title: Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households.
abstract: BACKGROUND
  Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa.
  
  
  METHODS
  Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD) study. Logistic regression analysis using the HEAD study data (2006-2011) was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt) within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm.
  
  
  RESULTS
  A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR) 5.72; 95% CI 1.64-19.97); that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39-33.56) and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14-16.47).
  
  
  CONCLUSIONS
  This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.
authors.affiliation: Environment & Health Research Unit, South African Medical Research Council, Johannesburg, South Africa.|Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nisha
authors.initials: N
authors.lastname: Naicker
authors.affiliation: Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.|Epidemiology and Surveillance Unit, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Pieter
authors.initials: P
authors.lastname: de Jager
authors.affiliation: Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shan
authors.initials: S
authors.lastname: Naidoo
authors.affiliation: Environment & Health Research Unit, South African Medical Research Council, Johannesburg, South Africa.|Department of Community Medicine, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.|Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
authors.forename: Angela
authors.initials: A
authors.lastname: Mathee
mesh_terms: D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D011203:Poverty / Q000523:psychology*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000209:etiology* / Q000523:psychology; D012959:Socioeconomic Factors; D013019:South Africa; D014505:Urban Population