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Groves S, Lascelles K, Bale L, Brand F, Casey D, Hawton K. Self-Harm by Nurses and Midwives - A Study of Hospital Presentations. CRISIS 2024; 45:128-135. [PMID: 38234244 PMCID: PMC10985583 DOI: 10.1027/0227-5910/a000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/19/2024]
Abstract
Background: Nursing professionals are an occupational group at increased risk of suicide, but little is known about self-harm in this population. Aims: To investigate the characteristics of nurses and midwives who present to hospital following self-harm. Method: We used data from the Oxford Monitoring System for Self-Harm to identify nurses and midwives who presented to the general hospital in Oxford during 2010-2020 following an episode of self-harm and received a psychosocial assessment. Results: During the eleven-year study period, 107 presentations of self-harm involving 81 nurses and midwives were identified. Self-poisoning was the most common self-harm method (71.6%), with antidepressants and paracetamol most frequently involved. Many had consumed alcohol before (43.8%) or during (25.3%) the self-harm act. Some individuals had high or very high suicide intent scores (22/70, 31.4%). Common problems preceding self-harm included problems with a partner (46.9%), psychiatric disorder (29.6%), and problems with employment (27.2%), family (24.7%), and alcohol (23.5%). A range of aftercare options were offered following presentation. Limitations: This study was limited to data from a single hospital. Conclusion: Prevention and management of self-harm within this occupational group requires preventative strategies and availability of interventions addressing the range of factors that may contribute to self-harm, especially relationship problems, psychiatric disorders, employment problems, and alcohol misuse.
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Affiliation(s)
- Samantha Groves
- Mental Health Directorate, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Karen Lascelles
- Mental Health Directorate, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Liz Bale
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Mental Health Directorate, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Mental Health Directorate, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Murray A, Wadman R, Townsend E. Do young people who self-harm experience cognitions and emotions related to post-traumatic growth? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 15:100683. [PMID: 38264626 PMCID: PMC10801152 DOI: 10.1016/j.jadr.2023.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024] Open
Abstract
Background Adolescent self-harm is a vast public health concern with self-harm rates increasing each year. Looked-after adolescents are a group at increased risk of self-harm owing to adverse life-events and attachment issues, giving rise to difficulties with problem solving and relationship difficulties (Ogundele, 2020). Whilst research into risk factors of self-harm is plentiful, fewer studies have explored what factors might facilitate self-harm recovery. This paper investigates whether looked-after adolescents with experience of self-harm can experience cognitions and emotions related to post-traumatic growth (PTG). Methods Secondary Data Analysis was conducted on a primary qualitative data set from a study including twenty-four looked-after young people aged between 14 and 21 with experience of self-harm; 20 females and 4 males. An Interpretive Phenomenological Analysis was conducted. Results Five themes were identified, four of which shared similarities to prior research into the recovery of self-harm and manifestations of PTG: 1) Self-Reflection, 2) Communication, 3) Embracing and Appreciating Support, 4) Better Management of feelings. The fifth theme suggested a potential barrier to experiencing PTG; 5) Reliance on Self-Harm. Findings revealed four relevant themes suggesting that individuals who self-harm can indeed experience cognitions and emotions relevant to PTG. Limitations This study utilised a homogeneous sample, limiting the generalisability of the findings to other populations. Perhaps future research should consider other populations of individuals who self-harm. Conclusions We suggest there is a need for interventions for self-harm to focus on protective factors to increase PTG within an individual, potentially moderating the risk of suicide.
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Affiliation(s)
- Alexandra Murray
- School of Psychology, University of Nottingham, NG7 2RD, United Kingdom
| | - Ruth Wadman
- Department of Health Sciences, The University of York, YO10 5DD, United Kingdom
| | - Ellen Townsend
- School of Psychology, University of Nottingham, NG7 2RD, United Kingdom
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Agyapong B, Shalaby R, Eboreime E, Wei Y, Agyapong VIO. Self-Reported Alcohol Abuse and the Desire to Receive Mental Health Counselling Predict Suicidal Thoughts/Thoughts of Self-Harm among Female Residents of Fort McMurray. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13620. [PMID: 36294198 PMCID: PMC9602661 DOI: 10.3390/ijerph192013620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Suicidal ideation and thoughts of self-harm continue to be challenging public health problems. It is presently unknown what the prevalence and correlates of suicidal thoughts and self-harm are in female residents of Fort McMurray, a city that has endured wildfires, flooding, and the COVID-19 pandemic in the last five years. This study aimed to determine the prevalence and correlates of suicidal ideation and thoughts of self-harm among female residents of Fort McMurray. A cross-sectional study using an online survey questionnaire was used to collect sociodemographic and clinical information from the residents of Fort McMurray between 24 April and 2 June 2021. Suicidal ideation and thoughts of self-harm among females were assessed using the ninth question of the Patient Health Questionnaire-9, a validated screening tool used to assess depression symptoms. Likely generalized anxiety disorder (GAD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and low resilience were measured using standardized rating scales. Data were analyzed with SPSS version 25 using chi-squared tests and multivariate logistic regression analysis. Among Fort McMurray residents, 249 accessed the online survey, while 186 ultimately completed it, yielding a survey completion rate of 74.7%. Of these, 159 (85%) were females. After controlling for other variables in the regression model, respondents who expressed a desire to receive mental health counselling were more than seven times more likely to report suicidal ideation and thoughts of self-harm compared to the respondents who did not desire to receive mental health counselling (OR: 7.29; 95% CI: 1.19-44.58). Similarly, respondents who reported having abused alcohol in the past year were nearly four times more likely to report suicidal ideation or thoughts of self-harm compared to the respondents who said they had not abused alcohol in the past year (OR: 3.91; 95% CI: 1.05-14.57). A high prevalence of suicidal thoughts and thoughts of self-harm were reported among female residents of Fort McMurray. Timely access to adequate mental health support should be offered to female residents of communities impacted by multiple natural disasters, particularly residents who self-report alcohol abuse or desire to receive mental health counselling.
