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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. SSM Popul Health 2024; 25:101592. [PMID: 38283541 PMCID: PMC10821139 DOI: 10.1016/j.ssmph.2023.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background Self-harm and suicide remain prevalent in later life. For younger adults, higher early-life cognitive ability appears to predict lower self-harm and suicide risk. Comparatively little is known about these associations among middle-aged and older adults. Methods This study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort (N = 53037), using hospital admission and mortality records to follow individuals from age 34 to 85. Multistate models examined the association between childhood cognitive ability and transitions between unaffected, self-harm, and then suicide or non-suicide death. Results After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among both males (451 events; HR = 0.90, 95% CI [0.82, 0.99]) and females (516 events; HR = 0.89, 95% CI [0.81, 0.98]). Childhood cognitive ability was not significantly associated with suicide risk among those with (Male: 16 events, HR = 1.05, 95% CI [0.61, 1.80]; Female: 13 events, HR = 1.08, 95% CI [0.55, 2.15]) or without self-harm events (Male: 118 events, HR = 1.17, 95% CI [0.84, 1.63]; Female: 31 events, HR = 1.30, 95% CI [0.70, 2.41]). Limitations The study only includes self-harm events that result in a hospital admission and does not account for self-harm prior to follow-up. Conclusions This extends work on cognitive ability and mental health, demonstrating that these associations can span the life course and into middle and older age.
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Affiliation(s)
| | - Emily L. Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J. Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R. Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G. David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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2
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Implementation of national guidance for self-harm among general practice nurses: a qualitative exploration using the capabilities, opportunities, and motivations model of behaviour change (COM-B) and the theoretical domains framework. BMC Nurs 2023; 22:452. [PMID: 38041157 PMCID: PMC10693142 DOI: 10.1186/s12912-023-01360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Patients who self-harm may consult with primary care nurses, who have a safeguarding responsibility to recognise and respond to self-harm. However, the responses of nursing staff to self-harm are poorly understood, and opportunities to identify self-harm and signpost towards treatment may be missed. It is unclear how to support nursing staff to implement national guidelines. AIMS Among primary care nursing staff to: [1] Examine reported barriers and enablers to nurses' use of, and adherence to, national guidance for self-harm; and [2] Recommend potential intervention strategies to improve implementation of the NICE guidelines. METHODS Twelve telephone interviews partly structured around the capabilities, opportunities and motivations model of behaviour change (COM-B) were conducted with primary care nurses in the United Kingdom. The Theoretical Domains Framework was used as an analytical framework, while the Behaviour Change Wheel was used to identify exemplar behaviour change techniques and intervention functions. RESULTS Nursing staff identified a need to learn more about risk factors (knowledge), and strategies to initiate sensitive conversations about self-harm (cognitive and interpersonal skills) to support their professional competencies (professional role and identity). Prompts may support recall of the guidance and support a patient centred approach to self-harm within practices (memory, attention, and decision making). GPs, and other practice nurses offer guidance and support (social influences), which helps nurses to navigate referrals and restricted appointment lengths (environmental context and influences). CONCLUSIONS Two converging sets of themes relating to information delivery and resource availability need to be targeted. Nine groups of behaviour change techniques, and five intervention functions offer candidate solutions for future intervention design. Key targets for change include practical training to redress conversational skill gaps about self-harm, the integration of national guidance with local resources and practice-level protocols to support decision-making, and creating opportunities for team-based mentoring.
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Affiliation(s)
- Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
| | - Chris Keyworth
- The School of Psychology, The University of Leeds, Woodhouse Lane, Leeds, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The Nowgen Centre, Manchester, UK
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McCarthy M, McIntyre JC, Nathan R, Ashworth EL, Saini P. Socioeconomic Predictors of Crisis and Clinical Pathways Among People Contacting a Mental Health Crisis Line. Health Serv Insights 2023; 16:11786329231212120. [PMID: 38028117 PMCID: PMC10655650 DOI: 10.1177/11786329231212120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Crisis lines are the first mental health service contact point for many people, making them a vital community and public health intervention. Given the current and potential utility of crisis lines, better understanding the characteristics, socioeconomic factors and subsequent referral pathways of callers is critical to identifying targeted ways to improve such services. Study Design The dataset captured calls to the Cheshire & Wirral Partnership NHS Foundation Trust (CWP) crisis line between August 2020 and August 2021. Calls were examined if self-harm, risk to self, or overdose were reported by the caller. Descriptive analyses were conducted to produce a clinical and demographic profile of the callers using the crisis line. Results Call handlers were significantly more likely to call 999, hand over to a practitioner and less likely to provide advice and guidance if self-harm, risk to self or overdose was reported. Social issues were found to be significantly associated with all 3 outcomes: self-harm, risk to self and overdose. Conclusion The current study provides the first exploratory analysis of the socioeconomic factors and resultant care pathways for those contacting a UK crisis line service. The findings have important implications for community early intervention efforts to reduce self-harm and suicidal behaviours.
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Affiliation(s)
| | | | - Rajan Nathan
- Cheshire & Wirral Partnership NHS Foundation Trust, Chester, UK
| | | | - Pooja Saini
- Liverpool John Moores University, Liverpool, UK
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Manning FM, Mughal F, Ismail HASM, Baines LM, Chew-Graham CA, Paskins Z, Prior JA. Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis. Br J Gen Pract 2023; 73:e735-e743. [PMID: 37722857 PMCID: PMC10523335 DOI: 10.3399/bjgp.2023.0035] [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: 01/16/2023] [Accepted: 07/03/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Increase in presentations of self-harm to primary care, a risk factor of suicide, has led to a growing interest in identifying at-risk populations. AIM To examine whether osteoporosis or fractures are risk factors for self-harm, suicidal ideation, and suicide. DESIGN AND SETTING This was a systematic review of observational studies in adults (>18 years) that had examined the role of osteoporosis and/or fractures in subsequent self-harm, suicidal ideation, and/or suicide. METHOD Six databases were searched from inception to July 2019. Additional citation tracking of eligible studies was undertaken in November 2022. Screening, data extraction, and quality assessment of full-text articles were performed independently by at least two authors. Where possible, meta-analysis was run on comparable risk estimates. RESULTS Fifteen studies were included: two examined the outcome of self-harm, three suicidal ideation, and 10 suicide. In approximately half of studies on osteoporosis, the risk of suicidal ideation and suicide remained significant. However, pooling of adjusted odds ratios from three studies indicated no association between osteoporosis and suicide (1.14, 95% confidence interval = 0.88 to 1.49). Nine studies examined the risk of a mixture of fracture types across different outcomes, limiting comparisons. However, all studies examining vertebral fracture (n = 3) reported a significant adjusted negative association for self-harm and suicide. CONCLUSION Patients with vertebral fractures, a risk potential factor for suicide, may benefit from clinical case finding for mood disorders with personalised primary care management. However, because of the limited number and quality of studies and mixed findings, further examination of these associations is warranted.
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Affiliation(s)
- Fay M Manning
- School of Medicine, Keele University, Keele, and Department of Medical Imaging, University of Exeter, Exeter, UK
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester; and honorary clinical research fellow, Warwick Medical School, Warwick, UK
| | | | | | | | - Zoe Paskins
- Keele University, Keele, and Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke-on-Trent, UK
| | - James A Prior
- School of Medicine, Keele University, Keele, and Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke-on-Trent, UK
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McCarthy M, Saini P, Nathan R, McIntyre J. Predictors of self-harm and emergency department attendance for self-harm in deprived communities. Int J Inj Contr Saf Promot 2023; 30:403-409. [PMID: 37126426 DOI: 10.1080/17457300.2023.2204474] [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: 07/28/2022] [Revised: 03/07/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
Emergency departments (EDs) are often the first point of contact for individuals following self-harm. The majority of previous research relies on hospital-based data, yet only a minority of individuals who self-harm in the community present to healthcare services. The study design is cross-sectional survey design. Data from the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC) Household Health Survey, a community-based public health survey in North West England, was collected using stratified random sampling. Three thousand four hundred twelve people were recruited in 2018 from relatively disadvantaged areas. The sample included 1490 men and 1922 women aged 18 to 100 years (M = 49.37, SD = 18.91). Logistic regression analysis was employed to examine demographic, health and socioeconomic predictors of self-harm and ED attendance for self-harm. Age (18-24 years), lower financial status, depression, anxiety and physical and mental health co-morbidity was associated with significantly higher levels of self-harm. People aged 18-24 years, with physical and mental health co-morbidity and lower levels of social support had significantly higher levels of attending EDs for self-harm. Improving people's financial situations, social connectivity, mental and physical health may help to reduce individual risk for self-harm and strain on health services.
