Keith Hawton

• DSc FMedSci DM
• University of Oxford

Aims To explore the experiences of qualified nurses who have lived experience of self‐harm (with or without suicidal intent) during nursing training or practice. Specifically, to examine characteristics and contributing factors and ideas for tailored suicide prevention interventions. Design Exploratory qualitative study. Methods Individual semi‐s...

Background: Over three-quarters of suicides occur in low- and middle-income countries (LMICs) and a better understanding of this behavior within these settings is crucial. Aim: To investigate stakeholders’ knowledge, attitudes, and experiences of self-harm and suicide in LMICs. Method: A systematic search was conducted using British Nursing Index,...

Background: Suicide prevention strategies internationally recommend promoting responsible media reporting of suicide to reduce negative impacts on population suicides. Existing tools to assess the quality of suicide reporting do not capture specific harmful features of the online setting. We aimed to adapt PRINTQUAL, a tool for assessing newspaper...

Background Alcohol use is a well-established potentially modifiable risk factor for suicide, yet few studies have investigated the impact of alcohol restrictions on suicide rates, particularly in low- and middle-income countries. Methods We used data from nationally representative annual surveys of postmortem investigations in 2017 (n=6117) and 20...

Background Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more information is needed to inform care. Aim To investigate rates, characteristics and outcomes of self-harm in women in midlife compared to younger women and identify...

Background Hypnotics have been linked to suicidal behaviors. While existing evidence has established findings of associations, more knowledge is needed regarding benzodiazepine (BZD) and non-benzodiazepine (n-BZD) hypnotics. Aim To examine whether individuals in treatment with hypnotics had higher rates of suicide and suicide attempts than those n...

Background: In 2016, globally, suicide was the second leading cause of death amongst those aged 15 to 29 years. Self-harm is increasingly common among young people in many countries, particularly among women and girls. The risk of suicide is elevated 30-fold in the year following hospital presentation for self-harm, and those with suicidal ideatio...

Background Self-harm is a major health issue resulting in high societal costs. Few psychological and psychosocial interventions have shown effectiveness in reducing repeat self-harm. Objective To assess the cost-effectiveness of psychological and psychosocial interventions that have shown evidence of effectiveness in adults and CYP (children and y...

Background Growing evidence suggests that self‐harm‐related mental imagery is involved in the transition from self‐harm ideation to enactment. However, there has been little research on this important phenomenon in adolescent populations. Methods Using an online questionnaire, the frequency, content and impact of self‐harm‐related mental imagery w...

Self-harm is when someone hurts themselves on purpose, regardless of the reasons for doing this. Often, shame and stigma stop people from seeking help. Self-harming behaviour increases the risk of death by suicide, and it is a common cause of disability in young people. Currently, people attending health services only represent the tip of the icebe...

Self-harm is when someone hurts themselves on purpose, regardless of the reasons for doing this. Often, shame and stigma stop people from seeking help. Self-harming behaviour increases the risk of death by suicide, and it is a common cause of disability in young people. Currently, people attending health services only represent the tip of the icebe...

Objective: Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalenc...

Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients...

Background Self‐harm is very common in young people and is associated with suicide. Rates of both self‐harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self‐harm. Method We significantly update and build on previous reviews with the aim of identifying issue...

Hospital records are used to identify suicide attempts in many countries but not all individuals present to hospital after a suicide attempt i.e., suggesting a ‘hidden number’. Our aim was to present the prevalence of suicide ideation, plans, attempts, and suicides among Danish adolescents, including attempts not resulting in hospital contact. The...

Background: Nursing professionals are an occupational group at increased risk of suicide, but little is known about self-harm in this population. Aims: To investigate the characteristics of nurses and midwives who present to hospital following self-harm. Method: We used data from the Oxford Monitoring System for Self-Harm to identify nurses and mid...

Suicidal behaviour in adolescents is a major public health problem. Much research on this issue has focused on epidemiology and risk factors for suicidal behaviour, paying less attention to the self-perceived needs of adolescents. However, to increase engagement in suicide prevention, it is important to include the views of adolescents. A scoping r...

Aim To synthesize research investigating suicide, suicide attempts, self‐harm and suicide ideation in nursing and midwifery students, a group of interest due to high rates of suicide among qualified nurses. Specific areas of interest for this review included prevalence, factors which may contribute to or mitigate risk and suicide prevention interve...

Background: There is little information about characteristics and long-term outcomes of individuals who self-harm during a suicide cluster. Aims: To compare characteristics of individuals who self-harmed during a suicide cluster in South Wales (∼10 deaths between December 2007 and March 2008) with others who self-harmed prior to the cluster and to...

Accessible Summary What is known on the subject Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work...

The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services a...

Introduction Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic. Objectives We aimed to examine the utilisation and acceptability of formal, informal, and online support accessed by adolescents following self-harm befor...