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Affiliation(s)
- Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
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Robins JE, Morley KI, Hayes RD, Ross KR, Pritchard M, Curtis V, Kalk NJ. Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt. Drug Alcohol Depend 2021; 224:108725. [PMID: 33940325 DOI: 10.1016/j.drugalcdep.2021.108725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. METHODS We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. RESULTS Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001). CONCLUSIONS The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.
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Affiliation(s)
- John E Robins
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Katherine I Morley
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; Innovation, Health, and Science, RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia
| | - Richard D Hayes
- Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Kezia R Ross
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Vivienne Curtis
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; Health Education England, 4 Stewart House, 32 Russell Square, Bloomsbury, London, WC1B 5DN, UK
| | - Nicola J Kalk
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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Rahman F, Webb RT, Wittkowski A. Risk factors for self-harm repetition in adolescents: A systematic review. Clin Psychol Rev 2021; 88:102048. [PMID: 34119893 DOI: 10.1016/j.cpr.2021.102048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 01/26/2023]
Abstract
Self-harm behavior can begin in early adolescence, with the highest rates of self-harm, between 1990 and 2000 in England, being among adolescents aged 16 to 24 years and there being considerable risk of fatal and non-fatal repetition. Previous systematic reviews have identified risk factors for self-harm in adolescents, but not for the repetition of this behavior. The aim of this review was to synthesise the psychological, psychosocial and sociodemographic risk factors for self-harm repetition in adolescents. By searching four databases, 27 studies were identified and included in the review. Several psychological (e.g., psychiatric morbidity, features of previous self-harm, psychological distress), psychosocial (e.g., alcohol misuse, poor family and peer relationships) and sociodemographic (e.g., age, gender and ethnicity) risk factors were identified for self-harm repetition in adolescents. Several risk factors across all categories for self-harm overlapped with that of self-harm repetition, such as depression, alcohol misuse and female gender. The clinical implications of these findings for practitioners were discussed. As was the case with prior reviews in this area, comparability between studies was limited and a meta-analysis was not possible due to considerable heterogeneity in outcome definitions, measures and methodologies.
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Affiliation(s)
- Farhan Rahman
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK
| | - Roger T Webb
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol 2021; 56:773-781. [PMID: 33146859 DOI: 10.1007/s00127-020-01981-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. METHODS Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. RESULTS During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years. CONCLUSION The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.
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Russell AE, Hemani G, Jones HJ, Ford T, Gunnell D, Heron J, Joinson C, Moran P, Relton C, Suderman M, Watkins S, Mars B. An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt. BMC Psychiatry 2021; 21:207. [PMID: 33892675 PMCID: PMC8066869 DOI: 10.1186/s12888-021-03216-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Empirical evidence supporting the distinction between suicide attempt (SA) and non-suicidal self-harm (NSSH) is lacking. Although NSSH is a risk factor for SA, we do not currently know whether these behaviours lie on a continuum of severity, or whether they are discrete outcomes with different aetiologies. We conducted this exploratory genetic epidemiology study to investigate this issue further. METHODS We explored the extent of genetic overlap between NSSH and SA in a large, richly-phenotyped cohort (the Avon Longitudinal Study of Parents and Children; N = 4959), utilising individual-level genetic and phenotypic data to conduct analyses of genome-wide complex traits and polygenic risk scores (PRS). RESULTS The single nucleotide polymorphism heritability of NSSH was estimated to be 13% (SE 0.07) and that of SA to be 0% (SE 0.07). Of the traits investigated, NSSH was most strongly correlated with higher IQ (rG = 0.31, SE = 0.22), there was little evidence of high genetic correlation between NSSH and SA (rG = - 0.1, SE = 0.54), likely due to the low heritability estimate for SA. The PRS for depression differentiated between those with NSSH and SA in multinomial regression. The optimal PRS prediction model for SA (Nagelkerke R2 0.022, p < 0.001) included ADHD, depression, income, anorexia and neuroticism and explained more variance than the optimal prediction model for NSSH (Nagelkerke R2 0.010, p < 0.001) which included ADHD, alcohol consumption, autism spectrum conditions, depression, IQ, neuroticism and suicide attempt. CONCLUSIONS Our findings suggest that SA does not have a large genetic component, and that although NSSH and SA are not discrete outcomes there appears to be little genetic overlap between the two. The relatively small sample size and resulting low heritability estimate for SA was a limitation of the study. Combined with low heritability estimates, this implies that family or population structures in SA GWASs may contribute to signals detected.
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Affiliation(s)
- Abigail Emma Russell
- Children and Young People's Mental Health Research Collaboration (ChYMe), University of Exeter College of Medicine and Health, Exeter, UK.
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Hannah J Jones
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Tamsin Ford
- University of Cambridge Department of Psychiatry, Cambridge, UK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Carol Joinson
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Sarah Watkins
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Robins JE, Kalk NJ, Ross KR, Pritchard M, Curtis V, Morley KI. The association of acute alcohol use and dynamic suicide risk with variation in onward care after psychiatric crisis. Drug Alcohol Rev 2021; 40:499-508. [PMID: 33569872 PMCID: PMC8647926 DOI: 10.1111/dar.13231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Despite the association of alcohol use with recurrent suicidal acts, individuals attempting suicide after drinking alcohol face barriers accessing crisis care following emergency assessment, demonstrated by higher odds of inpatient admission for those whose suicide attempt did not feature alcohol. This disparity may be due to suicidality dissipating more rapidly after a suicide attempt involving alcohol. We investigated the effect of acute alcohol use and ongoing suicidality on onward care decisions after emergency assessment. METHODS We analysed electronic health records of 650 suicidal adults detained under Section 136 of the Mental Health Act (1983, amended 2007) for up to 36 h at a London psychiatric emergency care centre. We used logistic regression to estimate the association of acute alcohol use and ongoing suicidality (including their interaction) with admission to psychiatric hospital. RESULTS Fifteen percent of previously intoxicated detainees expressed suicidal intent at detention end, compared to 24% of detainees who had not used alcohol prior to detention. Compared to those who were not previously intoxicated and not suicidal at detention end, acute alcohol use was associated with reduced odds of admission amongst those no longer suicidal (AOR 0.4, 95% CI 0.2, 0.6). Where suicidality persisted, odds of admission rose; however, the magnitude of increase when in combination with prior alcohol use (AOR 3.6, 95% CI 1.9, 7.1) was under half that of when alcohol was not involved (AOR 8.2, 95% CI 3.5, 19.1). DISCUSSION AND CONCLUSIONS Acute alcohol use is associated with transient suicidality, but this only partially accounts for disparities in care following suicide attempts.