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Affiliation(s)
- Molly McCarthy
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, England
| | - Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, England
| | - Rajan Nathan
- Cheshire & Wirral Partnership NHS Foundation Trust, Chester, England
| | - Jason McIntyre
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, England
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6
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Ross E, O'Reilly D, O'Hagan D, Maguire A. Mortality risk following self-harm in young people: a population cohort study using the Northern Ireland Registry of Self-Harm. J Child Psychol Psychiatry 2023; 64:1015-1026. [PMID: 36928638 PMCID: PMC10952668 DOI: 10.1111/jcpp.13784] [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] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Self-harm is a recognised predictor of suicide and is most common in those aged under 25 years. The aims of this study were to describe the characteristics of young people who present with self-harm; quantify the risk of suicide and other causes of death during follow up, and to identify factors associated with mortality risk. METHODS The Northern Ireland Registry of Self-Harm (NIRSH) is a national registry capturing complete data on all presentations made to the 12 Emergency Departments (EDs) in Northern Ireland (NI). Data relating to self-harm presentations registered in the NIRSH between 2012 and 2015 were linked to primary care registrations and death records up until 31st December 2018. Logistic regression was employed to examine the factors associated with self-harm. Cox regression was used to estimate mortality risk following self-harm and explore the associated risk factors. RESULTS The cohort consisted of 390,740 individuals aged 10-24 years registered with a General Practitioner (GP) in NI. During follow-up, 4,450 individuals presented with self-harm. Rates of self-harm were highest in females, those aged 20-24 years (ORadj = 3.53, 95% CI 3.28-3.80, p < .001), and in the most deprived areas (ORadj = 2.71, 95% CI 2.45-2.99, p < .001). Thirty five individuals who presented with self-harm died by suicide, accounting for 23% of all suicide deaths in the cohort. Suicide risk was increased 19-fold in those who presented with self-harm after adjustment for age, sex and area-level factors (HRadj = 19.00, 95% CI 12.80-28.21, p < .001). Increased suicide risk was observed in males (HRadj = 2.04, 95% CI 0.99-4.23, p = .05) and those using more violent methods of self-injury (HRadj = 3.89, 95% CI 1.65-9.13, p < .001). CONCLUSIONS Young people who self-harm are at a significantly greater risk of suicide. Almost a quarter of young people who died by suicide in NI had presented to EDs with self-harm, highlighting that the ED may provide a nodal point of intervention among a typically hard to identify and reach population.
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Affiliation(s)
- Emma Ross
- Centre for Public Health, Queen's University BelfastBelfastUK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University BelfastBelfastUK
| | | | - Aideen Maguire
- Centre for Public Health, Queen's University BelfastBelfastUK
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7
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Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review. J Psychiatr Res 2023; 164:28-36. [PMID: 37311401 DOI: 10.1016/j.jpsychires.2023.05.066] [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: 07/25/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
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Affiliation(s)
- Sarah Grube Jakobsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark.
| | - Torben Nielsen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Christina Petrea Larsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
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Mughal F, Clarke L, Connolly R, Lee AYT, Quinlivan L, Kapur N. Improving the management of self-harm in primary care. Br J Gen Pract 2023; 73:148-149. [PMID: 36997200 PMCID: PMC10049611 DOI: 10.3399/bjgp23x732297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
| | - Liam Clarke
- Paramedic, London Ambulance Service NHS Trust, London
| | - Rachel Connolly
- Systematic Reviewer, National Institute for Health and Care Excellence (NICE), Manchester
| | | | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, University of Manchester, Manchester
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester; Greater Manchester Mental Health NHS Foundation Trust; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester
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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.10.23285747. [PMID: 36798203 PMCID: PMC9934796 DOI: 10.1101/2023.02.10.23285747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Self-harm and suicide remain prevalent in later life. For younger adults, work has highlighted an association between higher early-life cognitive ability and lower self-harm and suicide risk. Comparatively little is known about its association with self-harm and suicide among older adults. Furthermore, most work has measured cognitive ability in early adulthood, raising issues of potential confounding by emerging psychiatric conditions. The present study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort of older adults (N = 53037), using health data linkage to follow individuals from age 34 to 85. Self-harm events were extracted from hospital admissions and suicide deaths were extracted from national mortality records. Multistate models were used to model transitions between unaffected, self-harm, and then suicide or non-suicide death, and to examine the association between childhood cognitive ability and each transition. After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among older females (N events = 516; HR = 0.90, 95% CI = [0.81, 0.99]). A similar, though non-significant, association was observed among older males (N events = 451; HR = 0.90, 95% CI = [0.82, 1.00]). Although suicide risk was higher among older adults experiencing self-harm, childhood cognitive ability was not significantly associated with suicide risk among either older adults experiencing no self-harm events (Male: N events = 118, HR = 1.17, 95% CI = [0.84, 1.63]; Female: N events = 31, HR = 1.30, 95% CI = [0.70, 2.41]) or those experiencing a self-harm event during follow-up (Male: N events = 16, HR = 1.05, 95% CI = [0.61, 1.80]; Female: N events = 13, HR = 1.08, 95% CI = [0.55, 2.14]). Higher suicide risk was significantly associated with covariates including higher adulthood deprivation and longer time in the self-harm state. These results extend work on cognitive ability and mental health, demonstrating that these associations can span across the life course and into older age.
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Affiliation(s)
- Matthew H Iveson
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | - Emily L Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Management of Incisional Self-Harm of the Upper Limb: A Systematic Review. JPRAS Open 2023; 36:76-84. [PMID: 37197690 PMCID: PMC10184042 DOI: 10.1016/j.jpra.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background The incidence of incisional self-harm of the upper limbs is increasing, and recurrence rates are high. It is not known whether different wound treatment strategies (dressings only vs. surgery) or the operative setting (main theatre vs. non-main theatre) affect wound or mental health-related outcomes. Methods Four electronic databases (Ovid MEDLINE, OVID EMBASE, PsycINFO and CENTRAL) were searched from inception to 14/09/2021 for studies which describe the management of incisional self-harm wounds of the upper limb(s) in adults and children. Dual-author screening and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results In total, 19 studies (1477 patients) were included. Overall, the evidence was limited by a paucity of comparative data on wound management strategy and setting, and poor-quality outcome reporting. Only four studies clearly identified the operative setting for definitive wound management (two in main operating theatres, one in the emergency department and one using both settings, depending on injury severity). Few studies inconsistently reported surgical outcomes (n=9) or mental health outcomes (n=4), hindering evidence synthesis. Conclusion Further investigation is needed to determine the most cost-effective management strategies and settings for these injuries.
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Waller G, Newbury-Birch D, Simpson D, Armstrong E, James B, Chapman L, Ahmed F, Ferguson J. The barriers and facilitators to the reporting and recording of self-harm in young people aged 18 and under: a systematic review. BMC Public Health 2023; 23:158. [PMID: 36694149 PMCID: PMC9871435 DOI: 10.1186/s12889-023-15046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND AIMS This systematic review sought to identify, explain and interpret the prominent or recurring themes relating to the barriers and facilitators of reporting and recording of self-harm in young people across different settings, such as the healthcare setting, schools and the criminal justice setting. METHODS A search strategy was developed to ensure all relevant literature around the reporting and recording of self-harm in young people was obtained. Literature searches were conducted in six databases and a grey literature search of policy documents and relevant material was also conducted. Due to the range of available literature, both quantitative and qualitative methodologies were considered for inclusion. RESULTS Following the completion of the literature searches and sifting, nineteen papers were eligible for inclusion. Facilitators to reporting self-harm across the different settings were found to be recognising self-harm behaviours, using passive screening, training and experience, positive communication, and safe, private information sharing. Barriers to reporting self-harm included confidentiality concerns, negative perceptions of young people, communication difficulties, stigma, staff lacking knowledge around self-harm, and a lack of time, money and resources. Facilitators to recording self-harm across the different settings included being open to discussing what is recorded, services working together and co-ordinated help. Barriers to recording self-harm were mainly around stigma, the information being recorded and the ability of staff being able to do so, and their length of professional experience. CONCLUSION Following the review of the current evidence, it was apparent that there was still progress to be made to improve the reporting and recording of self-harm in young people, across the different settings. Future work should concentrate on better understanding the facilitators, whilst aiming to ameliorate the barriers.
