title: The iceberg of suicide and self-harm in Irish adolescents: a population-based study.
abstract: OBJECTIVE
  Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community.
  
  
  METHODS
  Annual suicide rates were calculated for 15-17 year-old in the Cork and Kerry region in Ireland based on data from the Central Statistics Office. Rates of hospital-treated self-harm were collected by the Irish National Registry of Deliberate Self-Harm. Rates of self-harm in the community were assessed using a survey of 3,881 adolescents, the Child and Adolescent Self-harm in Europe study.
  
  
  RESULTS
  The annual suicide rate was 10/100,000. Suicide was six times more common among boys than girls. The annual incidence rate of hospital-treated self-harm was approximately 344/100,000, with the female rate almost twice the male rate. The rate of self-harm in the community was 5,551/100,000, and girls were almost four times more likely to report self-harm. For every boy who died by suicide, 16 presented to hospital with self-harm and 146 reported self-harm in the community. For every female suicide, 162 girls presented to hospital with self-harm and 3,296 reported self-harm.
  
  
  CONCLUSIONS
  Gender differences in relative rates of self-harm and suicide are very large, with boys who have harmed themselves at particularly high risk of suicide. Knowledge of the relative incidence of self-harm and suicide in adolescents can inform prevention programmes and services.
authors.affiliation: National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland, e.mcmahon@ucc.ie.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: McMahon
authors.forename: Helen
authors.initials: H
authors.lastname: Keeley
authors.forename: Mary
authors.initials: M
authors.lastname: Cannon
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
authors.forename: Derek
authors.initials: D
authors.lastname: Chambers
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D012042:Registries; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data*