title: Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study.
abstract: BACKGROUND
  Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people.
  
  
  METHODS
  Over 30,000 mainly 15- and 16-year-olds completed anonymous questionnaires at school in Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway. Study criteria were developed to identify episodes of self-harm; the prevalence of self-harm acts and thoughts, methods used, repetition, reasons given, premeditation, setting for the act, associations with alcohol and drugs, hospitalisation, and whether other people knew, were examined.
  
  
  RESULTS
  Self-harm was more than twice as common among females as males and, in four of the seven countries, at least one in ten females had harmed herself in the previous year. Additional young people had thought of harming themselves without doing so. More males and females in all countries except Hungary cut themselves than used any other method, most acts took place at home, and alcohol and illegal drugs were not usually involved. The most common reasons given were 'to get relief from a terrible state of mind' followed by 'to die', although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime.
  
  
  CONCLUSIONS
  Deliberate self-harm is a widespread yet often hidden problem in adolescents, especially females, which shows both similarities and differences internationally.
authors.affiliation: School of Health Sciences and Social Care, Brunel University, Uxbridge, UK. nicola.madge@brunel.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Madge
authors.forename: Anthea
authors.initials: A
authors.lastname: Hewitt
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Erik Jan
authors.initials: EJ
authors.lastname: de Wilde
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.forename: Sandor
authors.initials: S
authors.lastname: Fekete
authors.forename: Kees
authors.initials: K
authors.lastname: van Heeringen
authors.forename: Diego
authors.initials: D
authors.lastname: De Leo
authors.forename: Mette
authors.initials: M
authors.lastname: Ystgaard
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005060:Europe; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data