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Affiliation(s)
- Gillian Waller
- NHS Business Services Authority, Stella House, Newburn, Newcastle, NE15 8NY, UK.
| | - Dorothy Newbury-Birch
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Diane Simpson
- grid.7110.70000000105559901Faculty of Education and Society, University of Sunderland, Sunderland, SR6 0DD UK
| | - Emma Armstrong
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Becky James
- Department of Health and Social Care, Office for Health Improvement & Disparities, Newburn, Newcastle, NE15 8NY UK
| | - Lucy Chapman
- grid.433912.e0000 0001 0150 9675Durham County Council, County Hall, Durham, DH1 5UJ UK
| | - Farhin Ahmed
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Jennifer Ferguson
- grid.26597.3f0000 0001 2325 1783School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
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Hayes JF, Hardoon S, Deighton J, Viding E, Osborn DPJ. Association between quetiapine use and self-harm outcomes among people with recorded personality disorder in UK primary care: A self-controlled case series analysis. J Psychopharmacol 2022; 36:1218-1225. [PMID: 36317651 PMCID: PMC9643813 DOI: 10.1177/02698811221131990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines. AIMS To examine associations between periods of quetiapine prescribing and self-harm events in people with personality disorder. METHOD Self-controlled case series using linked primary care and hospital records covering the period 2007-2017. We calculated incidence rates and incidence rate ratios (IRRs) for self-harm events during periods when people were prescribed (exposed to) quetiapine, as well as periods when they were unexposed or pre-exposed to quetiapine. RESULTS We analysed data from 1,082 individuals with established personality disorder diagnoses, all of whom had at least one period of quetiapine prescribing and at least one self-harm episode. Their baseline rate of self-harm (greater than 12 months before quetiapine treatment) was 0.52 episodes per year. Self-harm rates were elevated compared to the baseline rate in the month after quetiapine treatment was commenced (IRR 1.85; 95% confidence interval (CI) 1.46-2.34) and remained raised throughout the year after quetiapine treatment was started. However, self-harm rates were highest in the month prior to quetiapine initiation (IRR 3.59; 95% CI 2.83-4.55) and were elevated from 4 months before quetiapine initiation, compared to baseline. CONCLUSION Self-harm rates were elevated throughout the first year of quetiapine prescribing, compared to the baseline rate. However, rates of self-harm reduced in the month after patients commenced quetiapine, compared to the month before quetiapine was initiated. Self-harm rates gradually dropped over a year of quetiapine treatment. Quetiapine may acutely reduce self-harm. Longer-term use and any potential benefits need to be balanced with the risk of adverse events.
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Affiliation(s)
- Joseph F Hayes
- Division of Psychiatry, University
College London, London UK,Camden and Islington NHS Foundation
Trust, London, UK,Joseph F Hayes, Division of Psychiatry,
University College London, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sarah Hardoon
- Division of Psychiatry, University
College London, London UK
| | - Jessica Deighton
- Anna Freud Centre, London, UK,Division of Psychology and Language
Sciences, University College London, London, UK
| | - Essi Viding
- Division of Psychology and Language
Sciences, University College London, London, UK
| | - David PJ Osborn
- Division of Psychiatry, University
College London, London UK,Camden and Islington NHS Foundation
Trust, London, UK
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13
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Hope H, Pierce M, Osam CS, Morgan C, John A, Abel KM. Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data. Br J Psychiatry 2022; 221:621-627. [PMID: 35227334 DOI: 10.1192/bjp.2022.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Perinatal self-harm is of concern but poorly understood. AIMS To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome. METHOD This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome. RESULTS The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination. CONCLUSIONS Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Cemre Su Osam
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Catharine Morgan
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Ann John
- Swansea University Medical School, Swansea University, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK and Greater Manchester Mental Health NHS Foundation Trust, UK
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14
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Men VY, Emery CR, Lam TC, Yip PSF. Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 2022; 52:2342-2351. [PMID: 33226318 DOI: 10.1017/s0033291720004250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
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Affiliation(s)
- Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Clifton Robert Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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15
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O'Donohoe MS. General Practitioners’ Experiences of Self-harm in Primary Care. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Haris AM, Pitman A, Mughal F, Bakanaite E, Morant N, Rowe SL. Harm minimisation for self-harm: a cross-sectional survey of British clinicians' perspectives and practices. BMJ Open 2022; 12:e056199. [PMID: 35980724 PMCID: PMC9171231 DOI: 10.1136/bmjopen-2021-056199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Harm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice. DESIGN A cross-sectional study using an online survey consisting of fixed-choice and open-ended questions. SETTING Primary and secondary care practices in England, Scotland and Wales. PARTICIPANTS Snowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients. RESULTS Of the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one's wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace. CONCLUSIONS In our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians' perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.
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Affiliation(s)
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Faraz Mughal
- School of Medicine, Keele University, Keele, UK
- Affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, Greater Manchester, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah L Rowe
- Division of Psychiatry, University College London, London, UK
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17
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Knipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. Lancet 2022; 399:1903-1916. [PMID: 35512727 DOI: 10.1016/s0140-6736(22)00173-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022]
Abstract
Suicide and self-harm are major health and societal issues worldwide, but the greatest burden of both behaviours occurs in low-income and middle-income countries. Although rates of suicide are higher in male than in female individuals, self-harm is more common in female individuals. Rather than having a single cause, suicide and self-harm are the result of a complex interplay of several factors that occur throughout the life course, and vary by gender, age, ethnicity, and geography. Several clinical and public health interventions show promise, although our understanding of their effectiveness has largely originated from high-income countries. Attempting to predict suicide is unlikely to be helpful. Intervention and prevention must include both a clinical and community focus, and every health professional has a crucial part to play.
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Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, Academic Health Science Centre, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
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18
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Haddad M, Young N. Self-harm and suicide: occurrence, risk assessment and management for general nurses. Nurs Stand 2022; 37:71-76. [PMID: 35502573 DOI: 10.7748/ns.2022.e11911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/09/2022]
Abstract
Suicide is a tragic event that has traumatic and far-reaching effects on families, friends and healthcare professionals, for whom feelings of guilt, blame and regret are common. Although there have been reductions in suicide rates globally and in the UK over past decades, it remains one of the leading causes of death. Assessing and supporting people who present with self-harm and risk of suicide are essential aspects of all nurses' clinical practice. This article explains the relationship between suicide, self-harm and other risk factors. It also provides guidance for general nurses on evidence-based approaches to managing self-harm and assessing suicide risk collaboratively with service users.
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Affiliation(s)
- Mark Haddad
- Centre for Health Services Research, City University of London School of Health Sciences, London, England
| | - Norman Young
- Early Intervention in Psychosis, Cardiff and Vale University Health Board, Hafan Y Coed, Llandough, Wales
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19
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Keyworth C, Quinlivan L, Leather JZ, O’Connor RC, Armitage CJ. The association between COVID-19-related fear and reported self-harm in a national survey of people with a lifetime history of self-harm. BMC Psychiatry 2022; 22:68. [PMID: 35105313 PMCID: PMC8807142 DOI: 10.1186/s12888-021-03625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatively little is known about the characteristics of people living in the community who have previously self-harmed and may benefit from interventions during and after COVID-19. We therefore aimed to: (a) examine the relationship between reported self-harm and COVID-19-related fear, and (b) describe the characteristics of a community sample of people who reported a lifetime history of self-harm. METHODS A cross-sectional national online survey of UK adults who reported a lifetime history of self-harm (n = 1029) was conducted. Data were collected May - June 2020. Main outcomes were self-reported COVID-19-related fear (based on the Fear of COVID-19 scale [FCV-19S]), lifetime history of COVID-19, and lifetime history of self-harm. Data were analysed using descriptive statistics and binary logistic regression. Chi-square was used to compare characteristics of our sample with available national data. RESULTS Overall, 75.1, 40.2 and 74.3% of the total sample reported lifetime suicidal ideation, suicidal attempts and non-suicidal self-harm respectively. When adjusting for age, sex, ethnicity, social grade, and exposure to death and suicide, binary logistic regression showed higher levels of perceived symptomatic (or physiological) reactions to COVID-19 were associated with suicidal ideation (OR = 1.22, 95%CI 1.07, 1.39) and suicidal attempts (OR = 3.91, 95%CI 1.18, 12.96) in the past week. CONCLUSIONS Results suggest an urgent need to consider the impact of COVID-19 on people with a lifetime history of self-harm when designing interventions to help support people in reducing suicidal ideation and suicidal attempts. Experiencing symptomatic reactions of fear in particular is associated with self-harm. Helping to support people to develop coping plans in response to threat-related fear is likely to help people at risk of repeat self-harm during public health emergencies.
