title: High-Volume Repeaters of Self-Harm.
abstract: BACKGROUND
  Repetition of self-harm is common and is strongly associated with suicide. Despite this, there is limited research on high-volume repetition.
  
  
  OBJECTIVE
  To investigate individuals with high-volume repeat self-harm attendances to the emergency department (ED), including their patterns of attendance and mortality.
  
  
  METHODS
  Data from the Multicentre Study of Self-Harm in England were used. High-volume repetition was defined as ⩾15 attendances within 4 years. An attendance timeline was constructed for each high-volume repeater (HVR) and the different patterns of attendance were explored using an executive sorting task and hierarchical cluster analysis.
  
  
  RESULTS
  A small proportion of self-harm patients are HVRs (0.6%) but they account for a large percentage of self-harm attendances (10%). In this study, the new methodological approach resulted in three types of attendance patterns. All of the HVRs had clusters of attendance and a greater proportion died from external causes compared with non-HVRs.
  
  
  CONCLUSIONS
  The approach used in this study offers a new method for investigating this problem that could have both clinical and research benefits. The need for early intervention is highlighted by the large number of self-harm episodes per patient, the clustered nature of attendances, and the higher prevalence of death from external causes.
authors.affiliation: 1 Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ness
authors.affiliation: 2 Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: 2 Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bergen
authors.affiliation: 1 Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.affiliation: 3 Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Risk, Manchester, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.affiliation: 3 Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Risk, Manchester, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.affiliation: 3 Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Risk, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.affiliation: 1 Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D016000:Cluster Analysis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: cluster; emergency department; repetition; self-harm; suicide