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Chen M, Wang X, Wang Y, Ren L, Jiang H, Xia L, Zhang L, Dong C. The characteristics of suicide attempters in Chinese patients: Comparison of adolescents, youths, middle-aged and elderly. J Forensic Leg Med 2024; 102:102658. [PMID: 38382217 DOI: 10.1016/j.jflm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Potential risk factors for suicide differ by age group. Therefore, this study aims to investigate the characteristics of patients with suicide attempts according to age group and any the relevant risk factors. METHODS This study retrospectively reviewed the medical records of attempted suicide patients who were admitted to the emergency departments (ED) of the First Affiliated Hospital of Wenzhou Medical University between January 1, 2017, and December 31, 2021. Demographic information and clinical characteristics were collected. The participants were divided into four age groups and the characteristics of each group were compared. RESULTS A total of 834 participants were included in this study. Suicide attempts were more prevalent in females, and the gender difference decreased with age. Having religious belief and less educated suicide attempts were concentrated in the elderly groups. Adolescents suicide attempts were more likely to occur in the spring, autumn and during non-office hours. Mental disorders were the major motivation for suicide among adolescents, and interpersonal and social problems were more prevalent among youths. Psychiatric medication was the leading suicidal substances among adolescents, while pesticides and herbicides were more prevalent in adults. The history of psychiatric diagnosis was more common in adolescents, while the history of somatic disorder was more prevalent in the elderly. CONCLUSION This study confirmed differences in the demographic and clinical characteristics of patients in different age groups. Therefore, it is necessary to construct individualized intervention strategies for each age group based on the characteristics of the patients in order to reduce suicide.
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Affiliation(s)
- Meijia Chen
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xinlu Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lin Xia
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Liping Zhang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
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Sunzi K, Luo H, Li Y, Zhou X, Lei C. What do older people who have attempted suicide experience? Study protocol for a qualitative meta-synthesis among older adults, family caregivers and healthcare professionals. BMJ Open 2023; 13:e074942. [PMID: 38070934 PMCID: PMC10729173 DOI: 10.1136/bmjopen-2023-074942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Attempted suicide among older adults represents a significant mental health concern that has witnessed a rising incidence within this demographic in recent years. Research indicates that attempted suicide among the older population serves as a primary risk factor for completed suicide. Consequently, the objective of this study is to provide a comprehensive overview of the prevailing factors that influence suicide attempts among older adults, thereby offering evidence to guide healthcare professionals in designing targeted interventions. METHODS AND ANALYSIS This study will adhere to the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. We will synthesise qualitative studies using a comprehensive and inclusive bibliographic search strategy. The following databases will be searched: PubMed, Embase, Web of Science, CINAHL and the Cochrane Library. The quality of the articles will be assessed using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. At the same time, data extraction will be performed using the Qualitative Assessment and Review Instrument data extraction form proposed by the Joanna Briggs Institute for Evidence-Based Practice. The synthesis of findings will adhere to the principles and procedures of Thomas and Hardens' three-stage thematic synthesis approach. ETHICS AND DISSEMINATION Ethical approval will not be required for this study, as it solely encompasses data derived from previously published research. The findings will be disseminated through publication in a peer-reviewed journal. Moreover, the results will be presented at relevant academic conferences to guarantee that the study's outcomes reach pertinent stakeholders. This protocol is registered with the PROSPERO prospective database for systematic review. PROSPERO REGISTRATION NUMBER CRD42023408385.
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Affiliation(s)
- Kejimu Sunzi
- Department of Nursing, Deyang People's Hospital, Deyang, Sichuan, China
| | - Hui Luo
- Department of Nursing, Sichuan Nursing Vocational College, Deyang, Sichuan, China
| | - Yadi Li
- Department of Traditional Chinese Medicine, Deyang People's Hospital, Deyang, Sichuan, China
| | - Xin Zhou
- Department of Psychosomatic Medicine, Deyang People's Hospital, Deyang, Sichuan, China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, Chongqing, China
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Waliski A, Matthieu MM, Allison MK, Wilson MP, Skaggs EM, Adkins DA, Owen RR. Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities. J Emerg Nurs 2023; 49:255-265. [PMID: 36653229 DOI: 10.1016/j.jen.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Veterans die by suicide at higher rates than nonveterans. Given that the emergency department is often the first point of entry to healthcare following a suicide attempt, it would be beneficial for community providers to have knowledge of the characteristics, medical issues, and effective treatments most often associated with those having served in the military to ensure guideline concordant and quality suicide care. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare. METHODS This qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices. RESULTS Although most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided. DISCUSSION Best practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.
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Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 81:51-56. [PMID: 36805332 DOI: 10.1016/j.genhosppsych.2023.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. METHODS This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. RESULTS A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. CONCLUSION One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.
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Patel A, Ness J, Kelly S, Waters K, Townsend E, Kapur N, Clements C, Farooq B, Geulayov G, Casey D, Hawton K. The characteristics, life problems and clinical management of older adults who self-harm: Findings from the multicentre study of self-harm in England. Int J Geriatr Psychiatry 2023; 38:e5895. [PMID: 36840547 DOI: 10.1002/gps.5895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision. OBJECTIVES To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 60 years and over presenting to hospital following self-harm. METHOD Data on Emergency Department (ED) presentations for self-harm from 2003 to 2016 from three centres in the Multicentre Study of Self-Harm in England were analysed. Changes in self-harm rates were examined using Poisson regression. Univariable logistic regression was used to investigate factors associated with 12-month self-harm repetition. RESULTS There were 3850 presentations for self-harm by 2684 individuals aged 60 years and over. Self-harm rates increased over time for 60-74-year-old men (Incident Rate Ratio = 1.04, 95% Confidence Interval 1.02-1.06, p < 0.0001). Problems most frequently reported to have preceded self-harm were mental health (40.5%) and physical health (38.3%) concerns. Problems with alcohol, finances, employment and relationship with partner were found more frequently in 60-74-year-olds compared with those aged over 74 years. Physical health problems were common with increasing age, as were problems with alcohol for men. One in ten (10.8%) individuals presented to hospital with self-harm within 12 months of their index presentation. CONCLUSIONS Self-harm-related ED attendances in older men have increased, particularly for men aged 60-74 years. Prevention and clinical management should involve a comprehensive psychosocial assessment to target common precipitants for the wide range of problems preceding self-harm and may include support with physical and mental wellbeing and advice on safer alcohol use.
