The iceberg model of self-harm

The model shows high levels of the problem in the community, especially in young girls, and the need for school-based prevention measures.


Scientists at the University of Oxford used national data on suicide, together with data on hospital-presenting self-harm from five hospitals and data on self-harm in the community from a large-scale school survey to estimate the relative incidence of fatal and non-fatal self-harm in 12–17-year-old adolescents.

Through the data, they described these as far as an icy mass model including deadly self-hurt, i.e., suicide, an obvious however exceptional conduct (a glimpse of a larger problem); self-hurt that outcomes in introduction to clinical administrations, particularly broad healing centers, which is additionally unmistakable, yet normal; and self-hurt that happens in the group, which is normal yet to a great extent concealed (the submerged piece of the icy mass).

Evaluated rates of deadly and non-lethal self-hurt demonstrated that for each immature who kicked the bucket by suicide, there were around 370 teenagers who displayed to a healing center for self-hurt and 3,900 youths who revealed self-hurt in the group. These figures propose that consistently in England, around 21,000 youths aged 12– 17 years present to a healing center after self-hurt, and 200,000 self-hurt in the group don’t present to a doctor’s facility.

The examiners additionally demonstrated that while the rate of suicide in youthful guys was twice that of females, the rates of both doctor’s facility displaying and group happening non-deadly self-hurt were generously higher in females than in guys. Prominently, the frequency of self-hurt happening in the group in more youthful young people (12-14 year-olds) was as high as that found for more seasoned teenagers (15-17 year-olds), the age at which self-hurt is thought to crest.

Professor Keith Hawton, from the Centre for Suicide Research, said, “Our discoveries affirm that there are abnormal amounts of self-hurt in teenagers. While extensive quantities of teenagers present to healing facility following self-hurt, there are numerous more youths who self-hurt in the group and don’t go to the consideration of clinicians.

“It is unmistakably a specific issue in females and exceptionally youthful young people. This demonstrates the need not just for good quality and responsive clinical administrations, yet in addition to powerful web-based intercessions and particularly counteracting action at the group level, especially through school-based activities.”

In young people, non-deadly self-hurt is a typical purpose behind doctor’s facility introduction and, furthermore, happens as often as possible in the group without coming to clinical consideration. Suicide is a main source of death in young people and is regularly gone before independent from anyone else hurt.

Self-harm and suicide in children and adolescents have been highlighted as key areas for intervention and prevention by the National Suicide Prevention Strategy for England.

This is the first study to explore the relative sizes of the populations of adolescents involved in these three levels of self-harm in England.

Journal reference:

  1. Galit Geulayov, and et al. Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. The Lancet Psychiatry, 2018; DOI: 10.1016/S2215-0366(17)30478-9