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Affiliation(s)
- John E. Robins
- National Addiction CentreKing's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Nicola J. Kalk
- National Addiction CentreKing's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Kezia R. Ross
- National Addiction CentreKing's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR Maudsley Biomedical Research CentreLondonUK
- King's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Vivienne Curtis
- South London and Maudsley NHS Foundation TrustLondonUK
- King's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- School of Psychiatry, Health Education EnglandLondonUK
| | - Katherine I. Morley
- National Addiction CentreKing's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- Innovation, Health, and Science, RAND EuropeCambridgeUK
- Centre for Epidemiology and BiostatisticsMelbourne School of Global and Population Health, The University of MelbourneMelbourneAustralia
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Daly C, Griffin E, McMahon E, Corcoran P, Webb RT, Witt K, Ashcroft DM, Arensman E. Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People-A National Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176159. [PMID: 32854234 PMCID: PMC7504369 DOI: 10.3390/ijerph17176159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022]
Abstract
Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- Correspondence: ; Tel.: +353-21-420-5551
| | - Eve Griffin
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Elaine McMahon
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Roger T. Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK; (R.T.W.); (D.M.A.)
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK
| | - Katrina Witt
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK; (R.T.W.); (D.M.A.)
- Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK
| | - Ella Arensman
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Queensland 4122, Australia
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Owens D, Wright-Hughes A, Graham L, Blenkiron P, Burton K, Collinson M, Farrin A, Hatcher S, Martin K, O'Dwyer J, Pembroke L, Protheroe D, Tubeuf S, House A. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial). Pilot Feasibility Stud 2020; 6:119. [PMID: 32832098 PMCID: PMC7437039 DOI: 10.1186/s40814-020-00668-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Non-fatal self-harm is one of the commonest reasons for adults’ emergency hospital attendance. Although strongly associated with fatal and non-fatal repetition, there is weak evidence about effective interventions—and no clear NICE guidance or clinical consensus concerning aftercare. We examined the practicability of a definitive trial to evaluate problem-solving therapy (PST) to reduce repetition of self-harm; MIDSHIPS is a single-centre, parallel-group, individually randomised controlled feasibility trial comparing treatment-as-usual (TAU) alone to TAU plus up to six sessions of brief problem-solving therapy (PST) with adults who had recently attended hospital because of self-harm. Objectives were to adapt the intervention for a UK setting, train therapists, recruit and randomise patients, deliver PST under supervision, and establish comparative outcomes, assessed blindly. Methods We adapted the problem-solving intervention from an earlier trial and trained a mental-health nurse to deliver it. Adult patients attending the general hospital for self-harm were recruited while undergoing psychosocial assessment by the mental health team, and 62 were randomly allocated (32 TAU, 30 PST). The primary outcome assessed repeat hospital attendance due to further self-harm 6 months post-randomisation. Secondary outcomes included participant-reported outcomes and service use at 3 and 6 months post-randomisation. Results The recruitment period had to be extended and 710 patients screened in order to establish a trial sample of the planned size (N = 62). A quarter of participants allocated to PST did not undertake the therapy offered; those who received PST attended a median of three sessions. Secondary outcomes were established for 49 (79%) participants at 6 months; all participants’ hospital records were retrieved. Repetition of self-harm leading to hospital presentation occurred in 19 of the 62 participants (30.6%, 95% CI 19.2%, 42.1%) within 6 months of randomisation. Promising differential rates of self-harm were observed with an event rate of 23.3% (95% CI 8.2%, 38.5%) in the PST arm; and 37.5% (95% CI 20.7%, 54.3%) in TAU. Economic findings were also encouraging, with a small QALY gain (0.0203) in the PST arm together with less reported use of the NHS in the PST arm (average £2120) than with TAU-only (£2878). Conclusions The feasibility trial achieved its objectives despite considerable difficulties with recruitment—adapting the PST, training a therapist, recruiting patients who had recently self-harmed, delivering the therapy, and establishing primary and secondary outcomes. These data provide a robust platform for a definitive multicentre randomised controlled trial of brief problem-solving therapy after hospital attendance due to self-harm. Trial registration Identification number and URL: ISRCTN54036115 http://www.isrctn.com/search?q=midships. Registered: 13 January 2012
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Affiliation(s)
- David Owens
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | | | - Liz Graham
- Leeds Institute of Clinical Trials Research, Worsley Building, Leeds, LS2 9NL UK.,Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ UK
| | - Paul Blenkiron
- Tees, Esk & Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, DL2 2TS UK
| | - Kayleigh Burton
- Leeds Institute of Clinical Trials Research, Worsley Building, Leeds, LS2 9NL UK
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, Worsley Building, Leeds, LS2 9NL UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, Worsley Building, Leeds, LS2 9NL UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario K1Z 7 K4 Canada
| | - Katie Martin
- Tees, Esk & Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, DL2 2TS UK
| | - John O'Dwyer
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise Pembroke
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - David Protheroe
- Leeds and York Partnership NHS Foundation Trust, 2150 Century Way, Thorpe Park, Leeds, LS15 8ZB UK
| | - Sandy Tubeuf
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK.,Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, Box B1.30.01, B-1200 Brussels, Belgium
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
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11
