Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study
Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study
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DOI：
10.1016/s2215-0366(17)30478-9
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发表时间：
2018-02-01
影响因子：
64.3
通讯作者：
Hawton, Keith
中科院分区：
文献类型：
--
作者：
Geulayov, Galit;Casey, Deborah;Hawton, Keith
背景对青少年致命性和非致命性自残的相对发生率知之甚少。我们估计了英国青少年自杀、医院呈现的非致命性自我伤害和社区发生的非致命性自我伤害的发生率。方法我们使用国家死亡率统计数据(2011年1月1日至2013年12月31日)、来自英格兰自我伤害多中心研究的五家医院的医院监测数据(2011年1月1日至2013年12月31日)以及学校调查(2015)的数据来估计英格兰12-17岁青少年每10万人年的致命性和非致命性自我伤害的发生率。在2011-13年间，英国有171名12-17岁的青少年(119名[70%]男性和133名[78%]15-17岁青少年)和1320名青少年(1028名[78%]女性和977名[74%]15-17岁青少年)因非致命性自残而被送往研究医院。2015年，在接受调查的5506名青少年中，有322名(6%)在过去一年中报告了社区中的自残行为(250名[78%]女性和164名[51%]15-17岁青少年)。在12至14岁的青少年中，自杀死亡的男孩中，109人在自杀后去医院，3067人报告在社区自杀，而每名女孩自杀死亡，1255人因自杀而去医院，21995人在社区报告自我伤害。在15-17岁的青少年中，男性每自杀120人，社区自残838人；而女性每自杀919人，社区自残6406人。自杀方式以上吊或窒息为最常见(125例，73%)，自杀后就医以自杀为主(849例，71%)，自残为社区主要自杀方式(286例，89%)。男性与女性、12~14岁青少年与15~17岁青少年自杀致死率与非致命性自伤率差异有统计学意义，尤其以女性自伤人数最多。我们的发现强调了为青少年提供资源充足的社区和医院心理健康服务的必要性，并在学校预防方面进行了更大的投资。
Background Little is known about the relative incidence of fatal and non-fatal self-harm in young people. We estimated the incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England.Methods We used national mortality statistics (Jan 1, 2011, to Dec 31, 2013), hospital monitoring data for five hospitals derived from the Multicentre Study of Self-Harm in England (Jan 1, 2011, to Dec 31, 2013), and data from a schools survey (2015) to estimate the incidence of fatal and non-fatal self-harm per 100 000 person-years in adolescents aged 12-17 years in England. We described these incidences in terms of an iceberg model of self-harm.Findings During 2011-13, 171 adolescents aged 12-17 years died by suicide in England (119 [70%] male and 133 [78%] aged 15-17 years) and 1320 adolescents presented to the study hospitals following non-fatal self-harm (1028 [78%] female and 977 [74%] aged 15-17 years). In 2015, 322 (6%) of 5506 adolescents surveyed reported self-harm in the past year in the community (250 [78%] female and 164 [51%] aged 15-17 years). In 12-14 year olds, for every boy who died by suicide, 109 attended hospital following self-harm and 3067 reported self-harm in the community, whereas for every girl who died by suicide, 1255 attended hospital for self-harm and 21 995 reported self-harm in the community. In 15-17 year olds, for every male suicide, 120 males presented to hospital with self-harm and 838 self-harmed in the community; whereas for every female suicide, 919 females presented to hospital for self-harm and 6406 self-harmed in the community. Hanging or asphyxiation was the most common method of suicide (125 [73%] of 171), self-poisoning was the main reason for presenting to hospital after self-harm (849 [71%] of 1195), and self-cutting was the main method of self-harm used in the community (286 [89%] of 322).Interpretation Ratios of fatal to non-fatal rates of self-harm differed between males and females and between adolescents aged 12-14 years and 15-17 years, with a particularly large number of females reporting self-harm in the community. Our findings emphasise the need for well resourced community and hospital-based mental health services for adolescents, with greater investment in school-based prevention.