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Evald TA, Møhl B. Before the damage is done: Early childhood hyperactivity difficulties in adolescents with deliberate self-harm - findings from the DALSC cohort. Scand J Child Adolesc Psychiatr Psychol 2021; 8:176-188. [PMID: 33598440 PMCID: PMC7879016 DOI: 10.21307/sjcapp-2020-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Deliberate self-harm (DSH) is a growing issue among Danish adolescents, and a dramatic increase in the incidence of DSH has been observed since the turn of the millennium. The importance of early childhood factors on later development has been established, but research on the trajectories of DSH is still scarce, and longitudinal studies are much needed. METHOD Participants were 3,291 children and their mothers from The Danish Longitudinal Survey of Children (DALSC), a Danish population-based birth cohort from 1995. Logistic regression and mediation analyses were used to examine significant early childhood determinants of self-harming behavior in adolescence. RESULTS The study found that 17.9% of the children had a history with DSH at the age of 18 years. A significant relationship was found between the likelihood of DSH at the age of 18 years and hyperactivity difficulties assessed through the Strengths and Difficulties Questionnaire (SDQ) at 3 and 7 years of age. Using a mediation model, it is documented that difficulties in peer relationships at the age of 11 years is a partial mediator explaining 19% of the variation. LIMITATIONS i) a vague definition of self-harm in the questionnaires; ii) lack of sample representation as children of lower socio-economic groups have lower participation rates, and only Danish-ethnicity children have been sampled; iii) possibility of omitted variable bias. CONCLUSION The adolescents engaging in DSH are experiencing a more complex range of psychosocial problems than those who do not have experience with DSH. The main finding of the study is that hyperactivity as a risk factor for the development of DSH in adolescence can be identified as early as 3-7 years of age. This relationship between the very early occurring hyperactivity and later DSH, to the best of our knowledge, has not previously been described.
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Affiliation(s)
- Therese A. Evald
- The Finance Committee, City Council of Copenhagen, Copenhagen, Denmark
| | - Bo Møhl
- Faculty of Humanities, Aalborg University, Aalborg, Denmark
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Implementing Exploratory Mediation to Clarify the Nonsuicidal Self-Injury – Suicidality Connection. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lockwood J, Townsend E, Daley D, Sayal K. Impulsivity as a predictor of self-harm onset and maintenance in young adolescents: a longitudinal prospective study. J Affect Disord 2020; 274:583-592. [PMID: 32663991 DOI: 10.1016/j.jad.2020.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/30/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rates of self-harm in young adolescents are increasing and self-harm typically emerges at this developmental stage. Greater specificity of impulsivity as a multifaceted construct is enabling investigation of links between individual impulsivity facets and self-harm outcomes. However, studies have yet to adequately explore these associations in young adolescents, and prospective relationships between multidimensional impulsivity and self-harm in younger adolescents remain untested. This study investigates unidimensional facets of impulsivity as risk-factors for the emergence and maintenance of self-harm, specifically within young community-based adolescents. METHODS A school-based sample of 594 adolescents (aged 13-15 years) provided data at two time points, 12 weeks apart. Logistic regression analyses determined associations between impulsivity-related facets (as delineated by the UPPS-P scale) and self-harm outcomes over time. RESULTS Overall, 23.6% of young people reported lifetime self-harm. A higher tendency towards Sensation Seeking was associated with self-harm onset over the study-period (OR 1.19, 95% CI 1.017-1.401). Deficits in Premeditation predicted maintained (versus remitted) self-harm behaviour during this time (OR 1.16, 95% CI 1.013-1.328). Negative Urgency was a significant cross-sectional correlate, but did not offer prospective predictive utility. LIMITATIONS The study relied on self-report. Interpretations are cautious given low incidence of self-harm outcomes over the course of the study. CONCLUSIONS Separate pathways to impulsive behaviour describe the psychological context in which self-harm starts and develops in young people. Findings support differential treatment targets and developmentally-focused early intervention. The predictive utility of impulsivity was inconsistent between cross-sectional and longitudinal analyses, underlining the role for temporality in the establishment of risk of self-harm.
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Affiliation(s)
- Joanna Lockwood
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK.
