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Grimholt TK, Bonsaksen T, Heir T, Schou Bredal I, Skogstad L, Ekeberg Ø. Prevalence of suicide attempt and associations with deliberate self-harm, mental health problems, drug misuse and traumatic experiences - a cross sectional survey of the Norwegian population. BMC Psychiatry 2024; 24:164. [PMID: 38408936 PMCID: PMC10895832 DOI: 10.1186/s12888-024-05610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Monitoring self-reported suicide attempts (SA) with nationally representative surveys is important to initiate suicide prevention strategies. The aim of the study was to assess the prevalence of SA and compare deliberate self-harm, (DSH), mental health, drug misuse and traumas between SA and non-suicide attempters (NSA). METHODS In this cross-sectional survey of a representative sample (N=1757) of the Norwegian population, we compared people with self-reported SA (n=54) to NSA (n=1703) regarding sociodemographic data, mental health problems, drug misuse and exposure to trauma. RESULTS The prevalence of SA was 3.1 %. There was a higher proportion of welfare recipients and more deliberate self-harm, mental health problems, drug misuse and traumas in the SA group compared to NSA. CONCLUSION This national study confirms the association between suicide attempt and deliberate self-harm, mental health problems, drug misuse and traumas.
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Affiliation(s)
- T K Grimholt
- Faculty of Health, VID Specialized University, Oslo, Norway.
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
| | - T Bonsaksen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Health, Faculty of Health Sciences, VID Specialized University, Stavanger, Norway
| | - T Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - I Schou Bredal
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - L Skogstad
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Ø Ekeberg
- Psychosomatic and Consultation-Liaison psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Rees S, Fry R, Davies J, John A, Condon L. Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study. PLoS One 2023; 18:e0281504. [PMID: 36800353 PMCID: PMC9937479 DOI: 10.1371/journal.pone.0281504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites. METHODS Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University's SAIL Databank, we created a cohort of Traveller site residents aged 11-25 years old, 2010-2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm. RESULTS Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population. CONCLUSIONS Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.
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Affiliation(s)
- Sarah Rees
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Jason Davies
- School of Psychology, Swansea University, Swansea, United Kingdom
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Louise Condon
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
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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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Affiliation(s)
- Katrina Witt
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia.,2 Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo Robinson
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia
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Clapperton AJ. Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1497-1504. [PMID: 31312852 DOI: 10.1007/s00127-019-01747-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors. METHODS A retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015-2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups. RESULTS Within the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married. CONCLUSIONS Preventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.
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Affiliation(s)
- Angela J Clapperton
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, 21 Alliance Lane, Melbourne, VIC, 3800, Australia.
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Cairns R, Brown JA, Wylie CE, Dawson AH, Isbister GK, Buckley NA. Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017. Med J Aust 2019; 211:218-223. [DOI: 10.5694/mja2.50296] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Rose Cairns
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
| | - Jared A Brown
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney NSW
| | | | - Andrew H Dawson
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
- Royal Prince Alfred Hospital Sydney NSW
| | | | - Nicholas A Buckley
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
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Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people? J Psychosom Res 2019; 120:96-101. [PMID: 30929715 DOI: 10.1016/j.jpsychores.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm. METHODS This register study included 16,235 cases in the ages 16-24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome. RESULTS In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year. CONCLUSIONS This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.
