This E-Learning program proposes the use of the De Leo definition (20) for the purpose of applying surveillance system inclusion and exclusion criteria.

In accordance with this definition, and considering the fluidity and varying underlying motives, we prefer use of the term ‘self-harm’ for the surveillance system.

Within this E-learning program, “self-harm” offers a common ground internationally. The concept of self-harm covers a spectrum that ranges in intent and motivation.

At the global level, terminology should be approached with a certain amount of flexibility. It is recognized that ‘self-harm’ cannot always be translated with the same meaning in other languages and the term “suicide attempt” might be preferred in such instances.

The terms “self-harm” or “suicide attempt” seem appropriate to be used for surveillance because they acknowledge and encompass recent findings on self-harm behavior, namely:

• Subgroups of self-harm patients, characterized as mild versus those with severe self-harm, represent opposite poles of dimensional severity. However, those characterized as mild do not show zero suicidal intent nor do they show absence of suicidal preoccupation.
• Even though research into self-harm subgroups has identified statistically significant and clinically meaningful differences, consistent evidence on homogeneous typologies of self-harm is lacking and the dimensionality of self-harm severity reflects the complexity of self-harm (16).

It is not always possible or appropriate to attempt to determine level of suicidal intent. The primary focus of this training is to establish a surveillance system of self-harm. Therefore, data collectors should be primarily concerned with determining whether an act was self-inflicted, and if so, whether it was intentional or accidental.

Based on the definition, operational criteria have been determined, which will help you in deciding whether a case should be included in the surveillance system. These operational criteria are outlined in Module 3.