Exploring the relationship between area characteristics and self-harm: Old and new approaches

Self-harm is strongly associated with later suicide and it is a major public health problem in its own right in many countries. There is a lack of evidence for effective individual level interventions following self-harm. Ecological studies examining the relationship between area characteristics and self-harm have yielded some interesting descriptive data but have had a number of limitations. Methodological and statistical developments in other fields of research may assist in building on findings to date. For example: The concept of social capital potentially provides a structure for examining sociocultural aspects of area; the use of more specific measures of locality will assist in studying area influences more fully; multilevel modelling may help to resolve the ecological fallacy through specifying variance attributable to factors at multiple levels simultaneously; areas in transition may provide natural conditions in which to investigate the impact of changing social environment. The potential utility of these new approaches is discussed with examples. Further investigation of the relationship between self-harm and area characteristics in a wide variety of settings may help to develop area-based interventions. Such interventions may have the potential to effect significant reductions in suicidal behavior.