Epidemiological profile of repeated self-harm presentations to healthcare services in a Brazilian urban centre (Vitoria, ES)
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Accepted Version
Date
2026-07-01
Authors
Kavalidou, Katerina
Predo, Renata Martins
de Oliveira, Vítor Fabri
Iglesias, Alexandra
Dimenstein, Magda Diniz
Costa, Raísa Catherinne Cagliari
Zortea, Tiago C.
Journal Title
Journal ISSN
Volume Title
Publisher
Hogrefe Publishing Group
Published Version
Abstract
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.
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Keywords
Self-harm , Repetition , Brazil , Vitoria , Public health data
Citation
Kavalidou, K., Predo, R. M., de Oliveira, V. F., Iglesias, A., Dimenstein, M. D., Costa, R. C. C. and Zortea, T. C. (2026) 'Epidemiological profile of repeated self-harm presentations to healthcare services in a Brazilian urban centre (Vitoria, ES)', Crisis: The Journal of Crisis Intervention and Suicide Prevention, 47(4), pp. 260-271. https://doi.org/10.1027/0227-5910/a001066