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Affiliation(s)
- Anita Patel
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Samantha Kelly
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, University Park Nottingham, Nottingham, UK
| | - Navneet Kapur
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Zarska A, Barnicot K, Lavelle M, Dorey T, McCabe R. A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm. Arch Suicide Res 2022:1-22. [PMID: 35583506 DOI: 10.1080/13811118.2022.2071660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm. METHOD Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted. RESULTS Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies-safety planning and follow-up contact-were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear. CONCLUSIONS There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts. HIGHLIGHTSMore RCTs are needed to improve the evidence base for ED providers managing self-harmSafety planning and follow up contacts are linked to reductions in repeat suicide attemptsFuture research should investigate the impact of staff training on patient outcomes.
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Goldman-Mellor SJ, Bhat HS, Allen MH, Schoenbaum M. Suicide Risk Among Hospitalized Versus Discharged Deliberate Self-Harm Patients: Generalized Random Forest Analysis Using a Large Claims Data Set. Am J Prev Med 2022; 62:558-566. [PMID: 34810041 PMCID: PMC8940689 DOI: 10.1016/j.amepre.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Suicide rates are extremely high among emergency department patients seen for deliberate self-harm. Inpatient hospitalization is often recommended for these patients, but evidence on the suicide prevention impacts of hospitalization is scarce. Confounding by indication and challenges to implementing randomized designs are barriers to advances in this field. METHODS Investigators used 2009-2012 statewide data on 57,312 self-harm emergency department patients from California, linked to mortality records. Naive 12-month and 30-day suicide risks were estimated among patients who were hospitalized versus those who were discharged. Then, generalized random forest methods were applied to estimate the average treatment impacts of hospitalization on suicide, conditioning on observable covariates. Associations were calculated separately for sex- and age-specific subgroups. Analyses were conducted in February 2019-August 2021. RESULTS In naive analyses, suicide risk was significantly higher in hospitalized than in discharged patients in each subgroup. In 12-month models accounting for the observed covariates through generalized random forest methods, hospitalized male patients had 5.4 more suicides per 1,000 patients (95% CI=3.0, 7.8), hospitalized patients aged 10-29 years had 2.4 more suicides per 1,000 (95% CI=1.1, 3.6), and those aged ≥50 years had 5.8 more suicides per 1,000 (95% CI=0.5, 11.2) than corresponding discharged patients. Hospitalization was not significantly associated with suicide among female patients or patients aged 30-49 years in generalized random forest analyses. Patterns were similar in 30-day generalized random forest models. CONCLUSIONS Emergency department personnel intend to hospitalize self-harm patients with high suicide risk; this study suggests that this goal is largely realized. Analyses that control for confounding by observable covariates did not find clear evidence that hospitalization reduces suicide risk and could not rule out the possibility of iatrogenic effects.
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Affiliation(s)
- Sidra J Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California.
| | - Harish S Bhat
- Department of Applied Mathematics, School of Natural Sciences, University of California Merced, Merced, California
| | - Michael H Allen
- Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
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Ruane-McAteer E, Corcoran P, Browne J, Hursztyn P, Griffin E. Study designs and outcomes used in evaluation studies of hospital-presenting self-harm: protocol for a methodological systematic review. BMJ Open 2021; 11:e044993. [PMID: 34362798 PMCID: PMC8351496 DOI: 10.1136/bmjopen-2020-044993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Self-harm is the most common risk factor for suicide, and so those who present to hospital following self-harm provide an opportunity for targeted clinical care interventions. Observational studies evaluating such interventions may be useful in overcoming limitations of controlled trials, but study design, statistical analyses and outcomes used must be appropriate. This methodological systematic review will describe, categorise, synthesise and compare the methodological aspects of studies evaluating interventions and aspects of clinical management following hospital-presenting self-harm in both observational and experimental (ie, controlled trials or quasi-experimental studies) study designs. METHODS AND ANALYSIS Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocol guidelines were followed in drafting this protocol. Search terms were developed (related to self-harm, hospital presentation and evaluation studies) and adapted for MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and grey literature databases. Two reviewers will independently screen 100 titles/abstracts until consensus is reached, with the remaining screened by one reviewer. Full-text screening will be conducted independently by two reviewers. Data will be extracted by one reviewer, and a second will check all data extracted. Validated risk of bias tools will be used. Data synthesis will focus on the heterogeneity of outcomes used in individual studies. Descriptive summary statistics of the data (eg, key study characteristics, type and frequency of outcomes) will be provided in categorical format, using frequencies and percentages. Outcomes will be reported separately for trials (both randomised and non-randomised trials), observational and quasi-experimental studies. Categorisation of outcomes will be guided by Cochrane Effective Practice and Organisation of Care resources for reviews of health systems interventions. ETHICS AND DISSEMINATION Results will be disseminated at national and international conferences and published in a peer-reviewed journal. Findings will be used to inform future studies in the area of hospital-presenting self-harm. Ethical approval is not required for this review. PROSPERO REGISTRATION NUMBER CRD42020208714.
