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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. Call or text 988 or chat via 988lifeline.org.
What is self-harm?
Self-harm refers to intentional actions taken to hurt oneself. Self-harm that results in injury may be done to express or lessen emotional pain. Some examples include cutting, poisoning, or burning oneself. Someone who self-harms may or may not have the intention to die by suicide. Self-harm, may, however, put a person at greater risk for repeated self-harm, suicide attempt, or death by suicide. The dashboard below includes all instances of self-harm, regardless of suicidal intent.
What data are included in the dashboard?
The data presented in the dashboard below come from non-fatal hospital and emergency department (ED) visit records noting a self-harm injury. Data are presented at the individual patient level. This means that a single patient may have multiple visits within a calendar year but is only counted once during that year.
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 self-inflicted injury 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 below 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.
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 full reference below); 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. 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. The following are the specific self-harm codes organized by method of self-harm.
|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
|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
|Unspecified means: suicide attempt
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.
The hospitalized and ED patient rates are calculated by dividing the number of patients per year by the population. It is usually expressed as the number of patients per 100,000 residents.
Population estimates are based on data provided by the U.S. Census Bureau and are updated annually.
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 age*sex category is less than 10, an asterisk will appear instead of a number.
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, 2018 rates compared to 2020). 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 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. In this dashboard, data are not provided separately for multiple race, unknown race, or unknown ethnicity. Unknown or multiple race accounts for less than 5 percent of patients with self-harm injury and unknown ethnicity accounts for less than 3 percent (for ED and hospitalization data per year). Race and ethnicity are reported separately. This means that race information includes both Hispanic and non-Hispanic ethnicity. Alternatively, classification as Hispanic includes all races, as does non-Hispanic.
Due to changes in the hospital/ED reporting form, there was a larger number of missing and inconsistent race information from some facilities in the first quarter of 2018. Race information for that year should be reviewed with caution (especially when comparing to later years).
This dashboard uses population estimates provided by the U.S. Census Bureau for the following racial categories: American Indian and Alaska Native, Asian, Black or African American, Native Hawaiian and Other Pacific Islander, White, and “two or more races.” For this dashboard, we have combined Asian and Native Hawaiian and Other Pacific Islander to match with the coding in Wisconsin hospital and ED visit records (referred to broadly as Asian). Data are not presented separately for “two or more races” or unknown race.
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, and “other 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. 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.
|Mental health disorders
|Mental, behavioral and neurodevelopmental disorders (exclusive of drug and alcohol use disorders)
|Suicidal ideations (thoughts but no actual attempt of suicide)
|Personal history of self-harm (parasuicide, self-poisoning, suicide attempt)
|Drug use disorders
|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
|Alcohol related disorders
Imm P, Grogan B, Diallo O. 2021. Self-harm injury hospitalizations: an analysis of case selection criteria. Injury Prevention Journal: 27(1): i49-i55. doi:10.1136/injuryprev-2019-043514.
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.
Learn more about self-harm, including how to identify and respond to it at the Department of Health Services self-harm webpage.