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
| | - David Daley
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
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Lee J, Bang YS, Min S, Ahn JS, Kim H, Cha YS, Park IS, Kim MH. Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults. BMC Psychiatry 2019; 19:231. [PMID: 31349782 PMCID: PMC6660711 DOI: 10.1186/s12888-019-2213-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults. METHODS This study included 149 children under the age of 18, and 1427 people in the age of 19-65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups. RESULTS In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults. CONCLUSION Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent's suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.
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Affiliation(s)
- Jinhee Lee
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Yeon Sik Bang
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Seongho Min
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Joung-Sook Ahn
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Hyun Kim
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong-Sung Cha
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Suk Park
- Yonsei Soul Psychiatric Clinic, Wonju, South Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea.
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Copeland M, Siennick SE, Feinberg ME, Moody J, Ragan DT. Social Ties Cut Both Ways: Self-Harm and Adolescent Peer Networks. J Youth Adolesc 2019; 48:1506-1518. [PMID: 30989471 DOI: 10.1007/s10964-019-01011-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/28/2019] [Indexed: 11/29/2022]
Abstract
Peers play an important role in adolescence, a time when self-harm arises as a major health risk, but little is known about the social networks of adolescents who cut. Peer network positions can affect mental distress related to cutting or provide direct social motivations for self-harm. This study uses PROSPER survey data from U.S. high school students (n = 11,160, 48% male, grades 11 and 12), finding that social networks predict self-cutting net of demographics and depressive symptoms. In final models, bridging peers predicts higher self-cutting, while claiming more friends predicts lower cutting for boys. The findings suggest that researchers and practitioners should consider peer networks both a beneficial resource and source of risk associated with cutting for teens and recognize the sociostructural contexts of self-harm for adolescents more broadly.
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Affiliation(s)
- Molly Copeland
- Department of Sociology, Duke University, Durham, NC, 27708, USA.
| | - Sonja E Siennick
- College of Criminology and Criminal Justice, Florida State University, Tallahassee, FL, 32306, USA
| | - Mark E Feinberg
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 310 BioBehavioral Health, University Park, PA, 16802, USA
| | - James Moody
- Department of Sociology, Duke University, Durham, NC, 27708, USA.,King Abdulaziz University, Jeddah, Saudi Arabia
| | - Daniel T Ragan
- Department of Sociology, University of New Mexico, Albuquerque, NM, 87131, USA
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Pisinger VS, Hawton K, Tolstrup JS. School- and class-level variation in self-harm, suicide ideation and suicide attempts in Danish high schools. Scand J Public Health 2018; 47:146-156. [DOI: 10.1177/1403494818799873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: Strong associations have been found between being exposed to self-harm in family and friends and own self-harm in adolescence. Therefore, self-harm and suicide behaviour might tend to cluster within school and school classes. The aim of this study was to describe the prevalence, frequency and type of self-harm, suicide ideation and suicide attempts within Danish high schools and to test whether self-harm and suicide behaviour cluster in schools and school classes. Methods: Data came from the Danish National Youth Study 2014, a national survey. The respective study included 66,284 high-school students nested in 117 schools and 3146 school classes. The prevalence and clustering of self-harm behaviour, ever and within the last year, type of self-harm (e.g. cutting, burning, scratching and hitting) and suicide ideation and suicide attempts were investigated. Multi-level logistic regression was applied to quantify clustering among participants within the same class and school. Results: In total, 12,960 (20%) reported self-harm ever and 5706 (8.6%) within the last year. Prevalence was higher among girls than boys. Among girls, cutting (15%) and scratching (13%) was the most common type of self-harm, whereas among boys, hitting (6.7%) was most prevalent. The degree of clustering of self-harm and suicide behaviour was low, with school-level intra-class correlation coefficients (ICC) ranging from 0.8–1.8% and school class level ICC’s from 4.3–6.8%. Conclusions: This study shows that self-harm was common, especially in girls. The degree of clustering of self-harm and suicide behaviour in school and school classes was low.