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Pitman A, Tsiachristas A, Casey D, Geulayov G, Brand F, Bale E, Hawton K. Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital: Cohort study. J Affect Disord 2020; 272:158-165. [PMID: 32379609 DOI: 10.1016/j.jad.2020.03.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/03/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is mixed evidence for whether psychosocial assessment following hospital presentation for self-harm reduces self-harm repetition. A possible reason is the differences in professional background of assessors (primarily psychiatrists and psychiatric nurses) due to variability in training and therapist style. METHODS Using data from the Oxford Monitoring System for Self-harm, we analysed data on patients making their first emergency department (ED) presentation for self-harm between 2000 and 2014, followed-up until 2015. Using logistic regression, we estimated the probability of repeat self-harm within 12 months, comparing: (i) patients receiving psychosocial assessment versus none, adjusting for age, gender, self-harm method, past self-harm presentation, and general hospital admission; and (ii) patients assessed by a psychiatric nurse versus those assessed by a psychiatrist, adjusting for age, self-harm method, time and year of presentation. RESULTS The 12,652 patients who had an index ED presentation for self-harm during the study period accounted for 24,450 presentations, in 17,303 (71%) of which a psychosocial assessment was conducted; in 9318 (54%) by a psychiatric nurse and in 7692 (45%) by a psychiatrist. We found a reduced probability of repeat self-harm presentation among patients receiving psychosocial assessment versus none (adjusted odds ratio [AOR] = 0.70; 95% CI = 0.65-0.75; p < 0.001), but no differences between patients assessed by a psychiatric nurse or a psychiatrist (AOR = 1.05; 95% CI = 0.98-1.13; p = 0.129). LIMITATIONS Findings from a single hospital may not be generalizable to other settings. CONCLUSIONS Short-term risk of repeat self-harm after psychosocial assessment for self-harm may not differ by the assessor's professional background.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London W1W 7NF, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom.
| | - Apostolos Tsiachristas
- Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Elizabeth Bale
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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12
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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13
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Daly C, Griffin E, Ashcroft DM, Webb RT, Perry IJ, Arensman E. Frequently used drug types and alcohol involvement in intentional drug overdoses in Ireland: a national registry study. Eur J Public Health 2019. [PMID: 29538652 DOI: 10.1093/eurpub/cky031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Intentional drug overdose (IDO) is the most common form of hospital-treated self-harm, yet no national study has systematically classified the range of drugs involved using a validated system. We aimed to determine the profile of patients engaging in overdose, to identify drugs frequently used and to quantify the contributions of multiple drug use and alcohol involvement. Methods Between 2012 and 2014, the National Self-Harm Registry, Ireland recorded 18 329 presentations of non-fatal IDO to Irish emergency departments. Information on demographic and overdose characteristics were obtained. Drugs were categorized using the Anatomical Therapeutic Chemical classification system. Results Analgesics (32.4%), antidepressants (21.9%), anxiolytics (21.2%) and hypnotics and sedatives (21.0%) were the most frequently used drugs types involved in overdose. Presentations involving analgesic and antidepressant medication were more common for females whereas males more often took illegal, anxiolytic and hypnotic and sedative drugs. Overdoses with drugs other than those which affect the nervous system were identified, including musculoskeletal drugs, taken in 12.0% of presentations. Paracetamol was the most frequently used drug, particularly among females (32.0%) and persons under 25 years (36.2%). Alcohol was most often present in overdoses involving anxiolytics and illegal drugs. Multiple drug use was a factor in almost half (47.1%) of presentations. Conclusions People who engage in IDO frequently take prescription only or sales restricted drugs, often involving alcohol and/or multiple drug use. These findings highlight the importance of addressing drug and alcohol misuse, potential inappropriate prescribing and the enforcement of legislation restricting specific drug sales.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland
| | - Eve Griffin
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Ivan J Perry
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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14
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Jung KY, Kim T, Hwang SY, Yoon H, Shin TG, Sim MS, Jo IJ, Cha WC. Availability of drug at convenient stores is not associated with an increased incidence of their poisoning. Pharmacoepidemiol Drug Saf 2019; 28:536-543. [PMID: 30848006 DOI: 10.1002/pds.4760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE In late 2012, South Korea revised the Pharmaceutical Affairs Act to make selected medications including acetaminophen, ibuprofen, and cold medications available in nonpharmacy outlets, including the 24-hour convenient stores (CVS). The objective of this study was to identify whether the characteristics and trend of self-poisonings associated with these medications were altered after the legislative change. METHODS A retrospective study was performed using national data from the Emergency Department (ED)-based Injury In-depth Surveillance database. The patients diagnosed with poisoning were sorted from 2011 to 2016 and included in the study. As the Act was implemented from 2013, the demographic characteristics and clinical outcomes were compared before and after January 2013. A piecewise regression analysis was performed to determine the association between the monthly use of acetaminophen, medication for cold, and nonsteroidal anti-inflammatory drugs (NSAIDs) and the incidence of total poisonings before and after the January 2013. RESULTS Among 1 536 277 patients included in the database, 17 523 patients diagnosed with poisoning were enrolled. After the legislative change, the etiology of poisoning did not change, although the frequency of hospitalization from ED was significantly increased. The monthly trend for poisoning due to acetaminophen, cold medications, and NSAIDs showed no significant slope change between before and after the legislative change. The proportional use of acetaminophen and cold medications was significantly decreased, while that of NSAIDs was unchanged before and after the legislative change. CONCLUSIONS The change in the Pharmaceutical Affairs Act was not associated with any change in the monthly frequency of medication-related poisoning.
