title: 'He left me a message on Facebook': comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media.
abstract: BACKGROUND
  In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper.
  
  
  OBJECTIVE
  In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors.
  
  
  METHODS
  Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving.
  
  
  RESULTS
  New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers.
  
  
  CONCLUSIONS
  Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm.
  
  
  BACKGROUND
  None.
  © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
authors.affiliation: , MSc, Peninsula Schools of Medicine & Dentistry (PUPSMD), Plymouth University, Plymouth, UK.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Barrett
authors.affiliation: , MSc, South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Shetty
authors.affiliation: , MA, South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Broadbent
authors.affiliation: , PhD, MRCPsych, Department of Psychological Medicine, St Thomas' Hospital, London, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Cross
authors.affiliation: , PhD, MRCPsych, Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology & Neuroscience), London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.affiliation: , MD, MRCPsych, King's College London (Institute of Psychiatry, Psychology & Neuroscience), London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: , PhD, MRCPsych, Peninsula Schools of Medicine & Dentistry (PUPSMD), Plymouth University, Plymouth, UK.
authors.forename: William
authors.initials: W
authors.lastname: Lee