1. Sarah Swannell, The University of Queensland, Australia Prof Graham Martin, The University of Queensland, Australia A/Prof Philip Hazell, University of Sydney, Australia Dr James Harrison, Flinders University, Australia Dr Anne Taylor, Department of Health, South Australian Government 12th European Symposium on Suicide and Suicidal Behaviour 27th - 30th August 2008 Glasgow - Scotland Saturday August 30, 2008 010.8.2 (0900-1100) 0915-0930

2.  Background of self injury  Population estimates of self injury  Aims  Design/sampling  Survey  Sample characteristics  Characteristics of those who self injure  Comparisons with earlier research  Imminent analyses

3.  Deliberate self harm burdens the Australian health care system 1  Non-suicidal self-injury (NSSI) is a type of self-harm  Causes distress for patients, families and therapists 2  Is a risk factor for future self harm and suicide 3,4  Differences between self injurers and suicide attempters ‘repulsion of life’ 5  No empirically proven treatments 4  NSSI not understood  stigmatisation/social exclusion  Need more information about the problem  Difficult to measure in population compared to clinical samples 1 Steenkamp et al 2000, 2 Lindgren et al 2004, 3 Garzotto et al. 1977, 4 RANZCP 2004, 5 Muehlenkamp et al. 2004

5.  Prevalence and nature of self injury in Australia  Differences between those who and do not self injure  Interactions between demographic, social and individual factors associated with self- injury and their relative importance

6. N=8285 N=14688 N=10619 N=1093 N=3229 N=3975 N=217 N=11,722 Non-connections (80.5%) Non-residential (11.3%) Fax/modem (7.7%) N=19,206 Refusals 48.5% Non-contact 7.5% Language 2.3% Incapacitated 2.9% Terminated 0.6% Unavailable 1.1% 12,010 12,006

7. Demographics: age, gender, education level, work status, postcode, suburb, country of birth, main language spoken at home, Aboriginal or Torres Strait Islander GHQ-12 Dissociation (DES) Emotion Regulation (ERQ) Impulsivity/aggression (PIS) Coping (COPE) Alexithymia (TAS) Ideation (GHQ-28)/attempts Freq, rec, sev, age onset, methods, medical att., stopping, how, who knew, help seeking Neglect, sexual and physical abuse Alcohol intake, binge drinking, tobacco smoking, illegal drugs Heterosexual, homosexual, bisexual, unsure Telephone and internet

8.  Average survey time 14 mins  Interviewed in English, Italian, Greek, Vietnamese, Chinese and Arabic  Lifeline and Kids Help Line numbers were offered at the end of the survey  Parental consent required for those under 18

9. 12.3%87.7%

10. 2006 Census ANESSI

11. Indigenous Australians Females n=99 (0.8%) Males n=57 (0.5%)

12. 12 month proportionsLifetime proportions Overall 12-month prevalence 1.7% Overall lifetime prevalence 8.3% Overall lifetime prevalence 8.3%

13. Indigenous (Aboriginal or Torres Strait Islander) or Not Indigenous Mental Health – GHQ12

14. MethodsMotivations

15.  In line with:  Ross & Heath, Laye-Gindhu et al., Patton et al., De Leo & Heller, adolescent samples, 12 month prevalence, females more likely to self injure  Hawton et al., Patton et al. & De Leo & Heller, adolescent samples, 12 month prevalence 4-6%  Ross & Heath, Muehlenkamp & Guttierrez, adolescent sample, lifetime prevalence 13-16% (our estimate was slightly lower)  Briere & Gil (1998), adult sample, no difference between genders  Muehlenkamp & Guttierrez, adolescent sample, lifetime prevalence, most common methods cutting and scratching  Lower prevalence than:  Laye-Gindhu et al. (13.2%; they included reckless behaviour), Ross & Heath (13.86%; lifetime, still higher), Muehlenkamp & Guttierrez (15.9 and 23.2%), Nada-Raja (23.5%), Hasking et al. (46%) and Lloyd-Richardson et al. (46.5%)

16.  Age standardisation  Social exclusion  Remoteness  Dissociation  Emotion regulation  Coping  Suicidal ideation  Suicide attempt  Neglect, sexual abuse, physical abuse  Sexual orientation  Substance use