This document summarizes key findings from two studies on self-harm and suicidal behavior among adolescents and LGBT youth in Ireland. The school-based study found that 12% of adolescents reported self-harm, with females more likely than males. Factors strongly associated with self-harm included experiences of friends or family self-harming and conflicts with parents. The LGBT Ireland study found much higher rates of self-harm (56%) and suicide attempts (32%) among 14-18 year old LGBT youth. Intersex youth reported the highest rates of self-harm and suicide attempts. Motivations for self-harm among both groups included relieving distress and feelings of worthlessness. Both studies call for improving support systems and reducing stigma around

1. Self-harm and suicidal behaviour in two Irish
adolescent cohorts; findings from a school-based
study and from the LGBT Ireland study
Dr Louise Doyle
Perspectives to Suicide Prevention
National Institute for Health and Welfare
Helsinki
26/10/2017

2. Trinity College Dublin, The University of Dublin
Higgins, A. 2008

3. Trinity College Dublin, The University of Dublin
Suicide and Self-Harm in Ireland
• Ireland does not have a high suicide rate overall by
international comparison however we have the 4th
highest suicide rate in the 15-19 year age group across 31
European countries.
• Rates of hospital-treated self-harm are captured
nationally and published each year in the National Self-
Harm Registry (Ireland) Report - this report consistently
identifies that the highest rate of self-harm in the 15-19
year age group.

4. Trinity College Dublin, The University of Dublin
Connecting for Life – Ireland’s National Strategy to
Reduce Suicide 2015-2020
– 7 strategic goals to reduce suicide and
self-harm.
– Goal 3: focuses on reducing suicidal
behaviour among priority groups
including:
– Demographic cohorts: e.g. young
people
– Minority groups: e.g. LGBT people
– Goal 7: focuses on improving access
to timely and high-quality data on
suicide and self-harm.

5. Trinity College Dublin, The University of Dublin
Self-Harm in Irish Adolescents – a School-Based Study
• Aim - To identify the rate of self-harm in adolescents and
to determine the factors associated with it.
• Administration of the 96-item anonymous, self-report
‘Lifestyle and Coping’ survey measuring a range of
demographic, lifestyle and mental health factors –
previously used in Child and Adolescent Self-Harm in
Europe (CASE) study.
• Significant focus on the measurement of self-harm.

6. Trinity College Dublin, The University of Dublin
Measuring self-harm
• Historically the measurement of self-harm in research
studies has been problematic.
• Inconsistent definitions and inconsistent measurement
techniques has rendered inter-and cross-country
comparisons of self-harm rates problematic.
• Self-harm was measured using a rigorous method which
required participants to identify if they had ever self-
harmed and then to provide a description of their last
self-harm act – replicating the CASE study.

7. Trinity College Dublin, The University of Dublin
Measuring self-harm
• This description was then coded according to the
standardised definition of self-harm adapted for use in
this study which described self-harm as an intentional act
with a non-fatal outcome.
• Episodes of self-harm were categorised as ‘yes’, ‘no
description given’ or ‘not meeting criteria’.

8. Trinity College Dublin, The University of Dublin
Results: Self-harm rate
• 856 post-primary students in 11 Dublin schools. Mean age of
16 years (males 51%, females 49%).
• 12% of adolescents (n=103) met the standardised criteria for
self-harm.
• Females were more likely to report self-harm than males (OR
3.20).
• Cutting was the most common method (63%) followed by
overdose (29%).
• 43% thought about self-harm for less than one hour and 23%
less than one day.

9. Trinity College Dublin, The University of Dublin
Help-seeking and self-harm
• Help-seeking was not common with more than half not
seeking help before self-harm and almost ¾ not seeking
help after self-harm.
• When help was sought, in the majority of cases it was
sought from a friend, followed by a family member.
• Only a small minority presented to hospital as a result of
their last (6.9%) or any (11.8%) self-harm attempt.

10. Trinity College Dublin, The University of Dublin
Factors associated with adolescent self-harm
A multivariate logistic regression model identified that the
strongest factors independently associated with self-harm
were:
1.Self-harm/suicide attempt of a friend (OR 3.40).
2.Fights with parents (OR 2.91).
3.Self-harm/suicide attempt of a family member (OR 2.67).
4.Worries about sexual orientation (OR 2.31).
5.Problems making/keeping friends (OR 2.05)
6.Bullied at school (OR 1.98).

11. Trinity College Dublin, The University of Dublin
Motivations for self-harm
• The most common motivation for self-harm was wanting
to ‘get relief from a terrible state of mind’ (79%). The next
most common motivations included ‘I wanted to punish
myself’ (38%) and ‘I wanted to die’ (37%).
• The least commonly chosen motivation was ‘I wanted to
get some attention’ (11%).

12. Trinity College Dublin, The University of Dublin
Future Direction
• Informal help-seeking predominates – there is a need
therefore to support parents, teachers and friends to
better respond to young people who disclose self-harm
and to sign-post to relevant youth-orientated services.
• Requirement for interventions which improve
perceptions about the outcomes of help-seeking.
• Requirement for a specific focus on factors which are
associated with self-harm in young people e.g LGBT
identity.