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Affiliation(s)
- Kwang Yul Jung
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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15
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Hafferty JD, Navrady LB, Adams MJ, Howard DM, Campbell AI, Whalley HC, Lawrie SM, Nicodemus KK, Porteous DJ, Deary IJ, McIntosh AM. The role of neuroticism in self-harm and suicidal ideation: results from two UK population-based cohorts. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1505-1518. [PMID: 31123787 PMCID: PMC6858388 DOI: 10.1007/s00127-019-01725-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Self-harm is common, debilitating and associated with completed suicide and increased all-cause mortality, but there is uncertainty about its causal risk factors, limiting risk assessment and effective management. Neuroticism is a stable personality trait associated with self-harm and suicidal ideation, and correlated with coping styles, but its value as an independent predictor of these outcomes is disputed. METHODS Prior history of hospital-treated self-harm was obtained by record-linkage to administrative health data in Generation Scotland:Scottish Family Health Study (N = 15,798; self-harm cases = 339) and by a self-report variable in UK Biobank (N = 35,227; self-harm cases = 772). Neuroticism in both cohorts was measured using the Eysenck Personality Questionnaire-Short Form. Associations of neuroticism with self-harm were tested using multivariable regression following adjustment for age, sex, cognitive ability, educational attainment, socioeconomic deprivation, and relationship status. A subset of GS:SFHS was followed-up with suicidal ideation elicited by self-report (n = 3342, suicidal ideation cases = 158) and coping styles measured by the Coping Inventory for Stressful Situations. The relationship of neuroticism to suicidal ideation, and the role of coping style, was then investigated using multivariable logistic regression. RESULTS Neuroticism was positively associated with hospital-associated self-harm in GS:SFHS (per EPQ-SF unit odds ratio 1.2 95% credible interval 1.1-1.2, pFDR 0.0003) and UKB (per EPQ-SF unit odds ratio 1.1 95% confidence interval 1.1-1.2, pFDR 9.8 × 10-17). Neuroticism, and the neuroticism-correlated coping style, emotion-oriented coping (EoC), were also associated with suicidal ideation in multivariable models. CONCLUSIONS Neuroticism is an independent predictor of hospital-treated self-harm risk. Neuroticism and emotion-orientated coping styles are also predictive of suicidal ideation.
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Affiliation(s)
- Jonathan D. Hafferty
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - L. B. Navrady
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - M. J. Adams
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - D. M. Howard
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - A. I. Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - H. C. Whalley
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - S. M. Lawrie
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK
| | - K. K. Nicodemus
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - D. J. Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK ,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - I. J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - A. M. McIntosh
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, EH10 5HF UK ,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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16
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Prasadi GAM, Mohamed F, Senarathna L, Cairns R, Pushpakumara PHGJ, Dawson AH. Paediatric poisoning in rural Sri Lanka: an epidemiological study. BMC Public Health 2018; 18:1349. [PMID: 30522467 PMCID: PMC6282383 DOI: 10.1186/s12889-018-6259-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute paediatric poisoning is a common public health concern for both developed and developing countries. The type of agent and underlying cause differ depending on the social, cultural, economic and educational background. The objectives of this study were to identify the incidence and pattern of paediatric poisoning in a rural district in Sri Lanka and establish whether tertiary referral hospital data are a useful surrogate for estimating district level epidemiology of paediatric poisoning. METHODS A subset of epidemiological data were obtained from March 2011 to February 2013 from a randomized controlled trial (SLCTR/2010/008) conducted in 45 hospitals in Kurunegala district. RESULTS The age adjusted annual incidence of all cause of acute poisoning in children aged 1 to 12 years in the study area was 60.4 per 100,000. The incidence of poisoning of younger age group (1 to 6 years; 76 per 100,000) was significantly higher than older age group (7 to 12 years; 41 per 100,000) (p = 0.0001) in Kurunegala district. The annual incidence rate of paediatric admissions due to deliberate self-poisoning is 18 per 100,000 population. This study also established that admission data from primary hospitals provided the most accurate epidemiological information on paediatric poisoning. CONCLUSIONS In rural districts of Sri Lanka, acute paediatric poisoning cases were less frequent and less severe compared to adult poisoning cases (426-446 per 100,000 population). The incidence of poisoning was significantly higher among young children with compared to old children. In this study, deliberate self-poisoning among older children was more frequently seen than in other comparable countries. Because most of the admissions are directed to and managed by primary hospitals, data from referral hospitals alone cannot be used to represent the true incidence of acute poisoning within a district. The data set from all the primary hospitals (n = 44) yielded more accurate poisoning incidence amongst a paediatric population.
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Affiliation(s)
| | - Fahim Mohamed
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,TACT, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rose Cairns
- Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Sydney, Australia.,New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Andrew Hamilton Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Central Clinical School, University of Sydney, Sydney, Australia
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17
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Daly C, Griffin E, Ashcroft DM, Webb RT, Perry IJ, Arensman E. Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings from the National Self-Harm Registry Ireland, 2007-2015. Clin Drug Investig 2018; 38:373-380. [PMID: 29264838 DOI: 10.1007/s40261-017-0616-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Intentional drug overdose (IDO) is a significant public health problem. Concerns about the misuse of gabapentinoids, i.e. pregabalin and gabapentin, including their consumption in IDO have grown in recent years. This paper examines the trends in the prevalence of gabapentinoids taken in IDO, the profile of individuals taking them, and associated overdose characteristics. METHODS Presentations to emergency departments involving IDO, recorded by the National Self-Harm Registry Ireland between 1 January 2007 and 31 December 2015 were examined. Data items included patient demographics, drug names, total tablet quantity consumed and alcohol involvement. RESULTS Gabapentinoids were involved in 2115 (2.9%) of the 72,391 IDOs recorded. Presentations involving a gabapentinoid increased proportionally from 0.5% in 2007 to 5.5% in 2015. The majority of IDOs involving a gabapentinoid were made by females (59.9%), with over one-third (37.2%) involving alcohol. Compared with IDOs involving other drugs, presentations with a gabapentinoid were made by persons who were older (median 37 vs. 32 years) and involved a significantly greater median quantity of tablets (30 vs. 21, p ≤ 0.001), with over one-quarter (27.4%) of these involving the ingestion of 50 tablets or more. Admission to hospital was significantly more common following IDOs with a gabapentinoid compared with those without (49.4% vs. 41.4%, p ≤ 0.001). CONCLUSIONS This study identified the increasing use of gabapentinoids in IDO, describing the profile and overdose characteristics of presentations. It is important for clinicians to exercise vigilance while prescribing gabapentinoids, including being aware of other medications that their patients may have access to. Our findings support the need for routine monitoring for signs of misuse among those prescribed gabapentinoids.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.
