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YURTSEVEN A, TURAN C, ORT DM, ISLAM M, KÖSE S, SAZ EU, HENNES H. Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments. Turk J Med Sci 2023; 53:1870-1876. [PMID: 38813494 PMCID: PMC10760584 DOI: 10.55730/1300-0144.5757] [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: 05/31/2023] [Revised: 12/12/2023] [Accepted: 11/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Suicide is one of the leading causes of death among adolescents. This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the differences in management and resource utilization between two pediatric emergency departments; one in Türkiye and one in the United States of America. Materials and methods Adolescents who presented to the emergency departments with a chief complaint of suicide attempt between October 2017 and September 2018 were eligible for including in the study. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records. Outcome was defined as re-admission to the emergency department for another suicide attempt within 3 months of the index visit. Results Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p < 0.001). Social worker assessment and hospitalization rates were significantly lower, with shorter mean duration of follow-up in the emergency department among Turkish compared to American adolescents (respectively, p < 0.001, p < 0.001 and p = 0.002). Repeated suicide attempts within three months were significantly higher in the Turkish group compared to the American one (29% vs. 8%, p < 0.001). Receiving a social worker assessment, hospitalization and longer observation in emergency department reduced the incidence of repeated suicide attempts (respectively, p < 0.001, p = 0.003 and p = 0.012). Conclusion Turkish adolescents had shorter observation time in the emergency department, received fewer assessment by social workers and were less likely to be hospitalized. These may have contributed to the higher rate of repeat suicide attempts following discharge from the emergency department. Adequate resources are needed to help decrease the burden of suicide among Turkish adolescents.
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Affiliation(s)
- Ali YURTSEVEN
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Caner TURAN
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Deborah Mary ORT
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
| | - Mehrin ISLAM
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
| | - Sezen KÖSE
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Eylem Ulaş SAZ
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Halim HENNES
- Department of Pediatric Emergency, Southwestern Medical Center, University of Texas, Dallas, Texas,
USA
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Rabbany JM, Ellis S, Metts A, Burke A, Brent DA, Melhem N, Marcott S, Mann JJ. Mood Disorders and Aggressive Traits Mediate Effects of Reported Childhood Adversity on Suicide Attempt Risk. Arch Suicide Res 2023; 27:1207-1230. [PMID: 36052407 DOI: 10.1080/13811118.2022.2112118] [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] [Indexed: 11/02/2022]
Abstract
BACKGROUND Childhood adversity (CA) is linked to suicidal behavior as well as to mood disorders and aggressive traits. This raises the possibility that depression and aggressive traits mediate the relationship of childhood adversity to suicide risk. Moreover, it is not known if they operate independently or interactively. AIMS To determine whether, and how, mood disorders and aggressive traits mediate the effects of reported physical and sexual abuse on future suicidal behavior. METHODS Five hundred and forty-eight subjects, offspring of parents with mood disorders, were interviewed at baseline and at yearly follow-ups with questionnaires assessing aggression, mood disorders, and suicidal behavior. The mediation analysis involved a three-step process, testing the relationships between (1) CA and attempt; (2) CA and putative mediators; and (3) putative mediators and suicide attempt, adjusting for CA. RESULTS Aggressive trait severity and mood disorder onset each mediated the relationship between CA and future suicide attempts. Greater aggression severity also raised the hazard of the development of a mood disorder. If aggressive trait severity was clearly elevated, then onset of mood disorder did not increase further the hazard of the suicide attempt. Including family as a random effect had a much bigger effect on attempt outcome for physical abuse compared with sexual abuse. CONCLUSIONS Amelioration of aggressive traits and treatment of mood disorders in CA-exposed offspring of a parent with a mood disorder may prevent future suicide attempts and may reduce the risk of mood disorder. Familial factors influence the impact of childhood physical abuse but not sexual abuse. HIGHLIGHTSChildhood Adversity (CA) predicted future mood disorder and aggression severity.Depression and aggression mediate the relationship between CA and suicide attempts.When one mediator is present, the presence of the other does not increase the hazard.Between family variation contributed much more to suicidal behavior outcomes relative to the effect of physical abuse, but sexual abuse contributed to suicidal outcomes more than family variation.