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Affiliation(s)
| | - Leah Quinlivan
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Jess Z. Leather
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Rory C. O’Connor
- grid.8756.c0000 0001 2193 314XSuicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher J. Armitage
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, M13 9PL UK
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20
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Shafti M, Steeg S, de Beurs D, Pratt D, Forrester A, Webb RT, Taylor PJ. The inter-connections between self-harm and aggressive behaviours: A general network analysis study of dual harm. Front Psychiatry 2022; 13:953764. [PMID: 35935416 PMCID: PMC9354883 DOI: 10.3389/fpsyt.2022.953764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Dual harm is the co-occurrence of self-harm and aggression during an individual's lifetime. This behaviour is especially prevalent within criminal justice and forensic settings. The forms of aggression that should be included in the definition of dual harm have not yet been established. This study aimed to use network analysis to inform an evidence-based definition of dual harm by assessing the relationship between self-harm and different forms of aggressive behaviour in young people (N = 3,579). We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Results revealed low correlations between the variables, leading to sparse network models with weak connections. We found that when separated into their distinct forms, aggressive acts and self-harm are only weakly correlated. Our work provides preliminary evidence to assist in understanding and managing dual harm within clinical and forensic settings and informs recommendations for future research.
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Affiliation(s)
- Matina Shafti
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Steeg
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Centre for New Treatments and Understanding in Mental Health (CeNTrUM), University of Manchester, Manchester, United Kingdom
| | - Derek de Beurs
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands
| | - Daniel Pratt
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Centre for New Treatments and Understanding in Mental Health (CeNTrUM), University of Manchester, Manchester, United Kingdom
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Roger T Webb
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester and Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom
| | - Peter James Taylor
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Division of Psychology and Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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21
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Rees S, Watkins A, Keauffling J, John A. Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales. Clin Epidemiol 2022; 14:21-38. [PMID: 35058718 PMCID: PMC8764170 DOI: 10.2147/clep.s325235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK. METHODS A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11-25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan-Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC). RESULTS Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12-1.24) in WLGP and 1.17 (1.10-1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20-29.40) in WLGP and 4.50 (4.08-4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00-3.58) in WLGP and 2.59 (2.36-2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78-0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54-0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84-1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5-10.0). CONCLUSION Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.
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Affiliation(s)
- Sarah Rees
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
- Correspondence: Sarah Rees Email
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | | | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
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22
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Farooq B, Clements C, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Patel A, Kelly S, Townsend E, Appleby L, Kapur N. Self-harm in children and adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:782-791. [PMID: 34555352 PMCID: PMC9766885 DOI: 10.1016/s2352-4642(21)00239-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes. METHODS In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10-19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10-19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models. FINDINGS Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03-1·11]), South Asian groups (1·05 [1·01-1·09]), and other non-White groups (1·11 [1·06-1·16]) than in White groups (1·02 [1·00-1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small. INTERPRETATION Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured. FUNDING UK Department of Health and Social Care.
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Affiliation(s)
- Bushra Farooq
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Caroline Clements
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Samantha Kelly
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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23
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McIntyre J, Elahi A, Latham C, Mullholland H, Haines-Delmont A, Saini P, Taylor PJ. Does neighbourhood identification buffer against the effects of socioeconomic disadvantage on self-harm? J Affect Disord 2021; 294:857-863. [PMID: 34375213 DOI: 10.1016/j.jad.2021.07.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Socioeconomic disadvantage and lack of group belonging (i.e., social identity) have been linked to poor mental health. However, no research has investigated the relationship between neighbourhood identity and self-harm, nor whether identifying with one's neighbourhood can mitigate the effects of economic stress on self-harm. METHODS Pre-registered secondary data analysis of a large (N = 3412) community health survey conducted in disadvantaged areas of North West England. RESULTS Despite the sample having a relatively high and therefore restricted level of disadvantage, individual and geographic indicators of disadvantage, as well as neighbourhood identification, were unique and strong predictors of self-harm thoughts and behaviours across several analyses. Specifically, experiencing disadvantage and disidentification predicted significantly higher odds of self-harm and self-harm thoughts. No consistent interactive effects emerged. LIMITATIONS The cross-sectional design limits firm conclusions regarding causal effects of neighbourhood identity and disadvantage on self-harm. However, causal direction is supported by past research and theory. The data is self-report, which is subject to response bias. The sample was also recruited from a region of the UK with low numbers of residents from ethnic minority backgrounds. CONCLUSIONS The results are consistent with past research indicating an association between social identity and better mental health, but for the first time extend these effects to self-harm. The findings demonstrate the importance of considering social and economic factors when attempting to prevent suicide and understand and treat self-harm thoughts.
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Affiliation(s)
- Jason McIntyre
- School of Psychology, Liverpool John Moores University, UK
| | - Anam Elahi
- Department of Primary Care and Mental Health. Institute of Population Health, University of Liverpool. UK
| | | | - Helen Mullholland
- Department of Primary Care and Mental Health. Institute of Population Health, University of Liverpool. UK
| | | | - Pooja Saini
- School of Psychology, Liverpool John Moores University, UK
| | - Peter J Taylor
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre, United Kingdom.
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Kapur N, Gorman LS, Quinlivan L, Webb RT. Mental health services: quality, safety and suicide. BMJ Qual Saf 2021; 31:419-422. [PMID: 34607913 DOI: 10.1136/bmjqs-2021-013532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK .,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Louise S Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
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Keyworth C, O'Connor R, Quinlivan L, Armitage CJ. Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation. J Med Internet Res 2021; 23:e28349. [PMID: 34518153 PMCID: PMC8479604 DOI: 10.2196/28349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. OBJECTIVE This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. METHODS We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. RESULTS Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=-15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). CONCLUSIONS Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rory O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
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Prior JA, Crawford-Manning F, Whittle R, Abdul-Sultan A, Chew-Graham CA, Muller S, Shepherd TA, Sumathipala A, Mallen CD, Paskins Z. Vertebral fracture as a risk factor for self-harm: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:757. [PMID: 34481480 PMCID: PMC8417993 DOI: 10.1186/s12891-021-04631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background The prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, particularly as self-harm is a risk factor for suicide. This study aims to examine the risk of self-harm in people with vertebral fractures. Methods Retrospective cohort study. Patients with vertebral fracture were identified within the Clinical Practice Research Datalink and matched to patients without fracture by sex and age. Incident self-harm was defined by primary care record codes following vertebral fracture. Overall incidence rates (per 10,000 person-years (PY)) were reported. Cox regression analysis determined risk (hazard ratios (HR), 95 % confidence interval (CI)) of self-harm compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by median age and sex. Results The number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1 %), median age was 76.3 years. Overall incidence of self-harm in the cohort with vertebral fracture was 12.2 (10.1, 14.8) /10,000 PY. There was an initial crude association between vertebral fracture and self-harm, which remained after adjustment (HR 2.4 (95 %CI 1.5, 3.6). Greatest risk of self-harm was found in those with vertebral fractures who were aged below 76.3 years (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)). Conclusions Primary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Male patients aged below 76 years of age appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.