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Affiliation(s)
- Veronica S.C. Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Janne S. Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Qin P, Sun S, Bøe AS, Stanley B, Mehlum L. Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry. BMC Psychiatry 2018; 18:200. [PMID: 29914430 PMCID: PMC6006963 DOI: 10.1186/s12888-018-1778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. METHODS Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10-19 years who were treated for self-poisoning with medication during 2008-2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. RESULTS 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. CONCLUSION Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Shihua Sun
- 0000 0004 1761 1174grid.27255.37Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Anne Seljenes Bøe
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
| | - Barbara Stanley
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway ,0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Lars Mehlum
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
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Appreciating Complexity in Adolescent Self-Harm Risk Factors: Psychological Profiling in a Longitudinal Community Sample. J Youth Adolesc 2017; 47:916-931. [DOI: 10.1007/s10964-017-0721-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/11/2017] [Indexed: 01/07/2023]
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9
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van der Walt F. Self-harming behaviour among university students: A South African case study. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1250420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Freda van der Walt
- Department of Business Management, Central University of Technology, Free State, South Africa
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10
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Zhang J, Song J, Wang J. Adolescent self-harm and risk factors. Asia Pac Psychiatry 2016; 8:287-295. [PMID: 27224048 DOI: 10.1111/appy.12243] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/13/2015] [Accepted: 03/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims to define the characteristics of adolescents who have engaged in self-harm behavior and ascertain the risk factors. METHODS From January 2013 to January 2014, 4,176 adolescents from senior middle schools in Linyi, China, were administered four questionnaire surveys to ascertain the following: incidence of self-harm behavior regarding the frequency of different self-harm behaviors by group (never/one to five times/greater than five times in the last 6 months) and then comparing the self-harm behavior of the different subgroups; symptom self-check, comparing the differences between the adolescents with self-harm behavior and without in nine subscales (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear, paranoid, and psychosis); Adolescent Self-Rating Life Events Check List scores; and Egna Minnenav Barndoms Uppfostran (EMBU) scores. Multivariate logistic regression analysis was used to determine the risk factors of self-harm in adolescents. RESULTS The incidence of adolescent self-harm was 27.60%; the occurrence of adolescent self-harm was closely related to their mental health status, stressful life events, and EMBU. Being female, an urban student, or an only child; having poor school performance or experiences of stressful life events, harsh parenting styles, or excessive interference; and poor mental health were the risk factors for adolescent self-harm. CONCLUSIONS The incidence of adolescent self-harm was high, and their mental health status, stressful life events, and EMBU affected the occurrence of adolescent self-harm, which is an issue that needs greater attention.
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Affiliation(s)
- Jixiang Zhang
- Department of Clinical Psychology, Linyi Municipal People's Hospital, Linyi, China
| | - Jianwei Song
- Department of Neurosurgery, Linyi Municipal People's Hospital, Linyi, China.
| | - Jing Wang
- Department of Obstetrics and Gynecology, Linyi Municipal Chinese Medicine Hospital, Linyi, China
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11
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Gardner KJ, Dodsworth J, Klonsky ED. Reasons for Non-Suicidal Self-Harm in Adult Male Offenders With and Without Borderline Personality Traits. Arch Suicide Res 2016; 20:614-34. [PMID: 26953689 DOI: 10.1080/13811118.2016.1158683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The presented study aimed to advance understanding of the reasons for non-suicidal self-harm (NSSH) in adult male offenders, with and without borderline personality traits. 179 offenders completed self-report measures of NSSH and other clinical constructs, with 42 being identified as having self-harmed. Results were consistent with past research and supported the relative importance of intrapersonal over interpersonal functions, but also highlight that self-harm is performed rarely for one type of reason. The results also show that the presence of borderline personality traits increases the likelihood of endorsing a range of interpersonal reasons. These findings highlight the importance of understanding the range of reasons for engaging in NSSH to help manage the behaviour within the prison.
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Kirtley OJ, O'Carroll RE, O'Connor RC. Pain and self-harm: A systematic review. J Affect Disord 2016; 203:347-363. [PMID: 27323296 DOI: 10.1016/j.jad.2016.05.068] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal. METHODS A keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review. RESULTS There is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies. LIMITATIONS The current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis. CONCLUSIONS The evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.
