Since 2008, hospital cases of men in England who engage in self-harm, such as cutting or overdosing on prescription meds, have been rising steadily, according to a new study published in the online journal BMJ Open.

The findings also reveal that only about half of these men who go to the hospital after such an incident received a special mental health assessment, as national guidelines specify should occur. The researchers are particularly concerned about this phenomenon, as episodes of self-harm precede half of all cases of suicide deaths.

For the study, the researchers evaluated data of reported cases of self-harm among people aged 15 and older at five general hospitals in the cities of Oxford, Manchester, and Derby between 2000 and 2012. Self-harm includes intentional injury and overdosing on prescription drugs.

Because these three cities are socially and economically diverse, the study participants are reasonably representative of urban patterns of self-harm across the country, say the researchers.

During the 13-year study period, there were 84,378 episodes of self-harm involving 47,048 people at the five different hospitals. One in four people self-harmed again within a year. Over half of these cases (58+ percent) were women.

Almost one-third (30 percent) were receiving some form of psychiatric care when they self-harmed.

Overall, self-harm among women began decreasing from 2000 onwards. Self-harm episodes also fell among men, but only until 2008, after which these events steadily began increasing, possibly because of the effects of the economic downturn, suggest the researchers.

The self-harm rates closely mirrored patterns of suicide seen in the general population, for both men and women.

Of all the self-harm episodes, more than three-quarters involved an intentional overdose. Of these, common painkillers were used in over half the overdoses, while antidepressants were used in one in four (just under 25 percent). Benzodiazepines, a class of drugs used to treat anxiety and sleep problems, were used in approximately one in seven cases (just under 14 percent). Major tranquilizers and antipsychotics were used in around seven percent of cases.

A sharp increase in reported cases of cutting/stabbings and hanging/strangulation occurred in the second half of the study period.

“It should be noted that there is a stronger risk of suicide following self-cutting compared to self-poisoning,” write the researchers, adding, “Also repetition of self-harm is more common in individuals who cut themselves.”

And while the proportion of people getting a specialized mental health assessment following their visit to hospital was greater in 2012 than in 2003, only just over half (53 percent) of 67,653 episodes of self-harm were followed up with a mental health assessment.

This was particularly true of people who cut themselves, with only just over a third (38 percent) of these patients receiving an assessment, compared with more than 56 percent of those who overdosed.

“Our finding that only a little over a half of individuals presenting to a hospital after self-harm were offered psychosocial assessment and that individuals who self-injured were least likely to receive an assessment, coupled with the rise in self-injury as a method of self-harm, and the link between such methods and suicide, may have important implications for the management of self-harm in hospitals,” suggest the researchers.

Source: BMJ

Young man talking with doctor photo by shutterstock.