Background: Increases in poor mental health and suicide have been identified among university students in the UK. However, little is known about self-harm in this group. Aims: To describe and identify care needs of university aged-students who self-harm via comparisons with an age-equivalent non-student group who self-harm. Methods: Observatio...

It has become increasingly apparent that rapidly available information about the occurrence of suicides is needed, particularly to support suicide prevention efforts. Concerns about the potential impact of the COVID-19 pandemic on vulnerability to suicide highlighted the need for such early data internationally. Here, we set out the nature, current...

Background Viewing self‐harm and suicide‐related images online can precede these behaviours. We reviewed studies of potential impacts and mechanisms associated with viewing self‐harm‐related images on the internet and social media. Method CINAHL, Cochrane Library, EMBASE, HMIC, MEDLINE, PsycArticles, PsycINFO, PubMed, Scopus, Sociological Abstract...

The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services a...

Background: Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297). Methods: MEDLINE, PsycINFO, and CINAHL were searched. Articles published fr...

Objectives: Since the start of the COVID-19 pandemic, there has been much concern and speculation about rises in suicide rates, despite evidence that suicides did not in fact increase in the first year of the pandemic in most countries with real-time suicide data. This public narrative is potentially harmful, as well as misleading, and is likely t...

Background: Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision. Objectives: To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 6...

Background: Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking. Aims: To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups. Method: A cohort design was applied to nat...

Background: Nursing professionals are an occupational group at increased risk of suicide, but little is known about self-harm in this population. Aims: To investigate the characteristics of nurses and midwives who present to hospital following self-harm. Method: We used data from the Oxford Monitoring System for Self-Harm to identify nurses and...

In the UK, at least a quarter of suicides occurs in patients whilst under the care of mental health services. This study investigated the effects of such deaths on non‐medical mental health clinicians. An online survey was conducted within a single NHS mental health Trust to elicit both quantitative and qualitative responses from staff across a ran...

Adolescents’ loneliness and self-harm have received considerable attention during the COVID-19 pandemic with concerns that the socioecological changes taking place would contribute to an escalation of both loneliness and self-harm. However, empirical evidence is scant. We estimated the prevalence of loneliness and self-harm in adolescent school pup...

Concerns have been raised about early vs. later impacts of the COVID-19 pandemic on suicidal behavior. However, data remain sparse to date. We investigated all calls for intentional drug or other toxic ingestions to the eight Poison Control Centers in France between 1st January 2018 and 31st May 2022. Data were extracted from the French National Da...

Media impact on suicide is well‐established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID‐19 pandemic. Print and online newspaper reports about suicide in nurses (incl...

Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official pu...

Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can ha...

Background We examined disparities in sociodemographic and clinical characteristics and in problems preceding self-harm across levels of socio-economic deprivation (SED) in persons who presented to hospital for self-harm. Method 108,092 presentations to hospitals (by 57,306 individuals) following self-harm in the Multicentre Study of Self-harm in...

Background Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. Method A comprehensive search of d...

Background Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic. Aims To examine the utilization and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the...

Objectives Since the start of the COVID-19 pandemic, there has been much concern and speculation about rises in suicide rates, despite evidence that suicides did not in fact increase in the first year of the pandemic in most countries with real-time suicide data. This public narrative is potentially harmful, as well as misleading, and is likely to...

Background: Deterioration in general population mental health since the start of the COVID-19 pandemic has been reported, but the impact of the pandemic on people with severe mental illness (SMI) has received less attention. Aims: To understand the impact of the early stages of the pandemic on the patients with SMI, in terms of provision of ment...

Background: Associations between sensational news coverage of suicide and increases in suicidal behavior have been well documented. Amid growing concern over the impact of the COVID-19 pandemic on suicide rates, it is especially important that news coverage adheres to recommended standards. Method: We analyzed the quality and content of print and o...

Introduction: Pesticide self-poisoning kills an estimated 110 000-168 000 people worldwide annually. Data from South Asia indicate that in 15%-20% of attempted suicides and 30%-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers repr...

Background There is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people. Objective To measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected co...

Background: People who experience homelessness are thought to be at high risk of suicide, but little is known about self-harm in this population. Aims: To examine characteristics and outcomes in people experiencing homelessness who presented to hospital following self-harm. Method: Data were collected via specialist assessments and/or hospital...

Background: Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. There is some evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm, but the potential cost-effectiveness of psychosocial assessm...

Background Evidence on the impacts of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims To systematically review evidence on health services utilisation for self-harm during the COVID-19 pandemic. Methods A comprehensive search of multiple d...

Background Self‐harm, a significant and increasing global problem in children and adolescents, is often repeated and is associated with risk of future suicide. To identify potential interventions, we need to understand the life problems faced by children and adolescents, and by sub‐groups of younger people who self‐harm. Our aims were to include th...