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Affiliation(s)
- Olivia J Kirtley
- University of Glasgow, Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom.
| | - Ronan E O'Carroll
- University of Stirling, Division of Psychology, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, United Kingdom
| | - Rory C O'Connor
- University of Glasgow, Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
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Matsuyama T, Kitamura T, Kiyohara K, Hayashida S, Kawamura T, Iwami T, Ohta B. Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan. Scand J Trauma Resusc Emerg Med 2016; 24:68. [PMID: 27170115 PMCID: PMC4864919 DOI: 10.1186/s13049-016-0261-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/05/2016] [Indexed: 11/17/2022] Open
Abstract
Background Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service (EMS) personnel. Methods This study retrospectively reviewed population-based ambulance records in Osaka City, Japan, between January 2010 and December 2012, and enrolled emergency patients who suffered from self-inflicted injuries such as poisoning by drugs or gas, cutting/piercing skin, jumping from heights, hanging, and drowning. The endpoint was the annual incidence per 100,000 populations in Osaka City of emergency patients who presented with self-inflicted injuries by age and sex. Their outcomes including deaths at the scene and hospital arrival were also evaluated. Results During the study period, a total of 8,671 patients with 9,424 incidents of self-inflicted injuries were documented. The annual incidence of self-inflicted injuries was higher among women than men in the whole population and in the age group < =49 years (136.9 versus 82.6, and 214.8 versus 93.3, both Ps < 0.001), but it was inversely lower among women in the age group > =50 years (49.0 versus 68.9, P < 0.001). The total number of self-inflicted deaths was 1,564 (16.6 %), and the overall proportion of self-inflicted deaths was greater among men than women (32.2 % [1075/3340] vs. 7.5 % [451/6027], P < 0.001). The proportion of self-inflicted hanging was 76.7 % [1142/1489], followed by poisoning by carbon monoxide at 57.1 % [56/98] and jumping to death at 47.6 % [254/534]. Discussion Using large-scale EMS records, we investigated characteristics and outcomes of emergency patients with self-inflicted injuries treated by EMS personnel. Our findings suggested the gender paradox that the proportion of self-inflicted deaths was higher among men than women, while the proportion of non-fatal self-inflicted injuries was higher among women than among men, particularly in the group aged <=49 years. Our findings showing the importance of the prevention for self-inflicted injuries as well as the gender paradox of self-inflicted injuries will provide important epidemiological information to improve psychiatric cares in prehospital emergency settings. Conclusions In the total population, the annual incidence of self-inflicted injuries responded to by EMS personnel was higher among women than among men. However, the proportion of self-inflicted deaths was greater among men than women, and the most frequent manner among deceased patients was by hanging.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-0841, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Sumito Hayashida
- Osaka Municipal Fire Department, 1-12-54 Kujo Minami, Nishi-ku, Osaka, 550-8566, Japan
| | - Takashi Kawamura
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-0841, Japan
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Whisenhunt JL, Chang CY, Brack GL, Orr J, Adams LG, Paige MR, McDonald CPL, O'Hara C. Self-Injury and Suicide: Practical Information for College Counselors. JOURNAL OF COLLEGE COUNSELING 2015. [DOI: 10.1002/jocc.12020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Catherine Y. Chang
- Department of Counseling and Psychological Services; Georgia State University
| | - Gregory L. Brack
- Department of Counseling and Psychological Services; Georgia State University
| | - Jonathan Orr
- Department of Counseling and Psychological Services; Georgia State University
| | | | - Melinda R. Paige
- Department of Counseling and Psychological Services; Georgia State University
- Now at Department of Counseling; Argosy University; Atlanta
| | | | - Caroline O'Hara
- Department of Counseling and Psychological Services; Georgia State University
- Now at Department of Counselor Education; University of Toledo
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15
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Long M, Manktelow R, Tracey A. The healing journey: help seeking for self-injury among a community population. QUALITATIVE HEALTH RESEARCH 2015; 25:932-944. [PMID: 25294343 DOI: 10.1177/1049732314554092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Help seeking is known to be a complex and difficult journey for people who self-injure. In this article, we explore the process of help seeking from the perspective of a group of people living in Northern Ireland with a history of self-injury. We conducted 10 semistructured interviews and employed a grounded theory approach to data analysis. We created two major categories from the interview transcript data: (a) "involution of feeling," which depicts participants' perspectives on barriers to help seeking; and (b) "to be treated like a person," in which participants communicate their experiences of help seeking. The findings pose important implications for policy, practice, theory, and future research, including the need to increase the uptake of follow-up care among people who arrive at hospitals as a result of self-injury, self-harm, or suicidal behaviors.
