Epidemiological Profile of Repeated Self-Harm Presentations to Healthcare Services in a Brazilian Urban Centre (Vitoria, ES).

Abstract

Background: In Brazil, national surveillance indicates a rise in self-harm, but little is known about patterns of repeated presentations to healthcare services or changes in self-harm methods over time. Aims: To examine sociodemographic and clinical factors associated with two or more (repeated) presentations to healthcare services for self-harm, and to explore method switching among individuals presenting to healthcare services in Vitória, Brazil. Method: A retrospective cohort analysis was conducted using administrative data from the Brazilian Unified Health System in Vitoria City (Espírito Santo; 2012-2022). Records from the Notifiable Diseases Information System and e-SUS National Health Surveillance System were used to identify individuals with self-harm presentations. Modified Poisson Regression was employed to examine associations between repeated self-harm episodes and sociodemographic and clinical characteristics between 2018 and 2022. Results: Among 2,152 self-harm notifications, 69% involved repeated presentations. The results revealed that female sex [RR = 1.14, 95% CI: 1.06-1.23], presence of disorder [RR = 1.41, 95% CI: 1.27-1.57], and use of sharp objects [RR = 1.22, 95% CI: 1.12-1.32] were positively associated with repetition, whereas Black [RR = 0.87, 95% CI: 0.79-0.95], multiracial ethnicity [RR = 0.92, 95% CI: 0.87-0.98], and poisoning [RR = 0.92, 95% CI: 0.85-1.00] were negatively associated. Among those with multiple episodes, half re-presented within 77 days and three-quarters within 260 days. Method switching was common: 42% changed methods between their first and second episodes, with cutting most frequently transitioning to self-poisoning. Limitations: Findings rely on routine notification data, which vary in completeness. Some clinical information was based on collateral reports rather than diagnosis. Conclusion: Repeated self-harm presentations often occur within short intervals. High levels of method switching underscore the need for person-centered assessments.