title: Self-harm in Oxford, England: epidemiological and clinical trends, 1996-2010.
abstract: BACKGROUND
  Self-harm is a major healthcare problem and changes in its prevalence and characteristics can have important implications for clinical services, treatment and prevention.
  
  
  METHODS
  We analysed data on all self-harm presentations to the general hospital in Oxford between 1996 and 2010 using the Oxford Monitoring System for Self-harm. We investigated trends in prevalence, methods and repetition of self-harm, and receipt of psychosocial assessment. For patients receiving a psychosocial assessment, we investigated trends in alcohol use and misuse, prior psychiatric treatment and self-harm, problems, and suicidal intent.
  
  
  RESULTS
  Rates of self-harm rose in both genders between 1996 and 2002/2003, after which they declined. There was evidence of a possible cohort effect, whereby higher rates in younger males in earlier years transferred over time to older age groups. Self-cutting, hanging and jumping became more common. Paracetamol was involved in 44.9 % of all self-poisoning episodes. Overdoses of antidepressants (particularly selective serotonin reuptake inhibitors) increased, as did those of mood stabilisers, non-opiate analgesics excluding paracetamol (e.g. non-steroidal anti-inflammatory drugs), and non-ingestible poisons. Alcohol use in relation to self-harm and alcohol-related problems became more common, as did history of prior psychiatric treatment and, especially, of self-harm, and employment problems from 2008. Despite national guidance, the proportion of patients undergoing psychosocial assessment declined.
  
  
  CONCLUSIONS
  Major changes in the extent and nature of self-harm occurred over the study period, some suggestive of increased psychopathology and others reflecting prescribing practices and changes in drinking patterns. The findings emphasise the need for psychosocial assessment following self-harm, to identify treatment needs and reduce repetition.
authors.affiliation: Centre for Suicide Research, University of Oxford, Oxford, UK, keith.hawton@psych.ox.ac.uk.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Camilla
authors.initials: C
authors.lastname: Haw
authors.forename: Deborah
authors.initials: D
authors.lastname: Casey
authors.forename: Liz
authors.initials: L
authors.lastname: Bale
authors.forename: Fiona
authors.initials: F
authors.lastname: Brand
authors.forename: Dorothy
authors.initials: D
authors.lastname: Rutherford
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose / Q000453:epidemiology* / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D012737:Sex Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data / Q000639:trends*; D055815:Young Adult