National Suicide Research Foundation
EVE GRIFFIN
NIALL McTERNAN
CONAL WRIGLEY
SARAH NICHOLSON
ELLA ARENSMAN
EILEEN WILLIAMSON
PAUL CORCORAN
NATIONAL SELF-HARM REGISTRY IRELAND
ANNUAL REPORT 2018
1
N S R F
Contents
Foreword 3
ExecutiveSummary 4
Recommendations 5
RecentpublicationsfromtheRegistry(2018-2019) 8
2018StatisticsataGlance 9
ImpactoftheRegistryatgloballevel 10
Methods 11
SectionI.Hospital Presentations 14
SectionII.Incidence Rates 28
AppendixI–Self-HarmbyHSEHospitalsGroupandHospital 36
AppendixII–RecommendedNextCarebyHospital 39
AppendixIII–RepetitionbyHospital 41
AppendixIV–Self-HarmbyResidentsoftheRepublicofIreland 43
2
TheNationalSelf-HarmRegistryIrelandteam
SuggestedCitation:
Griffin,E,McTernanN,Wrigley,C,Nicholson,S,
Arensman,E,Williamson,E,Corcoran,P.(2019).
NationalSelf-HarmRegistryIrelandAnnualReport
2018.Cork:NationalSuicideResearchFoundation.
Publishedby:
NationalSuicideResearchFoundation,Cork.
©NationalSuicideResearchFoundation2019
ISSN16494326
ThisreporthasbeencommissionedbytheHSE
NationalOfficeforSuicidePrevention.
HardcopiesoftheAnnualReport2018are
availablefrom:
NationalSuicideResearchFoundation
4thFloor
WesternGatewayBuilding
UniversityCollegeCork
Ireland
Tel:+353214205551
Email:[email protected]
ElectroniccopiesoftheAnnualReport2018
areavailablefromthewebsiteoftheNational
SuicideResearchFoundation:www.nsrf.ie
AcknowledgementsThefollowingistheteamofpeoplewhocollectedthedatathatformed
thebasisofthisAnnualReport.Theireffortsaregreatlyappreciated.
AlanO’Shea,aosdesign: GraphicDesign
SarahNicholson,NSRF ResearchOfficer
LeonFan,NSRF TechnicalSupport
TiernanHourihan,NSRF TechnicalSupport
WewouldliketoacknowledgetheassistanceofstaffoftheDepartment
ofHealth,theHSENationalOfficeforSuicidePrevention,therespective
HSEregionsandtheindividualhospitalsthathavefacilitatedtheworkof
theRegistry.
HSEDublin/MidlandsRegion
LiisaAula
EdelMcCarra
DiarmuidO’Connor
LauraShehan
HSEDublin/NorthEastRegion
AgnieszkaBiedrycka
AlanBoon
RitaCullivan
JamesMcGuiggan
HSESouthRegion
UrsulaBurke
TriciaShannon
KarenTwomey
UnaWalsh
HSEWestRegion
AilishMelia
CatherineMurphy
MaryNix
EileenQuinn
National Self-Harm Registry Ireland
3
WesternGatewayBuilding,UniversityCollegeCork
ForewordTheNationalSelf-HarmRegistryIreland(NSHRI)
wasestablishedoversixteenyearsagoatthe
requestoftheDepartmentofHealthandChildren,
bytheNationalSuicideResearchFoundation
workingincollaborationwiththeSchoolofPublic
Health,UniversityCollegeCork.Itisfundedby
theHealthServiceExecutive’sNationalOffice
forSuicidePrevention.Itistheworld’sfirst
nationalregistryofcasesofintentionalself-harm
presentingtohospitalemergencydepartments.
Inrecentyearstherehasbeenastabilisationin
therateofhospital-treatedself-harminIreland,
withanincreaseinself-harmdetectedin2018.
Theincreasewasrecordedforbothmenand
women,acrossallagegroups.Itisimportantto
highlighttheincreasingtrendinyoungpeople,
aswellasintheuseofmethodsassociatedwith
higherlethality.Thesestatisticsareofconcern,
andresearchwhichcanexaminethecausesof
suchtrendsshouldbeanurgentpriority.Such
emergingtrendssignaltheneedformulti-level
responsestopreventingself-harm,bothtargeted
interventionsforthoseengaginginself-harmas
wellaspublichealthinterventionsatapopulation
leveltoreducetheriskofself-harmforvulnerable
individuals.
TheRegistryrepresentsanimportantresource
inthecontextofbothnationalandinternational
suicidepreventionefforts.TheWorldHealth
Organisationhighlightedtheimportanceofsuch
systems,statingintheir2012report“Preventing
Suicide–AGlobalImperative”,that‘up-to-date
surveillanceofsuicidesandsuicideattemptsis
anessentialcomponentofnationalandlocal
suicidepreventionefforts’(p.16).Irelandwas
thefirstcountrytorecognisethis,throughthe
establishmentofTheNationalSelf-HarmRegistry
Ireland,whichhasbeenrecognisedasamodelof
bestpracticebytheWorldHealthOrganisation.
TheRegistryhasinformedcoreactionsinthe
IrishNationalStrategytoReduceSuicidein
Ireland,ConnectingforLife2015-2020,andis
akeycomponentoftheoutcomesframework
beingusedtomonitorprogressandexaminethe
impactofimplementedactions.TheRegistryhas
identifiedkeytrendsandriskfactorstoinform
policyandfurtherresearch.
In2019,twoHealthResearchBoardgrants,worth
morethan¤1million,wereawardedtoresearchers
attheNationalSuicideResearchFoundation
andtheSchoolofPublicHealthinUniversity
CollegeCork.Thefirstisafive-yearfellowship
whichaimstoexaminetheonsetofself-harm
inadolescenceaswellasidentifyingimportant
riskfactorsforrepeatself-harmandsuicide.The
second,afour-yearprogrammeofresearch,will
examinehowroutinemanagementofself-harmin
acutesettingsimpactsonpatientoutcomes,with
regardsrepeatself-harm,suicideandpremature
mortality.Theprojectwillalsoidentifythebarriers
andfacilitatorstoimplementingservicesin
Ireland,inordertoinformandoptimiseservice
delivery.Suchinnovativeresearchisessential
tofurtherunderstandhowbesttodevelop
appropriateresponsesandinterventionsforall
personswhoengageinself-harm.
Iwouldliketoacknowledgetheon-going
commitmentanddedicationofthedata
registrationofficersinensuringthehighquality
operationoftheRegistry.Wewouldalsoliketo
commendthehospitalstafffortheirdiligenceand
dedicationinmeetingtheneedsofindividuals
whopresenttohospitalasaresultofself-harm.
Dr Paul CorcoranHeadofResearch
NationalSuicideResearchFoundation,Cork.
National Self-Harm Registry Ireland
4
Thisistheseventeenthannualreportfromthe
NationalSelf-HarmRegistryIreland.Itisbasedon
datacollectedonpersonspresentingtohospital
emergencydepartmentsfollowingself-harmin
2018intheRepublicofIreland.TheRegistryhad
nearcompletecoverageofthecountry’shospitals
fortheperiod2002-2005and,since2006,all
generalhospitalandpaediatrichospitalemergency
departmentsintheRepublicofIrelandhave
contributeddatatotheRegistry.
Main findings
In2018,theRegistryrecorded12,588presentations
tohospitalduetoself-harmnationally,involving
9,785individuals.Theage-standardisedrateof
individualspresentingtohospitalfollowingself-harm
in2018was210per100,000.Thiswasasignificant
increaseof6%ontherateof199per100,000in2017.
Theratein2018was12%higherthanin2007,the
yearbeforetheeconomicrecession.
In2018,thenationalmalerateofself-harmwas193
per100,000,7%higherthan2017.Thefemalerate
ofself-harmin2018was229per100,000,5%higher
than2017.Thus,thefemalerateofself-harmin2018
was7%higherthanitwasin2007whereasthemale
ratein2018was19%higherthanitspre-recession
level.
Consistentwithpreviousyears,thepeakratefor
womenwasinthe15-19yearsagegroupat766per
100,000,whereasthepeakrateamongmenwas
in20-24year-oldsat543per100,000.Theserates
implythatoneinevery131girlsintheagegroup
15-19andoneinevery184menintheagegroup
20-24yearspresentedtohospitalin2018asa
consequenceofself-harm.In2018,themalerateof
self-harmamong10-24year-oldsincreasedby8%.
Therateofself-harmamongwomenaged65-69
yearsincreasedby47%.
Therewasvariationintherateofself-harm
byregion,withthehighestratesrecordedin
urbanareas.The2018reportpresentsdataby
administrativecity/county,byLocalHealth
Office(LHO)andbyHSECommunityHealthcare
Organisation(CHO).
Therewere539presentationsmadebyresidents
ofhomelesshostelsandpeopleofnofixedabode
in2018,accountingforapproximately4%ofall
presentationsrecordedbytheRegistry.Thenumber
ofpresentationsbythosewithnofixedabodewas
9%lowerthan2017,but57%higherthanin2007.
Consistentwithpreviousyears,intentionaldrug
overdosewasthemostcommonmethodofself-
harm,involvedinalmosttwo-thirds(62%)of
self-harmpresentationsregisteredin2018.Self-
cuttingwasrecordedin30%ofallepisodesand
wasmorecommoninmen(31%)thaninwomen
(28%).Attemptedhangingwasinvolvedin9%of
allself-harmpresentations(12%formenand5%
forwomen).At1,072,thenumberofpresentations
involvingattemptedhangingwas24%higher
than2017(+22%formenand+30%forwomen).
Presentationsinvolvingself-cuttingincreasedby
17%in2018.Whilerareasamethodofself-harm,
thenumberofpresentationsinvolvingattempted
drowningincreasedby19%from2017to2018(from
367to437).Alcoholwasinvolvedin30%ofallcases.
Alcoholwassignificantlymoreofteninvolvedinmale
episodesofself-harmthanfemaleepisodes(34%
and27%,respectively).
In2018,72%(n=8,490)ofpatientswereassessedbya
memberofthementalhealthteaminthepresenting
hospital.In2018,13%ofpatientslefttheemergency
departmentbeforeanextcarerecommendation
couldbemade.Mostcommonly,56%ofcaseswere
dischargedfollowingtreatmentintheemergency
department.Themajorityofthese(79%)were
providedwitharecommendedreferralorfollow-up
appointment.Therewasconsiderablevariationin
recommendednextcarebyhospital,particularlyin
relationtotheproportionofpatientsadmittedtothe
presentinghospital,theproportionleavingbefore
arecommendationandtheproportionreceivinga
mentalhealthassessment.Thisobservedvariation
islikelytobeduetovariationintheavailabilityof
resourcesandservicesbutitalsosuggeststhat
assessmentandmanagementprocedureswith
respecttoself-harmpatientsarelikelytobevariable
andinconsistentacrossthecountry.
Theproportionofactsaccountedforbyrepetition
in2018(22.3%)wassimilartopreviousyears.Ofthe
9,785self-harmpatientswhopresentedtohospital
in2018,1,427(14.6%)madeatleastonerepeat
presentationduringthecalendaryear.Therefore,
repetitioncontinuestoposeamajorchallengeto
hospitalstaffandfamilymembersinvolved.In2018,
atleastfiveself-harmpresentationsweremadeby
153individuals.Theserepresented2%ofallself-
harmpatients,butaccountedfor10%ofallself-harm
presentationsrecorded.Asinpreviousyears,self-
cuttingwasassociatedwithanincreasedlevelof
repetition.Riskofrepetitionwasgreatestinthedays
andweeksfollowingaself-harmpresentationto
hospitalandtheriskincreasedmarkedlywitheach
subsequentpresentation.
Executive Summary
National Self-Harm Registry Ireland
5
Recommendations
In2018,therateofself-harminIrelandincreased
by6%,followingaperiodofstabilisationover
thepastsevenyears,since2010.Theobserved
increaseinself-harmin2018wasevidentacross
allagesandforbothmenandwomen,with
anincreaseinpresentationsrecordedinmost
hospitals.Thisincreasecanbeattributedto
presentationsinvolvingattemptedhanging,self-
cuttingandstreetdrugs.Thesetrendsunderline
theneedtofurtherdevelopmentalhealthservices
inIrelandforindividualsengaginginself-harm,
particularlyforyoungpeople.Inaddition,activities
toreduceaccesstomeans,earlyinterventionand
preventionmeasures,andregulationofillegalor
restrictedsubstancesarecriticaltoreducingthe
incidenceofself-harminIreland.
Self-harm among young people
Thehighestratesofself-harmareconsistently
seeninyoungpeople.Thefindingsofthisreport
showafurtherincreaseinself-harmamong
youngpeopleaged10-24years,followinga22%
increaseinratesbetween2007and2016.1A
recentstudyshowedasimilarincreasein‘non-
suicidalself-harm’(NSSH)inEnglandbetween
2000and2014,particularlyamongwomenaged
16-24years,atrendassociatedwithanincreasein
self-cutting.2Changesinmentalhealthsymptoms
maybecontributingtoincreasingratesofself-
harm,3particularlyamonggirls,giventhestrong
associationsbetweenmentaldisordersand
self-harminadolescents.AEuropeansurvey
foundthat4%ofyoungpeopleaged15-24years
reportedchronicdepression,withtheratehighest
inIrelandat12%.4Thereisaneedtoensuretimely
andappropriatechildandadolescentmental
healthservicesinIrelandandtheRegistryfindings
supporttheprioritiesidentifiedbytheHSE’s
NationalServicePlan2019.5Inparticular,both
evidence-basedmentalhealthprogrammesand
appropriatereferralandtreatmentoptionsare
crucialtoaddresstheneedsofyoungpeoplein
thekeytransitionstagesbetweenchildhoodand
adolescenceandintoadulthood.Increasesinself-
harmamongchildrenaged10-14yearsindicate
thattheageofonsetofself-harmisdecreasing.
Thesetrendsunderlinetheneedforpreventative
interventions,suchasschool-baseduniversal
mentalhealthprogrammesthathavebeenfound
tobeeffectiveinpreventingsuicideattemptsin
youngadolescents.6Programmesinprimaryand
post-primarysettingsarerequiredandshould
focusonpreventingsuicidalbehaviouraswellas
buildingresilience.
Restricting access to means
Theproportionofpresentationsinvolving
methodsassociatedwithhighlethalityhas
steadilyincreasedinrecentyears.Therehavebeen
furtherincreasesrecordedin2018,inbothmen
andwomen.Ithaspreviouslybeenrecommended
thatmoreinnovativeandintensifiedeffortsshould
bemadetoreduceself-harmandsuicideby
hanging,includemonitoringofmediaandsocial
mediaplatformswhichhavebeenassociatedwith
increasedsuicidesinvolvingasphyxiaandother
highlylethalmethods.7
Intentionaldrugoverdoseisthemostcommon
methodofself-harmrecordedbytheRegistry.