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Affiliation(s)
- Eimear Ruane-McAteer
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | | | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Pawel Hursztyn
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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Furnes D, Gjestad R, Mehlum L, Hodgekins J, Kroken RA, Oedegaard K, Mellesdal L. Borderline Personality Disorder: What Predicts Acute Psychiatric Readmissions? J Pers Disord 2021; 35:481-493. [PMID: 31682191 DOI: 10.1521/pedi_2019_33_459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals diagnosed with borderline personality disorder (BPD) often struggle with chronic suicidal thoughts and behaviors and have frequent acute psychiatric admissions. Prevention of serial admissions and disruptions in long-term treatment strategies is needed. This study explored predictors of how frequently and how quickly patients diagnosed with BPD are readmitted after an index psychiatric admission. The authors identified self-harming behavior as a predictor of readmission frequency, whereas depression and hallucinations and delusions predicted time elapsed between the index admission and the first readmission. The authors recommend that predictors of readmissions should be carefully monitored and treated following index admission.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Joanne Hodgekins
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Rune A Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | - Ketil Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Noway
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Rahman F, Webb RT, Wittkowski A. Risk factors for self-harm repetition in adolescents: A systematic review. Clin Psychol Rev 2021; 88:102048. [PMID: 34119893 DOI: 10.1016/j.cpr.2021.102048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 01/26/2023]
Abstract
Self-harm behavior can begin in early adolescence, with the highest rates of self-harm, between 1990 and 2000 in England, being among adolescents aged 16 to 24 years and there being considerable risk of fatal and non-fatal repetition. Previous systematic reviews have identified risk factors for self-harm in adolescents, but not for the repetition of this behavior. The aim of this review was to synthesise the psychological, psychosocial and sociodemographic risk factors for self-harm repetition in adolescents. By searching four databases, 27 studies were identified and included in the review. Several psychological (e.g., psychiatric morbidity, features of previous self-harm, psychological distress), psychosocial (e.g., alcohol misuse, poor family and peer relationships) and sociodemographic (e.g., age, gender and ethnicity) risk factors were identified for self-harm repetition in adolescents. Several risk factors across all categories for self-harm overlapped with that of self-harm repetition, such as depression, alcohol misuse and female gender. The clinical implications of these findings for practitioners were discussed. As was the case with prior reviews in this area, comparability between studies was limited and a meta-analysis was not possible due to considerable heterogeneity in outcome definitions, measures and methodologies.
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Affiliation(s)
- Farhan Rahman
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK
| | - Roger T Webb
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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11
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Wadood A, Karim R, Hussain AAM, Rana M, Hossain G. Risk factors of suicidality among married adults: A cross-sectional survey in Rajshahi City, Bangladesh. PLoS One 2021; 16:e0251717. [PMID: 33984045 PMCID: PMC8118341 DOI: 10.1371/journal.pone.0251717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Suicide is a serious public health concern all over the world including Bangladesh. About 9% of the patients admitted with suicidal ideation (SI) or suicide attempt (SA) later complete suicide. To understand and prevent suicide, the study of SI and SA is necessary but research in this area is scanty in Bangladesh. Therefore, we studied suicidality (SI and SA) among married adults in Rajshahi City, Bangladesh. Methods This was a household cross-sectional study. A total of 708 married adults were selected for this study using a multi-stage random sampling. Suicidality was measured based on two factors: (i) suicidal ideation, and (ii) suicide attempt. Frequency distribution, Chi-square test and multiple binary logistic regression model were used in this study according to our objectives. Results The prevalence of suicidal ideation, suicide attempt, and suicidality was 5.8%, 3.4%, and 8.3% respectively among married adults. A multiple binary logistic regression model provided the following risk factors of suicidality: (i) joint family (AOR = 0.310, p<0.01), (ii) ≥26 years of age at the first marriage (AOR = 0.379, p<0.05), (iii) twice or more marriage (AOR = 0.214, p<0.01), (iv) conjugal life of ≥16 years (AOR = 0.410, p<0.05), (v) having no child (AOR = 6.343, p<0.01) and (vi) having 1–2 children (AOR = 6.190, p<0.01), (vii) medical comorbidity (AOR = 0.421, p<0.01), (viii) mental comorbidity (AOR = 0.253, p<0.01), (ix) stress-anxiety (AOR = 0.311, p<0.01), (x) family history of mental disorders (AOR = 0.059, p<0.01), (xi) family history of suicide/suicide attempt (AOR = 0.009, p<0.01), (xii) substance abuse (AOR = 0.065, p<0.01), (xiii) poor relationship with spouse (AOR = 0.209, p<0.01), and (xiv) poor relationship with other family members (AOR = 0.347, p<0.05). Conclusion The prevalence of suicidality is remarkable in Rajshahi city, Bangladesh. The government and non-government agencies can use the findings of this study to identify the vulnerable groups and undertake measures for preventing and reducing suicidality.
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Affiliation(s)
- Abdul Wadood
- Medical Centre, University of Rajshahi, Rajshahi, Bangladesh
| | - Rezaul Karim
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Masud Rana
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Golam Hossain
- Department of Statistics, Health Research Group, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail:
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Griffin E, Gunnell D, Corcoran P. Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study. BJPsych Open 2020; 6:e145. [PMID: 33234189 PMCID: PMC7745229 DOI: 10.1192/bjo.2020.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood. AIMS The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm. METHOD Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models. RESULTS Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments. CONCLUSIONS Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.
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Affiliation(s)
- Eve Griffin
- School of Public Health, University College Cork, Ireland; and National Suicide Research Foundation, Ireland
| | - David Gunnell
- National Institute for Health Research Bristol, Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK; and Population Health Sciences, University of Bristol, UK
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Pons-Baños J, Ballester-Ferrando D, Riesco-Miranda L, Escoté-Llobet S, Jiménez-Nuño J, Fuentes-Pumarola C, Serra-Millàs M. Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238765. [PMID: 33255772 PMCID: PMC7728328 DOI: 10.3390/ijerph17238765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. Aims: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. Methods: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013–2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. Results: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. Conclusion: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.
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Affiliation(s)
- Judit Pons-Baños
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - David Ballester-Ferrando
- Health and Healthcare Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain;
- Correspondence: ; Tel.: +34-972-418771
| | - Lola Riesco-Miranda
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
| | - Santiago Escoté-Llobet
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - Jordi Jiménez-Nuño
- Vic Forensic Medicine Department, Institute of Legal Medicine and Forensic Sciences of Catalonia, 08500 Vic, Spain;
| | | | - Montserrat Serra-Millàs
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
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Analysis of attempted suicide episodes presenting to the emergency department: comparison of young, middle aged and older people. Int J Ment Health Syst 2020; 14:46. [PMID: 32582367 PMCID: PMC7310195 DOI: 10.1186/s13033-020-00378-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Attempted suicide remains difficult for clinicians to predict with some established risk factors. We investigate the detailed characteristics of attempted suicide especially according to age and methods of suicide attempts. Methods A retrospective study was conducted to evaluate patients who visited the emergency department due to attempted suicide. A retrospective medical record review of all patients who presented to the emergency department (ED) of two tertiary teaching hospitals in Korea after suicide attempt between January 1, 2010, and December 31, 2017 was performed. Demographic information and detailed variables (methods and reasons of suicide attempts and variables regarding reattempts) were investigated. Total participants were classified into 3 groups according to age, young group, middle aged group and the older group, and each characteristics were compared. Results A total of 3698 patients were enrolled in this study. Deliberate self-poisoning (DSP) was the most common method of attempted suicide (66.5%) followed by cutting (24.4%), hanging (7.9%), falling (2.6%), and drowning (1.1%). In patients who had previous suicide attempts (n = 1029, 27.8%), attempted methods were likely to be concordant with previous attempted methods. The most common reason for suicide attempts was interpersonal relationship issues followed by socio-economic reasons. Older patients (n = 412, 11.2%) were significantly different from other 2 groups (n = 3286, 88.8%) regarding gender, suicide re-attempt, occupation, alcohol co-ingestion, previous psychiatric history, and discharge outcomes (all p-values < 0.001). Especially, in older patients, use of critical method and reason of physical illness were more common. Conclusion Our findings indicated that people who attempted suicide might have different sociodemographic and clinical factors depending on age group. Depending on age, it is necessary to apply additional suicide intervention programs in different ways.
