Self-harm hospitalizations in Germany between 2020 and 2024: an analysis of administrative data

Background

Self-harm is a strong predictor of suicide death and a major public health concern. Internationally, hospitalizations due to self-harm are used within suicide surveillance frameworks and serve as an important indicator of population mental health. Despite its considerable potential, hospital data are not yet systematically utilized for the purpose of monitoring suicidality in Germany.

Methods

We analyzed publicly available aggregated administrative data from all German hospitals from 2020 to 2024. Self-harm hospitalizations were identified using ICD-10-GM code X84.9! (“intentional self-harm”), which covers self-inflicted injury or poisoning regardless of suicidal intent. Analyses examined time trends overall as well as by sex, age, and general versus psychiatric hospital settings.

Results

A total of 15,536 hospitalizations due to self-harm were identified for 2024, including 1,664 in general and 13,872 in psychiatric hospitals. Overall, 75% occurred among female patients, 45% among individuals younger than 18 years, and 69% among those younger than 30 years. We observed an increase in self-harm hospitalizations between 2020 and 2021 (+9% in general hospitals, +14% in psychiatric hospitals), driven primarily by an increase in admissions among female patients. While self-harm admissions in general hospitals returned to pre-2021 levels by 2022, psychiatric hospitalizations remained elevated through 2024.

Conclusions

Administrative hospital records allow for the monitoring of self-harm hospitalizations and their temporal trends. Combined with complementary sources such as survey and emergency department data, they could provide a comprehensive empirical basis for suicide surveillance and prevention. In line with previous findings, adolescents, young adults, and women emerge as key target groups for prevention, particularly in light of the observed increases in self-harm hospitalizations in recent years.

Key messages

• Hospitalizations due to self-harm increased notably in 2021, with psychiatric admissions remaining elevated through 2024, disproportionately affecting adolescents, young adults and women.

• Administrative hospital data are a promising yet underutilized source for monitoring self-harm in Germany, enabling identification of trends and high-risk groups.