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Adolescent personality traits, low self-esteem and self-harm hospitalisation: a 15-year follow-up of the Norwegian Young-HUNT1 cohort. Eur Child Adolesc Psychiatry 2019; 28:329-339. [PMID: 30027416 DOI: 10.1007/s00787-018-1197-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/05/2018] [Indexed: 12/20/2022]
Abstract
Affective disorders are closely related to self-harm and suicidal behaviours. Less is known about how adolescent personality traits and self-esteem influence the development of later self-harm. We examined associations between personality traits such as neuroticism, psychoticism and extroversion, and self-esteem, in adolescence, and the risk of future self-harm hospitalisation. Baseline information from 13 to 19-year-old participants in the Norwegian Young-HUNT1 study in 1995-97 (n = 8965) was linked to endpoint data recorded from participants' hospital records, describing self-harm hospitalisation episodes within the catchment area. Crude and adjusted hazard ratios (HR) were estimated by Cox regression analyses. A one-unit increase on the 0-6 scale for neuroticism was associated with a HR of 1.29, 95% confidence interval (CI) 1.14-1.47. Corresponding HR for psychoticism was 1.30, 95% CI 1.03-1.63 per unit increase, and for extroversion risk was reduced (HR 0.89, 95% CI 0.77-1.04). Positive perception of self-esteem was more strongly associated with reduced risk of self-harm hospitalisation (HR per unit increase on the 0-12 scale was 0.74, 95% CI 0.68-0.82). Additional adjustment for alcohol use and symptoms of combined anxiety and depression symptoms attenuated effect estimates, in particular for neuroticism (HR 1.13, 95% CI 0.96-1.32) and psychoticism (HR 1.07, 95% CI 0.82-1.40). In contrast, self-esteem associations remained largely the same after adjustment. Our results indicate that brief assessments of personality and self-esteem might add additional relevant information, and could be included as a supplement to standard suicidal risk assessment in adolescents.
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Kaeley N, Bhushan B, Subramanyam V, Kumar S, Kabi A. Clinical and demographic characteristics of geriatric patients with acute poisoning in the state of Uttarakhand. J Family Med Prim Care 2019; 8:443-448. [PMID: 30984652 PMCID: PMC6436262 DOI: 10.4103/jfmpc.jfmpc_420_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Acute poisoning in geriatric age group is a clinical challenge due to multiple comorbidities and complications in this age group. There are very few studies done in the past, which have addressed this issue. Materials and Methods: This retrospective observational study was a carried out in the Department of Emergency Medicine of a tertiary care hospital of Uttarakhand over a period of 1 year from November 2017 to October 2018. Detailed demographic data and clinical history of patients with alleged history of acute poisoning was obtained from the hospital record section. Results: During the period of 1 year, 156 patients of acute poisoning attended the medical emergency department, of which 53 (33.9%) patients belonged to geriatric age group (>60 years). Maximum number of patients belonged to the age group of 71–80 years (n = 26, 16.6%). Males outnumbered female patients. The most common toxidrome in geriatric age group was alcohol intoxication followed by pesticide (organophosphorus) poisoning. Unintentional exposure of toxin in the form of drug over dosage encompassed more than one-third of poisonings in geriatric population. Nine (16.9%) geriatric patients succumbed to poisoning. Complications such as acute renal failure, shock, respiratory distress, acute liver injury, and need for ventilator support were more common in nonsurvivors as compared with survivors. Conclusion: The study demonstrated mortality of 16.9% (n = 9) among geriatric patients with alleged history of acute poisoning. The risk factors attributing to mortality were shock, aspiration pneumonia, and acute liver injury. Although cases of suicidal exposure outnumbered cases of unintentional exposure, the latter group comprised of a considerable number. Clearly, more attention is needed while managing a case of acute poisoning of geriatric age group as their pattern of presentation and complications differ from that of younger age group.
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Affiliation(s)
- Nidhi Kaeley
- Department of Emergency Medicine, AIIMS Rishikesh Campus, Uttrakhand, India
| | - Bharat Bhushan
- Department of Emergency Medicine, AIIMS Rishikesh Campus, Uttrakhand, India
| | | | - Subodh Kumar
- Department of Emergency Medicine, AIIMS Rishikesh Campus, Uttrakhand, India
| | - Ankita Kabi
- Department of Emergency Medicine, AIIMS Rishikesh Campus, Uttrakhand, India
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Abstract
Aims and MethodThis is an audit of 10 359 calls made to the national mental health helpline SANELINE between January 1996 and June 1998 aiming at describing the profile of suicidal callers.ResultsMore calls were by, or about, women. The most common age group for suicidal callers was 25–34 years, while those under 25 were least likely to call the helpline. Fifty-five per cent of all calls related to people suffering from depression, and 31% were for people with psychosis. The majority of sufferers who were planning suicide or were in the act of suicide at the time of the call were in contact with services, and almost three-fifths of sufferers reported problems with services.Clinical ImplicationsThere is an urgent need for innovative interventions targeting males and those under 25 years of age.
