Self-mutilation among male patients with alcohol dependency: the role of dissociation

Different Ways to Drown Out the Pain: A Meta-Analysis of the Association Between Nonsuicidal Self-Injury and Alcohol Use

OBJECTIVE

There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature.

METHOD

To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI.

RESULTS

Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems.

CONCLUSIONS

These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed.HighlightsThere are several reasons to think that NSSI and alcohol use are linked.No reviews or meta-analyses have been conducted.We found a significant and small effect linking greater NSSI with greater alcohol use.

Self -image and selected clinical variables in the context of childhood abuse in subjects with alcohol dependence

Objective: The objective of the study was to determine the differences in selected clinical variables and self-image in people with alcohol dependence differing in severity of physical, emotional and sexual abuse experienced before age 18.

Method: The study included 90 people with alcohol dependence. The following research tools were used: Early Trauma Inventory (ETI), Adjective Check List (ACL), MAST, SAAD, and a questionnaire designed by the authors. In order to identify groups with varying indices of physical, emotional and sexual childhood abuse, a cluster analysis method was used.

Results: Two groups of subjects with alcohol dependence were identified: Group 1 with high indices of physical, emotional and sexual childhood abuse and Group 2 with low indices. In terms of self-image the subjects in Group 1 compared to subjects in Group 2 were characterized by a lower self-esteem, self-acceptance, resistance to stress, less intense needs for achievement, endurance, order, nurturing others, interaction with opposite-sex partners, subordinations but more intense need for change. The age of alcohol use initiation and the onset of regular alcohol drinking was statistically significantly lower in Group 1. The severity of alcohol dependence was significantly lower in Group 2. The subjects in Group 1 significantly more frequently confirmed the history of a hereditary predisposition to alcohol dependence, suicidal ideation, suicide attempts and self-harm.

Discussion: The obtained results closely correspond to the data available in the literature.

Conclusions: An assessment of exposure to various forms of childhood abuse appears to be an indispensable element of collecting medical history of people with alcohol dependence.

Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin

Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.

Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Background

Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.

Methods

We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.

Results

Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.

Conclusions

Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis

BACKGROUND

Non-suicidal self-injury is being increasingly recognised as a prominent public health concern. Identification of early and modifiable risk factors is necessary to advance the screening and intervention efforts, particularly early detection of at-risk individuals. We aimed to examine childhood maltreatment, including its specific subtypes, in relation to non-suicidal self-injury.

METHODS

We did a comprehensive meta-analysis of childhood maltreatment (overall, sexual abuse, physical abuse and neglect, and emotional abuse and neglect) in association with non-suicidal self-injury. We also provided a qualitative review of mediators and moderators of this association. We identified relevant articles published from inception to Sept 25, 2017, through a systematic search of Embase, MEDLINE, and PsycINFO. We extracted continuous and categorical data and assessed for potential moderators using ten study characteristics. We generated random-effects models for analysis and evaluated for publication bias.

FINDINGS

We identified 71 publications that met eligibility criteria. Overall childhood maltreatment was associated with non-suicidal self-injury (odds ratio 3·42, 95% CI 2·74-4·26), and effect sizes for maltreatment subtypes ranged from 1·84 (1·45-2·34) for childhood emotional neglect to 3·03 (2·56-3·54) for childhood emotional abuse. Publication bias was not evident, except in the case of childhood emotional neglect. Across multiple maltreatment subtypes, we found stronger associations with non-suicidal self-injury in non-clinical samples.

INTERPRETATION

With the exception of childhood emotional neglect, childhood maltreatment and its subtypes are associated with non-suicidal self-injury. Screening of childhood maltreatment history in non-suicidal self-injury risk assessments might hold particular value in community settings, and increased attention to childhood emotional abuse is warranted.

FUNDING

National Institute of Mental Health.