Background Very little is known about self-harm in children. We describe the characteristics and outcomes of children under 13 years who presented following self-harm to five hospitals in England. Methods We included children under 13 years who presented after self-harm to hospitals in the Multicentre Study of Self-harm in England. Information on...

Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years wi...

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives of this review are threefold, as follows. Firstly, to assess service user experiences of emergency care following an episode of SH. Secondly, to understand how service user characteristics (e.g. gender, age, comorbidity with other illness), type of SH (e.g. method, r...

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives of this review are threefold, as follows. Firstly, to assess the content of knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff towards service users with SH presentations. Secondly, to understand how service user and...

There was a highly publicised cluster of at least ten suicides in South Wales, United Kingdom, in 2007–2008. We carried out a qualitative descriptive study using cross-case thematic analysis to investigate the experiences and narratives of eight individuals who lived in the area where the cluster occurred and who survived an episode of near-fatal s...

Background: Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate receptor modulators for depression in bipolar disorder. Objectives: 1. To assess the effects of ketamine and other glutamate receptor modulators in alleviating the acu...

Aims There are substantial costs to health care systems and society associated with self-harm. Moreover, individuals who have presented to hospital following self-harm have a much higher risk of suicide within the following year compared to the general population. National guidance in England recommends psychosocial assessment when presenting to ho...

Background: Many studies have recently been conducted to assess the antidepressant efficacy of glutamate modification in mood disorders. This is an update of a review first published in 2015 focusing on the use of glutamate receptor modulators in unipolar depression. Objectives: To assess the effects - and review the acceptability and tolerabili...

Background Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, c...

Background We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab. Method We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004–31/12/2014), with mortality follow-up to 31/12/2019. Informati...

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal beh...

Background Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms. Methods We performed secondary analyses...

Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide a...

Associations between sensational news coverage of suicide and subsequent increases in suicidal behaviour in the general population have been well documented. Amidst growing concern over the impact of the COVID-19 pandemic on suicide rates, it is especially important that news coverage of suicidal behaviour adheres to recommended standards for the r...

Background: Self‐harm (SH; intentional self‐poisoning or self‐injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for...

Summary Background The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods We sourced real-time s...

Objective An emerging body of research indicates that child sex abuse (CSA) offenders are at high risk of suicide when their offenses come to light and that those accused of accessing indecent images of children (IIOC) are at particular risk. Methods We conducted a systematic review and narrative synthesis on suicide rates and risk factors in this...

Background: Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especiall...

Introduction The COVID-19 pandemic and resulting public health measures may have major impacts on mental health, including on self-harm. We have investigated what factors related to the pandemic influenced hospital presentations following self-harm during lockdown in England. Method Mental health clinicians assessing individuals aged 18 years and...

Background Rates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners. Methods We did an updated syste...

Objectives Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs). Design An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to as...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects of interventions delivered in educational settings to prevent self-harm and suicide in young people (up to the age of 25) and examine whether the relative effects on repetition of self-harm are modified by education setting. Co...

Background The COVID-19 pandemic and public health measures necessary to address it may have major effects on mental health, including on self-harm. We have used well-established monitoring systems in two hospitals in England to investigate trends in self-harm presentations to hospitals during the early period of the pandemic. Method Data collected...

Background: Self‐harm (SH; intentional self‐poisoning or self‐injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of pharmacological agents and/or natural products in the treatment of SH is lacking, espe...

Background Ketamine has recently received considerable attention regarding its antidepressant and anti-suicidal effects. Trials have generally focused on short-term effects of single intravenous infusions. Research on patient experiences is lacking. Aims To investigate the experiences over time of individuals receiving ketamine treatment in a rout...

Introduction The COVID-19 pandemic and resulting public health measures may have major impacts on mental health, including on self-harm. We have investigated what factors related to the pandemic influenced hospital presentations following self-harm during lockdown in England. Method Mental health clinicians assessing individuals aged 18 years and...

Background Individuals attending emergency departments following self-harm have increased risks of future self-harm. Despite the common use of risk scales in self-harm assessment, there is growing evidence that combinations of risk factors do not accurately identify those at greatest risk of further self-harm and suicide. Aims To evaluate and comp...

Background : Suicide on roads is receiving increased attention. However, there has been little research on non-fatal road-related self-harm. This study was conducted in order to investigate the characteristics of such acts. Method : Information on non-fatal road self-harm was extracted from a self-harm monitoring system database of self-harm prese...

Background The COVID-19 pandemic and public health measures necessary to address it may have major effects on mental health, including on self-harm. We have used well-established monitoring systems in two hospitals in England to investigate trends in self-harm presentations to hospitals during the early period of the pandemic. Method Data collecte...

Background: Although research has identified a wide range of risk factors for suicidal behaviour in prisoners, it does not establish who is most likely to act on their suicidal thoughts while incarcerated. Methods: Self-report data were collected from a random sample of 1203 adult men incarcerated across 15 prisons in Belgium, who represent 12% of...