The iceberg model of self-harm

Researchers have created a model of self-harm that shows high levels of the problem in the community, especially in young girls, and the need for school-based prevention measures. The team from the University of Oxford used national data on suicide, together with data on hospital-presenting self-harm from five hospitals and data on self-harm in the community from a large-scale schools survey to estimate the relative incidence of fatal and non-fatal self-harm in 12-17 year-olds adolescents in England and described these in terms of an iceberg model including: fatal self-harm i.e. suicide, an overt but uncommon behaviour (the tip of the iceberg); self-harm that results in presentation to clinical services, especially general hospitals, which is also overt, but common; and self-harm that occurs in the community, which is common but largely hidden (the submerged part of the iceberg). Estimated rates of fatal and non-fatal self-harm showed that for every adolescent who died by suicide, there were approximately 370 adolescents who presented to hospital for self-harm and 3,900 adolescents who reported self-harm in the community. These figures suggest that every year in England, about 21,000 adolescents aged 12-17 years present to hospital following self-harm and 200,000 self-harm in the community and do not present to hospital. The investigators further showed that while the incidence of suicide in adolescent males was twice that of females, the incidences of both hospital-presenting and community-occurring non-fatal self-harm were substantially higher in females than in males.