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Slinn R, King A, Evans J. A national survey of the hospital services for the management of adult deliberate self-harm. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.25.2.53] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodServices were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England.ResultsResponses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group.Clinical ImplicationsStandards for deliberate self-harm services fall substantially below existing national guidelines, particularly in the areas of planning and training.
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Abstract
The need for specific psychiatric services for women has been debated by many practitioners involved in care delivery and management of women with differing degrees of mental health problems.
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Lepping P, Woodworth B, Roberts L, Turner J. Increasing psychosocial assessment by introducing a self-harm pathway. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.5.169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.ResultsAfter the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.Clinical ImplicationsThe introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.
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Prasad V, Owens D. Using the internet as a source of self-help for people who self-harm. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.25.6.222] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo describe the information and help available on the internet for people who self-harm. We searched the internet using a meta-search engine. We visited sites and followed up links with e-mails and letters. We also searched bibliographic databases, seeking published material about the internet and self-harm.ResultsThe support that we found largely took the form of information about suicide, self-injury and psychological issues. Less often, sites offered e-mail support and online discussions. We found little information about self-poisoning, and most about self-injury. There is little published research about self-harm and the internet.Clinical ImplicationsThe unregulated sites of the internet contain much material about self-injury. Although it is not possible at present to weigh up risks and benefits, many individuals and organisations plainly regard internet information about self-harm as a valuable service.
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Leslie SJ, Greig L, Mackie R, Gotz M, Morrison D. A survey of admissions following self-poisoning. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.8.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodPatients who self-poison are at increased risk of future self-poisoning and early death. Admission patterns and effective treatment strategies are unclear although psychosocial assessment may reduce readmissions. This study aimed to determine admission patterns and the proportion of patients receiving a psychiatric assessment in 4220 consecutive admissions.ResultsThe average age was 34 years (s.d.=13, range 13–94); most were female (56 v. 44%, P<50.001). Twelve per cent of patients were aged 13–18 years, again the majority were female (70 v. 30%, P<50.001). Twenty per cent of patients had multiple admissions, accounting for 42% of the total admissions. There were slightly more admissions per day at the weekend (Friday, Saturday and Sunday; P<0.002). As many as 245 patients were either not referred or ‘self-discharged’ before they were assessed by the liaison psychiatry service.Clinical ImplicationsThese findings may help target medical resources, suggesting that consistent numbers of staff are required during all days of the week.
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Weston SN. Comparison of the assessment by doctors and nurses of deliberate self-harm. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.27.2.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.ResultsThere was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).Clinical ImplicationsFurther research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.
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Thomassin K, Quint E, Sezlik S, Shaffer A. Profiles of Emotion Deficits and Adolescent Nonsuicidal Self-Injury in an Inpatient Sample. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2017; 27:752-764. [PMID: 29152867 DOI: 10.1111/jora.12312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined profiles of specific emotion deficits, including poor emotion awareness, reluctance to express emotion, sadness inhibition and dysregulation, and anger inhibition and dysregulation. Self-report questionnaires assessed adolescents' emotion skills and nonsuicidal self-injury (NSSI) engagement, frequency, severity, methods, and age of onset. Latent profile analysis yielded a three-profile solution: Low Deficit (LD; n = 49), Unaware/Anger Dysregulated (UAD; n = 24), and Anger Inhibited (AI; n = 20) profiles. Adolescents in the UAD profile were more likely to engage in NSSI, displayed a higher NSSI frequency, and reported a higher number of NSSI methods when compared to adolescents in the LD profile. No links emerged for NSSI severity or age of onset.