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15
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Griffin E, Kavalidou K, Bonner B, O'Hagan D, Corcoran P. Risk of repetition and subsequent self-harm following presentation to hospital with suicidal ideation: A longitudinal registry study. EClinicalMedicine 2020; 23:100378. [PMID: 32529177 PMCID: PMC7280762 DOI: 10.1016/j.eclinm.2020.100378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Few studies have focused on those who present to hospital with suicidal thoughts (suicidal ideation). The aim of this study was to establish the risk of repeat presentation to hospital following suicidal ideation and to identify factors which were associated with further ideation or subsequent self-harm. METHODS Data were obtained from the Northern Ireland Registry of Self-harm. Risk of repeat presentation following hospital-presenting ideation was analysed using Kaplan Meier analyses, specifically cox proportional hazard models. FINDINGS During the period April 2014 to March 2019, a total of 14,695 presentations to hospital due to suicidal ideation were made in Northern Ireland. The cumulative incidence of repeat presentation to hospital was 40·5% within five years, with an 18·3% risk of subsequent self-harm. Previous ideation had the strongest association with repeat presentation. There was evidence of recidivism considering further ideation, with an increased risk according to number of previous presentations. In contrast, risk of subsequent self-harm was highest after the first or second presentation. Male gender and alcohol were associated with further ideation, while females and young people were more likely to re-present with self-harm. INTERPRETATION The findings indicate that individuals who present to hospital with suicidal ideation are at risk of repeat presentation and future self-harm, however clinical guidelines do not specifically address hospital-presenting ideation. The transition from ideation to suicidal behaviour is important to consider and research could inform effective screening and early intervention measures. ROLE OF FUNDING The Northern Ireland Registry of Self-harm is funded by the Public Health Agency, Northern Ireland.
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Affiliation(s)
- E. Griffin
- School of Public Health, University College Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- Corresponding author at: School of Public Health, Room 4.26 Western Gateway Building, University College Cork, Ireland.
| | - K. Kavalidou
- National Suicide Research Foundation, Cork, Ireland
| | - B. Bonner
- Public Health Agency, Belfast, Northern Ireland, United Kingdom
| | - D. O'Hagan
- Public Health Agency, Belfast, Northern Ireland, United Kingdom
| | - P. Corcoran
- National Suicide Research Foundation, Cork, Ireland
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Jackson J, Nugawela MD, De Vocht F, Moran P, Hollingworth W, Knipe D, Munien N, Gunnell D, Redaniel MT. Long-term impact of the expansion of a hospital liaison psychiatry service on patient care and costs following emergency department attendances for self-harm. BJPsych Open 2020; 6:e34. [PMID: 32238204 PMCID: PMC7176831 DOI: 10.1192/bjo.2020.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In September 2014, as part of a national initiative to increase access to liaison psychiatry services, the liaison psychiatry services at Bristol Royal Infirmary received new investment of £250 000 per annum, expanding its availability from 40 to 98 h per week. The long-term impact on patient outcomes and costs, of patients presenting to the emergency department with self-harm, is unknown. AIMS To assess the long-term impact of the investment on patient care outcomes and costs, of patients presenting to the emergency department with self-harm. METHOD Monthly data for all self-harm emergency department attendances between 1 September 2011 and 30 September 2017 was modelled using Bayesian structural time series to estimate expected outcomes in the absence of expanded operating hours (the counterfactual). The difference between the observed and expected trends for each outcome were interpreted as the effects of the investment. RESULTS Over the 3 years after service expansion, the mean number of self-harm attendances increased 13%. Median waiting time from arrival to psychosocial assessment was 2 h shorter (18.6% decrease, 95% Bayesian credible interval (BCI) -30.2% to -2.8%), there were 45 more referrals to other agencies (86.1% increase, 95% BCI 60.6% to 110.9%) and a small increase in the number of psychosocial assessments (11.7% increase, 95% BCI -3.4% to 28.5%) per month. Monthly mean net hospital costs were £34 more per episode (5.3% increase, 95% BCI -11.6% to 25.5%). CONCLUSIONS Despite annual increases in emergency department attendances, investment was associated with reduced waiting times for psychosocial assessment and more referrals to other agencies, with only a small increase in cost per episode.
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Affiliation(s)
- Joni Jackson
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Manjula D Nugawela
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Nik Munien
- University Hospitals Bristol NHS Foundation Trust, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
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17
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Affiliation(s)
- Gregory Carter
- 1 Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Matthew J Spittal
- 2 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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18
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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de Cates AN, Catone G, Bebbington P, Broome MR. Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data. Int J Soc Psychiatry 2019; 65:114-122. [PMID: 30776948 DOI: 10.1177/0020764019827986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. AIMS We used the 2000 Adult Psychiatry Morbidity Survey and an 18-month follow-up data to test hypotheses relating to the role of impulsivity, CSA and MI in the inception and persistence of self-harm. METHODS We assessed associations of impulsivity with (1) suicidal self-harm (SSH) and (2) non-SSH (NSSH) at baseline and follow-up, controlling for confounders including MI. Finally, we tested whether impulsivity mediated the relationship between CSA and self-harm. RESULTS A total of 8,580 respondents were assessed at baseline and 2,406 at follow-up as planned. Impulsivity significantly predicted emergence of new NSSH at 18-month follow-up even after adjustment for MI and other confounders. Impulsivity did not significantly predict repetition of NSSH, or repetition or new inception of SSH, even before inclusion of MI in the model. However, the absolute numbers involved were small. Cross-sectionally, impulsivity was a stronger mediator of the link between CSA and SSH (13.1%) than that between CSA and NSSH (4.8%). CONCLUSION Impulsivity may increase the risk of future development of NSSH independently of MI, which is clinically important for risk assessment. The involvement of impulsivity in the repetition of self-harm generally appears less certain. However, impulsivity may have a role in SSH in the context of previous CSA.
