Wisconsin Self-Harm Data Dashboard

Help is available

If you or someone you know is experiencing a suicidal, mental health, and/or substance use crisis, the 988 Suicide & Crisis Lifeline provides 24/7 connection to confidential support with a trained counselor. Call or text 988 or chat via 988lifeline.org.

For other crisis and helpline options, visit the Wisconsin Department of Health Services Crisis Services webpage. Information on suicide warning signs, risk and protectives factors, and efforts to reduce suicide in Wisconsin is available on the Prevent Suicide webpage.

What is self-harm?

Self-harm refers to intentional actions taken to hurt oneself. Self-harm may be done as a coping strategy in response to stress, anxiety, or other emotional and/or mental health concerns. Someone who self-harms may or may not have the intention to die by suicide and injuries resulting from self-harm can range from minor to severe. Additionally, self-harm may refer to a current behavior that does not include an active injury (see Technical Notes for more detail). All instances are a public health concern and may put a person at greater risk for repeated self-harm, suicide attempt, or death by suicide. The dashboard includes all instances of self-harm, regardless of suicidal intent.

Learn more about self-harm, including the warning signs and how to help someone who is self-harming.

What data are included in the dashboard?

Emergency Department (ED) and hospital patient data are presented separately. We report data separately by patient type because this can be used as a proxy for severity. For example, if the injury is more severe, the patient would likely be admitted as a hospital patient instead of treated and released from the emergency department. Additionally, if the patient has a more severe health condition (whether related to the self-harm injury or not), they would be more likely to be admitted as a hospital patient. There are also demographic and diagnostic differences between type of patient that can be seen in the dashboard data.

What do the data tell us about disparities and inequities and what factors impact these differences?

Self-harm rates reveal disparities by race and sex, but they don’t explain the cause of these disparities. Additionally, other demographics, such as gender identification and sexual orientation, are not available in state health data, so a review of disparities by these demographics is not currently possible.
Racism, sexism, and heterosexism (discrimination or bias based on sexual orientation) may impact populations separately or they may compound to increase stress resulting in poor health outcomes that affect some communities more than others.
Economic, social, and legal conditions and issues can also drive despair and suffering; these can be intensified by racism, sexism and heterosexism and negatively influence a person’s health and mental status.
Stressors resulting from discriminatory systems may contribute to increased self-harming behaviors among communities harmed by these inequitable systems.
Understanding the impact of these structural inequities can support the development of appropriate public health intervention strategies and ensure equitable services for all.

How might these data be useful?

Self-harm is a serious public health concern, and a review of all instances allows us to see its impact on Wisconsin communities. Please note that while suicide deaths mark a tragic loss for families and society, they represent only a portion of people who experience suicidal thoughts and self-harming.

The dashboard may be used to detect populations at greater risk, medical conditions more often associated with self-harm, and methods more often used. The dashboard may also be useful to identify changes over time. Review of both ED and hospitalization data can also provide insight into the severity of injuries resulting from self-harm (for instance, more severe cases likely result in hospitalization).

Programs implementing evidence- or community-informed strategies and best practices to prevent suicide and self-harm should review data presented here, as well as other available data sources (such as death certificates), to better understand the full range of behaviors and life events that are associated with self-harm and suicide risk.

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What is unique about this dashboard?

The data in this dashboard are presented at the individual patient level (in other words, a single patient may have multiple visits, but the person is only counted once during any given year). This is different than most health data which is presented by number of visits. Patient data allows us to:

Review the percentage of individuals who repeat self-harming behaviors because, compared to other injuries, self-harm is more likely to be repeated and result in suicide (Imm et. al., 2021; see the following full reference); and
Detail the population impact and compare with suicide deaths.

Health care data

The data presented in the dashboard come from Wisconsin Hospital ED Visits and Inpatient Discharges, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services. This database includes information from Wisconsin’s hospitals including acute care, general medical and surgical, psychiatric, rehabilitation, and AODA (Alcohol and Other Drug Abuse) hospitals. We report these data separately because this can be used as a proxy for severity. For example, if the injury is more severe, the visit would likely result in hospital admission instead of treatment and release from the emergency department. Additionally, if the visit is for a more severe health condition (whether related to self-harm or not), this too would likely lead to hospital admission. Data from Veterans Affairs and other federal hospitals are not included. ED visit data and hospitalization data are presented separately. ED visit data includes only non-fatal, treated and released visits (meaning visits that do not result in immediate transfer and admission to a hospital). Hospitalization data includes only non-fatal hospital stays.