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Sutradhar B, Mukherjee D, Pathak K. An observational study on deliberate self-harm in individuals with alcohol dependence syndrome. Ind Psychiatry J 2023; 32:369-374. [PMID: 38161452 PMCID: PMC10756610 DOI: 10.4103/ipj.ipj_50_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 01/03/2024] Open
Abstract
Context Comorbidities in alcohol dependence syndrome (ADS) are often associated with poor treatment outcomes and high service utilization. Deliberate self-harm (DSH) in India is a silent epidemic. There is a shortage of research on individuals with ADS, psychiatric comorbidities, and DSH. Aim To study DSH and psychiatric comorbidity in persons with ADS. Settings and Design A cross-sectional study of 1-year duration is conducted in out patient department/indoor patient department of a tertiary care hospital. Methods and Material Eighty-one individuals with ADS were selected purposefully. A semi-structured pro forma, the severity of alcohol dependence questionnaire, Mini-International Neuropsychiatric Interview (MINI), and Deliberate Self-Harm Inventory were administered for assessment. The statistical analysis used is as follows: correlation statistics and logistic regression. Results Most subjects were married, belonged to upper-middle socioeconomic status, had at least secondary education, and had moderate alcohol dependence severity. Almost 3/4th of the subjects had at least one lifetime psychiatric disorder. A past episode of major depressive disorder was found in 47%. Nearly 20% of study subjects had a history of DSH, which was significantly associated with unmarried status, and earlier age of alcohol dependence. Marital status, educational level, and age of onset of alcohol dependence explain 64.3% of the variance in DSH attempts. Suicidality was significantly related to the presence of DSH. Conclusions The study found a high prevalence of psychiatric disorders and a history of DSH in individuals with ADS. The study confirmed the association between DSH and suicidality and indicated a specific subpopulation of ADS who need thorough clinical assessments to recognize these psychiatric comorbidities and DSH.
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Affiliation(s)
- Bikram Sutradhar
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
| | - Diptadhi Mukherjee
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
| | - Kangkan Pathak
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
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Rahman M, Leckman-Westin E, Stanley B, Kammer J, Layman D, Labouliere CD, Cummings A, Vasan P, Vega K, Green KL, Brown GK, Finnerty M, Galfalvy H. Predictors of Intentional Self -Harm Among Medicaid Mental Health Clinic Clients In New York. J Affect Disord 2022; 299:698-706. [PMID: 34813869 PMCID: PMC8808564 DOI: 10.1016/j.jad.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/15/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behavioral health outpatients are at risk for self-harm. Identifying individuals or combination of risk factors could discriminate those at elevated risk for self-harm. METHODS The study population (N = 248,491) included New York State Medicaid-enrolled individuals aged 10 to 64 with mental health clinic services between November 1, 2015 to November 1, 2016. Self-harm episodes were defined using ICD-10 codes from emergency department and inpatient visits. Multi-predictor logistic regression models were fit on a subsample of the data and compared to a testing sample based on discrimination performance (Area Under the Curve or AUC). RESULTS Of N = 248,491 patients, 4,224 (1.70%) had an episode of intentional self-harm. Factors associated with increased self-harm risk were age 17-25, being female and having recent diagnoses of depression (AOR=4.3, 95%CI: 3.6-5.0), personality disorder (AOR=4.2, 95%CI: 2.9-6.1), or substance use disorder (AOR=3.4, 95%CI: 2.7-4.3) within the last month. A multi-predictor logistic regression model including demographics and new psychiatric diagnoses within 90 days prior to index date had good discrimination and outperformed competitor models on a testing sample (AUC=0.86, 95%CI:0.85-0.87). LIMITATIONS New York State Medicaid data may not be generalizable to the entire U.S population. ICD-10 codes do not allow distinction between self-harm with and without intent to die. CONCLUSIONS Our results highlight the usefulness of recency of new psychiatric diagnoses, in predicting the magnitude and timing of intentional self-harm risk. An algorithm based on this finding could enhance clinical assessments support screening, intervention and outreach programs that are at the heart of a Zero Suicide prevention model.
