Causes

• Life events and social difficulties: about 70 per cent of these acts follow a distressing event, usually involving disharmony with another person. Long-term social problems, such as family or economic difficulties, are common.

• Psychiatric disorder: there is clearly a high prevalence of mental disorder among DSH patients, but it is difficult to generalize. All types of mental disorder are seen, including psychosis occasionally. Symptoms of low mood are common (over 50 per cent of cases), but most do not have a pervasive clinical depressive illness at follow-up. Personality disorder and substance misuse are also common (perhaps over 25 per cent).

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