In2018,asharpincreaseintheuseofstreet
drugswasrecorded,involvedinoneinten
1Griffin,E,etal.(2018).Increasingratesofself-harmamong
children,adolescentsandyoungadults:A10-yearnational
registrystudy2007-2016.SocialPsychiatryandPsychiatric
Epidemiology,53:663-71.
2McManus,S,etal.(2019).Prevalenceofnon-suicidalself-harm
andservicecontactEngland,2000-14:Repeatedcross-
sectionalsurveysofthegeneralpopulation.LancetPsychiatry,
6:573-81.
3Bor,W,etal.(2014).Arechildandadolescentmentalhealth
problemsincreasinginthe21stcentury?Asystematicreview.
Australia&NewZealandJournalofPsychiatry,48:606–16.
4Eurofound(2019).Inequalitiesintheaccessofyoungpeople
toinformationandsupportservices.PublicationsOfficeofthe
EuropeanUnion,Luxembourg.https://www.eurofound.europa.
eu/sites/default/files/ef_publication/field_ef_document/
ef19041en.pdf
5HealthServiceExecutive(2019).NationalServicePlan2019.
https://www.hse.ie/eng/services/publications/serviceplans/
national-service-plan-2019.pdf
6 Wasserman,D,etal.(2015).School-basedsuicideprevention
programmes:TheSEYLEcluster-randomised,controlledtrial.
TheLancet,385:136-44.
7Sinyor,M,etal.(2018).Theassociationbetweensuicidedeaths
andputativelyharmfulandprotectivefactorsinmediareports.
CanadianMedicalAssociationJournal.190:E900-07.
6
Recommendations
intentionaldrugoverdoses.Cannabiswasthemost
commonstreetdrugrecorded,particularlyamong
youngmen,reflectinganincreasedprevalence
ofcannabisuseamongthisdemographicinthe
generalpopulation.8Arecentsystematicreviewand
meta-analysis9foundthatcannabisconsumptionin
adolescencewasassociatedwithincreasedriskof
developingmajordepressioninyoungadulthood,
andanincreasedriskofsuicidalideationand
suicideattemptsinyoungadulthood.TheRegistry
detectedanincreaseintheinvolvementofcocaine
inself-harmpresentationsin2018,primarilyamong
thoseaged35-44years.Publichealthpoliciesto
addresstheuseofillegalsubstancesshouldbe
furtherdeveloped.Thereisgrowingevidencethat
suchactivitiescanresultinpositiveoutcomesfor
thegeneralpopulation.AnIrishstudyreportedthat
legislationintroducedin2010toendthetradeof
newpsychoactivesubstancesinheadshopsresulted
inadecreaseofdrug-relatedpsychiatricadmissions
betweenMay2010andSeptember2012,withthe
biggesteffectobservedamongyoungmalesaged
18-24years.10TheRegistryobservedadecreasein
thenumberofstreetdrugsinvolvedinintentional
overdosebetween2011and2013,aneffectmost
pronouncedamongmen.Howeversince2013,the
numberofpresentationsinvolvingstreetdrugshas
increasedby77%.
Alcoholisaconsistentfactorassociatedwithself-
harm,presentinapproximately30%ofpresentations
tohospital,andassociatedwithpeaksinattendances
atnight,weekendsandonpublicholidays.Alcohol
isanimportantprecipitatingfactorforself-harm,
asitmayhaveadisinhibitingeffect,aswellas
increasingaggressiveness,psychologicaldistressand
impulsivity.11Individualspresentingwithself-harm
mayalsohaveadiagnosisforanalcohol-related
disorder.Suchcomplexpresentationsindicate
theneedforactiveconsultationandcollaboration
betweenthementalhealthservicesandaddiction
treatmentservicesforpatientswhopresentwith
dualdiagnoses.12TheintroductionofthePublic
Health(Alcohol)Act2018isapositivedevelopment,
introducingevidence-basedpoliciestoreducethe
burdenofalcoholharmonoursocietybyimproving
health,safetyandwellbeing.TheRegistrywill
monitortheimpactofthelegislationandassociated
measuresonalcohol-relatedself-harm.
Clinical management of self-harm
Thereportedproportionofpatientsreceivinga
mentalhealthassessment(72%)aspartoftheircare
issimilartopreviousyears,andhigherthanthat
reportedinothercountries.TheNationalClinical
ProgrammefortheAssessmentandManagement
ofpeoplepresentingtotheEmergencyDepartment
followingSelf-Harmhasnowbeenimplemented
across24adultemergencydepartmentsinIreland.13
Oneoftheaimsoftheprogrammeistoimprovethe
responsereceivedbyeveryindividualpresenting
withself-harm,regardlessofthenatureofthe
self-harminvolved.TheProgrammeprovidesa
numberofevidence-basedrecommendationsonthe
managementofself-harminemergencydepartment
(seenextpage).
8Bates,G.(2017).ThedrugssituationinIreland:anoverview
oftrendsfrom2005to2015.CentreforPublicHealthat
LiverpoolJohnMooresUniversity.
9Gobbi,G,etal.(2019).Associationofcannabisusein
adolescenceandriskofdepression,anxiety,andsuicidality
inyoungadulthood:Asystematicreviewandmeta-analysis.
JAMAPsychiatry,76:426-34.
10Smyth,BP,etal.(2019).Legislationtargetingheadshops
sellingnewpsychoactivesubstancesandchangesindrug-
relatedpsychiatricadmissions:Anationaldatabasestudy.
EarlyInterventioninPsychiatry,1-8.
11Hufford,MR.(2001).Alcoholandsuicidalbehavior.Clinical
PsychologyReview,21,797–811.
12DepartmentofPublicHealthHSESouth(2019).Afocuson
alcoholandhealthinCorkandKerry.AreportoftheDirector
ofPublicHealth.Cork:DepartmentofPublicHealthHSE
South.https://www.drugsandalcohol.ie/30602/
13HealthServiceExecutive(2016).NationalClinicalProgramme
fortheAssessmentandManagementofPatientsPresenting
totheEmergencyDepartmentfollowingSelf-Harm.https://
www.hse.ie/eng/services/publications/clinical-strategy-
and-programmes/national-clinical-programme-for-the-
assessment-and-management-of-patients-presenting-to-
emergency-departments-following-self-harm.pdf
7
Recommendations
Eve GriffinManager,NationalSelf-HarmRegistryIreland,
NationalSuicideResearchFoundation,Cork
Niall McTernanDataManager,NationalSelf-HarmRegistry
Ireland,NationalSuicideResearchFoundation,
Cork
Conal WrigleyResearchPsychologist,NationalSelf-Harm
RegistryIreland,NationalSuicideResearch
Foundation,Cork
Sarah NicholsonResearchOfficer,NationalSelf-HarmRegistry
Ireland,NationalSuicideResearchFoundation,
Cork
Ella ArensmanChiefScientist,NationalSuicideResearch
Foundation,Cork
ResearchProfessor,SchoolofPublicHealth,
UniversityCollegeCork
Eileen WilliamsonChiefExecutiveOfficer,NationalSuicide
ResearchFoundation,Cork
Paul CorcoranHeadofResearch,NationalSuicideResearch
FoundationCork
Howeverthefindingsfromthe2018Registry
reportindicatethatthereisstillconsiderable
variationinrecommendednextcareacross
hospitals,andonaverage,oneineightpatients
leavetheemergencydepartmentwithout
beingseenbyaclinicianorwithoutanextcare
recommendation.Ongoingsupportiswarranted
fortheimplementationoftheNationalClinical
Programmeandtheapplicationofmeasuresto
standardizeprovisionofcare.
All patients should receive an empathic, compassionate and timely response within the emergency department
In all cases every effort should be made to encourage the patient to call a relative/supportive friend to assist in the assessment and management
All patients receive an expert biopsychosocial assessment of needs and risks
All patients should receive follow up and connecting to next appropriate care
Evidence-basedrecommendationsfromtheTheNationalClinicalProgrammefortheAssessmentand
ManagementofpeoplepresentingtotheEmergencyDepartmentfollowingSelf-Harm.13
National Self-Harm Registry Ireland
8
RecentpublicationsfromtheRegistry(2018-2019)
Background
Riskofself-harmrepetitionhasconsistentlybeenshowntobehigherfollowingself-cuttingcomparedtointentionaldrugoverdose(IDO)andotherself-harmmethods.Theutilityofpreviousevidenceislimitedduetothelargeheterogeneousmethodcategoriesstudied.Thisstudyexaminedriskofhospitalpresentedself-harmrepetitionaccordingtospecificcharacteristicsofself-harmmethods.Dataonconsecutiveself-harmpresentationstohospitalemergencydepartments(2010–2016)wereobtainedfromtheNationalSelf-HarmRegistryIreland.Associationsbetweenself-harmmethodandrepetitionwereanalysedusingsurvivalanalyses.
Findings
Overall,65,690self-harmpresentationsweremadeinvolving46,661individuals.Self-harmmethodsassociated
withincreasedriskofself-harmrepetitionwereminorandsevereself-cutting,intentionaldrugoverdoses(IDOs)involvingmultipledrugsincludingpsychotropicdrugsandself-harmbybluntobject.Minorself-cuttingwasthemethodassociatedwithhighestrepetitionrisk.RepetitionriskwassimilarfollowingIDOsoffourormoredrugsinvolvingpsychotropicdrugs,severeself-cuttingandbluntobject.
Conclusion
Self-harmmethodandtheassociatedriskofrepetitionshouldformacorepartofbiopsychosocialassessmentsandshouldinformfollow-upcareforself-harmpatients.TheobserveddifferencesinrepetitionassociatedwithspecificcharacteristicsofIDOunderlinetheimportanceofsafetyplanningandmonitoringprescribingforpeoplewhohaveengagedinIDO.
Background
Self-harmpresentationscanvarybothwithinandbetweenregionsduetoanumberofcomplexandmulti-facetedfactors.InNorthernIreland,self-harmratesarehigherthanthosereportedinneighbouringjurisdictionsandelevatedratescanbefoundamongmenandinurbanareas.Todate,therearerelativelyfewstudieswhichhaveexploredtherelationshipbetweenarea-levelfactorsandself-harmpresentations.Thisstudytookanecologicalapproach,usingmeasuresofpopulationdensity,socialfragmentationandamultipledeprivationmeasuretoexaminetheassociationofarea-levelcharacteristicsandhospitaltreatedself-harmpresentations.
Findings
Overall,14,477individualspresentedtohospitalsinNorthernIrelandbetween2013and2015.Withinthiscohort,therateofself-harmwashigheramongmen(478per100,000)comparedtowomen(467per100,000)andcityresidentsinBelfast(680per100,000)andDerry(751per100,000)comparedtothoseintherestofNorthernIreland(261per100,000).Apositiveassociationwas
foundbetweenincreasingratesofself-harmandmeasuresofdeprivation,socialfragmentationandpopulationdensity.Ratesofself-harmweremorethanfourtimeshigherinthemostdeprivedareas.Ratesofself-harmwerealsomorethanfourtimeshigherinareaswiththehighestsocialfragmentationscoresandmorethanthreetimeshigherinthemostdensely-populatedareas.Inparticular,areasdeprivedintermsofemployment,crimeanddisorder,educationskillsandtrainingandhealthanddisabilityhadthehighestratesofself-harm.Theseassociationsweremorepronouncedformen.
Conclusion
Thesefindingshighlightthechallengesfacedbyhealthservicesinrespondingtoself-harm,engagingvulnerablepopulationsandtacklinghealthinequalities.Self-harmratesarehighestforthoseresidinginhighlydeprivedareas,whereunemployment,crimeandlowlevelsofeducationarechallenges.Communityinterventionstailoredtomeettheneedsofspecificareasmaybeeffectiveinreducingsuicidalbehaviour.
METHOD OF SELF-HARM AND RISK OF SELF-HARM REPETITION: FINDINGS FROM A NATIONAL SELF-HARM REGISTRY
THE ASSOCIATION BETWEEN SELF-HARM AND AREA-LEVEL CHARACTERISTICS IN NORTHERN IRELAND: AN ECOLOGICAL STUDY
Source:CullyG,Corcoran,P,Leahy,D,GriffinE,Dillon,C,Cassidy,E,Shiely,F,ArensmanE(2019).Methodofself-harmandriskofself-harmrepetition:findingsfromanationalself-harmregistry.JournalofAffectiveDisorders,246:843-50.https://doi.org/10.1016/j.jad.2018.10.372
Source: GriffinE,BonnerB,DillonCB,O’HaganD,CorcoranP(2019).Theassociationbetweenself-harmandarea-levelcharacteristicsinNorthernIreland:anecologicalstudy.Europeanjournalofpublichealth.https://doi.org/10.1093/eurpub/ckz021
Presentations
12,588
210per 100,000
1 in every 476had a self-harm act
Female: 15-19 year-olds(766 per 100,000)
1 in every 131
Male: 20-24 year-olds(543 per 100,000)
1 in every 184
Rates in young peopleaged 10-24 years increasedby 29% between 2007-2018
PEAKRATESWERE
AMONGYOUNGPEOPLE
Persons
9,785
2018 Statistics at a Glance
Monday, Tuesday and Sundayhad the highest number
of self-harm presentations
Peak time
11pm
Men Women
Almost half (44%) of presentations were made
between 7pm-3am
7pm
3am
2 in every 3 involved overdose
72%received an assessment in the ED
79% received a follow-up recommendation after discharge
13% left ED before a recommendation was made
3 in every 10involved alcohol
3 in every 10involved self-cutting
M T W
F S S
T
62%34% 27% 30%
RATES:
TIME:
METHOD:
TREATMENT:
1 in 7persons
had a repeatattendance in 2018
20182007
+29%
9
NationalSelf-HarmRegistryIreland
National Self-Harm Registry Ireland
10
Impact of the Registry at global level
TheWorldHealthOrganisation’s(WHO)report
“Preventingsuicide:aglobalimperative”published
in2014,identifiedaneedformanycountries
tohaveguidanceonthesurveillanceofsuicide
attemptspresentingtogeneralhospitals.Currently,
thenumberofcountriesthathaveestablisheda
surveillancesystemforsuicideattemptsislimited,
andcomparisonbetweenestablishedsystemsis
oftenhinderedbydifferencesbetweensystems.
Eachyear,closeto800,000peopledieasaresult
ofsuicide,andforeachsuicide,therearelikelyto
havebeenmorethan20suicideattempts.Having
engagedinoneormoreactsofattemptedsuicide
orself-harmisthesinglemostimportantpredictor
ofdeathbysuicide.Consequently,long-term
monitoringoftheincidence,demographicpatterns
andmethodsinvolvedincasesofattempted
suicideandself-harmpresentingtohospitalsina
countryorregionprovidesimportantinformation
thatcanassistinthedevelopmentofsuicide
preventionstrategies.
In2015,theWHOrecognisedtheNSRFasaWHO
CollaboratingCentreforSurveillanceandResearch
inSuicidePrevention(WHOCC)andin2018
commissionedthedevelopmentofanE-Learning
Programme,basedontheWHOPracticeManualfor
EstablishingandMaintainingSurveillanceSystems
forSuicideAttemptsandSelf-Harm(2016).