| | - Eve Griffin
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Ivan J Perry
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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18
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Griffin E, McMahon E, McNicholas F, Corcoran P, Perry IJ, Arensman E. Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016. Soc Psychiatry Psychiatr Epidemiol 2018; 53:663-671. [PMID: 29721594 DOI: 10.1007/s00127-018-1522-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Rates of hospital-treated self-harm are highest among young people. The current study examined trends in rates of self-harm among young people in Ireland over a 10-year period, as well as trends in self-harm methods. METHODS Data from the National Self-Harm Registry Ireland on presentations to hospital emergency departments (EDs) following self-harm by those aged 10-24 years during the period 2007-2016 were included. We calculated annual self-harm rates per 100,000 by age, gender and method of self-harm. Poisson regression models were used to examine trends in rates of self-harm. RESULTS The average person-based rate of self-harm among 10-24-year-olds was 318 per 100,000. Peak rates were observed among 15-19-year-old females (564 per 100,000) and 20-24-year-old males (448 per 100,000). Between 2007 and 2016, rates of self-harm increased by 22%, with increases most pronounced for females and those aged 10-14 years. There were marked increases in specific methods of self-harm, including those associated with high lethality. CONCLUSIONS The findings indicate that the age of onset of self-harm is decreasing. Increasing rates of self-harm, along with increases in highly lethal methods, indicate that targeted interventions in key transition stages for young people are warranted.
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Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.
| | - Elaine McMahon
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Clinic, Rathgar, Dublin 6, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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O'Connor RC, Wetherall K, Cleare S, Eschle S, Drummond J, Ferguson E, O'Connor DB, O'Carroll RE. Suicide attempts and non-suicidal self-harm: national prevalence study of young adults. BJPsych Open 2018; 4:142-148. [PMID: 29922479 PMCID: PMC6003254 DOI: 10.1192/bjo.2018.14] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/14/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are few prevalence studies of suicide attempts and non-suicidal self-harm (NSSH). AIMS We aimed to estimate the prevalence of thoughts of NSSH, suicidal thoughts, NSSH and suicide attempts among 18- to 34-year-olds in Scotland. METHOD We interviewed a representative sample of young adults from across Scotland. RESULTS We interviewed 3508 young people; 11.3 and 16.2% reported a lifetime history of suicide attempts and NSSH, respectively. The first episode of NSSH tended to precede the first suicide attempt by about 2 years. Age at onset of NSSH and suicide attempt was younger in females. Earlier age at onset was associated with more frequent NSSH/suicide attempts. Women are significantly more likely to report NSSH and suicide attempts compared with men. CONCLUSIONS One in nine young people has attempted suicide and one in six has engaged in NSSH. Clinicians should be vigilant, as suicide attempts and NSSH are relatively common. DECLARATION OF INTEREST None.
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Affiliation(s)
- Rory C. O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | - Sarah Eschle
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | - Julie Drummond
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | | | | | - Ronan E. O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, UK
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Saunders NR, Lebenbaum M, Stukel TA, Lu H, Urquia ML, Kurdyak P, Guttmann A. Suicide and self-harm trends in recent immigrant youth in Ontario, 1996-2012: a population-based longitudinal cohort study. BMJ Open 2017; 7:e014863. [PMID: 28864687 PMCID: PMC5589002 DOI: 10.1136/bmjopen-2016-014863] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the trends in suicide and emergency department (ED) visits for self-harm in youth by immigration status and immigrant characteristics. DESIGN Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets. SETTING Ontario, Canada. PARTICIPANTS Youth 10 to 24 years, living in Ontario, Canada. EXPOSURE The main exposure was immigrant status (recent immigrant (RI) versus long-term residents (LTR)). Secondary exposures included region of birth, duration or residence, and refugee status. MAIN OUTCOME MEASURE Trends over time in suicide and ED self-harm were modelled within consecutive 3-year time periods. Rate ratios were estimated using Poisson regression models. RESULTS 2.5 to 2.9 million individuals were included per cohort period. LTR suicide rates ranged from 7.4 to 9.4/100 000 male person-years versus 2.2-3.4/100 000 females. RI's suicide rates were 2.7-7.2/100,000 male versus 1.9-2.7/100 000 female person-years. Suicide rates were lower among RI compared with LTR (adjusted relative rate (aRR)=0.70, 95% CI=0.57 to 0.85) with different mechanisms of suicide. No significant time trend in suicide rates was observed (p=0.40). ED self-harm rates for LTR and RI were highest in females (2.6-3.4/1000 LTR females versus 1.1-1.5/1000 males, 1.2-1.8/1000 RI females versus 0.4-0.6/1000 males). RI had lower rates of self-harm compared with LTR (aRR=0.60, 95% CI=0.56 to 0.65). Stratum-specific rates showed a steeper decline per period in RI compared with LTR (RI: aRR=0.85, 95% CI=0.81 to 0.89; LTR: aRR=0.91, 95% CI=0.90 to 0.93). Observed trends were not universal across region of origin and by refugee status. INTERPRETATION Suicide rates have been stable and ED self-harm rates are declining over time among RI youth. These trends by important subgroups should continue to be monitored to allow for early identification of subpopulations of immigrant youth in need of targeted and culturally appropriate public health interventions.
