Deaths from<unk>  per million people in 2012 World-map showing the disability-adjusted life year, which is a measure of each country's disease burden, for<unk> -inflicted injuries per 100,000 inhabitants in 2004. It is difficult to gain an accurate picture of incidence and prevalence of<unk> . This is due in a part to a lack of sufficient numbers of dedicated research centres to provide a continuous monitoring system. However, even with sufficient resources, statistical estimates are crude since most incidences of<unk>  are undisclosed to the medical profession as acts of<unk>  are frequently carried out in secret, and wounds may be superficial and easily treated by the individual. Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys. The World Health Organization estimates that, as of 2010, 880,000 deaths occur as a result of<unk> . About 10% of admissions to medical wards in the UK are as a result of<unk> , the majority of which are drug overdoses. However, studies based only on hospital admissions may hide the larger group of<unk> ers who do not need or seek hospital treatment for their injuries, instead treating themselves. Many adolescents who present to general hospitals with deliberate<unk>  report previous episodes for which they did not receive medical attention. In the United States up to 4% of adults<unk>  with approximately 1% of the population engaging in chronic or severe<unk> . Current research suggests that the rates of<unk>  are much higher among young people with the average age of onset between 14 and 24. The earliest reported incidents of<unk>  are in children between 5 and 7 years old. In the UK in 2008 rates of<unk>  in young people could be as high as 33%. In addition there appears to be an increased risk of<unk>  in college students than among the general population. In a study of undergraduate students in the US, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of<unk>  was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this. In Ireland, a study found that instances of hospital-treated<unk>  were much higher in city and urban districts, than in rural settings. The CASE (Child & Adolescent<unk>  in Europe) study suggests that the life-time risk of<unk> -injury is ~1:7 for women and ~1:25 for men. Gender differences In general, the latest aggregated research has found no difference in the prevalence of<unk>  between men and women. This is in contrast to past research which indicated that up to four times as many females as males have direct experience of<unk> . However, caution is needed in seeing<unk>  as a greater problem for females, since males may engage in different forms of<unk>  (e.g., hitting themselves) which could be easier to hide or explained as the result of different circumstances. Hence, there remain widely opposing views as to whether the gender paradox is a real phenomenon, or merely the artifact of bias in data collection. The WHO/EURO Multicentre Study of Suicide, established in 1989, demonstrated that, for each age group, the female rate of<unk>  exceeded that of the males, with the highest rate among females in the 13–24 age group and the highest rate among males in the 12–34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of<unk>  in general. Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of<unk>  are due to deliberate socially biased methodological and sampling errors, directly blaming medical discourse for pathologising the female. This gender discrepancy is often distorted in specific populations where rates of<unk>  are inordinately high, which may have implications on the significance and interpretation of psychosocial factors other than gender. A study in 2003 found an extremely high prevalence of<unk>  among 428 homeless and runaway youths (aged 16–19) with 72% of males and 66% of females reporting a history of<unk> . However, in 2008, a study of young people and<unk>  saw the gender gap widen in the opposite direction, with 32% of young females, and 22% of young males admitting to<unk> . Studies also indicate that males who<unk>  may also be at a greater risk of completing suicide. There does not appear to be a difference in motivation for<unk>  in adolescent males and females. Triggering factors such as low<unk> -esteem and having friends and family members who<unk>  are also common between both males and females. One limited study found that, among those young individuals who do<unk> , both genders are just as equally likely to use the method of skin-cutting. However, females who<unk> -cut are more likely than males to explain their<unk>  episode by saying that they had wanted to punish themselves. In New Zealand, more females are hospitalized for intentional<unk>  than males. Females more commonly choose methods such as<unk> -poisoning that generally are not fatal, but still serious enough to require hospitalization. Elderly In a study of a district general hospital in the UK, 5.4% of all the hospital's<unk>  cases were aged over 65. The male to female ratio was 2:3 although the<unk>  rates for males and females over 65 in the local population were identical. Over 90% had depressive conditions, and 63% had significant physical illness. Under 10% of the patients gave a history of earlier<unk> , while both the repetition and suicide rates were very low, which could be explained by the absence of factors known to be associated with repetition, such as personality disorder and alcohol abuse. However, NICE Guidance on<unk>  in the UK suggests that older people who<unk>  are at a greater risk of completing suicide, with 1 in 5 older people who<unk>  going on to end their life. A study completed in Ireland showed that older Irish adults have high rates of deliberate<unk> , but comparatively low rates of suicide. Developing world Only recently have attempts to improve health in the developing world concentrated on not only physical illness but also mental health. Deliberate<unk>  is common in the developing world. Research into<unk>  in the developing world is however still very limited although an important case study is that of Sri Lanka, which is a country exhibiting a high incidence of suicide and<unk> -poisoning with agricultural pesticides or natural poisons. Many people admitted for deliberate<unk> -poisoning during a study by Eddleston et al. were young and few expressed a desire to die, but death was relatively common in the young in these cases. The improvement of medical management of acute poisoning in the developing world is poor and improvements are required in order to reduce mortality. Some of the causes of deliberate<unk> -poisoning in Sri Lankan adolescents included bereavement and harsh discipline by parents. The coping mechanisms are being spread in local communities as people are surrounded by others who have previously deliberately<unk> ed themselves or attempted suicide. One way of reducing<unk>  would be to limit access to poisons; however many cases involve pesticides or yellow oleander seeds, and the reduction of access to these agents would be difficult. Great potential for the reduction of<unk>  lies in education and prevention, but limited resources in the developing world make these methods challenging. Prison inmates Deliberate<unk>  is especially prevalent in prison populations. A proposed explanation for this is that prisons are often violent places, and prisoners who wish to avoid physical confrontations may resort to<unk>  as a ruse, either to convince other prisoners that they are dangerously insane and resilient to pain or to obtain protection from the prison authorities.<unk>  also occurs frequently in inmates who are placed in solitary confinement.
Self-harm
Physical abuse
Bullying in medicine
Bullying and suicide
Copycat suicide
Bullying
Night terror
Assisted suicide