TheaimsoftheE-LearningProgrammeareto
facilitatesurveillanceofsuicideattemptsandself-
harmatgloballevelandtoimprovetheaccurate
reportingofhospitalbasedsuicideattempts
andself-harm.In2018,theNSRFandWHOCC,
incollaborationwiththeDepartmentofMental
HealthandSubstanceAbuseoftheWorldHealth
Organisation(WHO),producedtheE-Learning
programme,basedontheWHOPracticeManual.
Theworkinvolvedpreparingdifferentmodules,
includingatrainingmodulewithadditionaltest
vignettes.
TheE-LearningProgrammeisatoolforcountries
touseinsettingupapublichealthsurveillance
systemforsuicideattemptsandself-harmcases
presentingtogeneralhospitals.Thisprogramme
facilitatestrainingandcapacitybuildinginplaces
whereface-to-facetrainingcanbechallenging.
SincethelaunchoftheE-LearningProgramme,it
hasbeenaccessedintensivelybymanycountries,
andpreparationsarecurrentlyunderwayto
translatetheprogrammeintoRussian.
TheE-LearningProgrammecanbeaccessedhere:
https://suicideresearchpreventionelearning.com/
E-Learning Programme for Establishing and Maintaining Surveillance Systems for Suicide Attempts and Self-Harm
11
NationalSelf-HarmRegistryIreland
Methods
BackgroundTheNationalSuicideResearchFoundationwas
foundedinNovember1994bythelateDrMichaelJ
KelleherandisgovernedbyaBoardofDirectors.The
NationalSuicideResearchFoundationteamisledby
MsEileenWilliamson(ChiefExecutiveOfficer),Dr
PaulCorcoran(HeadofResearch)andProfessorElla
Arensman(ChiefScientist).DrPaulCorcoranisalso
HeadoftheNationalSelf-HarmRegistryIreland.DrEve
GriffinistheManageroftheRegistry.
FundingstatementTheNationalSelf-HarmRegistryIrelandisanational
systemofpopulationmonitoringfortheoccurrence
ofhospital-treatedself-harm.Itwasestablished,at
therequestoftheDepartmentofHealthandChildren,
bytheNationalSuicideResearchFoundationandis
fundedbytheHealthServiceExecutive’sNational
OfficeforSuicidePrevention.Thisreporthasbeen
commissionedbytheNationalOfficeforSuicide
Prevention.
DefinitionandterminologyTheRegistryusesthefollowingasitsdefinitionof
self-harm:‘anactwithnon-fataloutcomeinwhich
anindividualdeliberatelyinitiatesanon-habitual
behaviour,thatwithoutinterventionfromotherswill
causeself-harm,ordeliberatelyingestsasubstance
inexcessoftheprescribedorgenerallyrecognised
therapeuticdosage,andwhichisaimedatrealising
changesthatthepersondesiresviatheactualor
expectedphysicalconsequences’.Thisdefinition
wasdevelopedbytheWHO/EuroMulticentreStudy
WorkingGroupandwasassociatedwiththeterm
‘parasuicide’.Internationally,thetermparasuicidehas
beensupersededbytheterm‘deliberateself-harm’and
consequently,theRegistryhasadoptedtheterm‘self-
harm’.Thedefinitionincludesactsinvolvingvarying
levelsofsuicidalintentandvariousunderlyingmotives
suchaslossofcontrol,cryforhelporself-punishment.
Inclusioncriteria• Allmethodsofself-harmareincludedi.e.,drug
overdoses,alcoholoverdoses,lacerations,attempted
drownings,attemptedhangings,gunshotwounds,
etc.whereitisclearthattheself-harmwas
intentionallyinflicted.
• Allindividualswhoarealiveonadmissiontohospital
followingaself-harmactareincluded.
ExclusioncriteriaThefollowingcasesareNOTconsideredtobeself-harm:
• Accidentaloverdosese.g.,anindividualwhotakes
additionalmedicationinthecaseofillness,without
anyintentiontoself-harm.
• Alcoholoverdosesalonewheretheintentionwasnot
toself-harm.
• Accidentaloverdosesofstreetdrugsi.e.,drugsused
forrecreationalpurposes,withouttheintentionto
self-harm.
• Individualswhoaredeadonarrivalathospitalasa
resultofsuicide.
QualitycontrolThevalidityoftheRegistryfindingsisdependenton
thestandardisedapplicationofthecase-definition
andinclusion/exclusioncriteria.TheRegistryhas
undertakenacross-checkingexerciseinwhichpairsof
dataregistrationofficersindependentlycollectdata
fromtwohospitalsforthesameconsecutiveseriesof
attendancestotheemergencydepartment.Results
indicatedthatthereisaveryhighlevelofagreement
betweenthedataregistrationofficers(Kappa
statisticof0.90in2017).Furthermore,thedataare
continuouslycheckedforconsistencyandaccuracy.
DatarecordingSince2006,theRegistryhasrecordeditsdataonto
encryptedlaptopcomputersandtransferredthe
dataelectronicallytotheofficesoftheNational
SuicideResearchFoundation.Dataforallself-harm
presentationsmadein2018wererecordedusingthis
bespokeelectronicsystem.
DataitemsAminimaldatasethasbeendevelopedtodetermine
theextentofself-harm,thecircumstancesrelatingto
boththeactandtheindividualandtoexaminetrends
byarea.Whilethedataitemsbelowwillenablethe
systemtoavoidduplicaterecordingandtorecognise
repeatactsofself-harmbythesameindividual,itis
impossibletoidentifyanindividualonthebasisofthe
datarecorded.
InitialsInitiallettersfromanindividualself-harmpatient’s
namearerecordedinanencryptedformbythe
Registrydataentrysystemforthepurposesof
avoidingduplication,ensuringthatrepeatepisodesare
recognisedandcalculatingincidenceratesbasedon
personsratherthanevents.
12
Methods
GenderMaleorfemalegenderisrecordedwhenknown.
Date of birthDateofbirthisrecordedinanencodedformatto
furtherprotecttheidentityoftheindividual.Aswellas
beingusedtoidentifyrepeatself-harmpresentations
bythesameindividual,thedateofbirthisusedto
calculateage.
Area of residencePatientaddressesarecodedtotheappropriate
electoraldivisionandsmallareacodewhereapplicable.
Date and hour of attendance at hospital
Brought to hospital by ambulance
Method(s) of self-harmThemethod(s)ofself-harmarerecordedaccording
totheTenthRevisionoftheWHO’sInternational
ClassificationofDiseasescodesforintentionalinjury
(X60-X84).Themainmethodsareoverdoseofdrugs
andmedicaments(X60-X64),self-poisoningsby
alcohol(X65),poisoningswhichinvolvetheingestion
ofchemicals,noxioussubstances,gasesandvapours
(X66-X69)andself-harmbyhanging(X70),by
drowning(X71)andbysharpobject(X78).Some
individualsmayuseacombinationofmethodse.g.,
overdoseofmedicationsandself-cutting.Inthisreport,
resultsgenerallyrelatetothe‘mainmethod’ofself-
harm.Inkeepingwithstandardsrecommendedbythe
WHO/EuroStudyonSuicidalBehaviour,thisistakenas
themostlethalmethodemployed.Foractsinvolving
self-cutting,thetreatmentreceivedwasrecordedwhen
known.
Drugs takenWhereapplicable,thenameandquantityofthedrugs
takenarerecorded.
Medical card statusWhethertheindividualpresentinghasamedicalcard
ornotisrecorded.
Mental health assessmentWhethertheindividualpresentinghadareviewor
assessmentbythepsychiatricteaminthepresenting
hospitalemergencydepartmentisrecorded.
Recommended next careRecommendednextcarefollowingtreatmentinthe
hospitalemergencydepartmentisrecorded.
ConfidentialityConfidentialityisstrictlymaintained.TheNational
SuicideResearchFoundationisregisteredwiththe
DataProtectionAgencyandcomplieswiththeIrish
DataProtectionActof1988,theIrishDataProtection
(Amendment)Actof2003andtheGeneralData
ProtectionRegulation2018.Onlyanonymiseddataare
releasedinaggregateforminreports.Thenamesand
addressesofpatientsarenotrecorded.
EthicalapprovalEthicalapprovalhasbeengrantedbytheNational
ResearchEthicsCommitteeoftheFacultyofPublic
HealthMedicine.TheRegistryhasalsoreceivedethical
approvalfromtherelevanthospitalsandHealthService
Executive(HSE)ethicscommittees.
RegistrycoverageIn2018,self-harmdatawerecollectedfromhospitalsin
theRepublicofIreland(pop:4,856,900).
Therewascompletecoverageofallacutehospitalsin
theIrelandEastHospitalGroup–MaterMisercordiae
UniversityHospital,MidlandRegionalHospital,
Mullingar,OurLady’sHospitalNavan,St.Columcille’s
Hospital,Loughlinstown,St.Luke’sHospital,Kilkenny,
St.Michael’sHospital,DunLaoghaire,WexfordGeneral
Hospitalandanotherhospitalwhoseethicscommittee
stipulatedthatitshouldnotbenamedinRegistry
reports.
Therewascompletecoverageofallacutehospitalsin
theDublinMidlandsHospitalGroup–MidlandRegional
Hospital,Portlaoise,MidlandRegionalHospital,
Tullamore,NaasGeneralHospital,St.James’sHospital
andAdelaideandMeathHospitalTallaghtHospital
(adults).
Therewascompletecoverageofallacutehospitalsin
theRCSIHospitalGroup–BeaumontHospital,Cavan
GeneralHospital,ConnollyHospital,Blanchardstown
andOurLadyofLourdesHospital,Drogheda.
Therewascompletecoverageofallacutehospitals
intheSouth/SouthWestHospitalGroup–Bantry
GeneralHospital,CorkUniversityHospital,University
Hospital,Kerry,MallowGeneralHospital,Mercy
UniversityHospital,Cork,SouthTipperaryGeneral
HospitalandUniversityHospital,Waterford.
Therewascompletecoverageofallacutehospitals
intheUniversityofLimerickHospitalGroup–Ennis
Hospital,NenaghHospital,St.John’sHospital,Limerick
andUniversityHospital,Limerick.
Therewascompletecoverageofallacutehospitals
intheSaoltaUniversityHealthCareGroup–Galway
UniversityHospital,LetterkennyGeneralHospital,Mayo
GeneralHospital,PortiunculaHospital,Ballinasloeand
SligoRegionalHospital.
Therewascompletecoverageofallhospitalsinthe
Children’sHospitalGroup–Children’sUniversity
HospitalatTempleStreet,NationalChildren’sHospital
atTallaghtHospitalandOurLady’sChildren’sHospital,
Crumlin.
Intotal,self-harmdatawerecollectedforthefull
calendaryearof2018forall36acutehospitalsthat
operatedinIrelandduringthisyear.Asmentioned
previously,since2006theRegistryhashadcomplete
coverageofallacutehospitalsinIreland.
13
Methods
In2013,anumberofhospitalemergencydepartments
werere-designatedasModel2statushospitalsaspart
oftheHSE’sSecuringtheFutureofSmallerHospitals
framework,withsomeofthesehospitalsclosingtheir
emergencydepartmentandothersoperatingon
reducedhours.Thehospitalswhichcontinuetohave
emergencydepartmentsonreducedhoursinclude:
BantryGeneralHospital,EnnisHospital,MallowGeneral
Hospital,NenaghHospital,St.Columcille’sHospital
LoughlinstownandSt.John’sHospitalLimerick.Data
fromthesehospitalscontinuetoberecordedbythe
Registryfor2018.
PopulationdataFor2018,theCentralStatisticsOfficepopulation
estimateswereutilised.Theseestimatesprovide
age-sex-specificpopulationdataforthecountryand
itsconstituentregionalauthorityareas.Proportional
differencesbetweenthe2018regionalauthority
populationestimatesandtheequivalentNational
Census2016figureswerecalculatedandappliedto
theNationalCensus2016populationfiguresforIrish
cities,countiesandHSEregionfiguresinorderto
derivepopulationestimatesfor2018.ForHSELocal
HealthOffice(LHO)areasandCommunityHealthcare
Organisation(CHO)areas,NationalCensus2016
populationdatawereutilised.
CalculationofratesSelf-harmrateswerecalculatedbasedonthenumber
ofpersonsresidentintherelevantareawhoengaged
inself-harmirrespectiveofwhethertheyweretreated
inthatareaorelsewhere.Crudeandage-specificrates
per100,000populationwerecalculatedbydividingthe
numberofpersonswhoengagedinself-harm(n)by
therelevantpopulationfigure(p)andmultiplyingthe
resultby100,000,i.e.(n/p)*100,000.
Europeanage-standardisedrates(EASRs)are
theincidenceratesthatwouldbeobservedifthe
populationunderstudyhadthesameagecomposition
asatheoreticalEuropeanpopulation.Adjustingfor
theagecompositionofthepopulationunderstudy
ensuresthatdifferencesobservedbygenderorby
areaareduetodifferencesintheincidenceofself-
harmratherthandifferencesinthecompositionof
thepopulations.EASRswerecalculatedasfollows:for
eachfive-yearagegroup,thenumberofpersonswho
engagedinself-harmwasdividedbythepopulationat
riskandthenmultipliedbythenumberintheEuropean
standardpopulation.TheEASRisthesumofthese
age-specificfigures.
AnoteonsmallnumbersCalculatedratesthatarebasedonlessthan20events
maybeanunreliablemeasureoftheunderlyingrate.In
addition,self-harmeventsmaynotbeindependentof
oneanother,althoughtheseassumptionsareusedin
thecalculationofconfidenceintervals,intheabsence
ofanyclearknowledgeoftherelationshipbetween
theseevents.
TheRegistryrecordedfourcasesofself-harmfor
whichpatientinitials,genderordateofbirthwere
unknown.Thesefourcaseshavebeenexcludedfrom
thefindingsreportedhere.Inaddition,asmallnumber
ofself-harmpatientspresentedtohospitalmorethan
onceonthesamecalendarday.Thishappenedfor
avarietyofreasonsincludingbeingtransferredto
anotherhospital,abscondingandreturning,etc.These
patientswereconsideredasreceivingoneepisodeof
careandwererecordedonceinthefinalisedRegistry
databasefor2018.
AnoteonconfidenceintervalsConfidenceintervalsprovideuswithamarginoferror
withinwhichunderlyingratesmaybepresumedtofall
onthebasisofobserveddata.Confidenceintervals
assumethattheeventrate(n/p)issmallandthat
theeventsareindependentofoneanother.A95%
confidenceintervalforthenumberofevents(n),isn +/- 2√n.Forexample,if25self-harmpresentationsare
observedinaspecificregioninoneyear,thenthe95%
confidenceintervalwillbe25 +/- 2√25or15to35.Thus,
the95%confidenceintervalaroundaraterangesfrom
(n - 2√n) / pto(n + 2√n) / p,wherepisthepopulationat
risk.Iftherateisexpressedper100,000population,
thenthesequantitiesmustbemultipliedby100,000.