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Affiliation(s)
- James A Prior
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK. .,Midlands Partnership NHS Foundation Trust, Stafford, UK.
| | - Fay Crawford-Manning
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Rebecca Whittle
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK
| | - Alyshah Abdul-Sultan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK
| | - Carolyn A Chew-Graham
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK
| | - Tom A Shepherd
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK
| | - Athula Sumathipala
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, ST5 5BG, Staffordshire, UK.,Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, ST6 7AG, Stoke-on-Trent, UK
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Saini P, Hunt A, Taylor P, Mills C, Clements C, Mulholland H, Kullu C, Hann M, Duarte R, Mattocks F, Guthrie E, Gabbay M. Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS): a feasibility trial protocol. Pilot Feasibility Stud 2021; 7:165. [PMID: 34452642 PMCID: PMC8390538 DOI: 10.1186/s40814-021-00902-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background People who self-harm are at high risk for future suicide and often suffer considerable emotional distress. Depression is common among people who self-harm and may be an underlying driver of self-harm behaviour. Self-harm is often repeated, and risk of repetition is highest immediately after an act of self-harm. Readily accessible brief talking therapies show promise in helping people who self-harm, but further evaluation of these approaches is needed. A brief talking therapy intervention for depression and self-harm has been designed for use in a community setting. This mixed methods feasibility study with repeated measures will examine the feasibility and acceptability of the Community Outpatient Psychological Engagement Service for Self-Harm (COPESS) for people with self-harm and depression in the community, compared to routine care. Methods Sixty participants with a history of self-harm within the last six months, who are also currently depressed, will be recruited to take part in a feasibility single-blind randomised controlled trial (RCT). Participants will be randomised 1:1 to receive COPESS plus treatment as usual (TAU) or TAU alone. Recruitment will be via General Practitioners (GP) and self-referral. Assessment of feasibility and acceptability will be assessed via quantitative and qualitative methods including measures of recruitment and retention to the feasibility trial, participants’ experience of therapy, completion/completeness of outcome measures at relevant time-points and completion of a service use questionnaire. Discussion The results will indicate whether it is feasible to conduct a definitive full trial to determine whether COPESS is a clinically and cost effective intervention for people who self-harm in the community. Qualitative and quantitative data will in addition help identify potential strengths and/or challenges of implementing brief community-based interventions for people who self-harm. Trial registration NCT04191122 registered 9th December 2019.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Anna Hunt
- School of Psychology, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Taylor
- Division of Psychology & Mental Health, Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Catherine Mills
- Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, L34 1PJ, UK
| | - Caroline Clements
- Division of Psychology & Mental Health, Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Helen Mulholland
- Department of Primary Care and Mental Health, The University of Liverpool, Waterhouse Building Block B, Liverpool, L69 3GF, UK
| | - Cecil Kullu
- Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, L34 1PJ, UK
| | - Mark Hann
- Biostatistics, Division of Population Health, Health Services Research & Primary Care, Manchester, UK
| | - Rui Duarte
- Department of Primary Care and Mental Health, The University of Liverpool, Waterhouse Building Block B, Liverpool, L69 3GF, UK
| | | | - Else Guthrie
- School of Medicine, The University of Leeds, Woodhouse, Leeds, LS2 9JT, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, The University of Liverpool, Waterhouse Building Block B, Liverpool, L69 3GF, UK.
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Mughal F, Gorton HC, Michail M, Robinson J, Saini P. Suicide Prevention in Primary Care. CRISIS 2021; 42:241-246. [PMID: 34184574 DOI: 10.1027/0227-5910/a000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Staffordshire, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK.,Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | | | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Pooja Saini
- Faculty of Health, School of Psychology, Liverpool John Moores University, UK
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Experiences of general practice care for self-harm: a qualitative study of young people's perspectives. Br J Gen Pract 2021; 71:e744-e752. [PMID: 33950851 PMCID: PMC8340729 DOI: 10.3399/bjgp.2021.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-harm is a growing concern and rates of self-harm in young people (aged 12-25 years) presenting to general practice are rising. There is, however, little evidence about young people's experiences of GP care and on accessing general practice. AIM To explore the help-seeking behaviours, experiences of GP care, and access to general practice of young people who self-harm. DESIGN AND SETTING In this qualitative study, semi-structured interviews were conducted with young people aged 16-25 years from England with previous self-harm behaviour. METHOD Interviews with 13 young people took place between April and November 2019. Young people were recruited from the community, third-sector organisations, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings. RESULTS Young people described the avenues of help-seeking they employ and reflected on the mixed experiences of seeing GPs that can influence future help-seeking. Preconceptions and a lack of knowledge about accessing general practice were found to be barriers to help-seeking. GPs who attempt to understand the young person and establish relationship-based care can facilitate young people accessing general practice for self-harm. CONCLUSION It is important young people are aware of how to access general practice and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.
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30
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Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol 2021; 56:773-781. [PMID: 33146859 DOI: 10.1007/s00127-020-01981-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. METHODS Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. RESULTS During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years. CONCLUSION The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.
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Cunningham R, Milner A, Gibb S, Rijnberg V, Disney G, Kavanagh AM. Gendered experiences of unemployment, suicide and self-harm: a population-level record linkage study. Psychol Med 2021; 52:1-9. [PMID: 33875022 DOI: 10.1017/s0033291721000994] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unemployment and being not in the labour force (NILF) are risk factors for suicide, but their association with self-harm is unclear, and there is continuing debate about the role of confounding by prior mental health conditions. We examine associations between employment status and self-harm and suicide in a prospective cohort, taking into account prior mental-health-related factors. METHODS We used linked data from the New Zealand Integrated Data Infrastructure. The outcomes were chosen to be hospital presentation for self-harm and death by suicide. The exposure was employment status, defined as employed, unemployed, or NILF, measured at the 2013 Census. Confounders included demographic factors and mental health history (use of antidepressant medication, use of mental health services, and prior self-harm). Logistic regression was used to model effects. Analyses were stratified by gender. RESULTS For males, unemployment was associated with an increased risk of suicide [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.20-1.84] and self-harm (OR: 1.55, 95% CI: 1.45-1.68) after full adjustment for confounders. NILF was associated with an increased risk of self-harm (OR: 1.43, 95% CI: 1.32-1.55), but less of an association was seen with suicide (OR: 1.19, 95% CI: 0.94-1.49). For females, unemployment was associated with an increased risk of suicide (OR: 1.30, 95% CI: 0.93-1.80) and of self-harm (OR: 1.52, 95% CI: 1.43-1.62), and NILF was associated with a similar increase in risk for suicide (OR: 1.31, 95% CI: 0.98-1.75) and self-harm (OR: 1.32, 95% CI: 1.26-1.40). DISCUSSION Exclusion from employment is associated with a considerably heightened risk of suicide and self-harm for both men and women, even among those without prior mental health problems.
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Affiliation(s)
- R Cunningham
- Department of Public Health, University of Otago Wellington, Newtown Wellington, New Zealand
| | - A Milner
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - S Gibb
- Department of Public Health, University of Otago Wellington, Newtown Wellington, New Zealand
| | - V Rijnberg
- Department of Public Health, University of Otago Wellington, Newtown Wellington, New Zealand
| | - G Disney
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - A M Kavanagh
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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John A, Marchant A, Demmler J, Tan J, DelPozo-Banos M. Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank. BJPsych Open 2021; 7:e67. [PMID: 33736714 PMCID: PMC8058850 DOI: 10.1192/bjo.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes. AIMS To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring. METHOD We conducted a retrospective whole population e-cohort study of individuals aged 10-64 years from 2003 to 2016. Individuals were divided into: record of self-harm only; eating disorders only; both self-harm and eating disorders; and no record of self-harm or eating disorders. We used linked routinely collected healthcare data across primary care, emergency departments, hospital admissions and out-patient appointments to examine healthcare contacts and mortality. RESULTS We identified 82 627 individuals: n = 75 165 with self-harm only; n = 5786 with eating disorders only; n = 1676 with both combined. Across all groups and settings significantly more individuals attended with significantly more contacts than the rest of the population. The combined group had the highest number of contacts per person (general practitioner, incident rate ratio IRR = 3.3, 95% CI 3.1-3.5; emergency department, IRR = 5.2, 95% CI 4.7-5.8; hospital admission, IRR = 5.2, 95% CI 4.5-6.0; out-patients, IRR = 3.9, 95% CI 3.5-4.4). Standardised mortality ratios showed the highest excess mortality overall in the self-harm only group (SMR = 3.2, 95% CI 3.1-3.3), particularly for unnatural causes of death (SMR = 17.1, 95% CI 16.3-17.9). SMRs and years of life lost showed an increased risk of mortality in younger age groups in the combined group. Adjusted hazard ratios showed increased mortality across all groups (self-harm only, HR = 5.3, 95% CI 5.2-5.5; eating disorders only, HR = 4.1, 95% CI 3.4-4.9; combined group, HR = 6.8, 95% CI 5.4-8.6). CONCLUSIONS Individuals in all groups had higher healthcare service utilisation than the general population. The increased mortality risk in young people with a record of both eating disorders and self-harm highlights the need for early specialist intervention and enhanced support.
