url-status=dead |archive-url=https://web.archive.org/web/20080428132657/http://www.whc.ie/publications/reports_parasuicide.html |archive-date=April 28, 2008}}</ref> Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of self-harm are due to deliberate socially biased methodological and sampling errors, directly blaming medical discourse for pathologising the female.<ref>{{cite journal |vauthors=Brickman BJ |year=2004 |title='Delicate' Cutters: Gendered Self-mutilation and Attractive Flesh in Medical Discourse |journal=Body and Society |volume=10 |issue=4 |pages=87–111 |s2cid=145191075 |doi=10.1177/1357034X04047857}}</ref>

This gender discrepancy is often distorted in specific populations where rates of self-harm are inordinately high, which may have implications on the significance and interpretation of psychosocial factors other than gender. A study in 2003 found an extremely high prevalence of self-harm among 428 homeless and runaway youths (aged 16–19) with 72% of males and 66% of females reporting a history of self-harm.<ref>{{cite journal |vauthors=Tyler KA, Whitbeck LB, Hoyt DR, Johnson KD |year=2003 |title=Self Mutilation and Homeless Youth: The Role of Family Abuse, Street Experiences, and Mental Disorders |journal=Journal of Research on Adolescence |volume=13 |issue=4 |pages=457–474 |doi=10.1046/j.1532-7795.2003.01304003.x |url=https://digitalcommons.unl.edu/sociologyfacpub/37}}</ref> However, in 2008, a study of young people and self-harm saw the gender gap widen in the opposite direction, with 32% of young females, and 22% of young males admitting to self-harm.<ref name=affinity08>{{citation |publisher=Affinity Healthcare |year=2008 |title=New survey reveals almost one in three young females have tried to self-harm |url=http://www.affinityhealth.co.uk/pdf/SHS.pdf |access-date=2009-12-13 |url-status=dead |archive-url=https://web.archive.org/web/20081201220154/http://www.affinityhealth.co.uk/pdf/SHS.pdf |archive-date=2008-12-01}}</ref> Studies also indicate that males who self-harm may also be at [[Gender differences in suicide|a greater risk of completing suicide]].<ref name=Hawton_BMJ_03/>

There does not appear to be a difference in motivation for self-harm in adolescent males and females. Triggering factors such as low self-esteem and having friends and family members who self-harm are also common between both males and females.<ref name="Rodham05"/> One limited study found that, among those young individuals who do self-harm, both genders are just as equally likely to use the method of skin-cutting.<ref>{{cite journal |vauthors=Marchetto MJ |title=Repetitive skin-cutting: Parental bonding, personality and gender |journal=Psychology and Psychotherapy: Theory, Research and Practice |volume=79 |issue=3 |date=September 2006 |pages=445–459(15) |doi=10.1348/147608305X69795 |doi-access=free |pmid=16945201}}</ref> However, females who self-cut are more likely than males to explain their self-harm episode by saying that they had wanted to punish themselves. In New Zealand, more females are hospitalized for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalization.<ref>{{Citation|url=http://www.nzhis.govt.nz/moh.nsf/pagesns/323?Open |title=Hospitalisation for intentional self-harm |publisher=New Zealand Health Information Service |access-date=2008-05-03 |url-status=dead |archive-url=https://web.archive.org/web/20081015044544/http://www.nzhis.govt.nz/moh.nsf/pagesns/323?Open |archive-date=October 15, 2008}}</ref>

===Elderly===

In a study of a district general hospital in the UK, 5.4% of all the hospital's self-harm cases were aged over 65. The male to female ratio was 2:3, although the self-harm rates for males and females over 65 in the local population were identical. Over 90% had depressive conditions, and 63% had significant physical illness. Under 10% of the patients gave a prior history of earlier self-harm, while both the repetition and suicide rates were very low, which could be explained by the absence of factors known to be associated with repetition, such as personality disorder and alcohol abuse.<ref name=Pierce87/> However, NICE Guidance on Self-harm in the UK suggests that older people who self-harm are at a greater risk of completing suicide, with 1 in 5 older people who self-harm going on to end their life.<ref name=NICE04/> A study completed in Ireland showed that older Irish adults have high rates of deliberate self-harm, but comparatively low rates of suicide.<ref name="pmid20716390"/>

===Developing world===

Only recently have attempts to improve health in the developing world concentrated on not only physical illness but also mental health.<ref name="Eddleston98">{{cite journal |vauthors=Eddleston M, Sheriff MH, Hawton K |title=Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world |journal=BMJ |volume=317 |issue=7151 |pages=133–135 |date=July 1998 |pmc=1113497 |doi=10.1136/bmj.317.7151.133 |pmid=9657795}}</ref> Deliberate self-harm is common in the developing world. Research into self-harm in these areas is however, still very limited. Though an important case study is that of Sri Lanka, which is a country exhibiting a high incidence of suicide<ref>Ministry of Health. Annual health bulletin, Sri Lanka, 1995. Colombo, Sri Lanka: Ministry of Health (1997)</ref> and self-poisoning with agricultural [[pesticide]]s or natural poisons.<ref name="Eddleston98"/> Many people admitted for deliberate self-poisoning during a study by Eddleston ''et al.''<ref name="Eddleston98"/> were young and few expressed a desire to die, but death was relatively common in the young in these cases. The improvement of medical management of acute poisoning in the developing world is poor and improvements are required in order to reduce mortality.

Some of the causes of deliberate self-poisoning in Sri Lankan adolescents included [[grief|bereavement]] and harsh discipline by parents. The coping mechanisms are being spread in local communities as people are surrounded by others who have previously deliberately harmed themselves or attempted suicide.<ref name="Eddleston98"/> One way to reduce self-harm would be to limit access to poisons; however many cases involve pesticides or yellow [[Nerium oleander|oleander]] seeds, and the reduction of access to these agents would be difficult. Great potential for the reduction of self-harm lies in education and prevention, but limited resources in the developing world ultimately make these methods challenging.<ref name="Eddleston98"/>

===Prison inmates===

Deliberate self-harm is especially prevalent in prison populations. A proposed explanation for this is that prisons [[prison violence|are often violent places]], and prisoners who wish to avoid physical confrontations may resort to self-harm as a ruse, either to convince other prisoners that they are dangerously insane and resilient to pain or to obtain protection from the prison authorities.<ref>Diego Gambetta. ''Codes of the Underworld''. Princeton. {{ISBN|978-0-691-11937-3}}</ref> Prisoners are sometimes placed in cells with no furniture or objects to prevent them from harming themselves.<ref>{{Cite web |date=2022-04-14 |title=Walling up madness |url=https://www.prison-insider.com/en/articles/l-enfermement-a-la-folie |access-date=2024-05-14 |website=Prison Insider |language=en}}</ref> Self-harm also occurs frequently in inmates who are placed in [[solitary confinement]].<ref name=kaba2014>{{cite journal |vauthors=Kaba F, Lewis A, Glowa-Kollisch S, Hadler J, Lee D, Alper H, Selling D, MacDonald R, Solimo A, Parsons A, Venters H |display-authors=6 |title=Solitary confinement and risk of self-harm among jail inmates |journal=American Journal of Public Health |volume=104 |issue=3 |pages=442–447 |date=March 2014 |pmc=3953781 |doi=10.2105/ajph.2013.301742 |pmid=24521238}}</ref>