The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses

Dissociative disorders (DD) are frequently associated with suicidal behaviors. We performed the first meta-analysis of studies comparing rates of suicide attempts (SA) and non-suicidal self-injury (NSSI) in psychiatric individuals with and without DD. We included: 1) studies comparing SA and NSSI rates in psychiatric individuals with and without DD; 2) studies comparing Dissociative Experiences Scale (DES) scores in both SA and NSSI psychiatric patients versus non SA and non NSSI ones. Cochrane Collaboration Review Manager Software and STROBE statement were used. Nineteen studies were included in the analyses. DD patients were more likely to report both previous SA and NSSI in comparison to non DD patients. Importantly, results remained highly significant in both outcomes but with no more heterogeneity when including studies using a DSM-based method to diagnose DD. Both SA and NSSI patients reported higher DES scores in comparison to non SA and non NSSI patients. The presence of DD diagnosis or higher DES scores seems to be related to both SA and NSSI in psychiatric patients. Hence, it may be reasonable to hypothesize the presence of a dissociative subtype in a subset of these patients, which should be considered as a transdiagnostic factor and should be carefully assessed.

Relationship of self-mutilative behaviour with history of childhood trauma and adult ADHD symptoms in a sample of inpatients with alcohol use disorder

The aim of the present study was to evaluate relationship of self-mutilative behaviour (SMB) with the severity of childhood trauma and adult attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of inpatients with alcohol use disorder (AUD). Participants included 188 inpatients with AUD. Participants were evaluated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Questionnaire (CTQ-28) and the Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale (Adult ADHD Scale). Among inpatients with AUD those who have a history of SMB constituted the SMB group (n = 57, 30.3%), and those without a history of SMB constituted the group without SMB (n = 131, 69.7%). Risk of high ADHD risk was 2.5 times higher among those with SMB. Adult ADHD Scale and CTQ-28 scores were also higher in the group with SMB. In the first backward logistic regression model, the severity of ADHD symptoms predicted the presence of SMB, together with the severity of childhood trauma, whereas in the second model, physical neglect and inattentive (IN) dimension of ADHD predicted the presence of SMB. These findings suggest that the higher severity of physical neglect and adult IN dimension of ADHD may be related to SMB among inpatients with AUD.

Male genital self-mutilation: a systematic review of psychiatric disorders and psychosocial factors

OBJECTIVE

To identify psychiatric diagnoses and psychosocial factors associated with intentional male genital self-mutilation (GSM) of specific injury subtypes.

METHODS

A search of MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science and CINAHL for cases of GSM was conducted until December 2015, based on GSM and related terms. Cases were examined for injury subtype, psychiatric diagnosis and psychosocial factors. Chi-square analyses were employed to determine differences in frequency of such factors across injury subtypes.

RESULTS

Data were obtained from 173 cases: genital mutilation (n=21), penile amputation (n=62), castration (n=56) and combined amputation/castration (n=34). Common psychiatric disorders included schizophrenia spectrum (49%), substance use (18.5%), personality (15.9%) and gender dysphoric disorders (15.3%). Chi-square analyses revealed that schizophrenia spectrum disorders occurred significantly more often among auto-amputates as compared with self-castrators or mutilators. Gender dysphoria occurred significantly more often among self-castrators than auto-amputates. No significant differences emerged regarding psychosocial factors across GSM subtypes. However, associations were observed between psychosocial factors and psychiatric diagnoses. Although altogether not commonly reported, experiential factors were reported in 82% of psychotic individuals. Treatment inaccessibility was noted among 71% of gender dysphorics engaging in auto-castration.

CONCLUSION

Clinicians must consider the diverse range of psychiatric disorders and psychosocial factors underlying GSM.

Characteristics of nonsuicidal self-injury associated with suicidal ideation: evidence from a clinical sample of youth

BACKGROUND

Nonsuicidal self-injury (NSSI) and suicidal ideation (SI) are both distressing and quite common, particularly in youth. Given the relationship between these two phenomena, it is crucial to learn how we can use information about NSSI to understand who is at greatest risk of suicidal thoughts. In this study, we investigated how characteristics of nonsuicidal self-injury related to SI among treatment-seeking adolescents and young adults.

METHODS

Data were collected during routine program evaluation for a self-injury treatment program. Correlations between recent SI and NSSI characteristics were calculated for adolescent and young adult patients (N = 1502).

RESULTS

Low severity methods of NSSI (e.g. banging) were more strongly associated with SI than high severity methods (e.g. breaking bones). SI was associated with intrapersonal (automatic) NSSI functions. SI was associated with some indices of NSSI severity, such as number of methods and urge for NSSI, but not with others, such as age of onset.

