About 1 in 20 of all patients in psychiatric hospitals have cut themselves, usually using a razor blade, knife, broken glass or mirror. The incidence of self-injury in psychiatric patients is about 50 times greater than the general population in the United States. Many patients have cut themselves over many years. Often their families are aware of it. The incidence of oral and IV substance abuse is high in this patient group. Female to male ratio is about 3 to 1. Most patients are in their 20’s and claim to experience no pain and describe their motivations as anger at themselves or others, the relief of anxiety and the wish not to live. Suicidality must be assessed and co-morbid psychiatric conditions must be treated.
Suicidality can be assessed through determination of intent and planning. Lethality is a measure of the seriousness of the means. Factors associated with suicide risk include being 45 years of age or older, alcohol dependence, anger, rage and violence, prior suicidal behavior, being male, being unwilling to accept help, having a longer than usual duration of depression, having been a psychiatric inpatient, having recently experienced a loss or separation, depression, loss of physical health, being unemployed or retired and being single or divorced, in diminishing order of importance.