A95%confidenceintervalmaybecalculatedto
establishwhetherthetworatesdifferstatistically
significantly.Thedifferencebetweentheratesis
calculated.The95%confidenceintervalforthisrate
difference(rd)rangesfromrd - 2√(n1 / p12 + n2 / p2
2)to
rd + 2√(n1 / p12 + n2 / p2
2).Iftherateswereexpressedper
100,000population,then2√(n1 / p12 + n2 / p2
2)mustbe
multipliedby100,000beforebeingaddedtoand
subtractedfromtheratedifference.Ifzeroisoutside
oftherangeofthe95%confidenceinterval,thenthe
differencebetweentheratesisstatisticallysignificant.
Mappingofself-harmdataRatesofself-harmbygenderaccordingtocity/county
ofresidenceareillustratedinthereportusingmaps.
QGIS,version2.18.16,wasusedtogeneratethemaps
(www.qgis.org).
14
SECTIONI:
Hospital Presentations
NationalSelf-HarmRegistryIreland
Individualswhopresentedtohospitalwithself-harmintheRepublicofIreland
Fortheperiodfrom1Januaryto31December2018,theRegistryrecorded12,588self-harmpresentationsto
hospitalthatweremadeby9,785individuals.Thus,thenumberofself-harmpresentationswas8%higherthan
2017andthenumberofpersonsinvolvedincreasedby7%.Table1summarisesthechangesinthenumberof
presentationsandpersonssincetheRegistryreachednearnationalcoveragein2002.
PRESENTATIONS PERSONS
YEAR Number %difference Number %difference
2002 10,537 - 8,421 -
2003 11,204 +6% 8,805 +5%
2004 11,092 -1% 8,610 -2%
2005 10,789 -3% 8,594 -<1%
2006 10,688 -1% 8,218 -4%
2007 11,084 +4% 8,598 +5%
2008 11,700 +6% 9,218 +7%
2009 11,966 +2% 9,493 +3%
2010 12,337 +3% 9,887 +4%
2011 12,216 -1% 9,834 -<1%
2012 12,010 -2% 9,483 -4%
2013 11,061 -8% 8,772 -8%
2014 11,126 +<1% 8,708 -<1%
2015 11,189 +1% 8,791 +1%
2016 11,445 +2% 8,876 +1%
20171 11,620 +2% 9,114 +3%
2018 12,588 +8% 9,785 +7%
Table 1: Numberofself-harmpresentationsandpersonswhopresentedintheRepublicofIrelandin2002-2018
(2002-2005figuresextrapolatedtoadjustforhospitalsnotcontributingdata).
1Figuresfor2017havebeenupdatedtoincludeanadditional20caseswhichwerelateregistered.
Theage-standardisedrateofindividualspresentingtohospitalintheRepublicofIrelandfollowingself-harmin
2018was210(95%ConfidenceInterval(CI):206to215)per100,000.Thiswasasignificantincrease(+6%)on
therateof199(95%CI:195to203)per100,000from2017.Theincidenceofself-harminIrelandisexaminedin
detailinSectionIIofthisreport.
Thenumberofself-harmpresentationsintheRepublicofIrelandbyhospitalgroup,ageandgenderaregiven
inAppendix1.Oftherecordedpresentationsin2018,45%weremadebymenand55%weremadebywomen.
15
HospitalPresentations
Self-harmepisodesweregenerallyconfinedtotheyoungeragegroups.Halfofallpresentations(50%)wereby
peopleunder30yearsofageand86%ofpresentationswerebypeopleagedlessthan50years.
Inmostagegroupsthenumberofself-harmactsbywomenexceededthenumberbymen.Thiswasmost
pronouncedinthe10-19yearagegroupwherethereweretwiceasmanyfemalepresentations.Thenumberof
self-harmpresentationsmadebymenwasslightlyhigherthanthenumbermadebywomeninthe20-39year
agegroup.
Thenumberofself-harmpresentationsmadebyresidentsofhomelesshostelsandpeopleofnofixedabode
was539,representing4.0%ofallpresentations.Thisfigureis9%lowerthanthatrecordedin2017(n=591).A
minority(50;0.4%)ofpresentationsweremadebyhospitalinpatients.
Self-harmbyHSEhospitalgroup
BasedonprovisionalfiguresacquiredfromtheHSEBusinessInformationUnit,self-harmaccountedfor0.91%
oftotalattendancestogeneralemergencydepartmentsinthecountry.Thispercentageofattendances
accountedforbyself-harmvariedbyHSEhospitalgroupfrom0.27%intheChildren’s,to0.87%intheSaolta
University,0.89%intheUniversityofLimerickandIrelandEast,1.00%intheRCSI,and1.05%intheSouth/
SouthWestand1.14%intheDublinMidlandshospitalgroup.
Theproportionofself-harmpresentationsineachhospitalgroupin2018rangedfrom3%intheChildren’s,7%
intheUniversityofLimerick,to15%intheSaoltaUniversityandRCSI,18%intheDublinMidlands,20%inthe
South/SouthWestand22%intheIrelandEasthospitalgroup.
Thegenderbalanceofrecordedepisodesin2018(at45%mento55%women)variedbyhospitalgroup
(Figure1).Self-harmpresentationsbywomenoutnumberedthosebymeninallhospitalgroups.
Figure 1: Genderbalanceofself-harmpresentationsbyHSEhospitalgroup,2018
Annualchangeinself-harmpresentationstohospital
Thenationalincreaseinthenumberofself-harmpresentationstohospitalin2018wasreflectedatthelevel
oftheindividualhospitals(Figures2aand2b).Overall,28generalhospitalssawanincreaseinself-harm
presentationsbetween2017and2018,whilefourgeneralhospitalssawadecreaseduringthesameperiod.2
2Itshouldbenotedthatinsmallhospitals,largepercentagechangesarebasedonrelativelysmallnumbers.
RCSI Hospital Group
Ireland East Hospital Group
University of Limerick Hospital Group
0% 20% 40% 60% 80% 100%
Children's Hospital Group
Dublin Midlands Hospital Group
Saolta University Health Care Group
South/South West Hospital Group
Percentage of episodes
HSE
Hosp
ital G
roup
Men Women
31%
41%
43%
44%
47%
48%
48%
69%
59%
57%
56%
53%
52%
52%
16
HospitalPresentations
Figure 2a: Hospitalsreceivingmoreself-harmpresentationsin2018.
Note:Thisfigureexcludesthreehospitalswheretheincreaseswerebasedonsmallnumbers(<5).
Figure 2b: Hospitalsreceivingfewerself-harmpresentationsin2018.
0 10 20 30 40 50
University Hospital KerryMayo General Hospital
Adelaide and Meath Hospital, TallaghtNational Children's Hospital at Tallaght Hospital
Midland Regional Hospital, PortlaoiseOur Lady's Children's Hospital, CrumlinOur Lady of Lourdes Hospital, Drogheda
Sligo Regional HospitalBeaumont Hospital
University Hospital, LimerickMidland Regional Hospital, Tullamore
Cork University HospitalWexford General Hospital
Midland Regional Hospital, MullingarGalway University Hospital
South Tipperary General HospitalConnolly Hospital, Blanchardstown
St. Luke's Hospital, KilkennySt. James's Hospital
Mater Misericordiae University HospitalNaas General Hospital
Cavan General HospitalLetterkenny General Hospital
OtherPortiuncula Hospital, Ballinasloe
% change from 2017 to 2018
-50 -40 -30 -20 -10 0
Our Lady’s Hospital, Navan
Children’s University Hospital at Temple Street
University Hospital, Waterford
Bantry General Hospital
% change from 2017 to 2018
17
HospitalPresentations
Episodesbytimeofoccurrence
Variation by Month
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
Men 469 430 465 422 528 475 500 470 457 503 459 483 5661
Women 577 513 550 616 677 552 551 641 565 604 565 516 6927
Total 1046 943 1015 1038 1205 1027 1051 1111 1022 1107 1024 999 12588
Table 2:Numberofself-harmpresentationsin2018bymonthformenandwomen.
Figure 3:Percentagedifferencebetweentheobservedandexpectednumberofself-harmpresentationsby
monthin2018.
Themonthlyaveragenumberofself-harmpresentationstohospitalsin2018was1,049.Figure3illustratesthe
percentagedifferencebetweenobservedandexpectednumberofpresentations,accountingforthenumber
ofdaysineachcalendarmonth.In2018,thereweremoreself-harmpresentationsthanmightbeexpectedin
May(+13%),August(+4%)andOctober(+4%).Theendofyearfallinpresentationswassimilartoprevious
years.BetweenNovemberandMarch,therewere,onaverage,4%fewerpresentationsthanmightbeexpected.
Variation by Day
Figure 4: Numberofpresentationsbyweekday,2018.
Perc
enta
ge
-14
-10
-6
-2
2
6
10
14
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Num
ber o
f pre
sent
atio
ns
Men Women
0100200300400500600700800900
100011001200
Mon Tues Wed Thurs Fri Sat Sun
18
HospitalPresentations
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total
Men924 798 745 783 802 758 851 5661
(16.3%) (14.1%) (13.2%) (13.8%) (14.2%) (13.4%) (15%) (100%)
Women1139 1004 910 966 936 871 1101 6927
(16.4%) (14.5%) (13.1%) (13.9%) (13.5%) (12.6%) (15.9%) (100%)
Total2063 1802 1655 1749 1738 1629 1952 12588
(16.4%) (14.3%) (13.1%) (13.9%) (13.8%) (12.9%) (15.5%) (100%)
Note:Onaverage,eachdaywouldbeexpectedtoaccountfor14.3%ofpresentations.
Table 3: Self-harmpresentationsin2018byweekday.
Asinpreviousyears,thenumberofself-harmpresentationswashighestonMondays,TuesdayandSundays.
Thesedaysaccountedfor46%ofallpresentations.NumbersfellafterTuesdaybeforerisingagainonSunday.
During2018,therewereanaverageof34self-harmpresentationstohospitaleachday.Therewere24daysin
2018onwhich45ormoreself-harmpresentationsweremade,includingJanuary1st,NewYear’sDay(n=49),
May1st,MayBankHoliday(n=50)andDecember27th(n=56).Thereweresixdaysin2018onwhich20or
fewerself-harmpresentationsweremade,includingDecember31st,NewYear’sEve(n=20).
Variation by Hour
Figure 5: Numberofpresentationsbytimeofattendance.
Asinpreviousyears,therewasastrikingpatterninthenumberofself-harmpresentationsseenoverthe
courseoftheday.Thenumbersforbothmenandwomengraduallyincreasedduringtheday.Thepeak
formenwas11pm,whilethepeakforwomenwas6pmand11pm.Almosthalf(44%)ofthetotalnumberof
presentationsweremadeduringtheeight-hourperiod7pm-3am.Thiscontrastswiththequietesteight-hour
periodoftheday,from5am-1pm,whichaccountedforjust19%ofallpresentations.
Overhalf(53%)werebroughttohospitalbyambulanceandafurther3%werebroughtbyotheremergency
servicessuchasAnGardaSiochana.Theproportionofcasesbroughttotheemergencydepartmentby
ambulanceorotheremergencyservicesvariedoverthecourseofthedayfrom43%forpresentations
betweennoonand4pmto72%forthosewhopresentedbetweenmidnightand8am.
Time (24 Hour Clock)
Num
ber o
f pre
sent
atio
ns
Men Women
0
50
100
150
200
250
300
350
400
450
500
8 10 12 14 16 18 20 22 0 2 4 6
19
HospitalPresentations
Methodofself-harm
Overdose Alcohol Poisoning Hanging Drowning Cutting Other Total
Men3159 1921 135 704 254 1754 450 5661
(55.8%) (33.9%) (2.4%) (12.4%) (4.5%) (31%) (7.9%) (100%)
Women4633 1871 134 368 183 1954 353 6927
(66.9%) (27%) (1.9%) (5.3%) (2.6%) (28.2%) (5.1%) (100%)
Total7792 3792 269 1072 437 3708 803 12588
(61.9%) (30.1%) (2.1%) (8.5%) (3.5%) (29.5%) (6.4%) (100%)
Table 4: Methodsofself-harminvolvedinpresentationstohospitalin2018.
Approximately62%ofallself-harmpresentationsinvolvedadrugoverdose,whichwasmorecommonlyused
asamethodofself-harmbywomenthanbymen.Itwasinvolvedin56%ofmaleand67%offemaleepisodes.
Alcoholwasinvolvedin30%ofallcases.Alcoholwassignificantlymoreofteninvolvedinmaleepisodesof
self-harmthanfemaleepisodes(34%and27%,respectively).
Cuttingwastheonlyothercommonmethodofself-harm,involvedin30%ofallepisodes.Cuttingwasmore
commoninmen(31%)thaninwomen(28%).Presentationsinvolvingself-cuttingincreasedby17%in2018.
In93%ofallcasesinvolvingself-cutting,thetreatmentreceivedwasrecorded.Onequarter(25%)received
steristripsorsteribonds,54%didnotrequireanytreatment,19%requiredsutureswhile2%werereferredfor
plasticsurgery.Menwhocutthemselvesmoreoftenrequiredintensivetreatment.Respectively,20%received
suturesand3%werereferredforplasticsurgerycomparedto16%and2%ofwomenwhocutthemselves.
Attemptedhangingwasinvolvedin9%ofallself-harmpresentations(12%formenand5%forwomen).At
1,072,thenumberofpresentationsinvolvingattemptedhangingwas24%higherthan2017(+22%formen
and+30%forwomen).Overall,thenumberofself-harmpresentationsinvolvinghangingincreasedbetween
2007and2018from444to1,072.Whilerareasamethodofself-harm,thenumberofpresentationsinvolving
attempteddrowningincreasedby19%in2018(from367to437)whilepresentationsinvolvingingestionof
poisonoussubstancesorgasesincreasedby22%(from227to269).
Thegreaterinvolvementofdrugoverdoseasafemalemethodofself-harmisillustratedinFigure6.Drug
overdosealsoaccountedforahigherproportionofself-harmpresentationsintheolderagegroups,in
particularforwomen,whereasself-cuttingwaslesscommon.Self-cuttingwasmostcommonamongyoung
people–in38%ofpresentationsbyboysand36%ofpresentationsbygirlsagedunder15years.
Figure 6: Methodofself-harmusedbygenderandagegroup,2018.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<15yrs 15-24yrs 25-34yrs 35-44yrs 45-54yrs 55yrs+
Age group
Men
Age group
Women
Other
Attempted drowning only
Attempted hanging only
Overdose & self-cutting
Self-cutting only
Drug overdose only
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<15yrs 15-24yrs 25-34yrs 35-44yrs 45-54yrs 55yrs+
20
HospitalPresentations
Drugsusedinoverdose
Thetotalnumberoftabletstakenwasknownin69%ofallcasesofdrugoverdose.Onaverage,29tablets
weretakenintheepisodesofself-harmthatinvolveddrugoverdose.Three-quartersofdrugoverdoseacts
involvedlessthan36tablets,halfinvolvedlessthan20tabletsandonequarterinvolvedlessthan12tablets.