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Affiliation(s)
- Angharad N de Cates
- 1 Unit of Mental Health and Wellbeing, Warwick Medical School, The University of Warwick, Coventry, UK.,2 Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Gennaro Catone
- 3 Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy.,4 Faculty of Educational Sciences, Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Paul Bebbington
- 5 Division of Psychiatry, University College London, London, UK
| | - Matthew R Broome
- 6 Department of Psychiatry, University of Oxford, Oxford, UK.,7 Institute for Mental Health and School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Borruso LD, Buckley NA, Kirby KA, Carter G, Pilgrim JL, Chitty KM. Acute Alcohol Co-Ingestion and Hospital-Treated Deliberate Self-Poisoning: Is There an Effect on Subsequent Self-Harm? Suicide Life Threat Behav 2019; 49:293-302. [PMID: 29498087 DOI: 10.1111/sltb.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the relationship between alcohol co-ingestion in an index deliberate self-poisoning (DSP) episode with repeated DSP and subsequent suicide. A retrospective cohort study was conducted involving 5,669 consecutive index presentations to a toxicology service following DSP between January 1, 1996, and October 31, 2010. Records were probabilistically matched to National Coronial Information System data to identify subsequent suicide. Index DSPs were categorized on co-ingestion of alcohol, and primary outcomes analyzed were repetition of any DSP, rates of repeated DSP, time to first repeat DSP, and subsequent suicide. Co-ingestion of alcohol occurred in 35.9% of index admissions. There was no difference between those who co-ingested alcohol (ALC+) and those who did not co-ingest alcohol (ALC-) in terms of proportion of repeat DSP, number of DSP events, or time to first repeat DSP event. Forty-one (1.0%) cases were probabilistically matched to a suicide death; there was no difference in the proportion of suicide between ALC+ and ALC- at 1 or 3 years. There was no significant relationship between the co-ingestion of alcohol in an index DSP and subsequent repeated DSP or suicide. Clinically, this highlights the importance of mental health assessment of patients that present after DSP, irrespective of alcohol co-ingestion at the time of event.
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Affiliation(s)
- Luca D Borruso
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Katharine A Kirby
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Jennifer L Pilgrim
- Drug Harm Prevention Unit, Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Vic, Australia
| | - Kate M Chitty
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Deliberate self-harm among children with disabilities in China: a matched case-control study. Pediatr Res 2019; 85:275-282. [PMID: 30568186 DOI: 10.1038/s41390-018-0258-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/28/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Study about deliberate self-harm (DSH) in children with different types of disabilities was scarce. This study compared the incidence and patterns of DSH between children with and without disabilities aged 6-17 years using a matched case-control study in Beijing. METHODS A total of 650 pairs of children with and without disabilities were surveyed. Characteristics of latest episode of self-harm within the 12 months were compared. Associations between disability status, sociodemographic factors, smoking, drinking, sleep problems, and self-harm were examined. RESULTS Children with disabilities showed significant higher incidence of DSH than children without disabilities. Two groups differed significantly in terms of self-harm methods, body parts injured, premeditation, wishing to be known by others and help-seeking behavior. The adjusted OR for self-harm was 4.76 (2.99-7.55) for children with disabilities compared with children without disabilities. Children who slept fewer than 6 h per night, had difficulty falling asleep at night sometimes/often, and went to sleep after midnight 1 to 3 nights per month or at least once a week were at elevated risk of self-harm. CONCLUSION This study highlights a strong relationship between disability, sleep problems, and DSH. Interventions to reduce self-harm should target disability and sleep problems as important risk factors.
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22
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Lindh ÅU, Waern M, Beckman K, Renberg ES, Dahlin M, Runeson B. Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry 2018; 18:319. [PMID: 30285661 PMCID: PMC6167823 DOI: 10.1186/s12888-018-1883-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. METHODS Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. RESULTS In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. CONCLUSIONS The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.
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Affiliation(s)
- Åsa U. Lindh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81 Stockholm, Sweden
| | - Margda Waern
- 0000 0000 9919 9582grid.8761.8Department of Psychiatry and Neurochemistry, University of Göteborg, Gothenburg, Sweden
| | - Karin Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81 Stockholm, Sweden
| | - Ellinor Salander Renberg
- 0000 0001 1034 3451grid.12650.30Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Umeå, Sweden
| | - Marie Dahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81 Stockholm, Sweden
| | - Bo Runeson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81 Stockholm, Sweden
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Steeg S, Quinlivan L, Nowland R, Carroll R, Casey D, Clements C, Cooper J, Davies L, Knipe D, Ness J, O’Connor RC, Hawton K, Gunnell D, Kapur N. Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data. BMC Psychiatry 2018; 18:113. [PMID: 29699523 PMCID: PMC5921289 DOI: 10.1186/s12888-018-1693-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Risk scales are used widely in the management of patients presenting to hospital following self-harm. However, there is evidence that their diagnostic accuracy in predicting repeat self-harm is limited. Their predictive accuracy in population settings, and in identifying those at highest risk of suicide is not known. METHOD We compared the predictive accuracy of the Manchester Self-Harm Rule (MSHR), ReACT Self-Harm Rule (ReACT), SAD PERSONS Scale (SPS) and Modified SAD PERSONS Scale (MSPS) in an unselected sample of patients attending hospital following self-harm. Data on 4000 episodes of self-harm presenting to Emergency Departments (ED) between 2010 and 2012 were obtained from four established monitoring systems in England. Episodes were assigned a risk category for each scale and followed up for 6 months. RESULTS The episode-based repeat rate was 28% (1133/4000) and the incidence of suicide was 0.5% (18/3962). The MSHR and ReACT performed with high sensitivity (98% and 94% respectively) and low specificity (15% and 23%). The SPS and the MSPS performed with relatively low sensitivity (24-29% and 9-12% respectively) and high specificity (76-77% and 90%). The area under the curve was 71% for both MSHR and ReACT, 51% for SPS and 49% for MSPS. Differences in predictive accuracy by subgroup were small. The scales were less accurate at predicting suicide than repeat self-harm. CONCLUSIONS The scales failed to accurately predict repeat self-harm and suicide. The findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
| | - Leah Quinlivan
- 0000000121662407grid.5379.8Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Rebecca Nowland
- 0000000121662407grid.5379.8Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Robert Carroll
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Deborah Casey
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, England
| | - Caroline Clements
- 0000000121662407grid.5379.8Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Jayne Cooper