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Affiliation(s)
- Natasha Ruth Saunders
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada
| | | | - Therese A Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hong Lu
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Marcelo L Urquia
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Manitoba Centre for Health Policy, Department of Community Health Services, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Astrid Guttmann
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Parry MJ, Isoniemi H, Koivusalo AM, Hoppu K. Increased acetaminophen related calls to Finnish PIC better reflect acetaminophen sales than serious poisonings. Clin Toxicol (Phila) 2017; 56:209-215. [PMID: 28812385 DOI: 10.1080/15563650.2017.1359619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Acetaminophen (APAP) or paracetamol is a commonly encountered medicine in poisonings. We studied the changes in APAP related calls to the Finnish poison information centre (FPIC), and serious intoxications, involving hepatotoxicity or death in 2001-2014. These data were compared with paracetamol sales in Finland. METHODS This is a retrospective analysis of the FPIC database calls, national cause of death registry, registries of liver transplantations and molecular adsorbent recycling system (MARS)-treated patients from Helsinki University Hospital together with the National Institute of Health and Welfare registry of patients hospitalized. Data on APAP sales were obtained from the Finnish Medicines Agency. RESULTS Between 2001 and 2014, the number of calls/year related to human APAP exposures to the FPIC increased from 227 to 1058. No change in the age distribution of enquiries was seen. Most calls involved minors: 58% (range 52-64%) for children under 6 years old, and 9% (range 6-14%) for children of 6-15 years. In Finland, APAP related fatalities have gradually increased from an average of 7/year (range 4-10) in 2000-2005 to an average of 11/year (range 6-17) in 2010-2013, whereas the number of liver transplantations remained low, average 0.6/year (range 0-2). For patients in need of MARS-treatment, a slight decrease was seen. Total APAP sales increased from 5.6 (47% prescription, 53% OTC) to 29.7 (81% prescription, 19% OTC). DDD/1000 inhabitants/day from 2001 to 2014 is recorded. Best linear relationship (R2 = 0.97; p < .001) was observed between total FPIC calls and total sales of APAP in 2001-2014. Fatalities show a weaker relationship with sales (R2 = 0.317; p = .045). CONCLUSIONS During the study period, we see an increase in FPIC exposure calls accompanied by an increase in APAP sales. Changes in the chosen indicators for serious poisonings show only a weak association. Despite an evident trend between sales and fatalities, the correlation with fatality remains weak due to the small number of fatalities.
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Affiliation(s)
- Mikko J Parry
- a Poison Information Centre, Helsinki University Hospital , Helsinki , Finland
| | - Helena Isoniemi
- b Department of Transplantation and Liver Surgery , Abdominal Center, Helsinki University Hospital , Helsinki , Finland
| | - Anna-Maria Koivusalo
- c Department of Anaesthesiology and Intensive Care , Helsinki University Hospital , Helsinki , Finland
| | - Kalle Hoppu
- a Poison Information Centre, Helsinki University Hospital , Helsinki , Finland
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Birtwistle J, Kelley R, House A, Owens D. Combination of self-harm methods and fatal and non-fatal repetition: A cohort study. J Affect Disord 2017; 218:188-194. [PMID: 28477496 DOI: 10.1016/j.jad.2017.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/16/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Assessment and aftercare for people who self-harm needs to be related to an understanding of risks of adverse outcomes. We aimed to determine whether self-harm by a combination of methods and its early repetition are associated with adverse outcomes - especially non-fatal repetition and suicide. METHOD 10,829 consecutive general hospital attendances due to self-harm in one large English city were monitored, through scrutiny of Emergency Department attendances, over three years and followed up to determine the incidence of non-fatal repetition. Subsequent deaths, by any cause and by suicide, were determined from national statistical records. RESULTS 6155 patients accounted for the 10,829 episodes: 72% by self-poisoning, 21% self-injury, and 746 episodes (7%) due to a combination of methods. After a combined-methods index episode, non-fatal repetition (P=0.001) and suicide (P=0.002) occurred sooner and more frequently than it did among those who had self-poisoned. Further hospital attendance due to self-harm within a month was associated with a 3.7-fold (95% CI 2.1-6.4) risk of subsequent suicide. LIMITATIONS The data exclude self-harm episodes that do not result in a hospital attendance. Index episodes in the study are not generally life-time first episodes so follow-up data are based on an arbitrary start-point. Both of these limitations are common to all studies of this kind. CONCLUSIONS At psychosocial assessment and the making of aftercare arrangements, combined methods of self-harm or another recent episode should be considered 'red-flag' indicators for attention to care.
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Affiliation(s)
- Jacqueline Birtwistle
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - Rachael Kelley
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - Allan House
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - David Owens
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom.
