Interventions to reduce repetition of deliberate self-harm

Estimates of age-standardized DSH rates show marked variation between different countries with a ® ve-fold difference between European centres, although this variation may reect differences in service contact following DSH rather than true differ- ences in rates (Schmidtke et al., 1996). DSH is often a repetitive behaviour, with up to 30% of self- harmers repeating within one year. Kreftman and Casey (1988) reported that 13% weremajor repeat- ers', de® ned as those who had a lifetime history of ® ve or more episodes. Risk factors for repetition have been identi® ed, the strongest being a history of at least one previous episode (Kreitman & Foster, 1991). As well as being a common problem, those presenting following DSH are one of the groups at highest risk of future suicide, with 1% dying within one year of an attempt and 7% after ten years (NHS CRD, 1998). Offering effective interventions to those presenting following DSH will not only reduce the burden of DSH on general hospitals and psychiatric services, but may have an important role in suicide preven- tion. However, to date no single intervention has been shown to be effective in reducing repetition of DSH.