- 0000000121662407grid.5379.8Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England
| | - Linda Davies
- 0000000121662407grid.5379.8Institute of Population Health, University of Manchester, Manchester, England
| | - Duleeka Knipe
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, England
| | - Rory C. O’Connor
- 0000 0001 2193 314Xgrid.8756.cSuicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Keith Hawton
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, England
| | - David Gunnell
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Nav Kapur
- 0000000121662407grid.5379.8Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England ,Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
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Arensman E, Griffin E, Daly C, Corcoran P, Cassidy E, Perry IJ. Recommended next care following hospital-treated self-harm: Patterns and trends over time. PLoS One 2018; 13:e0193587. [PMID: 29494659 PMCID: PMC5832269 DOI: 10.1371/journal.pone.0193587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/14/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The specific objectives of this study were to examine variation in the care of self-harm patients in hospital settings and to identify the factors that predict recommended next care following self-harm. Methods Data on consecutive presentations to Irish emergency departments (EDs) involving self-harm from the National Self-Harm Registry Ireland from 2004 to 2012 were utilised. Univariate and multivariate regression analyses were performed to assess the associations between patients’ clinical and demographic characteristics, and recommended next care received. Results Across the study period a total 101,904 self-harm presentations were made to hospital EDs, involving 63,457 individuals. Over the course of the study there was a declining number of presentations resulting in patient admission following attendance with self-harm. Recommended next care varied according to hospital location, with general admission rates ranging from 11% to 61% across administrative health regions. Multinomial logistic regression identified that the factor which most strongly affected next care was the presenting hospital. Being male, older age, method, repeat self-harm, time of attendance and residence of the patient were all identified as influencing care received. Psychiatric admission was most common when highly lethal methods of self-harm were used (OR = 4.00, 95% CI, 3.63–4.41). A relatively large proportion of patients left the ED without being seen (15%) and the risk of doing so was highest for self-harm repeaters (1.64, 1.55–1.74 for those with 5+ presentations). Conclusions The extensive hospital variation in recommended next care indicates that management of self-harm patients may be determined more by where they present than by the needs of the patient. The study outcomes underline the need to standardise the clinical management of self-harm patients in general hospital settings.
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Affiliation(s)
- Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
- * E-mail:
| | - Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
| | | | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Eugene Cassidy
- Department of Psychiatry, University College Cork, Cork, Ireland
- Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Ireland
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Steeg S, Emsley R, Carr M, Cooper J, Kapur N. Routine hospital management of self-harm and risk of further self-harm: propensity score analysis using record-based cohort data. Psychol Med 2018; 48:315-326. [PMID: 28637535 DOI: 10.1017/s0033291717001702] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm. METHOD Observational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation. RESULTS Following PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80-0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort. CONCLUSIONS This study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.
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Affiliation(s)
- S Steeg
- Division of Psychology and Mental Health,Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - R Emsley
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - M Carr
- Division of Psychology and Mental Health,Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - J Cooper
- Division of Psychology and Mental Health,Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - N Kapur
- Division of Psychology and Mental Health,Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
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Olfson M, Blanco C, Wall M, Liu SM, Saha TD, Pickering RP, Grant BF. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry 2017; 74:1095-1103. [PMID: 28903161 PMCID: PMC5710225 DOI: 10.1001/jamapsychiatry.2017.2582] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022]
Abstract
Importance A recent increase in suicide in the United States has raised public and clinical interest in determining whether a coincident national increase in suicide attempts has occurred and in characterizing trends in suicide attempts among sociodemographic and clinical groups. Objective To describe trends in recent suicide attempts in the United States. Design, Setting, and Participants Data came from the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. These nationally representative surveys asked identical questions to 69 341 adults, 21 years and older, concerning the occurrence and timing of suicide attempts. Risk differences adjusted for age, sex, and race/ethnicity (ARDs) assessed trends from the 2004-2005 to 2012-2013 surveys in suicide attempts across sociodemographic and psychiatric disorder strata. Additive interactions tests compared the magnitude of trends in prevalence of suicide attempts across levels of sociodemographic and psychiatric disorder groups. The analyses were performed from February 8, 2017, through May 31, 2017. Main Outcomes and Measures Self-reported attempted suicide in the 3 years before the interview. Results With use of data from the 69 341 participants (42.8% men and 57.2% women; mean [SD] age, 48.1 [17.2] years), the weighted percentage of US adults making a recent suicide attempt increased from 0.62% in 2004-2005 (221 of 34 629) to 0.79% in 2012-2013 (305 of 34 712; ARD, 0.17%; 95% CI, 0.01%-0.33%; P = .04). In both surveys, most adults with recent suicide attempts were female (2004-2005, 60.17%; 2012-2013, 60.94%) and younger than 50 years (2004-2005, 84.75%; 2012-2013, 80.38%). The ARD for suicide attempts was significantly larger among adults aged 21 to 34 years (0.48%; 95% CI, 0.09% to 0.87%) than among adults 65 years and older (0.06%; 95% CI, -0.02% to 0.14%; interaction P = .04). The ARD for suicide attempts was also significantly larger among adults with no more than a high school education (0.49%; 95% CI, 0.18% to 0.80%) than among college graduates (0.03%; 95% CI, -0.17% to 0.23%; interaction P = .003); the ARD was also significantly larger among adults with antisocial personality disorder (2.16% [95% CI, 0.61% to 3.71%] vs 0.07% [95% CI, -0.09% to 0.23%]; interaction P = .01), a history of violent behavior (1.04% [95% CI, 0.35% to 1.73%] vs 0.00% [95% CI, -0.12% to 0.12%]; interaction P = .003), or a history of anxiety (1.43% [95% CI, 0.47% to 2.39%] vs 0.18% [95% CI, 0.04% to 0.32%]; interaction P = .01) or depressive (0.99% [95% CI, -0.09% to 2.07%] vs -0.08% [95% CI, -0.20% to 0.04%]; interaction P = .05) disorders than among adults without these conditions. Conclusions and Relevance A recent overall increase in suicide attempts among adults in the United States has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Tulshi D. Saha
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Roger P. Pickering
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Bridget F. Grant
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res 2017; 21:455-469. [PMID: 27602917 DOI: 10.1080/13811118.2016.1222318] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.
