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Abstract
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Background Highly lethal of methods of self-harm, such as attempted hanging and drowning, are a major public health concern due to their high associated risk of completed suicide. This study aims to describe hospital presentations for attempted hanging and drowning in Ireland and explore the factors associated with self-harm and repeat self-harm by these methods.
Methods Data on all self-harm presentations to Irish hospitals (2007-2019) were obtained from the National Self-Harm Registry Ireland, a national surveillance system of hospital-treated self-harm. The crude and age-standardised incidence of hospital presentations for attempted hanging and drowning were calculated. The latter was calculated using direct standardisation, with the European Standard Population as the reference population. Multivariable logistic regression was used to explore factors associated with any presentation for attempted hanging and drowning and factors associated with repetition of attempted hanging and drowning.
Results There were 9,719 and 4,637 attempted hanging and drowning hospital presentations, respectively, in Ireland in 2007-2019. The age-standardised incidence of hospital presentations for attempted hanging rose steadily between 2007 and 2019, increasing from 8.8 to 19.9 presentations per 100,000 population. Similarly, the age-standardised incidence of hospital presentations for attempted drowning increased over the study period, from 6.6 to 9.6 presentations per 100,000 population. The odds of presentations being due to hanging, rather than due to any other self-harm method, were highest for males (aOR 2.88, 95% CI: 2.76-3.02), children aged <15 (aOR 1.32, 1.17-1.48) and in summer (aOR 1.09, 1.02-1.14). The odds of presentations being due to drowning, rather than due to any other self-harm method, were highest for those aged ≥55 (aOR 1.60, 1.43-1.78), homeless individuals (aOR 2.59, 2.32-2.89) and in autumn (aOR 1.15, 1.06-1.25). Repetition of attempted hanging was positively associated with homelessness (aOR 2.47, 2.02-3.04) and acute alcohol ingestion (aOR 1.12, 1.02-1.23). Similar associations were observed for repetition of attempted drowning.
Conclusion This study demonstrates that self-harm by attempted hanging and drowning are significant and growing public health problems in Ireland. Furthermore, this study identifies key population groups for whom the risk of self-harm, or repeat self-harm, by hanging and drowning is greatest. The risk factors for self-harm and suicide are extensive, diverse and occur across the lifespan. Therefore, a combination of universal, selective and indicated interventions are needed to address the determinants of highly lethal methods of self-harm.
This duplicates a conference presentation published in the European journal of public health DOI: 10.1093/eurpub/ckac130.183
Language: en |