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Affiliation(s)
- Maggie Long
- University of Ulster, Jordanstown Campus, Newtownabbey, United Kingdom
| | | | - Anne Tracey
- University of Ulster, Magee Campus, Derry, United Kingdom
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Singaravelu V, Stewart A, Adams J, Simkin S, Hawton K. Information-Seeking on the Internet. CRISIS 2015; 36:211-9. [PMID: 26088826 DOI: 10.1027/0227-5910/a000307] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. AIMS We aimed to identify and analyze websites potentially accessed by these young people. METHOD Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. RESULTS In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. CONCLUSION Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.
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Rimkeviciene J, O'Gorman J, De Leo D. Impulsive suicide attempts: a systematic literature review of definitions, characteristics and risk factors. J Affect Disord 2015; 171:93-104. [PMID: 25299440 DOI: 10.1016/j.jad.2014.08.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive research on impulsive suicide attempts, but lack of agreement on the use of this term indicates the need for a systematic literature review of the area. The aim of this review was to examine definitions and likely correlates of impulsive attempts. METHODS A search of Medline, Psychinfo, Scopus, Proquest and Web of Knowledge databases was conducted. Additional articles were identified using the cross-referencing function of Google Scholar. RESULTS 179 relevant papers were identified. Four different groups of research criteria used to assess suicide attempt impulsivity emerged: (a) time-related criteria, (b) absence of proximal planning/preparations, (c) presence of suicide plan in lifetime/previous year, and (d) other. Subsequent analysis used these criteria to compare results from different studies on 20 most researched hypotheses. Conclusions regarding the characteristics of impulsive attempts are more consistent than those on the risk factors specific to such attempts. No risk factors were identified that uniformly related to suicide attempt impulsivity across all criteria groups, but relationships emerged between separate criteria and specific characteristics of suicide attempters. LIMITATIONS Only published articles were included. Large inconsistencies in methods of the studies included in this review prevented comparison of effect sizes. CONCLUSIONS The vast disparities in findings on risk factors for impulsive suicide attempts among different criteria groups suggest the need to address the methodological issues in defining suicide attempt impulsivity before further research into correlates of such attempts can effectively progress. Specific recommendations are offered for necessary research.
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Affiliation(s)
- Jurgita Rimkeviciene
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia.
| | - John O'Gorman
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia; Griffith Health Institute, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia
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Kirtley OJ, O’Carroll RE, O’Connor RC. The role of endogenous opioids in non-suicidal self-injurious behavior: Methodological challenges. Neurosci Biobehav Rev 2015; 48:186-9. [DOI: 10.1016/j.neubiorev.2014.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/21/2014] [Accepted: 11/07/2014] [Indexed: 01/10/2023]
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Mars B, Heron J, Crane C, Hawton K, Kidger J, Lewis G, Macleod J, Tilling K, Gunnell D. Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort. J Affect Disord 2014; 168:407-14. [PMID: 25108277 PMCID: PMC4160300 DOI: 10.1016/j.jad.2014.07.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. METHOD Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. RESULTS Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. LIMITATIONS i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. CONCLUSION Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm.
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Affiliation(s)
- Becky Mars
- School of Social and Community Medicine, University of Bristol, United Kingdom.
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Catherine Crane
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Judi Kidger
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Glyn Lewis
- Mental Health Sciences Unit, University College London, United Kingdom
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Cheng Q, Li H, Silenzio V, Caine ED. Suicide contagion: a systematic review of definitions and research utility. PLoS One 2014; 9:e108724. [PMID: 25259604 PMCID: PMC4178222 DOI: 10.1371/journal.pone.0108724] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/03/2014] [Indexed: 12/04/2022] Open
Abstract
Objectives Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research. Methods 100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research. Results 20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels. Conclusion Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.