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Affiliation(s)
- Ann John
- FFPH, Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Amanda Marchant
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Joanne Demmler
- Swansea University Medical School, Data Science Building, Swansea University, UK
| | - Jacinta Tan
- FRCPsych, Swansea University Medical School, Data Science Building, Swansea University, UK; and Specialist Eating Disorder Team, Abertawe Bro Morgannwg University Health Board, UK
| | - Marcos DelPozo-Banos
- Swansea University Medical School, Data Science Building, Swansea University, UK
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Hayden JC, Kelly L, McNicholas F. A clinician's guide to self-poisoning with paracetamol in youth: The what, when and why? Acta Paediatr 2020; 109:2237-2242. [PMID: 32542752 DOI: 10.1111/apa.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
AIM Deliberate self-poisoning or overdose is a common presentation to the paediatric emergency departments (ED) due to a lack of emergency access to child and adolescent mental health services. We overview medical and psychiatric assessment of overdoses in youth with the most commonly implicated drug, paracetamol, as a case study. METHODS A what, when and why framework is adopted to guide clinicians on what information should be ascertained, when overdose treatment should be initiated and how to explore why the overdose occurred. RESULTS Presentations are often asymptomatic while gastrointestinal symptoms offer an alarm signal for severe hepatotoxicity. A worst-case exposure amount and time elapsed since ingestion should be calculated to determine whether N-acetylcysteine treatment is indicated. Establishing reasons why the young person took the overdose, along with assessing the degree of remorse or regret, is crucial for discharge planning. CONCLUSION Given the importance of timely assessment and treatment, paediatric emergency staff need to be familiar with the protocol for care. Attention needs to be focused on both the medical and psychological risk, and staff need to consider the reasons behind the overdose and following a biopsychosocial assessment, ensure that the young person and family are adequately signposted for future mental health care if needed.
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Affiliation(s)
- John C Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louisa Kelly
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Lucena Clinic, Rathgar, Dublin, Ireland.,Children's Health Ireland, Crumlin, Dublin, Ireland
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Abstract
Research engaging qualitatively with clinical practitioners' understanding of, and response to, self-harm has been limited. Self-harm offers a particularly compelling case through which to examine the enduring challenges faced by practitioners in treating patients whose presenting symptoms are not clearly biomedical in nature. In this paper, we present an analysis of 30 General Practitioners' (GPs') accounts of treating patients who had self-harmed. Our analysis demonstrates the complex ways in which GPs seek to make sense of self-harm. Illustrated through three common 'types' of patients (the 'good girl', the 'problem patient' and the 'out of the blue'), we show how GPs grapple with ideas of 'social' and 'psychological' causes of self-harm. We argue that these tensions emerge in different ways according to the social identities of patients, with accounts shaped by local contexts, including access to specialist services, as well as by cultural understandings regarding the legitimacy of self-harming behaviour. We suggest that studying the social life of self-harm in general practice extends a sociological analysis of self-harm more widely, as well as contributing to sociological theorisation on the doctor-patient relationship.
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Prior JA, Paskins Z, Whittle R, Abdul-Sultan A, Chew-Graham CA, Muller S, Bajpai R, Shepherd TA, Sumathipala A, Mallen CD. Rheumatic Conditions as Risk Factors for Self-Harm: A Retrospective Cohort Study. Arthritis Care Res (Hoboken) 2020; 73:130-137. [PMID: 32526099 DOI: 10.1002/acr.24345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the risk of self-harm in rheumatic conditions. METHODS We conducted a retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis, or rheumatoid arthritis were identified from 1990 to 2016 and matched to patients without these conditions. Incident self-harm was defined by medical record codes following a rheumatic diagnosis. Incidence rates (per 10,000 person-years) were reported for each condition, both overall and year-on-year (2000-2016). Cox regression analysis determined risk (hazard ratio [HR] and 95% confidence interval [95% CI]) of self-harm for each rheumatic cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and sex. Due to nonproportionality over time, osteoarthritis was also stratified by disease duration (<1 year, ≥1 to <5 years, ≥5 to <10 years, and ≥10 years). RESULTS The incidence of self-harm was highest in patients with fibromyalgia (HR 25.12 [95% CI 22.45-28.11] per 10,000 person-years) and lowest for osteoarthritis (HR 6.48 [95% CI 6.20-6.76]). There was a crude association with each rheumatic condition and self-harm, except for ankylosing spondylitis. Although attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06 [95% CI 1.60-2.65]), rheumatoid arthritis (HR 1.59 [95% CI 1.20-2.11]), and osteoarthritis (1 to <5 years HR 1.12 [95% CI 1.01-1.24]; ≥5 to <10 years HR 1.35 [95% CI 1.18-1.54]). Age and sex were weak effect modifiers for these associations. CONCLUSION Primary care patients with fibromyalgia, osteoarthritis, or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self-harm compared to people without these rheumatic conditions. Clinicians need to be aware of the potential for self-harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.
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Affiliation(s)
- James A Prior
- Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Zoe Paskins
- Keele University, Newcastle, and Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | | | | | - Carolyn A Chew-Graham
- Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | | | | | - Athula Sumathipala
- Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust, Stafford, UK
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Online Resources for People Who Self-Harm and Those Involved in Their Informal and Formal Care: Observational Study with Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103532. [PMID: 32443533 PMCID: PMC7277667 DOI: 10.3390/ijerph17103532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022]
Abstract
Despite recent fears about online influences on self-harm, the internet has potential to be a useful resource, and people who self-harm commonly use it to seek advice and support. Our aim was to identify and describe UK-generated internet resources for people who self-harm, their friends or families, in an observational study of information available to people who search the internet for help and guidance. The different types of advice from different websites were grouped according to thematic analysis. We found a large amount of advice and guidance regarding the management of self-harm. The most detailed and practical advice, however, was limited to a small number of non-statutory sites. A lay person or health professional who searches the web may have to search through many different websites to find practical help. Our findings therefore provide a useful starting point for clinicians who wish to provide some guidance for their patients about internet use. Websites change over time and the internet is in constant flux, so the websites that we identified would need to be reviewed before making any recommendations to patients or their families or friends.
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Role of the GP in the management of patients with self-harm behaviour: a systematic review. Br J Gen Pract 2020; 70:e364-e373. [PMID: 32041771 DOI: 10.3399/bjgp20x708257] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/16/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Self-harm is a serious risk factor for suicide, a major public health concern, and a significant burden on the NHS. Rates of self-harm presentation in primary care are rising and GPs interact with patients both before and after they have self-harmed. There is significant public and political interest in reducing rates of self-harm, but there has been no robust synthesis of the existing literature on the role of GPs in the management of patients who self-harm. AIM This study aimed to explore the role of the GP in the management of patients with self-harm behaviour. DESIGN AND SETTING A systematic review and narrative synthesis of primary care literature. METHOD This systematic review was conducted and is reported in line with PRISMA guidance. Electronic databases systematically searched were MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and AMED. Two independent reviewers conducted study screening and selection, data extraction, and quality appraisal of all included studies. Thematic analysis was conducted. RESULTS From 6976 unique citations, 12 studies met eligibility criteria and were included. These 12 studies, published from 1997-2016, of 789 GPs/family medicine physicians from Europe, the US, and Australia were of good methodological quality. Five themes were identified for facilitating GP management of self-harm: GP training, improved communication, service provision, clinical guidelines, and young people. Four barriers for GP management of self-harm were identified: assessment, service provision, local, and systemic factors. CONCLUSION GPs recognise self-harm as a serious risk factor for suicide, but some feel unprepared for managing self-harm. The role of the GP is multidimensional and includes frontline assessment and treatment, referral to specialist care, and the provision of ongoing support.
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Marchant A, Turner S, Balbuena L, Peters E, Williams D, Lloyd K, Lyons R, John A. Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK. Arch Dis Child 2020; 105:347-354. [PMID: 31611193 PMCID: PMC7146921 DOI: 10.1136/archdischild-2019-317248] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10-24 years old in Wales, UK. METHODS A whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented. RESULTS A total of 937 697 individuals aged 10-24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15-19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10-15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty. CONCLUSIONS This is the first study to compare self-harm in people aged 10-24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.
