title: Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: A population-level record linkage study in Western Australia.
abstract: OBJECTIVE
  The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old).
  
  
  METHODS
  We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses.
  
  
  RESULTS
  The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode.
  
  
  CONCLUSIONS
  Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia The School of Population Health, The University of Western Australia, Perth, WA, Australia Nan.Hu@telethonkids.org.au.
authors.forename: Nan
authors.initials: N
authors.lastname: Hu
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Glauert
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia WZB Berlin Social Science Centre, Berlin, Germany Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
authors.forename: Jianghong
authors.initials: J
authors.lastname: Li
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000150:complications*; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000150:complications*; D013997:Time Factors; D014904:Western Australia; D055815:Young Adult
keywords: Deliberate self-harm; administrative record; adolescent and young adult; data linkage; repeated episode