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Affiliation(s)
- Qijin Cheng
- HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
- * E-mail:
| | - Hong Li
- School of Management, University of Chinese Academy of Sciences, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Vincent Silenzio
- Injury Control Research Center for Suicide Prevention and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Eric D. Caine
- Injury Control Research Center for Suicide Prevention and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
- VA Center of Excellence for Suicide Prevention, Canandaigua, New York, United States of America
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Whisenhunt JL, Chang CY, Flowers LR, Brack GL, O'Hara C, Raines TC. Working With Clients Who Self-Injure: A Grounded Theory Approach. JOURNAL OF COUNSELING AND DEVELOPMENT 2014. [DOI: 10.1002/j.1556-6676.2014.00165.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Julia L. Whisenhunt
- Department of Counseling and Psychological Services, Georgia State University
- Now at Department of Clinical and Professional Studies, University of West Georgia
| | - Catherine Y. Chang
- Department of Counseling and Psychological Services, Georgia State University
| | - Lea R. Flowers
- Department of Counseling and Psychological Services, Georgia State University
- Now at Chrysalis Counseling and Consulting; Atlanta Georgia
| | - Gregory L. Brack
- Department of Counseling and Psychological Services, Georgia State University
| | - Caroline O'Hara
- Department of Counseling and Psychological Services, Georgia State University
- Now at Department of School Psychology, Higher Education, and Counselor Education, University of Toledo
| | - Tara C. Raines
- Department of Counseling and Psychological Services, Georgia State University
- Now at Department of Educational Psychology and Higher Education, University of Nevada, Las Vegas
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O'Connor RC, Rasmussen S, Hawton K. Adolescent self-harm: a school-based study in Northern Ireland. J Affect Disord 2014; 159:46-52. [PMID: 24679388 DOI: 10.1016/j.jad.2014.02.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. METHODS Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. RESULTS Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. LIMITATIONS This is a cross-sectional study. CONCLUSIONS The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Mental Health & Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom.
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McMahon EM, Corcoran P, Keeley H, Perry IJ, Arensman E. Adolescents exposed to suicidal behavior of others: prevalence of self-harm and associated psychological, lifestyle, and life event factors. Suicide Life Threat Behav 2013; 43:634-45. [PMID: 23855284 DOI: 10.1111/sltb.12045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 05/05/2013] [Indexed: 01/22/2023]
Abstract
Exposure to suicidal behavior of others was examined among 3,881 Irish adolescents in the Child and Adolescent Self-harm in Europe (CASE) study. One third of the sample had been exposed to suicidal behavior, and exposed adolescents were eight times more likely to also report own self-harm. Exposed adolescents shared many risk factors with those reporting own self-harm. Those reporting both exposure and own self-harm presented the most maladaptive profile on psychological, life event, and lifestyle domains, but neither anxiety nor depression distinguished this group. Exposed adolescents are burdened by a wide range of risk factors and in need of support.
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Larkin C, Di Blasi Z, Arensman E. Self-cutting versus intentional overdose: Psychological risk factors. Med Hypotheses 2013; 81:347-54. [DOI: 10.1016/j.mehy.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/01/2013] [Indexed: 11/17/2022]
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Rissanen ML, Kylmä J, Hintikka J, Honkalampi K, Tolmunen T, Laukkanen E. Factors helping adolescents to stop self-cutting: descriptions of 347 adolescents aged 13-18 years. J Clin Nurs 2013; 22:2011-9. [DOI: 10.1111/jocn.12077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jari Kylmä
- School of Health Sciences, Nursing Science; University of Tampere; Tampere Finland
| | - Jukka Hintikka
- Department of Psychiatry; School of Medicine and Paijat-Hame Central Hospital; University of Tampere; Lahti Finland
| | | | - Tommi Tolmunen
- Department of Adolescent Psychiatry; Kuopio University Hospital and University of Eastern-Finland; Kuopio Finland
| | - Eila Laukkanen
- Department of Adolescent Psychiatry; Kuopio University Hospital and University of Eastern-Finland; Kuopio Finland
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Wu CY, Chang CK, Huang HC, Liu SI, Stewart R. The association between social relationships and self-harm: a case-control study in Taiwan. BMC Psychiatry 2013; 13:101. [PMID: 23531045 PMCID: PMC3621841 DOI: 10.1186/1471-244x-13-101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 03/21/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case-control study. METHODS The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models. RESULTS A total of 124 case-control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94). CONCLUSIONS More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, 1, Section 1, Jen-Ai Road, Taipei, 10051, Taiwan
| | - Chin-Kuo Chang
- King’s College London (Institute of Psychiatry), London, UK, De Crespigny Park, London, SE5 8AF, UK
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan, 45, Min-Sheng Road, Tam-Shui, New Taipei City, Taiwan,Mackay Medicine, Nursing and Management College, Taipei, Taiwan, 92, Shengjing Rd., Beitou Dist, Taipei City, 11260, Taiwan
| | - Shen-Ing Liu
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan, 92, Shengjing Rd., Beitou Dist, Taipei City, 11260, Taiwan,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan, 45, Min-Sheng Road, Tam-Shui, New Taipei City, Taiwan
| | - Robert Stewart
- King’s College London (Institute of Psychiatry), London, UK, De Crespigny Park, London, SE5 8AF, UK
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Abstract
Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Oxford, UK.