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Affiliation(s)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, NY; Department of Epidemiology and Biostatistics, University at Albany-SUNY, School of Public Health
| | - Barbara Stanley
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | - Christa D Labouliere
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | | | - Kelly L Green
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Gregory K Brown
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Molly Finnerty
- New York State Office of Mental Health, NY; Department of Child and Adolescent Psychiatry, New York University Langone Health, NY
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY; Department of Biostatistics Columbia University Mailman School of Public Health, NY
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Pinheiro TDP, Warmling D, Coelho EBS. Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021337. [PMID: 34878004 DOI: 10.1590/s1679-49742021000400026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018. METHODS This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared. RESULTS Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out. CONCLUSION We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.
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Affiliation(s)
| | - Deise Warmling
- Secretaria de Estado da Saúde de Santa Catarina, Florianópolis, SC, Brasil
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Using the integrated motivational-volitional (IMV) model of suicidal behaviour to differentiate those with and without suicidal intent in hospital treated self-harm. Prev Med 2021; 152:106592. [PMID: 34538374 DOI: 10.1016/j.ypmed.2021.106592] [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] [Received: 12/11/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Abstract
Self-harm is a major public health concern. In order to respond to self-harm effectively, it is important to understand the factors associated with self-harm with and without suicidal intent. To this end, we investigated psychological factors selected from the Integrated Motivational-Volitional (IMV) model of suicidal behaviour in individuals who had recently been admitted to hospital for self-harm, with the aim of examining the characteristics of those who expressed intent to die versus those without suicidal intent. Individuals (n = 500, 60.6% female) admitted to two hospitals in central Scotland following self-harm with (suicide attempt [SA] group, n = 336) or without (non-suicidal self-harm [NSSH] group, n = 164) suicidal intent completed a range of psychological measures. Over half of the participants reported previous episodes of self-harm (SA, n = 239, 71.1%; NSSH, n = 91, 55.5%). Univariate analyses revealed that the SA and NSSH groups differed on some of the psychological measures with higher depressive symptoms, defeat, entrapment, acquired capability and impulsivity in the SA compared to the NSSH group. In the multivariate model, suicidal ideation, defeat, internal entrapment and perceived burdensomeness independently differentiated between the groups. These findings highlight the complex profiles of individuals presenting at hospital with self-harm and emphasise the need to investigate differences between subtypes of self-harm in order to support individuals optimally. Applying frameworks such as the IMV model to further understanding of self-harm might assist in the development of targeted psychological interventions to reduce risk of repeat self-harm or suicide.
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Kim HJ, Lee DH. Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt. BMC Psychiatry 2021; 21:79. [PMID: 33549077 PMCID: PMC7866662 DOI: 10.1186/s12888-021-03089-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. METHODS This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. RESULTS This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343-3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302-3.119), and consciousness (1.840, 1.253-2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255-1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively. CONCLUSION The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.
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Affiliation(s)
- Hye Jin Kim
- grid.411612.10000 0004 0470 5112Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Anyangchoenro 1071 Yangcheon-gu, Seoul, Republic of Korea.
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Binnie V, Le Brocque R, Jessup M, Johnston ANB. Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review. Australas Emerg Care 2020; 24:264-279. [PMID: 33358578 DOI: 10.1016/j.auec.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Extensive literature reports the influence of childhood adversity on adult health, however few studies have explored these life antecedents in people who frequently present to the emergency department. This review synthesizes literature exploring childhood adversity influences on emergency department presentations, if and how it is identified, and interventions addressing the health care needs of this group. METHODS Eight electronic databases were searched. Arksey and O'Malley's framework guided this review, and a quality appraisal was undertaken. Searches included all published studies until August 2020. RESULTS Twenty-one articles were included in this review. They revealed that childhood adversity is common among adults who frequently attend the emergency department. It impacts physical and psychological health into adulthood and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood. CONCLUSIONS Several studies call for screening, intervention, and education to identify and address impacts of childhood adversity for patients who frequently present to the emergency department. However, reliable high-level studies exploring these topics specific to the emergency department are uncommon. Consequently, definitive interventions to address the healthcare needs of this group is lacking and warrants further research.