Onaverage,thenumberoftabletstakeninoverdoseactswashigherinmenthanwomen(mean:31vs.28).
Figure7illustratesthepatternofthenumberoftabletstakenindrugoverdoseepisodesforbothgenders.
Half(50%)offemaleepisodesand46%ofmaleepisodesofoverdoseinvolved10-29tablets.
Figure 7: Thepatternofthenumberoftabletstakenindrugoverdose,bygender.
Note:Somedrugs(e.g.compoundscontainingparacetamolandanopiate)arecountedintwocategories.
Figure 8: Thevariationinthetypeofdrugsused.
Number of tablets
Perc
enta
ge o
f ove
rdos
e ac
ts
Men Women
0
10
20
30
40
<10 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Percentage of all overdose episodes Men Women
0 10 20 30 40 50
SalicylateSalicylate Compound
ParacetamolParacetamol Compound
OpiateOpiate Compound
NSAIDS and other analgesicsMinor TranquilliserMajor Tranquilliser
SSRITCAD
Other anti-depressants (including Mood Stabilisers)Anti-epileptics/Barbiturates
Other drugsStreet Drugs
Herbal/Homeopathic
21
HospitalPresentations
Figure8illustratesthefrequencywithwhichthemostcommontypesofdrugswereusedinoverdose.
Approximatelyone-third(35%)ofalloverdosesinvolvedaminortranquilliserandsuchadrugwasused
significantlymoreoftenbymenthanwomen(41%vs.31%,respectively).Amajortranquilliserwasinvolved
in10%ofoverdoses.Intotal,48%ofallfemaleoverdoseactsand34%ofallmaleoverdoseactsinvolvedan
analgesicdrug.Paracetamolwasthemostcommonanalgesicdrugtaken,involvedinsomeformin30%of
drugoverdoseacts.Paracetamol-containingmedicationwasusedsignificantlymoreoftenbywomen(36%)
thanbymen(22%).Oneinfiveacts(19%)ofoverdoseactsinvolvedananti-depressant/moodstabiliser.The
groupofanti-depressantdrugsknownasSelectiveSerotoninReuptakeInhibitors(SSRIs)werepresentin11%
ofoverdosecases.Streetdrugswereinvolvedin17%ofmaleand4%offemaleoverdoseacts.‘Otherclassified
drugs’weretakeninmorethanonequarter(26%)ofalloverdoseswhichreflectsthewiderangeofdrugs
takendeliberatelyinactsofdrugoverdose.
Thenumberofself-harmpresentationstohospitalinvolvingdrugoverdosein2018(7,792)washigherthanthe
numberrecordedin2017(7,538).Therewassomefluctuationinthenumberofpresentationsinvolvingeach
ofthedrugtypesdescribedhere.Mostnotably,therewereincreasesinthenumberofself-harmpresentations
involvingopiatecompoundmedication(+31%),salicylatecompoundmedication(+29%),minortranquillisers
(+8%)andmajortranquillisers(+6%).Decreasesinthenumberofself-harmpresentationsinvolvingtricyclic
antidepressants(-6%),otherantidepressants(-7%)andotherdrugs(-7%)werealsorecorded.
Figure 9: Trendsinrateofstreetdrugsinintentionaloverdosebygender,2007-2018.
In2018,therewasanincreaseinthenumberofself-harmpresentationstohospitalinvolvingstreetdrugsby
27%(from583to742).Since2007,therateper100,000ofintentionaldrugoverdoseinvolvingstreetdrugs
hasincreasedby54%(from9.9to15.3per100,000).Themalerateincreasedby57%(from14.6to22.8per
100,000)whilethefemaleratehasincreasedby50%(from5.3to7.9per100,000).Cocaineandcannabis
werethemostcommonstreetdrugsrecordedbytheRegistryin2018,presentin5%and3%ofoverdoseacts,
respectively.Cocainewasmostcommonamongmen,involvedin15%ofoverdoseactsby25-34year-olds.
Cannabiswasmostcommonamongmenaged15-24year-olds–presentin8%ofoverdoseacts.
Rate
per
100
,000
Men Women
0
5
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
22
HospitalPresentations
Recommendednextcare
Overall,in13%of2018cases,thepatientlefttheemergencydepartmentbeforeanextcarerecommendation
couldbemade.Followingtheirtreatmentintheemergencydepartment,inpatientadmissionwasthenext
stageofcarerecommendedfor31%ofcases,irrespectiveofwhethergeneralorpsychiatricadmissionwas
intendedandwhetherthepatientrefusedornot.Ofallself-harmcases,24%resultedinadmissiontoaward
ofthetreatinghospitalwhereas7%wereadmittedforpsychiatricinpatienttreatmentfromtheemergency
department.Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectly
admittedtopsychiatricinpatientcare.Therefore,directpsychiatricadmissionfiguresprovidedheremaybe
underestimated.Inaddition,someofthepatientsadmittedtoageneralhospitalwardwillsubsequentlybe
admittedaspsychiatricinpatients.Infewerthan1%ofcases,thepatientrefusedtoallowhim/herselftobe
admittedwhetherforgeneralorpsychiatriccare.Mostcommonly,56%ofcasesweredischargedfollowing
treatmentintheemergencydepartment.
Nextcarerecommendationsin2018werebroadlysimilarformenandwomen.Menmoreoftenleftthe
emergencydepartmentbeforearecommendationwasmade(16%vs.11%).Womenweremoreoftenadmitted
toageneralwardofthetreatinghospitalthanmen(28%vs.20%).
Overdose(N=7792)
Alcohol(N=3792)
Poisoning(N=269)
Hanging(N=1072)
Drowning(N=437)
Cutting(N=3708)
Other(N=848)
All(N=12588)
Generaladmission
31.8% 23.6% 28.3% 13.9% 10.8% 12.4% 12.4% 24.3%
Psychiatricadmission
5.0% 4.3% 9.3% 15.8% 10.1% 5.9% 10.7% 6.5%
Patientwouldnotallowadmission
0.5% 0.4% 0.7% 0.5% 0.5% 0.3% 0.9% 0.5%
Leftbeforerecommendation
12.6% 17.2% 9.3% 8.5% 13.0% 14.8% 11.6% 12.8%
Dischargedfromemergencydepartment
50.0% 54.4% 52.4% 61.4% 65.7% 66.5% 64.4% 55.8%
Table 5: Recommendednextcarein2018bymethodsofself-harm.
Recommendednextcarevariedaccordingtothemethodofself-harm(Table5).Generalinpatientcarewas
mostcommonfollowingcasesofdrugoverdoseandself-poisoning,lesscommonafterattemptedhanging
andleastcommonafterself-cuttingandattempteddrowning.Thefindinginrelationtoself-cuttingmaybe
areflectionofthesuperficialnatureoftheinjuriessustainedinsomecases.Ofthosecaseswherethepatient
usedcuttingasamethodofself-harm,67%weredischargedafterreceivingtreatmentintheemergency
department.Thegreaterthepotentiallethalityofthemethodofself-harminvolved,thehighertheproportion
ofcasesadmittedforpsychiatricinpatientcaredirectlyfromtheemergencydepartment.
NextcarevariedsignificantlybyHSEhospitalgroup(Table6).Theproportionofself-harmpatientswho
leftbeforearecommendationwasmadevariedfrom1%intheChildren’shospitalgroup,to19%inthe
RCSIhospitalgroup.Acrossthehospitalgroups,inpatientcare(irrespectiveoftypeandwhetherpatient
refused)wasrecommendedfor16%ofthepatientstreatedintheUniversityofLimerick,28%intheIreland
East,31%intheDublinMidlands,32%intheSouth/SouthWestandRCSI,38%intheSaoltaUniversityand
63%intheChildren’shospitalgroups.Asacorollarytothis,theproportionofcasesdischargedfollowing
emergencytreatmentrangedfromalowof36%intheChildren’sgrouptoahighof72%intheUniversityof
Limerickgroup.Thebalanceofgeneralandpsychiatricadmissionsdirectlyaftertreatmentintheemergency
departmentdifferedsignificantlybyhospitalgroup.Directgeneraladmissionsweremorecommonthandirect
psychiatricadmissionsinallhospitalgroups.
23
HospitalPresentations
Ireland East
Hospital Group
Dublin Midlands Hospital
Group
RCSI Hospital
Group
South/ South West
Hospital Group
University of
Limerick Hospital
Group
Saolta University
Health Care
Group
Children’s Hospital
Group
Republicof
Ireland
(n=2741) (n=2305) (n=1934) (n=2532) (n=927) (n=1826) (n=323) (n=12588)
Generaladmission
24.7% 24.1% 25.2% 24.5% 9.7% 23.5% 62.8% 24.3%
Psychiatricadmission
3% 5.9% 6% 7.1% 5.9% 13.7% 0% 6.5%
Patientwouldnotallowadmission
0.2% 0.8% 0.4% 0.3% 0% 1.2% 0.3% 0.5%
Leftbeforerecommendation
12.9% 14.1% 18.8% 10.9% 12.4% 9.7% 0.9% 12.8%
Dischargedfromemergencydepartment
59.2% 55% 49.6% 57.2% 72% 51.9% 35.9% 55.8%
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmitted
topsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinthistablemay
beunderestimates.
Table 6:Recommendednextcarein2018byHSEhospitalgroup.
In2018,13%ofpatientslefttheemergencydepartmentbeforearecommendationcouldbemade.Thefunnel
plotinFigure10illustratestheproportionofpresentationsresultinginthepatientleavingwithoutbeingseen
foreachhospital.Formosthospitals,theproportionwassimilartothenationalrate.However,therewere
eighthospitalsfallingoutsideofthedashedlines,whichindicatesthattheirrateisdifferenttothenational
rate.Thereisevidenceofanassociationwiththelocationofahospital,withtheproportionofpatientsleaving
beforerecommendationhigherininnercityhospitalemergencydepartments.
Note:Duetosmallnumbers,dataforLocalInjuryUnitsandChildren’sHospitalshavebeenexcluded.
Figure 10:Funnelplotoftheproportionleavingbeforerecommendation,accordingtohospital,2018.
Appendix2detailstherecommendednextcareforself-harmpatientsaccordingtohospital.Foreachhospital
group,thereweresignificantdifferencesbetweenthehospitalsintheirpatternofnextcarerecommendations.
Hospital rate (%) National rate (%) 95% CI
Number of self-harm presentations
Perc
enta
ge w
ho le
ft be
fore
reco
mm
enda
tion
0
5
10
15
20
25
30
0 100 200 300 400 500 600 700 800 900 1000
24
HospitalPresentations
Self-harmcasesdischargedfromemergencydepartment
Informationonfollow-oncareorreferralsofferedwasrecordedforpatientsdischargedfromtheemergency
departmentfollowingtreatment(n=7,030).
• In33%ofepisodes,anout-patientappointmentwasrecommendedasanextcarestepforthepatient.
• Recommendationstoattendtheirgeneralpractitionerforafollow-upappointmentweregivento18%of
dischargedpatients.
• Ofthosenotadmittedtothepresentinghospital,11%weretransferredtoanotherhospitalfortreatment(8%
forpsychiatrictreatmentand3%formedicaltreatment).
• Otherservices(e.g.psychologicalservices,community-basedmentalhealthteamsandaddictionservices)
wererecommendedin17%ofepisodes.
• Approximatelyoneinfive(21%)ofpatientsdischargedfromtheemergencydepartmentweredischarged
homewithoutareferral.
Figure 11: Referralofself-harmpatientsin2018followingdischargefromtheemergencydepartment.
Referralsofferedtoself-harmpatientsvariedaccordingtoHSEhospitalgroup,with76%ofpatientsinthe
Children’shospitalgroupreferredforanout-patientappointmentcomparedwith17%intheSaoltaUniversity
groups.Referralstocommunity-basedmentalhealthteamswerehighestintheSaoltaUniversitygroup(33%),
withreferralstogeneralpractitionershighestintheDublin-Midlandsgroup(25%).
Mentalhealthassessment
Whetherthepatienthadamentalhealthassessmentinthepresentinghospitalwasknownin94%ofallcases.
Ofthoseknown,72%(n=8,490)ofpatientswereassessedbyamemberofthementalhealthteam(74%for
women,69%formen).Assessmentwasmostcommonfollowingattemptedhanging(80%)andattempted
drowning(77%).Thosewithalcoholonboardorwithself-cuttingwerelesslikelytoreceiveanassessment
(69%and70%,respectively).Aminority(4%)ofpatientsrefusedamentalhealthassessmentatthetimeof
presentation(n=472).
Morethanthree-quarters(81%)ofthosenotadmittedtothepresentinghospitalreceivedamentalhealth
assessmentpriortodischarge.Howeveronly18%ofpatientswholeftbeforerecommendationreceivedan
assessment.
Mentalhealthassessmentprovisionvariedaccordingtowhethertheself-harmattendancewasarepeat
presentationornot.In2018,almostthree-quarters(73%)offirstpresentationsofself-harmwereassessed,
comparedwith58%ofthosewithfiveormorepresentations.
Percentage of episodes
0 5 10 15 20 25 30 35
Referred for out-patient appointment
Discharged home
Referred to General Practitioner
Transfer to a psychiatric unit/ hospital
Referred to Community Based Mental Health Teams
Other
Referred to psychological services
Transfer to another hospital
Referred to addiction services
25
HospitalPresentations
ThefunnelplotinFigure12illustratestheproportionofattendancesreceivingamentalhealthassessment
foreachhospital.Themajorityofhospitals(n=18)falloutsideofthedashedlines,indicatingthattheirrateis
differenttothatnationally.
Note:Duetosmallnumbers,dataforLocalInjuryUnitsandChildren’sHospitalshavebeenexcluded.
Figure 12:Funnelplotoftheproportionreceivingamentalhealthassessment,accordingtohospital,2018
Repetitionofself-harm
9,785individualspresentedtohospitalfor12,588self-harmepisodesin2018.Thisimpliesthatmorethan
oneinfive(2,803,22.3%)ofthepresentationsin2018wereduetorepeatacts,whichissimilartotheyears
2003-2009and2013-2017(range:20.5-23.1%).Ofthe9,785self-harmpatientswhopresentedtohospital,
1,427(14.6%)madeatleastonerepeatpresentationduringthecalendaryear.Thisproportioniswithinthe
rangereportedfortheyears2003-2017(13.3-16.4%).Atleastfiveself-harmpresentationsweremadeby
153individuals.Theyaccountedforjust1.6%ofallself-harmpatientsintheyearbuttheirpresentations
represented9.8%(n=1,239)ofallself-harmpresentationsrecorded.