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28
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de Cates AN, Rees K, Jollant F, Perry B, Bennett K, Joyce K, Leyden E, Harmer C, Hawton K, van Heeringen K, Broome MR. Are neurocognitive factors associated with repetition of self-harm? A systematic review. Neurosci Biobehav Rev 2016; 72:261-277. [PMID: 27923730 DOI: 10.1016/j.neubiorev.2016.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/13/2016] [Accepted: 10/27/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established AIMS: Identify neurocognitive factors that may predict repetition of self-harm. METHODS Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed. RESULTS 7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions. CONCLUSIONS Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.
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Affiliation(s)
- Angharad N de Cates
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, UK
| | - Fabrice Jollant
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; Academic Hospital (CHU) of Nîmes, France
| | - Benjamin Perry
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Katie Joyce
- Warwick Medical School, University of Warwick, UK
| | - Eimear Leyden
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | | | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Matthew R Broome
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Wang Y, Bhaskaran J, Sareen J, Bolton SL, Chateau D, Bolton JM. Clinician Prediction of Future Suicide Attempts. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:428-432. [PMCID: PMC4910410 DOI: 10.1177/0706743716645287] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Objective: Established risk assessment tools are often inaccurate at predicting future suicide risk. We therefore investigated whether clinicians are able to predict individuals’ suicide risk with greater accuracy. Method: We used the SAFE Database, which included consecutive adult (age ≥18 years) presentations (N = 3818) over a 22-month period to the 2 tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual and recorded his or her predicted risk for future suicide attempt (SA) on a 0-10 scale—the clinician prediction scale. The SAD PERSONS scale was completed as a comparison. SAs within 6 months, assessed using the Columbia Classification Algorithm for Suicide Assessment, were the primary outcome measure. Receiver operating characteristic curve and logistic regression analyses were conducted to determine the accuracy of both scales to predict SAs, and the scales were compared with z scores. Clinician prediction scale performance was stratified based on level of training. Results: Clinicians were able to predict future SAs with significantly greater accuracy (area under the curve [AUC] = 0.73; 95% CI, 0.68 to 0.77; P < 0.001) compared with the SAD PERSONS scale (z = 3.79, P < 0.001). Both scales nonetheless showed positive predictive value of less than 7%. Analyses by level of training showed that junior psychiatric residents and non–psychiatric residents did not accurately predict SAs, whereas senior psychiatric residents and staff psychiatrists demonstrated greater accuracy (AUC = 0.76 and 0.78, respectively). Conclusions: Clinicians are able to predict future attempts with fewer false positives than a conventional risk assessment scale, and this skill appears related to training level. Predicting future suicidal behaviour remains very challenging.
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Affiliation(s)
- Yunqiao Wang
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Joanna Bhaskaran
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Shay-Lee Bolton
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba
| | - James M. Bolton
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Reuter Morthorst B, Soegaard B, Nordentoft M, Erlangsen A. Incidence Rates of Deliberate Self-Harm in Denmark 1994-2011. CRISIS 2016; 37:256-264. [PMID: 27278571 PMCID: PMC5137321 DOI: 10.1027/0227-5910/a000391] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented. AIM To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records. METHOD A register study based on all individuals recorded with an episode of deliberate self-harm or probable deliberate self-harm in nationwide registers during 1994-2011. RESULTS A substantial difference in the rates of deliberate self-harm and probable deliberate self-harm was noted for both genders. The average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI = 129.6-131.8) per 100,000 and 86.9 (95% CI = 86.0-87.8) per 100,000, respectively. The rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9-142.3) per 100,000 in 1994 to 152.7 (95% CI = 147.8-157.5) in 2011. For a subgroup of younger women aged 15-24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4-2.7). The most frequently used method was self-poisoning. CONCLUSION The rates of deliberate self-harm and probable deliberate self-harm differed significantly. An increased incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed.
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Affiliation(s)
- Britt Reuter Morthorst
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Faculty of Health Sciences, University of
Copenhagen, Capital Region of Denmark, Denmark
| | - Bodil Soegaard
- Department of Psychiatry, Region of Southern
Denmark, Aabenraa, Denmark
| | - Merete Nordentoft
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Faculty of Health Sciences, University of
Copenhagen, Capital Region of Denmark, Denmark
| | - Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen,
Capital Region of Denmark, Denmark
- Department of Mental Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
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Clements C, Turnbull P, Hawton K, Geulayov G, Waters K, Ness J, Townsend E, Khundakar K, Kapur N. Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics. BMJ Open 2016; 6:e009749. [PMID: 26883238 PMCID: PMC4762081 DOI: 10.1136/bmjopen-2015-009749] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Rates of hospital presentation for self-harm in England were compared using different national and local data sources. DESIGN The study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data. SETTING Local area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES). PRIMARY OUTCOME Rate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources. RESULTS The total number of self-harm episodes between 2010 and 2012 was 13,547 based on Multicentre Study data, 9600 based on HES emergency department data and 8096 based on HES admission data. Nationally, routine HES data underestimated overall rates of self-harm by approximately 60% compared with rates based on Multicentre Study data (rate ratio for HES emergency department data, 0.41 (95% CI 0.35 to 0.49); rate ratio for HES admission data, 0.42 (95% CI 0.36 to 0.49)). Direct local area comparisons confirmed an overall underascertainment in the HES data, although the difference varied between centres. There was a general increase in self-harm over time according to HES data which contrasted with a fall and then a rise in the Multicentre Study data. CONCLUSIONS There was a consistent underestimation of presentations for self-harm recorded by HES emergency department data, and fluctuations in year-on-year figures. HES admission data appeared more reliable but missed non-admitted episodes. Routinely collected data may miss important trends in self-harm and cannot be used in isolation as the basis for a robust national indicator of self-harm.