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Affiliation(s)
- Vicki Binnie
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia.
| | - Robyne Le Brocque
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Melanie Jessup
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Amy N B Johnston
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Qld, 4102, Australia
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Bae Y, Seong Y, Kim SH, Kim S. Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review. Psychiatry Investig 2020; 17:320-330. [PMID: 32213802 PMCID: PMC7176559 DOI: 10.30773/pi.2019.0269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Limited data exist on non-suicidal self-injury (NSSI) and suicide attempts among psychiatric patients in Korea. In this study, we investigated the clinical characteristics of patients who engaged in NSSI and/or suicide attempts. METHODS We performed a retrospective medical chart review of patients with NSSI and/or suicide attempts at the psychiatric department of a university medical center in Seoul between 2017 and 2019. According to their history, patients were allocated to one of three groups: NSSI only, suicide attempts only and NSSI and suicide attempts group. Groups were compared based on sociodemographic characteristics and psychological assessments. RESULTS Overall, 80 patients with NSSI and/or suicide attempts were evaluated. Patients with NSSI and suicide attempts were more likely to be female than the other two groups. Patients with NSSI and suicide attempts were more likely to suffer from Cluster B personality disorder than the other groups. And patients with NSSI and suicide attempts scored significantly higher on novelty-seeking in TCI and RC8, RC9 in MMPI-2. CONCLUSION Patients with NSSI and/or suicide attempts were more likely to be female, younger, and showed higher levels of psychological disturbances. These findings highlight the importance of early detection and intervention for patients with NSSI.
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Affiliation(s)
- Yubeen Bae
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yoanna Seong
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sojung Kim
- Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea
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Evans CM, Simms LJ. The latent structure of self-harm. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 128:12-24. [PMID: 30589306 DOI: 10.1037/abn0000398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The underlying structure of self-harm behaviors is not well-understood; for example, whether suicidality and nonsuicidal self-injury (NSSI) lie on a single dimension or two separate dimensions is unknown. We used confirmatory factor analyses to examine the factor structure of self-harm items in a clinical/community sample (N = 641). Of three alternative factor structures (one-factor, correlated-factors, bifactor), the bifactor model fit best. The general factor, representing overlap between suicidality and NSSI, captured the majority of model variance and was the strongest predictor of psychosocial correlates. The NSSI-specific factor captured a moderate amount of variance and correlated uniquely with both antagonistic traits and obsessive-compulsive tendencies; this factor was named NSSI. The suicidality-specific factor explained little model variance and was weakly associated with external criteria; this factor was named low attraction to life. Results are interpreted as preliminary evidence for the utility of bifactor modeling in understanding the latent structure of self-harm. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Karanikola MNK, Lyberg A, Holm AL, Severinsson E. The Association between Deliberate Self-Harm and School Bullying Victimization and the Mediating Effect of Depressive Symptoms and Self-Stigma: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4745791. [PMID: 30519578 PMCID: PMC6241337 DOI: 10.1155/2018/4745791] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Identifying deliberate self-harm in the young and its relationship with bullying victimization is an important public health issue. METHODS A systematic review was performed to explore evidence of the association between deliberate self-harm and school bullying victimization in young people, as well as the mediating effect of depressive symptoms and self-stigma on this association. An advanced search in the following electronic databases was conducted in January 2018: PubMed/Medline; CINAHL; PsycINFO; PsycARTICLES; Science Direct; Scopus, and Cochrane Library. Studies that fulfilled the inclusion criteria were further assessed for their methodological integrity. The Norwegian Knowledge Centre for Health Services tool was applied for cross-sectional studies and the Critical Appraisal Skills Programme instrument for the cohort studies. Only empirical quantitative studies published in the English language in peer reviewed journals during the last decade (2007-2018) aimed at exploring the association between deliberate self-harm and school bullying victimization in community-based schoolchildren with a mean age of under 20 years were included. RESULTS The reviewed cross-sectional and cohort studies (22) revealed a positive association between school bullying victimization and deliberate self-harm, including nonsuicidal self-injury, which remained statistically significant when controlled for the main confounders. The mediating role of depressive symptoms in the association between deliberate self-harm and school bullying victimization was confirmed. A dose-response effect was shown in the association between nonsuicidal self-injury and school bullying victimization, whilst the mediating effect of depressive symptoms needs to be further explored. No studies were found directly exploring the mediating effect of self-stigma in the association between deliberate self-harm and bullying victimization. CONCLUSION Targeted interventions aimed at eliminating victimization behaviours within the school context are therefore proposed, as well as interventions to promote healthy parenting styles for the parents of schoolchildren. Moreover, school healthcare professionals should screen students involved in bullying for self-injury, and vice versa.