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Mitchell AJ, Hussain S, Leaver J, Rajan C, Jones A, Malcolm N, Coats T. Is there a difference between hospital-verified and self-reported self-harm? Implications for repetition. Gen Hosp Psychiatry 2016; 43:12-16. [PMID: 27796251 DOI: 10.1016/j.genhosppsych.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/20/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Repeated intentional self-harm (SH) is associated with economic costs and increased risk of suicide. Estimates of repetition vary according to method of data capture and are limited by short periods of follow-up observation. Some sources use hospital records and others self-reported SH (SRSH). Our aim was to examine the relationship between SRSH and hospital-verified SH (HVSH) and later repetition of SH (predictive validity). We also aimed to examine whether rates of SH repetition differ between first-time presenters and non-first-time presenters using either definition of SH. METHOD We conducted a large prospective study tracking SH attempts through an Accident and Emergency (A&E) department within the United Kingdom. We took a representative sample of 774 patients (30% of total who reported SH) and followed them for 5.6 years on average. The index episode of SH was recorded at the time of referral to staff in A&E. Prior episodes of SH were determined from an electronic search of A&E patient database, and in addition, recollection of prior SH as reported by the patient to their clinician at the time of index presentation was recorded. RESULTS Across the whole sample 32.0% of patients repeated SH within 1 year, which rose to 54.1% at completion of follow-up. Repetition rates were considerably higher in patients with a prior SH history than those presenting with a first SH episode after 1 year (47.9% vs. 19.6%) and by the end of follow-up (73.8% vs. 39.4%) (P<.001). Of 411 with self-reported first presentations, 45.2% repeated over the study period. In terms of predictive validity, 65.2% of those with previous SRSH repeated vs. 73.8% with previous HVSH (P<.001). There was low agreement between SRSH and HVSH (Kappa=0.353, 95% confidence interval 0.287-0.419, low). CONCLUSIONS We found relatively poor agreement between hospital-defined and self-reported SH. A total of 62.8% of those who denied SH actually had a hospital-verified previous episode. Patients with recorded prior SH and those who recall previous SH have significantly higher rates of repetition, but the two samples imprecisely overlap and predictive validity is stronger for HVSH.
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Affiliation(s)
| | | | | | | | | | | | - Tim Coats
- Leicester Royal Infirmary, Department of Emergency medicine
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Idenfors H, Strömsten LMJ, Renberg ES. Non-psychiatric inpatient care preceding admission for self-harm in young people. J Psychosom Res 2016; 88:8-13. [PMID: 27521645 DOI: 10.1016/j.jpsychores.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm. METHODS From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for having been admitted with different diagnoses during the year preceding the self-harm admission. RESULTS The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma. CONCLUSION Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.
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Affiliation(s)
- Hans Idenfors
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
| | - Lotta M J Strömsten
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
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Rafnsson SB, Oliver JJ, Elton RA, Bateman DN. Poisons admissions in Edinburgh 1981-2001: agent trends and predictors of hospital readmissions. Hum Exp Toxicol 2016; 26:49-57. [PMID: 17334179 DOI: 10.1177/0960327107071855] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-poisoning is a major public health problem. This study describes patterns of admissions and readmissions from self-poisoning to the Royal Infirmary of Edinburgh from 1981 to 2001. A database on hospital discharges with a diagnosis (ICD-9/10) of poisoning between 1981 and 2001 was used. Annual admissions were described for seven main drug categories, and proportions of patients readmitted within 1-5 years from first admission, were computed for each category. Cox proportional hazards regression was used to evaluate prognostic factors for readmission risk over 1981-2001. For both sexes, admissions increased from the early to mid 1990s, and declined thereafter. The proportion readmitted varied with the drug taken at first admission, from 11.9% (95% CI: 10.8-13%) for non-opiate analgesics, to 17.6% (16.5-18.7%) for benzodiazepines. Deprivation was positively related to readmission risk after first admissions with paracetamol (P<0.001) and benzodiazepines (P<0.001). Timing of first admissions involving paracetamol (P<0.01), benzodiazepines (P<0.001), antidepressants (P<0.001), non-opiate analgesics (P<0.001), and opiates (P<0.05), was inversely associated with readmission risk. In patients admitted for drug overdose, readmission risk is influenced by type of drug taken at first admission. Information on drug type used in self-poisoning may assist in identifying patients at risk for future events, and in reducing hospital read-missions.
