Is there a difference between hospital-verified and self-reported self-harm? Implications for repetition

Area of Science:

• Public Health
• Psychiatry
• Epidemiology

Background:

• Repeated intentional self-harm (SH) carries significant economic costs and increases suicide risk.
• Estimates of SH repetition rates vary due to differing data capture methods and follow-up durations.
• Existing research often relies on either hospital records or self-reported SH (SRSH), with limited comparison.

Purpose of the Study:

• To examine the relationship between self-reported SH (SRSH) and hospital-verified SH (HVSH) concerning the prediction of future SH repetition (predictive validity).
• To compare SH repetition rates between first-time presenters and non-first-time presenters using both SRSH and HVSH definitions.

Main Methods:

• A large prospective study conducted in a UK Accident and Emergency (A&E) department.
• Followed a representative sample of 774 patients who reported SH for an average of 5.6 years.
• Index SH episodes were recorded; prior SH episodes were identified through electronic A&E database searches and patient self-recall.

Main Results:

• Overall SH repetition rates were 32.0% within 1 year and 54.1% by study completion.
• Patients with a prior SH history exhibited significantly higher repetition rates (47.9% at 1 year, 73.8% by follow-up) compared to first-time presenters (19.6% at 1 year, 39.4% by follow-up).
• Predictive validity for repetition was higher for hospital-verified SH (73.8%) than for self-reported SH (65.2%), with low agreement (Kappa=0.353) between SRSH and HVSH.

Conclusions:

• There is poor agreement between hospital-defined and self-reported SH, with many denying prior SH having verified episodes.
• Both recorded prior SH and recalled previous SH indicate significantly higher repetition rates.
• Hospital-verified SH demonstrates stronger predictive validity for future repetition compared to self-reported SH.