CONCLUSIONS

This study provides a valuable opportunity to expand our knowledge of suicide risk factors beyond those that may apply broadly to self-injurers and to non-injurers (e.g., depression, substance use) to NSSI-related factors that might be specifically predictive of suicidal thoughts among self-injurers. Findings inform clinical risk assessment of self-injurious youth, a population at high risk of suicidal thoughts and behaviors, and provide further insight into the complex NSSI/suicide relationship.

Levels of dissociation and nonsuicidal self-injury: a quartile risk model

Extant research indicates that dissociation may act as a risk factor for nonsuicidal self-injury (NSSI), but the data are mixed. In this study, 75 university and community females ages 18-35 were assessed for rates of normative, clinical, and severely clinical dissociation as well as for NSSI. Significant differences in normative dissociation were found between the control group and the group reporting a history of NSSI. In addition, normative dissociation--but not clinical or severely clinical dissociation--was found to be significantly associated with NSSI in this sample. Considering this finding in the context of the existing literature, we propose a quartile risk model of dissociation and NSSI as a new approach to the influences of levels of dissociation on NSSI risk.

The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.

Self-injurious behaviors in posttraumatic stress disorder: an examination of potential moderators

BACKGROUND

Despite increasing evidence for a relation between posttraumatic stress disorder (PTSD) and self-injurious behaviors (SIB), limited research has examined the factors that may moderate the associations between PTSD and both nonsuicidal SIB (deliberate self-harm; DSH) and suicidal SIB (suicide attempts). Nonetheless, research suggests that characteristics of the traumatic event, co-occurring borderline personality disorder (BPD), and emotion dysregulation may influence the relations between PTSD and SIB.

METHODS

Thus, the aim of this study was to examine the moderating role of these factors in the association between PTSD and SIB (including history and frequency of DSH and suicide attempts, and DSH versatility) among a sample of substance use disorder inpatients with (n=116) and without (n=130) a history of PTSD.

RESULTS

Results from stepwise regression analyses indicate that sexual assault-related PTSD predicted suicide attempt frequency and DSH versatility among those with PTSD. Furthermore, results from hierarchical linear and logistic regression analyses suggest that co-occurring BPD moderates the relationship between PTSD and both DSH history and versatility and emotion dysregulation moderates the relationship between PTSD and DSH frequency. Specifically, the relations between PTSD and DSH outcomes were stronger among participants with co-occurring BPD and higher levels of emotion dysregulation.

LIMITATIONS

This study is limited by its reliance on cross-sectional, self-report data.

CONCLUSIONS

Despite limitations, findings suggest distinct risk factors for suicide attempts and DSH, and highlight the importance of examining characteristics of the trauma and associated BPD and emotion dysregulation in assessing risk for SIB in PTSD.

Complicated alcohol withdrawal presenting as self mutilation

Self-mutilation has been defined as deliberate self injury to body tissue without the intent to die. There has been an association between substance abuse and self mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self harm behavior when the hallucinosis is commanding type. We are presenting a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis. This has clinical implication to enquire about substance abuse in patients presenting to emergency setting.

Relationship of self-mutilative behaviours with severity of borderline personality, childhood trauma and impulsivity in male substance-dependent inpatients

The aim of this study was to investigate the relationship of self-mutilation (SM) with the severity of borderline personality features (BPF), childhood trauma and impulsivity in male substance-dependent inpatients. Participants were consecutively admitted comprising 200 male substance-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Childhood Trauma Questionnaire (CTQ-28), the Barratt Impulsiveness Scale (BIS-11) and the Borderline Personality Inventory (BPI). Among 200 subjects, 62.0% (n=124) were considered as the group with SM. Mean scores of CTQ-28 total and subscales (other than emotional abuse), BIS-11 total and attentional impulsiveness subscale and BPI were higher in the SM group. In the regression model, emotional neglect, attentional impulsiveness and drug dependency were the predictors of SM, whereas in the new model in which the severity of BPF was included emotional neglect and the severity of BPF predicted SM. Among those with SMB, physical neglect and the severity of BPF predicted the number of SM episodes. Thus, to better understand SMB among substance-dependent patients, clinicians must carefully evaluate BPF and history of childhood trauma among substance-dependent inpatients. In addition, results suggest that the relationship between SMB and BPF is more prominent in drug-dependent inpatients than alcohol-dependent inpatients.

