title: Individual- and area-level predictors of self-harm repetition.
abstract: BACKGROUND
  No ecological studies have examined the relationship between area characteristics, individual characteristics and self-harm repetition.
  
  
  OBJECTIVE
  To investigate the association between area-level factors and incidence and repetition of self-harm, and to identify which area-level factors are independently associated with repetition after adjustment for individual factors.
  
  
  METHODS
  Prospective cohort study using the Manchester Self-Harm database. Adults who were resident in Manchester and presented to an emergency department following self-harm between 1997 and 2002 were included (n = 4743). The main outcome measure was repeat self-harm within 6 months of the index episode.
  
  
  RESULTS
  Four individual factors (previous self-harm, previous psychiatric treatment, employment status, marital status) and one area-based factor (proportion of individuals who were of White ethnicity) were independently associated with repetition.
  
  
  CONCLUSIONS
  Repetition of self-harm may be more strongly related to individual factors than to area characteristics. We need to better understand the processes underlying ecological associations with suicidal behaviour before embarking on area-based interventions.
authors.affiliation: Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Johnston
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.forename: Roger
authors.initials: R
authors.lastname: Webb
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D012959:Socioeconomic Factors