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Abstract
Adolescence is a life phase in which the opportunities for health are great and future patterns of adult health are established. Health in adolescence is the result of interactions between prenatal and early childhood development and the specific biological and social-role changes that accompany puberty, shaped by social determinants and risk and protective factors that affect the uptake of health-related behaviours. The shape of adolescence is rapidly changing-the age of onset of puberty is decreasing and the age at which mature social roles are achieved is rising. New understandings of the diverse and dynamic effects on adolescent health include insights into the effects of puberty and brain development, together with social media. A focus on adolescence is central to the success of many public health agendas, including the Millennium Development Goals aiming to reduce child and maternal mortality and HIV/AIDS, and the more recent emphases on mental health, injuries, and non-communicable diseases. Greater attention to adolescence is needed within each of these public health domains if global health targets are to be met. Strategies that place the adolescent years centre stage-rather than focusing only on specific health agendas-provide important opportunities to improve health, both in adolescence and later in life.
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Affiliation(s)
- Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia.
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O'Connor RC, Rasmussen S, Hawton K. Distinguishing adolescents who think about self-harm from those who engage in self-harm. Br J Psychiatry 2012; 200:330-5. [PMID: 22403089 DOI: 10.1192/bjp.bp.111.097808] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescent self-harm is a major public health concern, yet little is known about the factors that distinguish adolescents who think about self-harm but do not act on these thoughts from those who act on such thoughts. AIMS Within a new theoretical model, the integrated motivational-volitional model, we investigated factors associated with adolescents having thoughts of self-harm (ideators) v. those associated with self-harm enaction (enactors). METHOD Observational study of school pupils employing an anonymous self-report survey to compare three groups of adolescents: self-harm enactors (n = 628) v. self-harm ideators (n = 675) v. those without any self-harm history (n = 4219). RESULTS Enactors differed from ideators on all of the volitional factors. Relative to ideators, enactors were more likely to have a family member/close friend who had self-harmed, more likely to think that their peers engaged in self-harm and they were more impulsive than the ideators. Enactors also reported more life stress than ideators. Conversely, the two self-harm groups did not differ on any of the variables associated with the development of self-harm thoughts. CONCLUSIONS As more adolescents think about self-harm than engage in it, a better understanding of the factors that govern behavioural enaction is crucial in the effective assessment of the risk of self-harm.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Group, School of Natural Sciences, University of Stirling, Stirling FK9 4LA.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK.
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Baetens I, Claes L, Muehlenkamp J, Grietens H, Onghena P. Non-suicidal and suicidal self-injurious behavior among Flemish adolescents: A web-survey. Arch Suicide Res 2011; 15:56-67. [PMID: 21294000 DOI: 10.1080/13811118.2011.540467] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study investigated the prevalence of non-suicidal self-injury (NSSI) and suicidal self-injury (SSI) in a sample of 1,417 Flemish adolescents aged 12 to 18, as well as psychosocial differences between adolescents engaging in NSSI and adolescents engaging in SSI. Participants completed an anonymous online survey inquiring about NSSI and SSI functions, sociodemographic correlates, help seeking behaviors, and stressful life events. Lifetime prevalence of NSSI was 13.71% and SSI was 3.93%. No gender or age differences appeared between adolescents engaging in NSSI or SSI; however, differences in educational level were observed. Significant differences in functions of the behavior and number of stressful life events were noted between groups. Finally, the likelihood of receiving professional help differed between adolescents engaging in NSSI and adolescents engaging in SSI. Implications of the findings for assessment and treating NSSI and SSI are discussed.
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Arango C. Clinical subtyping and early detection: short-term challenges for child and adolescent psychiatry. Eur Child Adolesc Psychiatry 2010; 19:627-8. [PMID: 20661688 DOI: 10.1007/s00787-010-0123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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