Self-mutilative behaviors in male substance-dependent inpatients and relationship with anger and aggression: mediator effect of childhood trauma

The aim of this study was to investigate the relationship of self-mutilation (SM) with anger and aggression in male substance-dependent inpatients. Also, we wanted to evaluate the mediator effect of childhood trauma on these relationships while controlling variables such as age, substance of dependence (alcohol/drug), and negative effect. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Reports, the Buss-Perry's Aggression Questionnaire, the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Rate of being married, current age, and age onset of regular substance use were lower, whereas being unemployed and history of childhood trauma (HCT) were higher in group with SM (n = 124, or 62.0%). Higher mean scale scores were found in SM group. Predictors of SM were being younger, impaired anger control, and physical aggression in logistic regression model. Being younger and the outward expression of anger (anger-out) predicted SM in the subgroup of patients without HCT, whereas being younger, severity of anger, and the inward expression of anger (anger-in) predicted SM in the subgroup of patients with HCT. Thus, to reduce self-mutilative behavior among substance-dependent patients, clinicians must improve anger control, particularly in younger patients. Type of strategy for coping with anger, which must be worked on, may differ in different subgroup patients, that is, focusing anger toward self among those with HCT, whereas anger toward others among those without.

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.

Development and validation of the Minnesota borderline personality disorder scale

Although large epidemiological data sets can inform research on the etiology and development of borderline personality disorder (BPD), they rarely include BPD measures. In some cases, however, proxy measures can be constructed using instruments already in these data sets. In this study, the authors developed and validated a self-report measure of BPD from the Multidimensional Personality Questionnaire (MPQ). Items for the new instrument-the Minnesota BPD scale (MBPD) -were identified and refined using three large samples: undergraduates, community adolescent twins, and urban substance users. The authors determined the construct validity of the MBPD scale by examining its association with (a) diagnosed BPD, (b) questionnaire-reported BPD symptoms, and (c) clinical variables associated with BPD: suicidality, trauma, disinhibition, internalizing distress, and substance use. The authors also tested the MBPD scale in two prison inmate samples. Across samples, the MBPD scores correlated with BPD indices and external criteria and showed incremental validity above measures of negative affect, thus supporting its construct validity as a measure of BPD.

Self-mutilative behaviours in male alcohol-dependent inpatients and relationship with posttraumatic stress disorder

The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% (n=53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB)among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity.

Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N=156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL. Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.

The Relationship Between Emotion Dysregulation and Deliberate Self-Harm Among Inpatients with Substance Use Disorders

Despite the emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), no studies have examined this association among patients with substance use disorders (SUD). This study examined if emotion dysregulation is heightened among SUD inpatients with (vs. without) DSH, and if the association between DSH and emotion dysregulation remains significant when controlling for their shared association with risk factors for both, including borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood abuse, and substance use severity. Findings indicate heightened emotion dysregulation among SUD patients with (vs. without) DSH, and provide evidence of a unique association between emotion dysregulation and DSH when controlling for BPD, PTSD, childhood abuse, and substance use severity. Findings also highlight the particular relevance of three dimensions of emotion dysregulation to DSH among SUD patients: limited access to effective emotion regulation strategies, difficulties engaging in goal-directed behaviors when distressed, and emotional nonacceptance.

Preliminary spatiotemporal analysis of the association between socio-environmental factors and suicide

BACKGROUND

The seasonality of suicide has long been recognised. However, little is known about the relative importance of socio-environmental factors in the occurrence of suicide in different geographical areas. This study examined the association of climate, socioeconomic and demographic factors with suicide in Queensland, Australia, using a spatiotemporal approach.

METHODS

Seasonal data on suicide, demographic variables and socioeconomic indexes for areas in each Local Government Area (LGA) between 1999 and 2003 were acquired from the Australian Bureau of Statistics. Climate data were supplied by the Australian Bureau of Meteorology. A multivariable generalized estimating equation model was used to examine the impact of socio-environmental factors on suicide.

RESULTS

The preliminary data analyses show that far north Queensland had the highest suicide incidence (e.g., Cook and Mornington Shires), while the south-western areas had the lowest incidence (e.g., Barcoo and Bauhinia Shires) in all the seasons. Maximum temperature, unemployment rate, the proportion of Indigenous population and the proportion of population with low individual income were statistically significantly and positively associated with suicide. There were weaker but not significant associations for other variables.

CONCLUSION

Maximum temperature, the proportion of Indigenous population and unemployment rate appeared to be major determinants of suicide at a LGA level in Queensland.