title: The area-level association between hospital-treated deliberate self-harm, deprivation and social fragmentation in Ireland.
abstract: BACKGROUND
  The extensive literature on the area-level association between socioeconomic characteristics and suicide indicates that the more deprived and socially fragmented an area, the higher its suicide rate. Relatively few studies have examined the association between the incidence of non-fatal suicidal behaviour and area characteristics.
  
  
  OBJECTIVE
  This study investigated the area-level association between hospital-treated deliberate self-harm, deprivation and social fragmentation in Ireland.
  
  
  METHODS
  During 2002-2004, the Irish National Registry of Deliberate Self Harm collected data on self-harm presentations to 38 of Ireland's 40 hospital accident and emergency (A&E) departments, using a standardised methodology that included geocoding patient addresses to small-area level. Annual deliberate self-harm incidence rates and levels of deprivation and social fragmentation were examined nationally and by geographic area. Negative binomial regression was used to investigate the small-area association between deliberate self-harm, deprivation and social fragmentation.
  
  
  RESULTS
  During 2002-2004, an estimated 32 777 deliberate self-harm presentations to A&E departments were made by 25 797 individuals. The total, male and female annual incidence rates were 204, 172 and 237 per 100 000, respectively. There were striking geographic differences in deliberate self-harm presentation rates which were largely explained by the distribution of deprivation, fragmentation, age and gender, and interactions between these factors. Deprivation, rather than fragmentation, had the stronger independent effect on small-area rates of self-harm.
  
  
  CONCLUSIONS
  The highest rates of hospital-treated deliberate self-harm in Ireland are in deprived urban areas. Priority should be given to these areas when implementing community-based interventions aimed at reducing suicidal behaviour.
authors.affiliation: National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Ireland. paul.nsrf@iol.ie
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D011610:Psychosocial Deprivation; D012042:Registries; D016728:Self-Injurious Behavior / Q000191:economics* / Q000523:psychology; D012737:Sex Factors; D012934:Social Isolation; D014504:Urban Health / Q000706:statistics & numerical data*