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Affiliation(s)
- Amanda Marchant
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Samantha Turner
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Evyn Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Dave Williams
- Child and Adolescent Psychiatry, Aneurin Bevan Health Board, Newport, UK
| | - Keith Lloyd
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Quinlivan L, Littlewood DL, Webb RT, Kapur N. Patient safety and suicide prevention in mental health services: time for a new paradigm? J Ment Health 2020; 29:1-5. [DOI: 10.1080/09638237.2020.1714013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Donna L. Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Roger T. Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
- Centre for Mental Health and Safety, University of Manchester
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Raymond C, Myers S, Daly R, Murray D, Lyne J. Care Pathways in a Suicide Crisis Assessment Nurse (SCAN) service. Int J Nurs Pract 2019; 26:e12798. [PMID: 31749210 DOI: 10.1111/ijn.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/30/2019] [Accepted: 10/18/2019] [Indexed: 12/14/2022]
Abstract
AIM The Suicide Crisis Assessment Nurse service has been developed as a Primary Care suicide intervention over the last decade. The current study aimed to describe the demographic details of users of this nurse led service, and to evaluate subsequent care pathways following this intervention. METHODS This study was conducted using a retrospective file review with a cross-sectional observational design investigating demographic details of service users and care pathways in a Suicide Crisis Assessment Nurse service within a defined catchment area of Ireland between June 2015 and May 2017. RESULTS The majority of referrals were managed in Primary Care following Suicide Crisis Assessment Nurse intervention. There was an increase in Primary Care management pathway in the second year of the service which was independent of age and gender. CONCLUSION There was an increase in referrals to the service over time, and the majority of presentations were managed in primary care following Suicide Crisis Assessment Nurse intervention. The study suggests that primary care interventions for suicidal crises merit further research.
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Affiliation(s)
- Cora Raymond
- North Dublin Mental Health Services, St. Francis Centre, Station Road, Raheny, Dublin 5, Ireland
| | - Susan Myers
- Dip Psych Nursing CHO 9 DNC&C North Dublin Mental Health Services, St. Ita's Campus, Ireland
| | - Robert Daly
- Royal College of Surgeons in Ireland and North Dublin Mental Health Services, Dublin 9, Ireland
| | | | - John Lyne
- Royal College of Surgeons in Ireland and North Dublin Mental Health Services, Dublin 9, Ireland
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Gorton HC, Webb RT, Carr MJ, DelPozo-Banos M, John A, Ashcroft DM. Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurol 2019; 75:929-938. [PMID: 29630689 DOI: 10.1001/jamaneurol.2018.0333] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported. Objective To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths. Design, Setting, and Participants This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017. Exposures People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions. Main Outcomes and Measures Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths. Results In total, 44 678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy. Conclusions and Relevance Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.
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Affiliation(s)
- Hayley C Gorton
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, MAHSC (Manchester Academic Health Sciences Centre), Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom
| | - Roger T Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester, United Kingdom
| | - Matthew J Carr
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester, United Kingdom
| | | | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, United Kingdom
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, MAHSC (Manchester Academic Health Sciences Centre), Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom
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Bailey D, Kemp L, Wright N, Mutale G. Talk About Self-Harm (TASH): participatory action research with young people, GPs and practice nurses to explore how the experiences of young people who self-harm could be improved in GP surgeries. Fam Pract 2019; 36:621-626. [PMID: 30796781 DOI: 10.1093/fampra/cmz006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of self-harm in young people in primary care is increasing dramatically, and many young people who self-harm visit their GP surgery as a first point of contact for help. OBJECTIVE To explore with young people, GPs and practice nurses (PNs): (i) why young people present with self-harm to primary care and (ii) whether young people, GPs and PNs can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place. METHODS Participatory action research with GPs, PNs and young people employed mixed methods to collect statistical and narrative data. Statistics from 285 young people's medical records were captured, including more detailed analyses of a random sample of 75 of these records. A series of 24 focus groups with a total of 45 GPs, PNs and young people, with an average number of eight participants in each group, was conducted. Statistical data were subject to descriptive and inferential analyses, and thematic analysis was applied to the transcripts from the focus groups. RESULTS AND CONCLUSION The type of self-harm young people presented with influenced whether they would see a GP or PN. While self-help materials were welcomed and deemed helpful, young people, GPs and PNs were ambivalent about using these in short consultations where time was an overriding constraint. More research is needed on the feasibility of adopting self-help assisted interventions in GP surgeries.
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Affiliation(s)
- Di Bailey
- Social Work and Health, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Linda Kemp
- Social Work and Health, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Nicola Wright
- Faculty of Medicine, School of Health Sciences, University of Nottingham, Mental Health and Learning Disabilities Office, Queens Medical Centre, Nottingham, UK
| | - Gabriella Mutale
- Social Work and Health, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Palmer C, Connor C, Channa S, Lavis A, Leung N, Parsons N, Birchwood M. The Development of First-Episode Direct Self-Injurious Behavior and Association with Difficulties in Emotional Regulation in Adolescence. Suicide Life Threat Behav 2019; 49:1266-1280. [PMID: 30178563 DOI: 10.1111/sltb.12512] [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: 06/22/2017] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Self-harm remains a serious public health concern; however, identifying adolescents at risk is challenging. While self-harm has been linked with difficulties in emotional regulation postinjury, comparatively little is known about how such difficulties may impact on the future development of self-harm behavior. METHODS A total of 318 pupils aged 14-15 years completed measures on history of direct self-injurious behavior (D-SIB), emotional regulation, depression, and anxiety at two time points across a six-month period. RESULTS Of 13% (42) of participants reported their first episode of D-SIB over the six-month period and reported increased difficulties with emotional regulation prior to initial D-SIB. Regression analyses found significant associations for emotional regulation and specifically lack of emotional clarity prior to first episode of D-SIB. Lack of emotional awareness and difficulties with impulse control was significantly associated in those with ongoing D-SIB. CONCLUSIONS Prior to first episode of D-SIB, young people may experience difficulty regulating emotions, a difficulty which appears less pronounced following their engagement with D-SIB. Our findings implicate difficulties in the early evaluation and understanding of emotions which may later impair attempts at emotion modulation and increase risk of D-SIB. Such findings might help inform early identification of adolescents at risk of initial D-SIB.
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Affiliation(s)
- Colin Palmer
- Mental Health & Well-being, University of Warwick Medical School, Coventry, UK
| | - Charlotte Connor
- Mental Health & Well-being, University of Warwick Medical School, Coventry, UK
| | - Sunita Channa
- Mental Health & Well-being, University of Warwick Medical School, Coventry, UK
| | - Anna Lavis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Newman Leung
- Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Nick Parsons
- Mental Health & Well-being, University of Warwick Medical School, Coventry, UK
| | - Max Birchwood
- Mental Health & Well-being, University of Warwick Medical School, Coventry, UK
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Gorton HC, Littlewood D, Lotfallah C, Spreadbury M, Wong KL, Gooding P, Ashcroft DM. Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: A qualitative interview study. PLoS One 2019; 14:e0222132. [PMID: 31498831 PMCID: PMC6733435 DOI: 10.1371/journal.pone.0222132] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Suicide prevention is a global priority. Despite the focus on primary care in suicide prevention, little is known about the contributory role of community pharmacists and nothing about the role of the wider community pharmacy team in this area. We aimed to explore the current and potential role of community pharmacy teams in self-harm and suicide prevention. METHODS We conducted one-to-one semi-structured qualitative interviews with community pharmacy staff (pharmacists, pre-registration pharmacists, pharmacy technicians, dispensing/pharmacy assistants, delivery drivers) in the North West of England, UK. We identified themes from the interview transcripts through an iterative process of inductive thematic analysis. RESULTS We conducted twenty-five interviews with community pharmacy staff. Many described examples of helping those who were contemplating suicide or self-harm. No participants had received suicide prevention training. We identified six themes. The first two themes (i) Relationship with Patient and (ii) Pharmacy environment were seen as facilitators, which, if supported by (iii) Training, could underpin the final three themes: (iv) Opportunities for contact, (v) Facilitated referral pathway and (v) Restricting access to means. The distinct lack of training should be overcome with evidence-informed training. Referral pathways should be clear and enable direct and accessible referral by community pharmacy teams. There are opportunities for existing pharmacy services and schemes to be adapted to maximise suicide and self-harm prevention activities. Pharmacy teams did not identify themselves to have a clear role in restricting access to medication. CONCLUSIONS Pharmacy teams already support patients in relation to self-harm and suicide, often relying on their personal experience in the absence of formal training. With the implementation of evidence-informed training and clear referral pathways, this could be done in a more effectively.
