School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Grace Cully
School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Dorothy Leahy
School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Eugene Cassidy
Cork University Hospital Group, Liaison Psychiatry Service, Ireland
Anvar Sadath
School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Sarah Nicholson
School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Ana Paula Ramos Costa
School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
Íñigo Alberdi-Páramo
Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Spain; and Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
Anne Jeffers
National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead – Mental Health, Dr. Steeven's Hospital, Ireland
Frances Shiely
School of Public Health, College of Medicine and Health, University College Cork, Ireland
Ella Arensman
School of Public Health, College of Medicine and Health, University College Cork, Ireland; National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
Background Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. Aims We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. Method A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. Results Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94−9.94, P = 0.00). Three themes emerged when exploring participants’ CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. Conclusions CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