Therateofrepetitionvariedaccordingtothemethodofself-harminvolvedintheself-harmact(Table7).Of
thecommonlyusedmethodsofself-harm,self-cuttingwasassociatedwithanincreasedlevelofrepetition.
Almostoneinfive(18.3%)whousedcuttingasamethodofself-harmintheirindexactmadeatleastone
subsequentself-harmpresentationinthecalendaryear.
Overdose Alcohol Poisoning Hanging Drowning Cutting Other All
Numberofindividualswhopresented
6187 2994 212 865 359 2638 613 9785
Numberwhorepeated
842 423 31 133 48 482 109 1427
Percentagewhorepeated
13.6% 14.1% 14.6% 15.4% 13.4% 18.3% 17.8% 14.6%
Table 7:Repeatpresentationafterindexself-harmpresentationin2018bymethodsofself-harm.
Therateofrepetitionwasbroadlysimilarinmenandwomen(15.0%vs.14.2%).Repetitionvariedsignificantly
byage.Approximately14%ofself-harmpatientsagedlessthan20yearsre-presentedwithself-harm.The
proportionwhorepeatedwashighest,at16.5%,for25-34year-olds.
Hospital rate (%) National rate (%) 95% CI
Number of self-harm presentations
Perc
enta
ge w
ho re
ceiv
ed a
men
tal h
ealth
ass
essm
ent
0
10
20
30
40
50
60
70
80
90
100
0 100 200 300 400 500 600 700 800 900 1000
26
HospitalPresentations
TherewaslittlevariationinrepetitionrateswhenexaminedbyHSEhospitalgroup(Table8).Thelowest
ratewasamongself-harmpatientswhopresentedtotheChildren’sandSouth/SouthWesthospitalgroups
(10.3%and13.9%respectively),withrepetitionratesrangingfrom14.5%-17.1%acrosstheothergroups.
Ireland East
Hospital Group
Dublin Midlands Hospital
Group
RCSI Hospital
Group
South/ South West
Hospital Group
University of Limerick
Hospital Group
Saolta University
Health Care
Group
Children’s Hospital
Group
Republic of Ireland
Numberofindividualswhopresented
Men 949 850 717 994 326 625 94 4448
Women 1175 945 833 1056 427 842 196 5337
TOTAL 2124 1795 1550 2050 753 1467 290 9785
Numberwhorepeated
Men 153 167 116 136 53 85 6 669
Women 200 140 131 149 59 128 24 758
TOTAL 353 307 247 285 112 213 30 1427
Percentagewhorepeated
Men 16.1% 19.6% 16.2% 13.7% 16.3% 13.6% 6.4% 15%
Women 17% 14.8% 15.7% 14.1% 13.8% 15.2% 12.2% 14.2%
TOTAL 16.6% 17.1% 15.9% 13.9% 14.9% 14.5% 10.3% 14.6%
Table 8:Repetitionin2018bygenderandHSEhospitalgroup.
ThefunnelplotinFigure13illustratestherateofrepetitionforeachhospital.Theaveragerateofrepetition
nationallywas14.6%.Forthemajorityofhospitals,therateofrepetitionwassimilartothenationalrate,
indicatinglittlevariationintherateofrepetitionacrosshospitals.
Note:Duetosmallnumbers,dataforLocalInjuryUnitshavebeenexcluded.
Figure 13:Funnelplotoftherateofrepetitionaccordingtohospital,2018
Appendix3detailstherepetitionratebyhospitalformale,femaleandallpatientswhopresentedtohospital
followingself-harm.Cautionshouldbetakenininterpretingtherepetitionratesassociatedwithsmaller
hospitalsasthecalculationsmaybebasedonasmallnumberofpatients.
Hospital rate (%) National rate (%) 95% CI
Number of individuals who presented
Perc
enta
ge w
ho re
peat
ed
0
5
10
15
20
25
0 100 200 300 400 500 600 700 800
27
HospitalPresentations
Riskofrepetitionwasgreatestinthedaysandweeksfollowingaself-harmpresentation.Atotalof9,458
self-harmpresentationsweremadetohospitalemergencydepartmentsinthefirstninemonthsof2018.For
19.3%ofthese(n=1,823)therewasarepeatself-harmpresentationmadewithinthreemonths(91days).This
proportionvariedsignificantlybyHSEhospitalgroup:Children’s(7.8%),UniversityofLimerick(15.2%),South/
SouthWest(16.8%),SaoltaUniversity(18.3%),DublinMidlands(20.8%),RCSI(21.3%),andIrelandEast(22.2%).
Theproportionofself-harmpresentationsfollowedbyarepeatpresentationwithinthreemonthswashigher
forwomen(20.0%)thanmen(18.4%)andvariedaccordingtoage.Theproportionwaslowestamongthose
agedunder15years(10.0%)andover55years(13.2%),comparedwith18.3%among15-24year-oldsand21.6%
among25-54year-olds.Theproportionofself-harmpresentationsfollowedbyarepeatpresentationwithin
threemonthsalsovariedaccordingtomethodofself-harm(12.4%followinganattemptedhanging,14.4%
followinganattempteddrowning,16.8%followingadrugoverdose,24.9%followinganactofself-cuttingonly
and28.5%followinganactinvolvingdrugoverdoseandself-cuttingonly).
Variationintheproportionofself-harmpresentationsfollowedbyarepeatpresentationwithinthreemonths
wasalsoobservedbasedonrecommendednextcarefollowinganindexact.Theproportionwaslowestfor
thosewhowereadmittedtoageneralward(15.3%),comparedto18.4%ofthosewhoweredischargedfrom
theemergencydepartment,22.7%whowereadmittedtoapsychiatricwardand28.7%wholeftbeforea
recommendation.
However,thefactorhavingbyfarthestrongestinfluenceonlikelihoodofrepetitionwasthenumberofself-
harmpresentationsmadetohospital.Justoneinten(11.6%)firstpresentationsinJanuary-September2018
werefollowedbyarepeatpresentationinthenextthreemonths.Thisproportionwas33.3%followingsecond
presentations,51.4%followingthirdpresentations,62.3%followingfourthpresentationsand82.7%following
fifthorsubsequentpresentations.
28
NationalSelf-HarmRegistryIreland
SECTIONII:
Incidence Rates
Fortheperiodfrom1Januaryto31December2018,theRegistryrecorded12,588self-harmpresentationsto
hospitalthatweremadeby9,785individuals.Basedonthesedata,theIrishperson-basedcrudeandage-
standardisedrateofself-harmin2018was201(95%CI:197to206)and210(95%CI:206to215)per100,000,
respectively.Thus,therewasa6%increaseintheage-standardisedratein2018,whichaccountsforthe
changingagedistributionofthepopulation,from2017(199per100,000).
MEN WOMEN ALL
YEAR Rate %difference Rate %difference Rate %difference
2002 167 - 237 - 202 -
2003 177 +7% 241 +2% 209 +4%
2004 170 -4% 233 -4% 201 -4%
2005 167 -2% 229 -1% 198 -2%
2006 160 -4% 210 -9% 184 -7%
2007 162 +2% 215 +3% 188 +2%
2008 180 +11% 223 +4% 200 +6%
2009 197 +10% 222 -<1% 209 +5%
2010 211 +7% 236 +6% 223 +7%
2011 205 -3% 226 -4% 215 -4%
2012 195 -5% 228 +1% 211 -2%
2013 182 -7% 217 -5% 199 -6%
2014 185 +2% 216 -<1% 200 +1%
2015 186 +1% 222 +3% 204 +2%
2016 184 -1% 228 +3% 205 +<1%
20171 181 -2% 219 -4% 199 -3%
2018 193 +7% 229 +5% 210 +6%
Table 9: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin
2002-2018(extrapolateddatausedfor2002-2005toadjustfornon-participatinghospitals).
Theratein2018was6%lowerthanthepeakrateof223per100,000reportedfor2010.However,therate
in2018wasstill12%higherthanin2007,theyearbeforetheeconomicrecession.
1Figuresfor2017havebeenupdatedtoincludeanadditional20caseswhichwerelateregistered.
29
IncidenceRates
Figure 14: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandby
gender,2002-2018.
Populationfiguresandthenumberandrateofpersonswhopresentedtohospitalfollowingself-harmin2018
aregiveninAppendix4.
Variationbygenderandage
Theperson-basedage-standardisedrateofself-harmformenandwomenin2018was193(95%CI:187-198)
and229(95%CI:223-235)per100,000,respectively.Thus,therewasa7%increaseinthemalerateofself-
harmfrom2017,whilethefemalerateincreasedby5%.Takingrecentyearsintoaccount,themaleself-harm
ratein2018was19%higherthanin2007whereasthefemaleratewas7%higher.
Thefemalerateofself-harmin2018was19%higherthanthemalerate.Thisgenderdifferencehasbeen
decreasinginrecentyears.Thefemaleratewas37%higherin2004-2005,32-33%higherin2006-2007,and
10-24%higherin2008-2017.
Therewasastrikingpatternintheincidenceofself-harmwhenexaminedbyage.Theratewashighestamong
theyoung.At766per100,000,thepeakrateforwomenwasamong15-19year-olds.Thisrateimpliesthatone
inevery131girlsinthisagegrouppresentedtohospitalin2018asaconsequenceofself-harm.Thepeakrate
formenwas543per100,000among20-24year-oldsoroneinevery184men.Theincidenceofself-harm
graduallydecreasedwithincreasingageinmen.Thiswasthecasetoalesserextentinwomenastheirrate
remainedrelativelystable,atapproximately225per100,000,acrossthe30to54yearagerange.
Rate
per
100
,000
0
50
100
150
200
250
300
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Men
Women
30
IncidenceRates
Figure 15: Person-basedrateofself-harmintheRepublicofIrelandin2018byageandgender.
Genderdifferencesintheincidenceofself-harmvariedwithage.Thefemaleratewas1.7timeshigherthan
themaleratein10-14year-olds(196vs.73per100,000)andtwiceashighin15-19year-olds(766vs.377per
100,000),respectively.Thefemalerateofself-harmwasagainhigherthanthemalerateacrossthe45-59-year
agerange.However,themaleratewas37%higherthanthefemaleratein25-29year-olds(456vs.332per
100,000)and18%higherin30-34year-olds(318vs.269per100,000).Since2009,theRegistryhasrecorded
asignificantlyhigherrateofself-harminmenaged25-29yearscomparedtowomenofthatage.
In2018,themalerateofself-harmamong10-24year-oldsincreasedby8%(from296to320per100,000).
Therateofself-harmamongwomenaged65-69yearsincreasedby47%(from58to85per100,000).
Self-harmwasrarein10-14year-olds.However,theincidenceofself-harmincreasedrapidlyoverashort
agerange.ThisisillustratedingreaterdetailinFigure16.In13-21year-olds,thefemalerateofself-harmwas
significantlyhigherthanthemalerate.Theincreasesinthefemalerateinearlyteenageyearswereparticularly
striking.Thepeakratesamongyoungerpeoplewerein18year-oldwomenand21year-oldmen,withratesof
826and606per100,000,respectively.
Figure 16: Person-basedrateofself-harmintheRepublicofIrelandin2018bysingleyearofagefor10-24
year-olds.
Age group
Rate
per
100
,000
Men Women
0100200300400500600700800900
1000
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age (in years)
Rate
per
100
,000
Men Women
0100200300400500600700800900
1000
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
31
IncidenceRates
Self-harmbyregion
Rates by city and county
Therewaswidespreadvariationinthemaleandfemaleself-harmratewhenexaminedbycity/countyof
residence.Thematicmaps(1and2)areprovidedtoillustratethevariationinthemaleandfemaleincidenceof
hospital-treatedself-harmbycity/countyofresidence.Themaleratevariedfrom115per100,000forLeitrim
to410per100,000forCorkCity.ThelowestfemalerateswererecordedforMonaghan(150per100,000)
withthehighestratesrecordedforLimerickCityresidentsat459per100,000.Relativetothenationalrate,a
highrateofself-harmwasrecordedformaleandfemalecityresidentsandformenlivinginTipperarySouth,
Carlow,KerryandLouthandforwomenlivinginTipperarySouth,Carlow,KerryandMayo.In2018highrates
forbothmenandwomenwereseeninCorkCity,wherethemaleratewas1.1timeshigherthanthenational
averageandthefemaleratewas38%higher.InLimerickCitythemaleandfemalerateswereapproximately
twicethenationalaverage.
Atanationallevel,thefemaleself-harmrateexceededthemalerateby19%.Themagnitudeofthisgender
differencevariedbycity/county.ThefemaleratefarexceededthemalerateinLeitrim(+112%),Westmeath
(+87%),LimerickCounty(+69%)andGalwayCity(+53%).Theoppositepatternofasignificantlylowerfemale
ratewasobservedinCorkCity(-23%),Louth(-5%)andKilkenny(-5%).
Figure 17a: Person-basedEuropeanage-
standardisedrate(EASR)ofself-harminthe
RepublicofIrelandin2018bycity/countyof
residenceformen.
Figure 17b: Person-basedEuropeanage-
standardisedrate(EASR)ofself-harminthe
RepublicofIrelandin2018bycity/countyof
residenceforwomen.
EASR per 100,000
0 100 200 300 400 500 600
Cork CityLimerick City
Tipperary SouthCarlow
KerryLouth
Galway CitySouth Dublin
DonegalDublin City
SligoWaterford City
Tipperary NorthKilkenny
LaoisWicklow
OffalyMayo
WexfordClare
KildareFingalMeath
Galway CountyCavan
Cork CountyLongford
Waterford CountyMonaghanWestmeath
Dun Laoghaire-RathdownLimerick County
RoscommonLeitrim
Irish
mal
e ra
te(1
93 p
er 1
00,0
00)
EASR per 100,000
0 100 200 300 400 500 600
Limerick CityGalway City
Tipperary SouthCork City
CarlowKerry
Dublin CityMayo
WestmeathWexford
South DublinWaterford CB
LeitrimTipperary North
DonegalLaoisLouth
WicklowGalway County
SligoLongford
Limerick CountyOffalyMeathFingal
KilkennyClare
Dun Laoghaire-RathdownKildare
Cork CountyWaterford County
CavanRoscommon
Monaghan
Irish
fem
ale
rate
(229
per
100
,000
)
32
IncidenceRates
Map 2: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018
bycity/countyofresidenceforwomen.
Male rate of self-harm (per 100,000)
Self-harm rate greater than 236
Self-harm rate between 204 and 236
Self-harm rate between 170 and 203
Self-harm rate between 145 and 169
Self-harm rate less than 145
Cork City
Limerick City
Waterford City
Dublin City
Dublin areaGalway City
Female rate of self-harm (per 100,000)
Self-harm rate greater than 259
Self-harm rate between 242 and 259
Self-harm rate between 207 and 241
Self-harm rate between 193 and 206
Self-harm rate less than 193
Cork City
Limerick City
Waterford City
Dublin City
Galway City Dublin area
Map 1: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018
bycity/countyofresidenceformen.