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Affiliation(s)
- Hayley C. Gorton
- Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- * E-mail:
| | - Donna Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Christine Lotfallah
- Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Matthew Spreadbury
- Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Kai Ling Wong
- Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Patricia Gooding
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Abstract
INTRODUCTION Intentional self-harm is an international public health issue with high personal, social and financial costs to society. Poor relationship dynamics are known to have a negative influence on the psyche of people who self-harm, and this can increase anxiety and decrease self-esteem, both shown to be significant contributors to self-harm behaviours. Positive and functional social supports have been proposed as a cost-effective and constructive approach in diminishing self-harming behaviours. AIM This qualitative study investigated the aspects of professional, social, familial and romantic relationships that people who have self-harmed identified as having a positive and constructive effect on their self-harm behaviour. METHODS Twelve participants with a history of self-harming behaviours were recruited through free press advertising in primary care and interviewed. The participants ranged in age from 19 to 70 years, and represented New Zealand (NZ) European and Māori from across the Southern region of NZ. RESULTS This study shows that constructive relationships that inhibit self-harm behaviours are characterised by participants' perceptions of authenticity in their relationships, and knowing that other people genuinely care. Feeling cared for within an authentic therapeutic relationship enabled participants to overcome their perception of being damaged selves and gave them the skills and confidence to develop functional relationships within their communities. A relationship-centred care approach may be useful for general practitioners seeking to develop more effective therapeutic relationships with patients who deliberately self-harm.
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Affiliation(s)
- Joanne Rowe
- University of Otago, Department of General Practice and Rural Health, Dunedin, New Zealand
| | - Chrystal Jaye
- University of Otago, Department of General Practice and Rural Health, Dunedin, New Zealand
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Wood S, Marchant A, Allsopp M, Wilkinson K, Bethel J, Jones H, John A. Epidemiology of eating disorders in primary care in children and young people: a Clinical Practice Research Datalink study in England. BMJ Open 2019; 9:e026691. [PMID: 31378721 PMCID: PMC6688704 DOI: 10.1136/bmjopen-2018-026691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Examination of current temporal trends and clinical management patterns of eating disorders (ED) in primary care is lacking. We aimed to calculate annual incidence rates of EDs in primary care by age, sex and deprivation. We also explored the care received through referrals, psychotropic prescriptions and associated secondary care service use. PARTICIPANTS AND SETTINGS A retrospective electronic cohort study was conducted using the Clinical Practice Research Datalink in those aged 11-24 years between 2004 and 2014 in England (n=1 135 038). RESULTS A total of 4775 individuals with a first ever recorded ED diagnosis were identified. The crude incidence rate was 100.1 per 100 000 person years at risk (95% CI 97.2 to 102.9). Incidence rates were highest in females (189.3 per 100 000 person years, 95% CI 183.7 to 195.0, n=4336), 16-20 years of age (141.0 per 100 000 person years, 95% CI 135.4 to 146.9, n=2348) and individuals from the least deprived areas (115.8 per 100 000 person years (95% CI 109.3 to 122.5, n=1203). Incidence rates decreased across the study period (incidence rate ratio (IRR) 0.6, 95% CI 0.5 to 0.8), particularly for individuals with bulimia nervosa (IRR 0.5, 95% CI 0.3 to 0.7) and from the most deprived areas (IRR 0.5, 95% CI 0.4 to 0.7). A total of 17.4% (95% CI 16.3 to 18.5, n=831) of first ever recorded ED cases were referred from primary to secondary care. 27.1% (95% CI 25.9 to 28.4, n=1294) of individuals had an inpatient admission 6 months before or 12 months after an incident ED diagnosis and 53.4% (95% CI 52.0 to 54.9, n=2550) had an outpatient attendance. Antidepressants were the most commonly prescribed psychotropic medication. CONCLUSIONS New ED presentations in primary care are reducing. Understanding the cause of this decrease (coding behaviours, changes in help-seeking or a genuine reduction in new cases) is important to plan services, allocate resources and deliver effective care.
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Affiliation(s)
- Sophie Wood
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Amanda Marchant
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
| | - Mark Allsopp
- Child and Adolescent Psychiatry, Berkshire Healthcare NHS Foundation Trust, England, UK
- NCEPOD, London, UK
| | | | - Jackie Bethel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Hywel Jones
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
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Troya MI, Chew-Graham CA, Babatunde O, Bartlam B, Higginbottom A, Dikomitis L. Patient and Public Involvement and Engagement in a doctoral research project exploring self-harm in older adults. Health Expect 2019; 22:617-631. [PMID: 31131529 PMCID: PMC6737763 DOI: 10.1111/hex.12917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/23/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background The contribution of involving patients and public in health research is widely reported, particularly within mental health research. Less is written about such contributions to doctoral research. The research focus of this doctoral research, self‐harm in older adults, was put forward by a Patient Public Involvement Engagement (PPIE) group, who contributed to its development. Aims Critically reflect on the process, potential impact and identify challenges and opportunities in involving robust PPIE in a doctoral study. Methods Three PPIE members contributed to a systematic review (SR) and a qualitative study through a series of four workshops to meet the aims of the study. PPIE contributed to developing the SR review questions, protocol, data analysis and dissemination of findings. For the qualitative study, they helped develop research questions, protocol, public‐facing documentation, recruitment strategies and data analysis. Involvement followed the GRIPP2‐SF reporting checklist. Results PPIE enhanced methodological rigour, data analysis, interpretation and dissemination of findings. Challenges included lack of ethical guidance, time‐related pressures and ensuring support for PPIE members. These were successfully managed through ongoing dialogue and regular communication. Conclusions PPIE can enhance the quality and depth of doctoral research, as lived experiences shared by PPIE members add to research's components. Exposing early‐career researchers to PPIE can build research cultures sensitive to PPIE's potential contribution and develop the expertise needed to avoid tokenistic involvement. Capturing lay perspectives is essential in mental health research to ensure research findings are accessible and that findings inform clinical practice. However, clear guidance on the ethical dimensions to PPIE is needed.
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Affiliation(s)
- M Isabela Troya
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Midlands Partnership Foundation Trust, Stafford, UK.,West Midlands Collaboration for Leadership in Applied Health Research and Care, Coventry, UK
| | - Opeyemi Babatunde
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
| | - Adele Higginbottom
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Lisa Dikomitis
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,School of Medicine, Keele University, Keele, UK
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Reducing risk following self-harm: the need for careful prescribing. Br J Gen Pract 2019; 69:224-225. [PMID: 31023669 DOI: 10.3399/bjgp19x702317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Mahar AL, Cramm H, Aiken AB, Whitehead M, Tien H, Fear NT, Kurdyak P. A retrospective cohort study comparing non-fatal self-harm emergency department visits between Canadian veterans living in Ontario and matched civilians. Int Rev Psychiatry 2019; 31:25-33. [PMID: 30994372 DOI: 10.1080/09540261.2019.1580685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This was a retrospective cohort study linking provincial administrative databases to compare rates of non-fatal self-harm between CAF and RCMP veterans living in Ontario and age-matched civilians. This study included male veterans who registered for provincial health insurance between 2002 and 2013. A civilian comparator group was matched 4:1 on age and sex. Self-harm emergency department (ED) visits were identified from provincial ED admission records until death or December 31, 2015. Multivariable Poisson regression compared the risk of self-harm. Analyses adjusted for age, geography, income, rurality, and major physical and mental comorbidities. In total, 9514 male veterans and 38,042 age- and sex-matched civilians were included. Overall, 0.55% of veterans had at least one non-fatal self-harm ED visit, compared with 0.81% of civilians. The rate of ED self-harm visits was 40% lower in the veteran population, compared to the civilian population (RR = 0.60; 95% CI = 0.41-0.87). In both groups, psychosocial and physical comorbidities, and death by suicide were more common in those who self-harmed than those who did not. A better understanding of why veterans have a lower rate of self-harm emergency department visits and how it is related to the number of completed suicides is an important area for future consideration.
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Affiliation(s)
- Alyson L Mahar
- a Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Heidi Cramm
- b School of Rehabilitation Therapy , Queen's University , Kingston , Canada
| | | | | | - Homer Tien
- e Canadian Armed Forces , Ottawa , Canada
| | - Nicola T Fear
- f Psychological Medicine , Kings College London , London , UK
| | - Paul Kurdyak
- d IC/ES , Toronto , Canada.,g Centre for Addiction and Mental Health , Toronto , Canada
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