13. Trinity College Dublin, The University of Dublin
LGBTIreland Study
Aim: To identify the
prevalence and
characteristics of self-
harm and suicide
attempts among LGBTI
people in Ireland

14. Trinity College Dublin, The University of Dublin
Positive changes
Decriminalisation
1993
Passport
act 2000
Civil
partnership
2010
Marriage equality
Gender recognition Act
2015
Employment equality act 1998

15. Trinity College Dublin, The University of Dublin
LGBTIreland study
Module 1:
Survey of LGBTI
people
N=2,264
Module 2:
Survey of general
public
N=1,008

16. Module 1: Survey
• 102-item anonymous online survey.
• Elicited ‘coming out’ experiences and experiences of
being LGBTI in school, College and in the workplace.
• Measured mental health and wellbeing including alcohol
misuse, self-esteem, depression, anxiety & stress, coping
mechanisms, self-harm and suicide attempts.
• Use of mental health measures that had previously been
used in the Irish adolescent population to allow
comparison.

17. Trinity College Dublin, The University of Dublin
Depression, Anxiety and Stress

18. Trinity College Dublin, The University of Dublin
Mental health by age group

19. Trinity College Dublin, The University of Dublin
Self-harm
• Over half of 14-18 year old participants (56%) had a
lifetime history of self-harm (compared to 12% in school-
based study).
• Over three quarters (77%) of whom reported self-harm
within the past year.
• Ave. age of first self-harm was 13 years.
• 94% had self-harmed more than once.
• 69% reported that they self-harmed six times or more.
56% self harm

20. Trinity College Dublin, The University of Dublin
Self-harm
• Self harm related to their LGBTI identity
• A quarter (24.6%) felt it was ‘very’/’very much related’.
• A third (34.1%) felt it was ‘somewhat related’.
• Two-thirds had thought about self-harming for less than
24 hours

21. Trinity College Dublin, The University of Dublin
Self-harm
• When disaggregated, there were statistically significant
differences in self-harm rates depending on L-G-B-T-I
group, with gay males significantly less likely to self-harm.
72,7%
67,1% 66,0%
61,3%
32,0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Intersex Transgender Bisexual Lesbian/gay
females
Gay males

22. Trinity College Dublin, The University of Dublin
Self-harm method
Methods of self-harm were broadly in line with other
community studies of self-harm:
• Self-cutting 76%
• Overdose 12.7%
• Self-battery 10.7%
• Burning 6.6%
• Significant alcohol misuse 2.6%
• Attempted hanging 1.1%
• Other 3.8%

23. Trinity College Dublin, The University of Dublin
Self-harm motivation
Other motivations behind self-harm are similar to those
found in young people in general (Doyle et al, 2017):
• Release of tension The best way to describe it is I felt like a pressure
cooker ready to explode and I discovered that by cutting myself it allowed
‘the steam’ to escape. (Lesbian/gay female)
• Dissociation – wanting to feel ‘something’ A desire to ‘feel’. A
desire to feel that I’m actually alive. (Bisexual female).
• Control I felt very out of control and extremely upset. I felt like I needed to
do it to calm myself down, to gain back some self-control of my thoughts and
body. (Lesbian/gay female)

24. Trinity College Dublin, The University of Dublin
Self-harm motivation
• Escape When I took an overdose, I just wanted it all to end. For the noise
to stop and for peace to arrive. (Gay male).
• Feelings of worthlessness I didn’t feel like I was worth anything as a
person. I hadn’t met a lot of my now friends at the time and found life
difficult and heavy. (Bisexual female).
• To get help I was hoping someone would see it and therefore try and get
me help. I had a lot of problems and I was too embarrassed to ask for help
myself. (Bisexual male).

25. Trinity College Dublin, The University of Dublin
Suicide
• Over two-thirds (69%) had seriously thought of ending own life
• Nearly one third (32%) had seriously tried to take their own life.
• Over half (53%) had tried in previous year
• Related to their LGBTI identity ( 57%)
• Over a quarter (28%) felt it was ‘very’/’very much’ related
• Over a quarter (29%) felt it was ‘somewhat related’.
32% Suicide attempt

26. Trinity College Dublin, The University of Dublin
Suicide attempts
• When disaggregated, there were statistically significant
differences in suicide attempt rates depending on L-G-B-T-I
group, with gay males significantly less likely to attempt suicide
and intersex people significantly more likely to do so.
63,6%
37,7% 37,7%
31,2%
21,2%
0%
10%
20%
30%
40%
50%
60%
70%
Intersex Transgender Lesbian/gay
females
Bisexual Gay males

27. Trinity College Dublin, The University of Dublin
Mental Health by Age Group

28. Trinity College Dublin, The University of Dublin
The hardest person for me to tell was my best friend (Male) I was
absolutely terrified of losing his friendship. Once I finally plucked up
the courage to tell him, he took it really well, didn’t make a big deal
about it. I was so lucky to have such a good friend. (Gay, Male)

29. Trinity College Dublin, The University of Dublin
Future
• Expand curriculum in schools to address LGBT issues.
• Reduce risks particularly homophobic, biphobic and
transphobic bullying in school.
• Build knowledge and skills of professionals.
• Increase public understanding.
• Reduce stigma associated with mental health issues and
promote help seeking.

30. Trinity College Dublin, The University of Dublin
Positive changes – Visibility!

31. Papers – more to follow!

32. Thank You