ORIGINAL CONTRIBUTION Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England Keith Hawton • Helen Bergen • Keith Waters • Jennifer Ness • Jayne Cooper • Sarah Steeg • Navneet Kapur Received: 23 November 2011 / Accepted: 13 March 2012 / Published online: 25 March 2012 Ó Springer-Verlag 2012 Abstract We examined epidemiology and characteristics of self-harm in adolescents and impact of national guidance on management. Data were collected in six hospitals in three centres between 2000 and 2007 in the Multicentre Study of Self-harm in England. Of 5,205 individuals (7,150 episodes of self-harm), three-quarters were female. The female:male ratio in 10–14 year-olds was 5.0 and 2.7 in 15–18 year-olds. Rates of self-harm varied somewhat between the centres. In females they averaged 302 per 100,000 (95 % CI 269–335) in 10–14 year-olds and 1,423 (95 % CI 1,346–1,501) in 15–18 year-olds, and were 67 (95 % CI 52–82) and 466 (95 % CI 422–510), respectively, in males. Self-poisoning was the most common method, involving paracetamol in 58.2 % of episodes. Presenta- tions, especially those involving alcohol, peaked at night. Repetition of self-harm was frequent (53.3 % had a history of prior self-harm and 17.7 % repeated within a year). Relationship problems were the predominant difficulties associated with self-harm. Specialist assessment occurred in 57 % of episodes. Self-harm in children and adolescents in England is common, especially in older adolescents, and paracetamol overdose is the predominant method. National guidance on provision of psychosocial assessment in all cases of self-harm requires further implementation. Keywords Children Á Adolescents Á Self-harm Á Epidemiology Á Alcohol Á Paracetamol Introduction Self-harm (intentional self-poisoning or self-injury, with or without suicidal intent) in children and adolescents has been identified as a major problem in several countries [1, 2]. Much recent information on self-harm in young people has been based on surveys, usually in schools [3, 4]. This has highlighted the extent of the problem at the community level. Most individuals who gain access to clinical care, however, have presented to hospital following self-harm [5]. However, only a minority of individuals who self-harm in the community present to hospital [3] or any health facility [5]. Studies of children and adolescents presenting to hospital have usually been based on single hospitals [6, 7]. There is a need for data from multiple centres to give a more representative picture of the extent and nature of clinical demand. In official clinical guidance on management of self-harm there has been an understandable focus on children and adolescents who self-harm. This includes, for example, the National Institute for Clinical Excellence guides on self- harm published in the UK in 2004 [8] and 2011 [9] and guidance from the Australian and New Zealand Colleges of Psychiatrists and Emergency Medicine [10]. In addition, national strategies on prevention of suicide include a focus on self-harm patients [11–13]. This is because of the risk of suicide following self-harm [14], including in young peo- ple [6, 15]. K. Hawton (&) Á H. Bergen Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK e-mail: keith.hawton@psych.ox.ac.uk K. Waters Á J. Ness Derbyshire Healthcare NHS Foundation Trust, Derby, England J. Cooper Á S. Steeg Á N. Kapur Centre for Suicide Prevention, University of Manchester, Manchester, UK 123 Eur Child Adolesc Psychiatry (2012) 21:369–377 DOI 10.1007/s00787-012-0269-6