Self-harm injury codes

The health data presented in the dashboard are based on ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) coding. A new code, R45.88 (non-suicidal self-harm), was added in October 2021. This code is in the Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified Chapter of the ICD-10-CM codebook. All other codes in the table below are in the Injury, Poisoning, and Certain Other Consequences of External Causes Chapter. With the introduction of this code, trends are difficult to interpret before and after 2022 (the first full year when code R45.88 was in use) as we cannot be certain if increases are due to increasing self-harm or if this is the result of adding a previously unavailable ICD-10-CM code. Therefore, this dashboard will begin with 2022 data and continue to add years and report on trends over time based on the availability of the same codes for all years reported. The following are the specific self-harm codes organized by method of self-harm.

Diagnosis and external cause codes detailing method of self-harm (inclusion of any one of these codes anywhere in the record will lead to identification of self-harm).
ICD-10-CM Codes	Description
X71-X77, X79-X83; T71 (6th character=2)	Other methods: drowning/submersion, firearm, explosive material, fire/flame, hot vapors/objects, blunt object, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, asphyxiation, suffocation, hanging, other specified means
X78	Cutting: sharp object
T36-T50 with 6th character=2. Note: Include T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9 with 5th character=2	Drug poisoning: drugs, medications, and biological substances
T51-T53, T55-T62, T64, T540 with 6th character=2 (note: include T51.9, T52.9, T53.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, and T64.8 with a 5th character = 2); T650, T651, T652, T653, T654, T655, T656, T6581, T6583, T6589 with 6th character=2; T659 with 5th character=2	Non-drug poisoning: toxic effects of nonmedicinal substances
T14.91	Unspecified means: suicide attempt
R45.88	Unspecified means: non-suicidal self-harm; applicable to non-suicidal self-injury, non-suicidal self-mutilation, self-inflicted injury without suicidal intent.

Note: seventh character of A or missing (reflecting initial encounter, active treatment) is required for all of the above codes except for R45.88.

Patient-level data

The data presented in the dashboard represent unique patients (Wisconsin residents). The hospitalization/ED dataset includes a unique patient identifier that allows us to link multiple hospitalizations or multiple ED visits to the same patient. The unique identifier is only given to patients seen in Wisconsin hospitals/EDs. Wisconsin residents treated in Minnesota or Iowa hospitals are not included in the data presented in this dashboard. Counts, rates and number of visits are presented by patients by calendar year. This means that if a patient was seen in the ED more than once in a calendar year, they would only be counted once and the information from the first visit will be presented (such as age at time of first visit or method of self-harm at first visit). If that same patient is seen again in the following calendar year, they would be counted for that calendar year as well. The same is true of hospital stays which are presented separately. Data presented in this dashboard are different than the data presented in the WISH (Wisconsin Interactive Statistics on Health) Injury-Related Health Outcomes modules:

Data presented in the WISH modules are based on visits and not patients; and
Hospitalization data presented in WISH follow standard injury methodology which identifies only those visits with a principal diagnosis of injury; methodology for this dashboard includes hospital stays with any self-harm ICD-10-CM code for initial injury regardless of the principal diagnosis. More detail on the WISH Injury Hospitalization module.

Rates

The hospital and ED patient rates are calculated by dividing the number of resident deaths per year by the population. It is usually expressed as the number per 100,000 residents. For example, the overall ED patient rate for Wisconsin is based on the following calculation: [number of ED patients with self-harm ÷ total Wisconsin population]*100,000. If a rate is based on a sub-population, the calculation might look like this: [number of ED patients with self-harm among males aged 25 to 34 ÷ total Wisconsin population of males aged 25 to 34]*100,000.

When making comparisons between populations, it is recommended to select rate instead of count as this accounts for differences in population size and age composition.

If a rate is based on a count of less than 20, it is considered unstable and an asterisk (*) will appear instead of a rate. Additionally, if the count for a specific age or racial category is less than 10, the count will be referenced as more than 0 and less than 10.

Population estimates are based on data provided by the U.S. Census Bureau and are updated annually.

Age-adjusted rates

Age-adjusted rates are provided throughout the dashboard for all health data except when selecting data by Age or Age*Sex (see Age-specific rates below). Age-adjusted rates are recommended when making comparisons between two populations (for example, Southern Region rates compared to Northern Region rates) or two different time periods (for example, 2022 rates compared to 2023). Age-adjustment accounts for differences in age composition across populations and time. We use the Standard U.S. Population for Year 2000 for age-adjustment.

The age groups used to create the age-adjusted rates are those detailed in the dashboard (see selection of count or rate by age group).

Age-specific rates

Age-specific rates are provided when Age or Age*Sex is selected in the dashboard. An age-specific rate is calculated by dividing the total number of patients for the specific age group of interest by the total population of that age group. This is also known as an observed or unadjusted rate.

