Individual- and area-level predictors of self-harm repetition.
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.
Johnston
Amy
A
Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
Cooper
Jayne
J
Webb
Roger
R
Kapur
Navneet
N
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