33
IncidenceRates
Comparedto2017,significantincreasesinthefemalerateofself-harmwereobservedinKerry(+57%)and
Mayo(+49%)withasignificantdecreaseobservedinRoscommon(-39%).Formen,significantincreaseswere
observedinTipperaryNorth(+46%),Fingal(+38%)andSouthDublin(+23%).
Rates by HSE Community Healthcare Organisation (CHO)
In2018,theincidenceofself-harmwashighest,at230per100,000inCHOArea5(SouthTipperary,Carlow/
Kilkenny,Waterford,Wexford)andlowestinCHOArea6(Wicklow,DunLaoghaireandDublinSouthEast)at
167per100,000.Themalerateofself-harmvariedfrom139per100,000inCHOArea6to216per100,000in
CHOArea4(Cork/Kerry).Thefemalerateofself-harmvariedfrom196per100,000inCHOArea6to250per
100,000inCHOArea5.
Men Women All
Po
pu
lati
on
Pe
rso
ns
Rate
95
% C
I
Po
pu
lati
on
Pe
rso
ns
Rate
95
% C
I
Po
pu
lati
on
Pe
rso
ns
Rate
95
% C
I
CHOArea1 196647 332 195 (+/-19) 197686 380 210 (+/-20) 394333 712 201 (+/-14)
CHOArea2 225087 331 162 (+/-16) 228022 507 241 (+/-20) 453109 838 200 (+/-13)
CHOArea3 191641 319 185 (+/-19) 193357 436 241 (+/-22) 384998 755 209 (+/-14)
CHOArea4 341730 673 216 (+/-15) 348845 720 221 (+/-15) 690575 1393 214 (+/-11)
CHOArea5 253523 482 213 (+/-17) 256810 587 250 (+/-19) 510333 1069 230 (+/-13)
CHOArea6 187477 253 139 (+/-17) 200684 371 196 (+/-19) 388161 624 167 (+/-13)
CHOArea7 346715 686 202 (+/-15) 356007 799 229 (+/-16) 702722 1485 211 (+/-11)
CHOArea8 306727 484 178 (+/-14) 309502 646 225 (+/-16) 616229 1130 197 (+/-11)
CHOArea9 304881 569 177 (+/-16) 316524 706 230 (+/-17) 621405 1275 205 (+/-11)
Table 10: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018
byHSECommunityHealthcareOrganisation(CHO)areaofresidenceandgender
*PopulationderivedbytheNationalCensus2016
**Person-basedEuropeanage-standardisedrateper100,000population
34
IncidenceRates
Map 3: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018
byHSECommunityHealthcareOrganisation(CHO)formen.
Map 4: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018
byHSECommunityHealthcareOrganisation(CHO)forwomen.
Male rate of self-harm (per 100,000)
Self-harm rate greater than 205
Self-harm rate between 193 and 205
Self-harm rate between 179 and 192
Self-harm rate between 171 and 178
Self-harm rate less than 171
CH01
CH02
CH03
CH04
CH05
CH06
CH08
CH09
CH07
CH01
CH02
CH03
CH04
CH05
CH06
CH08
CH09
CH07
Female rate of self-harm (per 100,000)
Self-harm rate greater than 249
Self-harm rate between 231 and 249
Self-harm rate between 226 and 230
Self-harm rate between 211 and 225
Self-harm rate less than 211
35
IncidenceRates
Rates by HSE Local Health Office (LHO)
For2018,Table11detailsthepopulation(derivedbytheNationalCensus2016),numberofmenandwomen
whopresentedtohospitalasaresultofself-harmandtheincidencerate(age-adjustedtotheEuropean
standardpopulation)foreachLHOarea.Therewasmorethanatwo-folddifferenceintherateofself-harm
whenexaminedbyLHOarea.Therateformenrangedfrom104per100,000inDublinSouthEastto296per
100,000inSouthTipperaryandforwomenrangedfrom147per100,000inWestCorkto318per100,000in
SouthTipperary.
Table 11: Self-harmin2018byHSELocalHealthOffice(LHO)areaofresidenceandgender.
HSE Region and LHO
MEN WOMEN
Population*
SELF-HARM
Population*
SELF-HARM
Persons Rate** Rank Persons Rate** Rank
DU
BL
IN
MID
LE
INS
TE
R
Dublin South City 71533 112 145 27 73410 143 198 24
Dublin South East 62054 66 104 32 66642 99 159 30
Dublin South West 78334 208 269 2 82564 233 295 2
Dublin West 76727 174 227 8 78616 195 255 9
Kildare/West Wicklow 120121 192 168 17 121417 228 195 26
Laois/Offaly 81649 125 165 19 81009 163 217 20
Longford/Westmeath 64669 77 129 30 64974 149 247 10
Dun Laoghaire 64842 85 137 29 71232 133 202 23
Wicklow 60581 102 187 13 62810 139 239 13
DU
BL
IN
NO
RT
H E
AS
T
Cavan/Monaghan 68535 92 152 26 67859 105 168 28
Dublin North 126283 223 187 12 132869 267 218 19
Dublin North Central 72256 126 161 23 73715 179 239 14
Dublin North West 106342 220 194 10 109940 260 241 11
Louth 63633 140 234 5 65251 145 233 16
Meath 96776 142 163 21 98268 189 211 21
SO
UT
H
Carlow/Kilkenny 67879 143 233 6 68204 149 237 15
Cork North 46260 65 153 25 46466 67 165 29
Cork North Lee 95758 244 265 3 96348 237 262 5
Cork South Lee 98048 184 185 14 102936 200 196 25
Cork West 28609 34 143 28 28443 33 147 32
Kerry 73055 146 241 4 74652 183 274 4
Tipperary South 46979 122 296 1 46932 136 318 1
Waterford 64943 101 168 18 65674 121 209 22
Wexford 73722 116 179 15 76000 181 255 8
WE
ST
Clare 58785 83 158 24 60032 106 192 27
Donegal 79022 157 232 7 80170 174 240 12
Galway 127663 202 163 20 130395 315 256 6
Limerick 77864 153 204 9 78447 211 288 3
Mayo 65047 98 178 16 65460 148 256 7
Tipperary North/East Limerick 54992 83 163 22 54878 119 224 17
Roscommon 32377 31 109 31 32167 44 157 31
Sligo/Leitrim/West Cavan 49090 82 191 11 49657 101 221 18
*PopulationderivedbytheNationalCensus2016
**Person-basedEuropeanage-standardisedrateper100,000population
36
NationalSelf-HarmRegistryIreland
Appendices
HOSPITAL GROUP
IRELAND EAST
DUBLIN MIDLANDS RCSI SOUTH/
SOUTH WESTUNIVERSITY OF LIMERICK
SAOLTA UNIVERSITY CHILDREN’S REPUBLIC
OF IRELAND
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
0-4yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-9yrs 0 0 0 0 0 <5 7 0 0 0 <5 <5 <5 <5 12 6
10-14yrs 11 32 6 16 5 26 23 70 <5 42 19 68 62 115 129 369
15-19yrs 133 289 150 220 120 223 162 308 41 111 103 229 33 104 742 1484
20-24yrs 206 198 215 188 182 148 227 251 68 72 126 159 <5 0 1025 1016
25-29yrs 231 176 147 139 146 101 176 116 69 70 105 80 0 0 874 682
30-34yrs 131 132 158 106 97 94 133 154 58 51 84 106 0 0 661 643
35-39yrs 144 138 124 165 107 93 131 73 45 48 79 88 0 0 630 605
40-44yrs 100 136 96 107 88 93 62 80 29 45 71 92 0 0 446 553
45-49yrs 78 172 81 93 73 78 89 104 36 25 59 89 0 0 416 561
50-54yrs 70 90 41 58 45 63 55 51 16 18 42 73 0 0 269 353
55-59yrs 52 83 28 59 32 46 49 49 12 17 38 42 0 0 211 296
60-64yrs 18 46 21 28 12 18 29 31 10 11 <5 23 0 0 94 157
65-69yrs 12 28 21 15 8 13 18 21 <5 12 8 13 0 0 71 102
70-74yrs 5 8 5 8 6 9 16 11 <5 <5 <5 6 0 0 40 46
75-79yrs 6 8 <5 <5 <5 <5 11 11 <5 <5 <5 <5 0 0 27 30
80-84yrs <5 <5 <5 <5 <5 0 <5 <5 0 0 <5 <5 0 0 10 9
85yrs+ <5 <5 0 <5 0 <5 <5 6 0 <5 <5 <5 0 0 <5 15
Total 1201 1540 1098 1207 924 1010 1192 1340 397 530 749 1077 100 223 5661 6927
APPENDIXI:
APPENDIX 1A:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEIRELANDEASTHOSPITALGROUP,2018
MA
TE
R
MIS
ER
ICO
RD
IAE
U
NIV
ER
SIT
Y
HO
SP
ITA
L
MID
LA
ND
R
EG
ION
AL
H
OS
PIT
AL
, M
UL
LIN
GA
R
OU
R L
AD
Y’S
H
OS
PIT
AL
,
NA
VA
N
ST. C
OLU
MC
ILL
E’S
H
OS
PIT
AL
, LO
UG
HL
INS
TO
WN
ST. LU
KE
’S
HO
SP
ITA
L,
KIL
KE
NN
Y
ST. M
ICH
AE
L’S
H
OS
PIT
AL
,
DU
N L
AO
GH
AIR
E
OT
HE
R
WE
XF
OR
D
GE
NE
RA
L
HO
SP
ITA
L
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
<16yrs 0 0 6 11 <5 <5 0 0 6 12 0 <5 0 12 <5 24
16-17yrs 6 28 8 11 <5 12 0 0 <5 15 <5 <5 27 51 <5 21
18-24yrs 69 84 24 37 14 17 <5 0 73 49 <5 <5 74 84 21 40
25-34yrs 143 131 28 18 18 16 0 <5 57 26 8 5 84 81 24 30
35-44yrs 87 76 14 14 12 18 <5 0 32 44 <5 <5 81 85 14 35
45-54yrs 46 55 8 33 13 25 <5 0 15 31 <5 6 49 69 14 43
55-64yrs 22 20 <5 23 8 8 0 0 15 22 <5 0 18 45 <5 11
65yrs+ <5 <5 <5 <5 <5 5 0 0 5 5 0 <5 8 20 8 8
Total 376 398 91 151 72 102 <5 <5 206 204 18 25 341 447 93 212
APPENDIX 1:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEREPUBLICOFIRELANDBYHOSPITALGROUP,2018
37
AppendixI
ADELAIDE AND MEATH HOSPITAL, TALLAGHT
MIDLAND REGIONAL HOSPITAL, PORTLAOISE
MIDLAND REGIONAL HOSPITAL, TULLAMORE
NAAS GENERAL HOSPITAL ST. JAMES’S HOSPITAL
Male Female Male Female Male Female Male Female Male Female
<16yrs 0 0 10 20 <5 7 <5 <5 0 0
16-17yrs 25 52 11 16 <5 12 9 13 13 18
18-24yrs 106 83 29 29 13 17 60 61 90 95
25-34yrs 75 56 45 48 21 14 51 38 113 89
35-44yrs 73 93 19 28 10 16 39 62 79 73
45-54yrs 30 39 22 20 8 15 19 25 43 52
55-64yrs 14 38 5 8 <5 <5 <5 13 26 25
65yrs+ 10 11 <5 0 <5 <5 8 <5 7 12
Total 333 372 144 169 61 87 189 215 371 364
APPENDIX 1B:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018
APPENDIX 1C:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSERCSIHOSPITALGROUP,2018
BEAUMONT HOSPITAL CAVAN GENERAL HOSPITAL CONNOLLY HOSPITAL, BLANCHARDSTOWN
OUR LADY OF LOURDES HOSPITAL, DROGHEDA
Male Female Male Female Male Female Male Female
<16yrs 0 0 0 8 0 <5 9 32
16-17yrs 29 40 <5 16 7 21 13 26
18-24yrs 80 94 26 23 52 83 88 53
25-34yrs 73 62 21 14 84 76 65 43
35-44yrs 63 51 30 27 57 61 45 47
45-54yrs 33 29 10 20 19 52 56 40
55-64yrs 11 18 9 11 8 11 16 24
65yrs+ 7 8 0 <5 <5 9 7 7
Total 296 302 99 121 230 315 299 272
BANTRY GENERAL HOSPITAL
CORK UNIVERSITY HOSPITAL
UNIVERSITY HOSPITAL, KERRY
MERCY UNIVERSITY HOSPITAL, CORK
SOUTH TIPPERARY GENERAL HOSPITAL
UNIVERSITY HOSPITAL,
WATERFORD
Male Female Male Female Male Female Male Female Male Female Male Female
<16yrs 0 0 20 46 7 21 13 23 9 15 11 17
16-17yrs 0 0 11 37 <5 29 16 18 10 15 9 20
18-24yrs <5 7 68 100 54 49 110 79 36 45 40 108
25-34yrs <5 6 70 80 49 29 114 76 39 44 34 35
35-44yrs <5 <5 42 27 31 27 72 47 19 27 26 23
45-54yrs <5 <5 41 43 27 39 45 33 13 24 17 15
55-64yrs <5 <5 30 19 12 18 26 21 <5 10 6 11
65yrs+ <5 <5 16 13 6 12 14 7 5 10 7 7
Total 14 21 298 365 187 224 410 304 133 190 150 236
APPENDIX 1D:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018
1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.
