Reducing risk following self-harm: the need for careful prescribing

SELF-HARM AS A RISK FACTOR FOR SUICIDE

Self-harm is the strongest risk factor for suicide.^1,2 Globally, suicide is the second most common cause of death among 10– to 24-year-olds after road traffic incidents.³ Recent evidence indicates that the incidence of self-harm may be increasing among adolescents.⁴ Older people who self-harm have an increased suicidal intent,⁵ and, although repetition rates are low compared with middle-aged adults, self-harm is more often fatal in older adults.⁶

Tyrell et al ⁷ identify antidepressants and analgesics as common drugs used by young people for self-poisoning. Overdose as a form of self-harm may be with prescription-only or sales-restricted drugs, often in combination with alcohol.⁸ Depression is also a key risk factor for suicide.⁹ Older adults with previously diagnosed comorbid mental and physical health conditions have an increased risk of self-harm.^6,10

THE INVERSE CARE LAW

Recent evidence also suggests that the Inverse Care Law,¹¹ whereby quantity or quality of healthcare service provision is inversely associated with the level of healthcare need, operates in the clinical management of self-harm in all age groups. Thus, self-harm incidence is elevated across the life-course in practice populations in deprived areas.^4,10,12 Among children and adolescents,⁴ and adults of working age,¹³ the incidence of self-harm is highest and the likelihood of referral to specialist services following self-harm is lowest in …