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23
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Griffin E, Arensman E, Perry IJ, Bonner B, O’Hagan D, Daly C, Corcoran P. The involvement of alcohol in hospital-treated self-harm and associated factors: findings from two national registries. J Public Health (Oxf) 2017; 40:e157-e163. [DOI: 10.1093/pubmed/fdx049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/11/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | | | | | - Caroline Daly
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Paul Corcoran
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Gedeborg R, Svennblad B, Holm L, Sjögren H, Bardage C, Personne M, Sjöberg G, Feltelius N, Zethelius B. Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population-based registry study. Pharmacoepidemiol Drug Saf 2017; 26:518-527. [PMID: 28083980 DOI: 10.1002/pds.4166] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/27/2016] [Accepted: 12/16/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To estimate the incidence trend and outcome of paracetamol poisoning, in relation to increased availability of paracetamol from non-pharmacy outlets in 2009. METHOD Patients' serum paracetamol results over 14 years (2000-2013) from 20 (out of 21) regions in Sweden were linked to national registers of hospital care, cause of death, and prescriptions. Paracetamol poisonings were defined by serum paracetamol levels, hospital diagnoses, or cause of death. The change in incidence of poisonings following increased availability of paracetamol was analysed by using segmental regression of time series. RESULTS Of the 12 068 paracetamol poisonings, 85% were classified as intentional self-harm. Following increased availability from non-pharmacy outlets, there was a 40.5% increase in the incidence of paracetamol poisoning, from 11.5/100 000 in 2009 to 16.2/100 000 in 2013. Regression analyses indicated a change in the trend (p < 0.0001) but not an immediate jump in the incidence (p = 0.5991) following the increased availability. Adjusting for trends in hospital episodes for self-harm, suicides, and the sales volume of paracetamol did not influence the result. All-cause mortality at 30 days (3.2%) did not change over time. CONCLUSIONS The incidence of paracetamol poisoning in Sweden has increased since 2009, contrasting the decreased incidence in the period of 2007-2009. The change in trend was temporally associated with the introduction of availability of paracetamol from non-pharmacy outlets but did not appear to be related to sales volume of paracetamol or general trends in self-harm or suicides. © 2017 Commonwealth of Australia. Pharmacoepidemiology and Drug Safety © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rolf Gedeborg
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
| | - Bodil Svennblad
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lennart Holm
- Department of Usage, Medical Products Agency, Uppsala, Sweden
| | - Hans Sjögren
- Department of Efficacy and Safety 1, Medical Products Agency, Uppsala, Sweden
| | - Carola Bardage
- Department of Usage, Medical Products Agency, Uppsala, Sweden
| | - Mark Personne
- Swedish Poisons Information Centre, Medical Products Agency, Uppsala, Sweden
| | - Gunilla Sjöberg
- Swedish Poisons Information Centre, Medical Products Agency, Uppsala, Sweden
| | - Nils Feltelius
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
| | - Björn Zethelius
- Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden
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Xin X, Wang Y, Fang J, Ming Q, Yao S. Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:815-826. [DOI: 10.1007/s10802-016-0201-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Norheim AB, Grimholt TK, Loskutova E, Ekeberg O. Attitudes toward suicidal behaviour among professionals at mental health outpatient clinics in Stavropol, Russia and Oslo, Norway. BMC Psychiatry 2016; 16:268. [PMID: 27465292 PMCID: PMC4964267 DOI: 10.1186/s12888-016-0976-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 06/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attitudes toward suicidal behaviour can be essential regarding whether patients seek or are offered help. Patients with suicidal behaviour are increasingly treated by mental health outpatient clinics. Our aim was to study attitudes among professionals at outpatient clinics in Stavropol, Russia and Oslo, Norway. METHODS Three hundred and forty-eight (82 %) professionals anonymously completed a questionnaire about attitudes. Professionals at outpatient clinics in Stavropol (n = 119; 94 %) and Oslo (n = 229; 77 %) were enrolled in the study. The Understanding Suicidal Patients (USP) scale (11 = positive to 55 = negative) and the Attitudes Towards Suicide Scale (ATTS) (1 = totally disagree, 5 = totally agree) were used. Questions about religious background, perceived competence and experiences of and views on suicidal behaviour and treatment (0 = totally disagree, 4 = totally agree) were examined. RESULTS All groups reported positive attitudes, with significant differences between Stavropol and Oslo (USP score, 21.8 vs 18.7; p < 0.001). Professionals from Stavropol vs. Oslo reported significantly less experience with suicidal patients, courses in suicide prevention (15 % vs 79 %) guidelines in suicidal prevention (23 % vs 90 %), interest for suicide prevention (2.0 vs 2.7; p < 0.001), and agreed more with the ATTS factors: avoidance of communication on suicide (3.1 vs 2.3; p < 0.001), suicide is acceptable (2.9 vs 2.6; p = 002), suicide is understandable (2.9 vs 2.7; p = 0.012) and (to a lesser extent) suicide can be prevented (4.2 vs 4.5; p < 0.001). In both cities, psychiatric disorders (3.4) were considered as the most important cause of suicide. Use of alcohol (2.2 vs 2.8; p < 0.001) was considered less important in Stavropol. Psychotherapy was considered significant more important in Stavropol than Oslo (3.6 vs 3.4; p = 0.001). CONCLUSIONS Professionals reported positive attitudes towards helping suicidal patients, with significant differences between cities. A need for further education was reported in both cities, but education was less integrated in mental health care in Stavropol than it was in Oslo. In both cities, psychiatric disorders were considered the major reasons for suicide, and psychotherapy was the most important treatment measure.
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Affiliation(s)
- Astrid Berge Norheim
- Diakonhjemmet hospital, Postboks 23, Vinderen, Oslo, 0319, Norway. .,Regional Centre of Violence Traumatic stress and suicide Prevention Eastern Norway, RVTS-East, Postboks 4623, Nydalen, Oslo, 0405, Norway.
| | - Tine K. Grimholt
- Regional Centre of Violence Traumatic stress and suicide Prevention Eastern Norway, RVTS-East, Postboks 4623, Nydalen, Oslo 0405 Norway ,Department of Acute Medicine, Oslo University Hospital Ullevål, Pb 4965, Nydalen, Oslo 0424 Norway
| | - Ekaterina Loskutova
- Ekaterina Loskutova, ProPsy, Lermontova str. 239/4, ofice 18, Stavropol, 355041 Russia
| | - Oivind Ekeberg
- Division of Mental Health and Addicion, Oslo University Hospital, Box 4956, Nydalen, Oslo 0424 Norway ,Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo, Pb 10/2 Blindern, Oslo, N-0316 Norway
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Prevalence and Correlates of Self-Harm in the German General Population. PLoS One 2016; 11:e0157928. [PMID: 27362348 PMCID: PMC4928828 DOI: 10.1371/journal.pone.0157928] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022] Open
Abstract
The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2= 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more depth.
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Vancayseele N, Portzky G, van Heeringen K. Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013. PLoS One 2016; 11:e0156711. [PMID: 27249421 PMCID: PMC4889035 DOI: 10.1371/journal.pone.0156711] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. Methods We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. Results Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. Conclusion This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients.
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Affiliation(s)
- Nikita Vancayseele
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Gwendolyn Portzky
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
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