38
AppendixI
APPENDIX 1E:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018
ENNIS HOSPITAL NENAGH HOSPITAL ST. JOHN’S HOSPITAL, LIMERICK
UNIVERSITY HOSPITAL, LIMERICK
Male Female Male Female Male Female Male Female
<16yrs 0 0 0 0 0 0 9 59
16-17yrs 0 0 0 0 0 0 11 44
18-24yrs <5 <5 <5 <5 0 0 89 119
25-34yrs 0 <5 <5 0 0 0 126 117
35-44yrs 0 10 0 0 0 0 74 83
45-54yrs <5 <5 0 0 0 <5 51 39
55-64yrs 0 0 0 0 0 0 22 28
65yrs+ 0 0 0 0 0 0 10 20
Total <5 19 <5 <5 0 <5 392 509
APPENDIX 1F: INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018
GALWAY UNIVERSITY HOSPITAL
LETTERKENNY GENERAL HOSPITAL
MAYO GENERAL HOSPITAL
PORTIUNCULA HOSPITAL,
BALLINASLOE
SLIGO REGIONAL HOSPITAL
Male Female Male Female Male Female Male Female Male Female
<16yrs 14 54 6 22 <5 17 0 <5 5 13
16-17yrs 10 37 5 14 7 <5 0 15 7 11
18-24yrs 64 113 57 45 29 41 20 33 22 34
25-34yrs 63 87 51 31 30 26 15 18 30 24
35-44yrs 56 49 37 47 14 37 16 20 27 27
45-54yrs 39 46 22 41 14 26 17 18 9 31
55-64yrs 12 17 12 8 9 18 <5 7 8 15
65yrs+ 6 10 0 0 7 11 <5 <5 <5 <5
Total 264 413 190 208 113 180 71 118 111 158
APPENDIX 1G:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSECHILDREN’SHOSPITALGROUP,2018
CHILDREN’S UNIVERSITY HOSPITAL AT TEMPLE STREET
NATIONAL CHILDREN’S HOSPITAL AT TALLAGHT HOSPITAL
OUR LADY’S CHILDREN’S HOSPITAL, CRUMLIN
Male Female Male Female Male Female
<16yrs 47 102 34 68 17 53
16-17yrs <5 0 0 0 0 0
18-24yrs 0 0 <5 0 0 0
25-34yrs 0 0 0 0 0 0
35-44yrs 0 0 0 0 0 0
45-54yrs 0 0 0 0 0 0
55-64yrs 0 0 0 0 0 0
65yrs+ 0 0 0 0 0 0
Total 48 102 35 68 17 53
39
AppendixII
APPENDIXII:
APPENDIX 2A: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEIRELANDEASTHOSPITALGROUP,2018
MA
TE
R
MIS
ER
ICO
RD
IAE
U
NIV
ER
SIT
Y
HO
SP
ITA
L
MID
LA
ND
R
EG
ION
AL
H
OS
PIT
AL
, M
UL
LIN
GA
R
OU
R L
AD
Y’S
H
OS
PIT
AL
, N
AV
AN
ST. C
OLU
MC
ILL
E’S
H
OS
PIT
AL
, LO
UG
HL
INS
TO
WN
ST. LU
KE
’S
HO
SP
ITA
L,
KIL
KE
NN
Y
ST. M
ICH
AE
L’S
H
OS
PIT
AL
,
DU
N L
AO
GH
AIR
E
OT
HE
R
WE
XF
OR
D
GE
NE
RA
L
HO
SP
ITA
L
(n=774) (n=242) (n=174) (n=5) (n=410) (n=43) (n=788) (n=305)
Admitted(generalandpsychiatric)
14.5% 36.4% 19.5% 0% 49.3% 32.6% 23.6% 40.3%
Patientwouldnotallowadmission
0.5% 0.4% 0% 0% 0% 0% 0% 0%
Leftbeforerecommendation
21.1% 9.9% 19% 0% 8.8% 9.3% 6.9% 12.8%
Notadmitted 64% 53.3% 61.5% 100% 42% 58.1% 69.5% 46.9%
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.
APPENDIX 2B:RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018
ADELAIDE AND MEATH HOSPITAL,
TALLAGHT
MIDLAND REGIONAL HOSPITAL,
PORTLAOISE
MIDLAND REGIONAL HOSPITAL,
TULLAMORE
NAAS GENERAL HOSPITAL
ST. JAMES’S HOSPITAL
(n=705) (n=313) (n=148) (n=404) (n=735)
Admitted(generalandpsychiatric)
26.2% 55% 24.3% 26.7% 26%
Patientwouldnotallowadmission
1.4% 0.3% 0% 2% 0%
Leftbeforerecommendation
10.8% 9.9% 9.5% 14.9% 19.7%
Notadmitted 61.6% 34.8% 66.2% 56.4% 54.3%
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.
BEAUMONT HOSPITAL
CAVAN GENERAL HOSPITAL
CONNOLLY HOSPITAL, BLANCHARDSTOWN
OUR LADY OF LOURDES HOSPITAL, DROGHEDA
(n=598) (n=220) (n=545) (n=571)
Admitted(generalandpsychiatric)
23.1% 50% 32.1% 31.7%
Patientwouldnotallowadmission
0.7% 0% 0.6% 0%
Leftbeforerecommendation
22.4% 14.5% 15% 20.3%
Notadmitted 53.8% 35.5% 52.3% 48%
APPENDIX 2C: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSERCSIHOSPITALGROUP,2018
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.
40
AppendixII
APPENDIX 2D: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018
BANTRY GENERAL HOSPITAL
CORK UNIVERSITY HOSPITAL
UNIVERSITY HOSPITAL, KERRY
MERCY UNIVERSITY
HOSPITAL, CORK
SOUTH TIPPERARY GENERAL HOSPITAL
UNIVERSITY HOSPITAL,
WATERFORD
(n=35) (n=663) (n=411) (n=714) (n=323) (n=386)
Admitted(generalandpsychiatric)
34.3% 50.7% 32.1% 14.1% 37.8% 24.9%
Patientwouldnotallowadmission
0% 0.2% 1.2% 0% 0.3% 0%
Leftbeforerecommendation
5.7% 6.6% 10.5% 13.3% 15.8% 10.9%
Notadmitted 60% 42.5% 56.2% 72.5% 46.1% 64.2%
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.
APPENDIX 2E:RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018
ENNIS HOSPITAL
NENAGH HOSPITAL
ST. JOHN’S HOSPITAL, LIMERICK
UNIVERSITY HOSPITAL, LIMERICK
(n=21) (n=4) (n=1) (n=901)
Admitted(generalandpsychiatric)
9.5% 0% 0% 15.9%
Patientwouldnotallowadmission
0% 0% 0% 0%
Leftbeforerecommendation
0% 25% 0% 12.7%
Notadmitted 90.5% 75% 100% 71.5%
APPENDIX 2F: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.
GALWAY UNIVERSITY HOSPITAL
LETTERKENNY GENERAL HOSPITAL
MAYO GENERAL HOSPITAL
PORTIUNCULA HOSPITAL,
BALLINASLOE
SLIGO REGIONAL HOSPITAL
(n=677) (n=398) (n=293) (n=189) (n=269)
Admitted(generalandpsychiatric)
25% 53.5% 31.7% 50.3% 40.9%
Patientwouldnotallowadmission
1.3% 0% 2.7% 1.6% 0.4%
Leftbeforerecommendation
12.1% 9.8% 8.5% 8.5% 5.9%
Notadmitted 61.6% 36.7% 57% 39.7% 52.8%
APPENDIX 2G: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSECHILDREN’SHOSPITALGROUP,2018
Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.
CHILDREN’S UNIVERSITY HOSPITAL AT TEMPLE STREET
NATIONAL CHILDREN’S HOSPITAL AT TALLAGHT HOSPITAL
OUR LADY’S CHILDREN’S HOSPITAL, CRUMLIN
(n=150) (n=103) (n=70)
Admitted(generalandpsychiatric)
40% 76.7% 91.4%
Patientwouldnotallowadmission
0.7% 0% 0%
Leftbeforerecommendation
0% 1% 2.9%
Notadmitted 59.3% 22.3% 5.7%
41
AppendixIII
APPENDIXIII:
APPENDIX 3A:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEIRELANDEASTHOSPITALGROUP,2018
MA
TE
R
MIS
ER
ICO
RD
IAE
U
NIV
ER
SIT
Y
HO
SP
ITA
L
MID
LA
ND
R
EG
ION
AL
H
OS
PIT
AL
, M
UL
LIN
GA
R
OU
R L
AD
Y’S
H
OS
PIT
AL
, N
AV
AN
ST. C
OLU
MC
ILL
E’S
H
OS
PIT
AL
, LO
UG
HL
INS
TO
WN
ST. LU
KE
’S
HO
SP
ITA
L,
KIL
KE
NN
Y
ST. M
ICH
AE
L’S
H
OS
PIT
AL
,
DU
N L
AO
GH
AIR
E
OT
HE
R
WE
XF
OR
D
GE
NE
RA
L
HO
SP
ITA
L
Numberofindividualswhopresented
Men 272 83 61 4 167 18 267 88
Women 291 120 76 1 165 19 363 158
Total 563 203 137 5 332 37 630 246
Numberwhorepeated
Men 53 10 10 0 24 2 47 8
Women 60 21 15 0 24 8 56 28
Total 113 31 25 0 48 10 103 36
Percentagewhorepeated
Men 19.5% 12% 16.4% 0% 14.4% 11.1% 17.6% 9.1%
Women 20.6% 17.5% 19.7% 0% 14.5% 42.1% 15.4% 17.7%
Total 20.1% 15.3% 18.2% 0% 14.5% 27% 16.3% 14.6%
APPENDIX 3B: REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018
ADELAIDE AND MEATH HOSPITAL,
TALLAGHT
MIDLAND REGIONAL HOSPITAL,
PORTLAOISE
MIDLAND REGIONAL HOSPITAL,
TULLAMORE
NAAS GENERAL HOSPITAL
ST. JAMES’S HOSPITAL
Numberofindividualswhopresented
Men 281 109 56 151 290
Women 306 131 71 163 291
Total 587 240 127 314 581
Numberwhorepeated
Men 50 25 6 24 77
Women 38 17 9 24 60
Total 88 42 15 48 137
Percentagewhorepeated
Men 17.8% 22.9% 10.7% 15.9% 26.6%
Women 12.4% 13% 12.7% 14.7% 20.6%
Total 15% 17.5% 11.8% 15.3% 23.6%
APPENDIX 3C:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSERCSIHOSPITALGROUP,2018
BEAUMONT HOSPITAL
CAVAN GENERAL HOSPITAL
CONNOLLY HOSPITAL, BLANCHARDSTOWN
OUR LADY OF LOURDES HOSPITAL, DROGHEDA
Numberofindividualswhopresented
Men 228 82 196 222
Women 252 102 257 237
Total 480 184 453 459
Numberwhorepeated
Men 41 13 32 37
Women 41 17 46 33
Total 82 30 78 70
Percentagewhorepeated
Men 18% 15.9% 16.3% 16.7%
Women 16.3% 16.7% 17.9% 13.9%
Total 17.1% 16.3% 17.2% 15.3%
42
AppendixIII
APPENDIX 3D:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018
BANTRY GENERAL HOSPITAL
CORK UNIVERSITY HOSPITAL
UNIVERSITY HOSPITAL,
KERRY
MERCY UNIVERSITY HOSPITAL,
CORK
SOUTH TIPPERARY GENERAL HOSPITAL
UNIVERSITY HOSPITAL,
WATERFORD
Numberofindividualswhopresented
Men 14 258 258 333 118 136
Women 19 300 300 263 147 152
Total 33 558 558 596 265 288
Numberwhorepeated
Men 1 36 36 48 15 16
Women 2 35 35 33 22 34
Total 3 71 71 81 37 50
Percentagewhorepeated
Men 7.1% 14% 14% 14.4% 12.7% 11.8%
Women 10.5% 11.7% 11.7% 12.5% 15% 22.4%
Total 9.1% 12.7% 12.7% 13.6% 14% 17.4%
1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.
APPENDIX 3E:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018
ENNIS HOSPITAL
NENAGH HOSPITAL
ST JOHN’S HOSPITAL, LIMERICK
UNIVERSITY HOSPITAL, LIMERICK
Numberofindividualswhopresented
Men 2 2 0 323
Women 9 1 1 420
Total 11 3 1 743
Numberwhorepeated
Men 1 1 0 52
Women 2 1 1 57
Total 3 2 1 109
Percentagewhorepeated
Men 50% 50% 0% 16.1%
Women 22.2% 100% 100% 13.6%
Total 27.3% 66.7% 100% 14.7%
APPENDIX 3F:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018
GALWAY UNIVERSITY HOSPITAL
LETTERKENNY GENERAL HOSPITAL
MAYO GENERAL HOSPITAL
PORTIUNCULA HOSPITAL,
BALLINASLOE
SLIGO REGIONAL HOSPITAL
Numberofindividualswhopresented
Men 215 155 101 57 103
Women 312 162 152 95 133
Total 527 317 253 152 236
Numberwhorepeated
Men 31 24 11 12 8
Women 60 20 19 17 16
Total 91 44 30 29 24
Percentagewhorepeated
Men 14.4% 15.5% 10.9% 21.1% 7.8%
Women 19.2% 12.3% 12.5% 17.9% 12%
Total 17.3% 13.9% 11.9% 19.1% 10.2%
43
AppendixIV
APPENDIX 3G: REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSECHILDREN’SHOSPITALSGROUP,2018
CHILDREN’S UNIVERSITY HOSPITAL AT TEMPLE STREET
NATIONAL CHILDREN’S HOSPITAL AT TALLAGHT HOSPITAL
OUR LADY’S CHILDREN’S HOSPITAL, CRUMLIN
Numberofindividualswhopresented
Men 43 35 16
Women 89 64 45
Total 132 99 61
Numberwhorepeated
Men 4 0 2
Women 12 6 7
Total 16 6 9
Percentagewhorepeated
Men 9.3% 0% 12.5%
Women 13.5% 9.4% 15.6%
Total 12.1% 6.1% 14.8%
APPENDIXIV:
APPENDIX 4: SELF-HARMBYRESIDENTSOFTHEREPUBLICOFIRELAND,2018
Age group
MEN WOMEN
Population
SELF-HARM
Population
SELF-HARM
Persons Rate 95% CI* Persons Rate 95% CI*
0-4yrs 163300 0 0 (+/-0) 156000 0 0 (+/-0)
5-9yrs 182100 12 7 (+/-4) 174700 6 3 (+/-3)
10-14yrs 170500 124 73 (+/-13) 162100 318 196 (+/-22)
15-19yrs 161200 608 377 (+/-31) 155000 1188 766 (+/-44)
20-24yrs 147300 800 543 (+/-38) 142000 772 544 (+/-39)
25-29yrs 145200 662 456 (+/-35) 145900 485 332 (+/-30)
30-34yrs 161100 512 318 (+/-28) 174800 470 269 (+/-25)
35-39yrs 193100 485 251 (+/-23) 205200 460 224 (+/-21)
40-44yrs 183200 346 189 (+/-20) 186700 400 214 (+/-21)
45-49yrs 170200 302 177 (+/-20) 171000 390 228 (+/-23)
50-54yrs 152000 213 140 (+/-19) 154600 291 188 (+/-22)
55-59yrs 138600 166 120 (+/-19) 141300 244 173 (+/-22)
60-64yrs 122400 84 69 (+/-15) 124100 126 102 (+/-18)
65-69yrs 106800 57 53 (+/-14) 108900 93 85 (+/-18)
70-74yrs 87400 39 45 (+/-14) 90200 44 49 (+/-15)
75-79yrs 57600 26 45 (+/-18) 64200 27 42 (+/-16)
80-84yrs 37500 9 24 (+/-16) 47600 9 19 (+/-13)
85yrs+ 26200 3 11 (+/-13) 46800 14 30 (+/-16)
Total** 2405800 4448 193 (+/-6) 2451300 5337 229 (+/-6)
*95%ConfidenceInterval.**ThetotalratesareEuropeanage-standardisedratesper100,000.
4th Floor
Western Gateway Building
University College Cork
Ireland
Tel: +353 21 420 5551
Email: [email protected]
www.nsrf.ie
EVE GRIFFIN
NIALL McTERNAN
CONAL WRIGLEY
SARAH NICHOLSON
ELLA ARENSMAN
EILEEN WILLIAMSON
PAUL CORCORAN