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Affiliation(s)
- S B Rafnsson
- Department of Public Health Sciences, University of Edinburgh Medical School, Teviot Place, EH8 9AG, Edinburgh, UK.
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21
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Prevalence and Correlates of Self-Harm in the German General Population. PLoS One 2016; 11:e0157928. [PMID: 27362348 PMCID: PMC4928828 DOI: 10.1371/journal.pone.0157928] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/07/2016] [Indexed: 11/23/2022] Open
Abstract
The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2= 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more depth.
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22
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Young people who self-harm: a prospective 1-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:171-81. [PMID: 26607729 PMCID: PMC4748007 DOI: 10.1007/s00127-015-1149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 11/08/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore repetition, service provision and service engagement following presentation of young people to emergency services with self-harm. METHODS 969 patients who presented to accident and emergency services after self-harm were followed up prospectively for a period of 1 year. Data on rates, method, clinical history, initial service provision, engagement and repetition (defined as re-presenting to emergency services with further self-harm) were gathered from comprehensive electronic records. RESULTS Young people were less likely to repeat self-harm compared to those aged 25 and above. A psychiatric history and a history of childhood trauma were significant predictors of repetition. Young people were more likely to receive self-help as their initial service provision, and less likely to receive acute psychiatric care or a hospital admission. There were no differences in engagement with services between young people and those aged 25 and above. CONCLUSION Younger individuals may be less vulnerable to repetition, and are less likely to represent to services with repeated self-harm. All young people who present with self-harm should be screened for mental illness and asked about childhood trauma. Whilst young people are less likely to be referred to psychiatric services, they do attend when referred. This may indicate missed opportunity for intervention.
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Abstract
Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007-2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6-8 or 8-13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.
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Cross S, Bhugra D, Dargan PI, Wood DM, Greene SL, Craig TKJ. Ethnic differences in self-poisoning across South London. CRISIS 2015; 35:268-72. [PMID: 25113891 DOI: 10.1027/0227-5910/a000258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK's most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. AIMS To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. METHOD All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. RESULTS A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. CONCLUSION Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.
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Affiliation(s)
- Sean Cross
- Department of Psychological Medicine, St. Thomas' Hospital, London, UK
| | - Dinesh Bhugra
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Paul I Dargan
- Department of Clinical Toxicology, St. Thomas' Hospital, London, UK
| | - David M Wood
- Department of Clinical Toxicology, St. Thomas' Hospital, London, UK
| | - Shaun L Greene
- Department of Clinical Toxicology, St. Thomas' Hospital, London, UK
| | - Tom K J Craig
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
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25
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Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, House A, van Heeringen K. WITHDRAWN: Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database Syst Rev 2015; 2015:CD001764. [PMID: 26436718 PMCID: PMC10759787 DOI: 10.1002/14651858.cd001764.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This review has been withdrawn because the topic has been split into three separate reviews, one on psychosocial interventions for self‐harm in adults; another on interventions for self‐harm in children and adolescents; and a third on pharmacological interventions for self‐harm in adults. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Keith Hawton
- Warneford HospitalCentre for Suicide Research, University Department of PsychiatryOxfordUKOX3 7JX
| | - Ellen Townsend
- University of NottinghamSelf‐Harm Research Group, School of PsychologyUniversity ParkNottinghamUKNG7 2RD
| | - Ella Arensman
- University College CorkNational Suicide Research Foundation and Department of Epidemiology and Public HealthCorkIreland
| | - David Gunnell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PR
| | - Philip Hazell
- Sydney Medical SchoolDiscipline of PsychiatryG03 ‐ Thomas Walker HospitalHospital RdConcord WestNew South WalesAustralia2138
| | - Allan House
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Kees van Heeringen