The age groups reported here are based on 10-year age groups starting at age 25 and older as is standard for reporting surveillance data and calculating rates. For those under age 24, the ages 0 to 9 were combined due to low numbers, and pre-teens, teens and young adults were separated in order to reveal differences in counts and rates for those ages with the highest rates of self-harm.

Race and ethnicity

Race and ethnicity data are collected and reported for hospitalizations and ED visits. This information may be obtained from the patient, from a previous electronic medical record, or from a medical staff person’s perception. Hospitals have different policies and methods regarding the collection and recording of this information. In this dashboard, data are not provided separately for multiple race, unknown race, or unknown ethnicity. Unknown race accounts for about 4-5 percent of patients with self-harm and unknown ethnicity accounts for less than 3 percent (for ED and hospital patients per year). Those identified as 2 or more races account for 1-2% of ED and hospital patients with self-harm. Race and ethnicity are reported separately. This means that race information includes both Hispanic or Latino/a/x and non-Hispanic ethnicity. Alternatively, classification as Hispanic or Latino/a/x includes all races, as does non-Hispanic.

This dashboard uses population estimates provided by the U.S. Census Bureau for the following racial categories: American Indian and Alaska Native; Asian, Native Hawaiian, or Pacific Islander; Black or African American; White; and two or more races. Data are not presented separately for “two or more races” or unknown race.

Rural/urban county residency

County urban and rural designations can vary based on the methodology used. The urban and rural breakdown used for this dashboard is based on the Federal Office of Rural Health Policy classification as of 2020. The list of rural counties can be found on the Health Resources & Services Administration website. Urban counties include Brown, Calumet, Chippewa, Dane, Douglas, Eau Claire, Fond du Lac, Kenosha, La Crosse, Marathon, Milwaukee, Outagamie, Ozaukee, Racine, Rock, Sheboygan, Vernon, Washington, Waukesha, and Winnebago.

Self-harm methods

The methods detailed in the dashboard include drug poisoning (including medication, drugs, and biological substances), poisoning by other substance (such as toxic effects of cleaning fluids), cutting by sharp object, “other methods", and unspecified methods. “Other methods” includes drowning/submersion, firearm, explosive material, fire/flame, hot vapors/objects, blunt object, jumping from a high place, jumping or lying in front of a moving object, crashing of a motor vehicle, asphyxiation, suffocation, hanging, and other specified methods. Unspecified methods indicates that only code R45.88 or T14.91 were included in the patient record. The methods of self-harm are not mutually exclusive (i.e., a person can cause self-harm by more than one of these methods).

See table above for a list of the specific codes for each method displayed.

Additional diagnosis codes

The information on additional diagnosis in a patient’s record is detailed below. The codes are mutually exclusive though a patient may have more than one of these diagnosis in their record and this would be identified in the percentages displayed.

Diagnosis Codes	ICD-10-CM Codes	Description
Mental health disorders	F00-F09, F20-F99	Mental, behavioral and neurodevelopmental disorders (exclusive of drug and alcohol use disorders)
Suicidal Ideation	R45.851	Suicidal ideations (thoughts but no actual attempt of suicide)
History of self-harm	Z91.5	Personal history of self-harm (parasuicide, self-poisoning, suicide attempt)
Drug use disorders	F11-F19	Opioid, cannabis, sedative, hypnotic or anxiolytic, cocaine, other stimulant, or hallucinogen related disorders, nicotine dependence, inhalant or other psychoactive substance related disorders
Alcohol use disorders	F10	Alcohol related disorders

Note: 7th character of A or missing for all above codes (reflects initial encounter, active treatment).

Additional data sources

Wisconsin Youth Risk Behavior Survey (YRBS): This survey is conducted as part of a national effort by the U.S. Centers for Disease Control and Prevention to monitor health-risk behaviors of the nation's high school students. The Wisconsin Department of Public Instruction administers this survey to public school students in grades 9 through 12 every two years. Included in the survey are questions on suicidal ideation, suicide attempts, mental health and other related topics. Data are available at the Wisconsin Department of Public Instruction.

Suicide Mortality: Suicide data for Wisconsin residents based on death certificates are available to query in the WISH Injury-Related Health Outcomes module.

Wisconsin Violent Death Reporting System: More comprehensive data on the circumstances surrounding deaths by suicide, such as employment and health status, are available to query in the WISH Violent Death module.

Suicide in Wisconsin: Impact and Response, P-02657 (PDF) Sept 2020: This report seeks to guide coordinated action to reduce suicide attempts and death. This includes data on suicide and self-harm injuries and strategies for action to reduce suicidal behavior in Wisconsin.