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Affiliation(s)
- Maria N K Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Street, 3041-Limassol, Cyprus
| | - Anne Lyberg
- Centre for Women's, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, P.O. Box 235, N-3606 Kongsberg, Norway
| | - Anne-Lise Holm
- Department of Health Science, Western Norway University of Applied Sciences, Bjørnsonsgt, 45, 5528 Haugesund, Norway
| | - Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway
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Calegaro VC, Zatti C, Bastos AG, Freitas LHM. Suicidal patients in a psychiatric emergency unit: clinical characteristics and aggression profile. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 41:9-17. [PMID: 30156650 DOI: 10.1590/2237-6089-2017-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/17/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression. METHODS This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA). RESULTS 63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002). CONCLUSION The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.
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Affiliation(s)
- Vítor Crestani Calegaro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria (UFSM), Porto Alegre, RS, Brazil
| | - Cleonice Zatti
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Andre Goettems Bastos
- Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lucia Helena Machado Freitas
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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The Strengths and Difficulties Questionnaire -Dysregulation Profile, Non-Suicidal Self-Injury Behaviors and the Mediating Role of Stressful Life Events. SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E22. [PMID: 29897027 DOI: 10.1017/sjp.2018.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Non-suicidal self-injury (NSSI) behaviors are self-injurious behaviors inflicted without intending death. Literature has shown the relationship between stressful life events (SLE) and NSSI behaviors. The Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) is defined as an index of self-regulatory problems, related to higher risk for suicidal ideation and attempts in adolescents. In this study the relationship between SDQ-DP and NSSI behaviors, mediated by SLE in a clinical sample of children and adolescents is analyzed. A cross-sectional study was conducted on 239 subjects (aged from 11 to 17) to test the mediation model. SDQ-DP significantly correlates with NSSI behaviors (Wald = 6.5477, p = .0105); SDQ-DP significantly correlates with SLE (T = 5.7229, p < .001); SLE significantly correlates NSSI behaviors, and the relation remains significant whilst controlling for SDQ-DP (Wald = 4.1715, p = .041); the relation between SDQ-DP and NSSI behaviors stops being significant whilst controlling for the potential mediator (SLE) (Wald = 2.9951, p = .0835). Study of indirect effect supports the mediation model (.0585 CI [.0016, .1266]). Findings are compatible with the complete mediation scenario. These results point out the importance of self-regulatory problems in coping strategies with regards to SLE and the development of NSSI behaviors.
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Chartrand H, Kim H, Sareen J, Mahmoudi M, Bolton JM. A comparison of methods of self-harm without intent to die: Cutting versus self-poisoning. J Affect Disord 2016; 205:200-206. [PMID: 27449552 DOI: 10.1016/j.jad.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/06/2016] [Accepted: 07/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) in DSM-5 Section 3 is restricted to damaging the skin, while self-poisoning is not considered NSSI even if there was no suicidal intent. The objective of this study was to compare correlates of people who self-cut and those who self-poison without suicidal intent, to determine whether people who harm themselves by cutting are a distinct subgroup. METHODS There were 12,435 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Manitoba between January 2009 and December 2013. Chart reviews were conducted for all presentations with self-harm without suicidal intent (n=219; 1.8% of the total sample). People presenting with cutting (n=47) were compared to those presenting with self-poisoning (n=116). RESULTS There were no differences between the groups on most demographic measures, except for age, where the people who cut were younger. Mental disorders were common in both groups. 31.9% of the cutting group had an alcohol use disorder, as did 25% of the self-poisoning group. Cluster B personality traits/disorder was diagnosed more frequently in the cutting group (51.1%) than the self-poisoning group (37.9%), but this difference was non-significant. Previous non-suicidal self-harm was more common among people cutting. LIMITATIONS We were unable to draw conclusions about the risk of suicide. CONCLUSIONS People who engage in non-suicidal self-harm have high rates of mental disorders. The method that people use to harm themselves does not appear to distinguish these groups; they appear to be similar on most demographic and diagnostic correlates. Further study is required to determine the validity of NSSI, including studies that compare those who self-harm with and without suicidal intent.