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Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Pauline Turnbull
- Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Kazem Khundakar
- Northern and Yorkshire Knowledge and Intelligence Team, Chief Knowledge Office, Public Health England, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
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Wilhelm K, Handley T, Reddy P. Exploring the validity of the Fantastic Lifestyle Checklist in an inner city population of people presenting with suicidal behaviours. Aust N Z J Psychiatry 2016; 50:128-34. [PMID: 26681263 DOI: 10.1177/0004867415621393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Although patients demonstrate a range of problematic health-related lifestyle behaviours preceding suicidal behaviour, there is little research that routinely measure these behaviours. This paper seeks to establish the utility of health-related lifestyle measure (Fantastic Lifestyle Checklist) in people presenting to a major inner city Emergency Department with a range of suicidal behaviours. METHODS From 2007-2014, data from the 366 patients who had completed the Fantastic Lifestyle Checklist, after referral by the Emergency Department to a service for people with deliberate self-harm or suicidal ideation, were included in the analysis study. A Maximum Likelihood factor analysis was performed to assess the factor structure of the Fantastic Lifestyle Checklist and the resultant factors were explored in relation to measures of health; namely the Depression, Anxiety and Stress Scale and the 12-item Short-Form Health Survey. RESULTS A three-component factor structure emerged comprising Component 1 'positive life investments', Component 2 'poor emotional regulation' and Component 3 'poor health behaviours'. There was a significant negative correlation between 'positive life investments' and each of the Depression, Anxiety and Stress scales subscales and significant positive associations with 'poor emotional regulation' and Short Form Health Survey-12 mental health scores. Only the Short Form Health Survey-12 physical health subscale was weakly correlated with 'poor health behaviours', in females. CONCLUSION Our findings support the construct and concurrent validity of the Fantastic Lifestyle Checklist measure. The three factors obtained for the Fantastic Lifestyle Checklist were coherent and seem useful for research and clinical practice.
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Affiliation(s)
- Kay Wilhelm
- School of Psychiatry, Faculty of Medicine and Black Dog Institute, University of New South Wales, Randwick, NSW, Australia Faces in the Street, Urban Mental Health and Wellbeing Research Institute, St Vincent's Hospital Sydney, Sydney, NSW, Australia Consultation Liaison Psychiatry Service, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Tonelle Handley
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Prasuna Reddy
- Faces in the Street, Urban Mental Health and Wellbeing Research Institute, St Vincent's Hospital Sydney, Sydney, NSW, Australia School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Kapur N, Steeg S, Turnbull P, Webb R, Bergen H, Hawton K, Geulayov G, Townsend E, Ness J, Waters K, Cooper J. Hospital management of suicidal behaviour and subsequent mortality: a prospective cohort study. Lancet Psychiatry 2015; 2:809-16. [PMID: 26254717 DOI: 10.1016/s2215-0366(15)00169-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/25/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Self-poisoning and self-injury are associated with a high risk of suicide or death from any cause but the effect of routine aspects of hospital management on mortality risk is unknown. METHODS We did a prospective cohort study using data for adults who had self-harmed presenting to five emergency departments in the UK between 2000 and 2010. We assessed the relation between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for mental health follow-up) and death by suicide or any cause within 12 months of presentation. FINDINGS Of 38 415 individuals presenting with self-harm, 261 (0·7%) died by suicide and 832 (2·2%) died from any cause within 12 months. Most aspects of management were associated with a higher mortality risk in unadjusted analyses. Psychiatric admission was associated with the highest risks for both suicide (hazard ratio 2·35, 95% CI 1·59-3·45) and all-cause mortality (2·35, 2·04-2·72). After adjustment for baseline variables, the hazard ratios were generally smaller, particularly for psychiatric admission. There were significant interactions by sex, age, and history of self-harm. INTERPRETATION This was an observational study and so we cannot infer causation. However, our finding that clinical services seem to reserve the most intensive levels of treatment for patients at highest risk is reassuring. Aspects of routine management might be associated with a lower mortality risk but these effects vary by clinical subgroup. FUNDING UK Department of Health.
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Affiliation(s)
- Nav Kapur
- Centre for Mental Health and Safety, Centre for Suicide Prevention, University of Manchester, Manchester, UK; Manchester Mental Health and Social Care Trust, Manchester, UK.
| | - Sarah Steeg
- Centre for Mental Health and Safety, Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- Centre for Mental Health and Safety, Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Safety, Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Helen Bergen
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Jayne Cooper
- Centre for Mental Health and Safety, Centre for Suicide Prevention, University of Manchester, Manchester, UK
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Cooper J, Steeg S, Gunnell D, Webb R, Hawton K, Bennewith O, House A, Kapur N. Variations in the hospital management of self-harm and patient outcome: a multi-site observational study in England. J Affect Disord 2015; 174:101-5. [PMID: 25496757 DOI: 10.1016/j.jad.2014.11.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Studies have shown wide variations in delivery of self-harm services but it is unclear how these relate to important outcomes such as self-harm repetition. METHODS Data were collected on self-harm presentations and hospital management from 31 hospitals in England. Key staff were interviewed about service provision for self-harm patients and responses were mapped to a 21-item service quality scale. Our main outcome was repeat hospital-presenting self-harm within six months. RESULTS 6347 individuals presented with 7599 episodes of self-harm during a three month period in 2010-2011. Re-attendance with self-harm within six months of index episode occurred in 21% (1308/6347) of individuals (range between hospitals 9-27%). We found little association between clinical management at hospital level (i.e. proportion of episodes receiving psychosocial assessment, medical or psychiatric admission, and referral to statutory or non-statutory services) and repetition rate. The median score on service quality scale was 14.5 (range between hospitals 10.5-19). There was no evidence of correlation between total service quality score and repetition of self-harm (Spearman׳s r=-0.06, p=0.73) or between individual service items and repetition. LIMITATIONS We did not explore certain aspects of service provision e.g. quality of psychosocial assessments and length of admission. Hospital presentation for repeat self-harm may not be the most reliable measure of service quality. CONCLUSION At aggregate level aspects of management and service structures did not appear to be associated with self-harm repetition rates. Future research should focus on better understanding the processes underlying the delivery of services at hospital level and their relationship to outcome.
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Affiliation(s)
- Jayne Cooper
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
| | - Sarah Steeg
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Roger Webb
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Olive Bennewith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Allan House
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds, UK
| | - Navneet Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
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