title: Switching methods of self-harm at repeat episodes: Findings from a multicentre cohort study.
abstract: BACKGROUND
  Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital.
  
  
  METHODS
  The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods.
  
  
  RESULTS
  Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching.
  
  
  CONCLUSIONS
  Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases.
  
  
  CONCLUSIONS
  Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm.
authors.affiliation: Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK. Electronic address: d.w.owens@leeds.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Owens
authors.affiliation: Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Kelley
authors.affiliation: Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK.
authors.forename: Theresa
authors.initials: T
authors.lastname: Munyombwe
authors.affiliation: Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bergen
authors.affiliation: Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ness
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.affiliation: Institute of Health Sciences, University of Leeds, Charles Thackrah Building, Clarendon Road, Leeds, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology*; D012737:Sex Factors
keywords: Longitudinal study; Self-harm; Suicide