Fatal and non-fatal repetition of self-harm

Declaration of interest J.H.’s salaryis paid by thementalhealth charity Leeds Mind froma research grant awardedby the UKNational Lottery Charities Board. We estimate that around a quarter of suicides are preceded by non-fatal self-harm in the previous year (Owens & House, 1994). If so, an episode of self-harm ranks with recent discharge from in-patient psychiatric care as the major risk factor for suicide (Gunnell & Frankel, 1994). This estimate of the link between self-harm and suicide needs to be accurate if we are to plan services aimed at reduction in suicide rate – a governmental priority for health improvement in the UK over recent years (Department of Health, 1999; Secretary of State for Health, 1999) and the target of a recent initiative by the USA Surgeon General (Vastag, 2001). Suicide is, nevertheless, too infrequent to be the main outcome event for a clinical trial of intervention after non-fatal self-harm. Instead, trials will continue to be designed to determine whether an intervention reduces the non-fatal repetition rate. Consequently, reliable estimates of repetition rate are needed for power calculation. We have undertaken a systematic review of the published literature in order to produce the best available estimates of rates of subsequent suicide and of non-fatal repetition following self-harm.