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Affiliation(s)
- Hayley Chartrand
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Huntae Kim
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Minoo Mahmoudi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Ahmed N, John A, Islam S, Jones R, Anderson P, Davies C, Khanom A, Harris S, Huxley P. Investigating the feasibility of an enhanced contact intervention in self-harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH). BMJ Open 2016; 6:e012043. [PMID: 27630071 PMCID: PMC5030583 DOI: 10.1136/bmjopen-2016-012043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Self-harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include no support, discharge to general practitioner or referral to primary care mental health support services. The aim of this study is to assess whether it is feasible to deliver a brief intervention after an episode and whether this can reduce depressive symptoms and increase the sense of well-being for patients who self-harm. METHODS This is a non-blinded parallel group randomised clinical trial. 120 patients presenting with self-harm and/or suicidal ideation to mental health services over a 12-month period who are not referred to secondary services will be randomised to either intervention plus treatment as usual (TAU), or control (TAU only). Patients are assessed at baseline, 4 and 12 weeks with standardised measures to collect data on depression, well-being and service use. Primary outcome is depression scores and secondary outcomes are well-being scores and use of services. The findings will indicate whether a rapid response brief intervention is feasible and can reduce depression and increase well-being among patients who self-harm and do not require secondary services. ETHICS AND DISSEMINATION Ethical approval was granted by the UK National Health Service (NHS) Ethics Committee process (REC 6: 14/WA/0074). The findings of the trial will be disseminated through presentations to the participating Health Board and partners, peer-reviewed journals and national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN76914248; Pre-results.
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Affiliation(s)
| | | | | | - Richard Jones
- Hywel Dda University Health Board, Haverfordwest, UK
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Nonsuicidal self-injury and suicide attempts among ED patients older than 50 years: comparison of risk factors and ED visit outcomes. Am J Emerg Med 2016; 34:1016-21. [DOI: 10.1016/j.ajem.2016.02.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/21/2016] [Accepted: 02/21/2016] [Indexed: 11/18/2022] Open
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Fresán A, Camarena B, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez L, González-Ramón AE, Hernández-Díaz Y. Risk-factor differences for nonsuicidal self-injury and suicide attempts in Mexican psychiatric patients. Neuropsychiatr Dis Treat 2016; 12:1631-7. [PMID: 27462155 PMCID: PMC4939986 DOI: 10.2147/ndt.s110044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The present study compared sociodemographic characteristics, comorbidities with substance use, and impulsivity features in three groups of psychiatric patients - suicide attempters, nonsuicidal self-injury, and nonsuicidal without self-injury - to determine the predictive factors for nonsuicidal self-injury or suicide behavior. PATIENTS AND METHODS Demographic features and self-reported substance use were assessed in 384 Mexican psychiatric patients. Impulsivity features were evaluated using the Plutchik Impulsivity Scale. Comparison analyses between groups were performed and a logistic regression model used to determine the factors associated with nonsuicidal with self-injury behavior and suicidal behavior. RESULTS Different predictive factors were observed for nonsuicidal self-injury and suicidal behavior. Females were more likely to present nonsuicidal self-injury behaviors (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.93; P=0.03). For suicide attempters, the factors associated were younger age (OR 0.89, 95% CI 0.85-0.93; P<0.001), less than 6 years of schooling (OR 0.2, 95% CI 0.06-0.6; P=0.004), and higher impulsivity traits, such as self-control (OR 1.19, 95% CI 1.03-1.36; P=0.01), planning of future actions (OR 0.79, 95% CI 0.66-0.95; P=0.01), and physiological behavior (OR 1.34, 95% CI 1.01-1.78; P=0.03). CONCLUSION Our results show that in a Mexican population, impulsivity features are predictors for suicide attempts, but not for self-injury. Other factors related to sociocultural background and individual features (such as personality) may be involved in this behavioral distinction, and should be studied in future research aimed at better understanding of both self-harmful behaviors.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City
| | - Beatriz Camarena
- Departamento de Genética Psiquiátrica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City
| | | | | | | | | | - Alicia E González-Ramón
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez
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Crawford A. A National Suicide Prevention Strategy for Canadians--From Research to Policy and Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:239-41. [PMID: 26175320 PMCID: PMC4501580 DOI: 10.1177/070674371506000601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Allison Crawford
- Program Director, Northern Psychiatric Outreach Program and Telepsychiatry, Centre for Addiction and Mental Health, Toronto, Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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