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It is difficult to gain an accurate picture of incidence and prevalence of self-harm.[5][71] This is due in a part to a lack of sufficient numbers of dedicated research centres to provide a continuous monitoring system.[71] However, even with sufficient resources, statistical estimates are crude since most incidences of self-harm are undisclosed to the medical profession as acts of self-harm are frequently carried out in secret, and wounds may be superficial and easily treated by the individual.[5][71] Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys.[72] The World Health Organization estimates that, as of 2010, 880,000 deaths occur as a result of self-harm.[73] About 10% of admissions to medical wards in the UK are as a result of self-harm, the majority of which are drug overdoses.[41] 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,[10] 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.[72] In the United States up to 4% of adults self-harm with approximately 1% of the population engaging in chronic or severe self-harm.[74] Current research suggests that the rates of self-harm are much higher among young people[5] with the average age of onset between 14 and 24.[1][5][6][17][18] The earliest reported incidents of self-harm are in children between 5 and 7 years old.[5] In the UK in 2008 rates of self-harm in young people could be as high as 33%.[75] In addition there appears to be an increased risk of self-harm in college students than among the general population.[29][74] 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.[76] In Ireland, a study found that instances of hospital-treated self-harm were much higher in City and Urban Districts, than in Rural settings.[77] 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.[78] Gender differences In general, the latest aggregated research has found no difference in the prevalence of self-harm between men and women.[74] This is in contrast to past research which indicated that up to four times as many females as males have direct experience of self-harm.[10] However, caution is needed in seeing self-harm as a greater problem for females, since males may engage in different forms of self-harm (e.g., hitting themselves) which could be easier to hide or explained as the result of different circumstances.[5][74] Hence, there remain widely opposing views as to whether the gender paradox is a real phenomenon, or merely the artifact of bias in data collection.[71] 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.[79] 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.[80] 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 youth (age 16 to 19) with 72% of males and 66% of females reporting a past history of self-harm.[81] However, in 2008, a study of young people and self-harm saw the gender gap close, with 32% of young females, and 22% of young males admitting to self-harm.[75] Studies also indicate that males who self-harm may also be at a greater risk of completing suicide.[9] There does not appear to be a difference in motivation for self-harm in adolescent males and females. For example, for both genders there is an incremental increase in deliberate self-harm associated with an increase in consumption of cigarettes, drugs and alcohol. Triggering factors such as low self-esteem and having friends and family members who self-harm are also common between both males and females.[72] 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.[82] 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 hospitalised 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 hospitalisation.[83] 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 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.[20] 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.[18] A study completed in Ireland showed that older Irish adults have high rates of deliberate self-harm, but comparatively low rates of suicide.[77] Developing world Only recently have attempts to improve health in the developing world concentrated on not only physical illness but mental health also.[84] Deliberate self-harm is common in the developing world. Research into self-harm in the developing world is however still very limited although an important case study is that of Sri Lanka, which is a country exhibiting a high incidence of suicide[85] and self-poisoning with agricultural pesticides or natural poisons.[84] Many people admitted for deliberate self-poisoning during a study by Eddleston et al. [84] 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 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.[84] One way of reducing self-harm would be to limit access to poisons;[84] however many cases involve pesticides or yellow 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 make these methods challenging. Prison inmates Deliberate self-harm is especially prevalent in prison populations. A proposed explanation for this is that prisons 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.[86] |
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