- Ghent UniversityUnit for Suicide Research, Department of Psychiatry and Medical PsychologyGhentBelgium9000
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26
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Islam MA, Steiger H, Jimenez-Murcia S, Israel M, Granero R, Agüera Z, Castro R, Sánchez I, Riesco N, Menchón JM, Fernández-Aranda F. Non-suicidal Self-injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender. EUROPEAN EATING DISORDERS REVIEW 2015; 23:553-60. [DOI: 10.1002/erv.2374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A. Islam
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Susana Jimenez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Zaida Agüera
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Rita Castro
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
- Ciber Salud Mental (CIBERSAM); Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
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Hawton K, Haw C, Casey D, Bale L, Brand F, Rutherford D. Self-harm in Oxford, England: epidemiological and clinical trends, 1996-2010. Soc Psychiatry Psychiatr Epidemiol 2015; 50:695-704. [PMID: 25488606 DOI: 10.1007/s00127-014-0990-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 11/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-harm is a major healthcare problem and changes in its prevalence and characteristics can have important implications for clinical services, treatment and prevention. METHODS We analysed data on all self-harm presentations to the general hospital in Oxford between 1996 and 2010 using the Oxford Monitoring System for Self-harm. We investigated trends in prevalence, methods and repetition of self-harm, and receipt of psychosocial assessment. For patients receiving a psychosocial assessment, we investigated trends in alcohol use and misuse, prior psychiatric treatment and self-harm, problems, and suicidal intent. RESULTS Rates of self-harm rose in both genders between 1996 and 2002/2003, after which they declined. There was evidence of a possible cohort effect, whereby higher rates in younger males in earlier years transferred over time to older age groups. Self-cutting, hanging and jumping became more common. Paracetamol was involved in 44.9 % of all self-poisoning episodes. Overdoses of antidepressants (particularly selective serotonin reuptake inhibitors) increased, as did those of mood stabilisers, non-opiate analgesics excluding paracetamol (e.g. non-steroidal anti-inflammatory drugs), and non-ingestible poisons. Alcohol use in relation to self-harm and alcohol-related problems became more common, as did history of prior psychiatric treatment and, especially, of self-harm, and employment problems from 2008. Despite national guidance, the proportion of patients undergoing psychosocial assessment declined. CONCLUSIONS Major changes in the extent and nature of self-harm occurred over the study period, some suggestive of increased psychopathology and others reflecting prescribing practices and changes in drinking patterns. The findings emphasise the need for psychosocial assessment following self-harm, to identify treatment needs and reduce repetition.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK,
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28
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Rowe SL, French RS, Henderson C, Ougrin D, Slade M, Moran P. Help-seeking behaviour and adolescent self-harm: a systematic review. Aust N Z J Psychiatry 2014; 48:1083-95. [PMID: 25335872 DOI: 10.1177/0004867414555718] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Self-harm is common in adolescence, but most young people who self-harm do not seek professional help. The aim of this literature review was to determine (a) the sources of support adolescents who self-harm access if they seek help, and (b) the barriers and facilitators to help-seeking for adolescents who self-harm. METHOD Using a pre-defined search strategy we searched databases for terms related to self-harm, adolescents and help-seeking. Studies were included in the review if participants were aged 11-19 years. RESULTS Twenty articles met criteria for inclusion. Between a third and one half of adolescents who self-harm do not seek help for this behaviour. Of those who seek help, results showed adolescents primarily turned to friends and family for support. The Internet may be more commonly used as a tool for self-disclosure rather than asking for help. Barriers to help-seeking included fear of negative reactions from others including stigmatisation, fear of confidentiality being breached and fear of being seen as 'attention-seeking'. Few facilitators of help-seeking were identified. CONCLUSIONS Of the small proportion of adolescents who seek help for their self-harm, informal sources are the most likely support systems accessed. Interpersonal barriers and a lack of knowledge about where to go for help may impede help-seeking. Future research should address the lack of knowledge regarding the facilitators of help-seeking behaviour in order to improve the ability of services to engage with this vulnerable group of young people.
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Affiliation(s)
- Sarah L Rowe
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Rebecca S French
- London School of Hygiene and Tropical Medicine, Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London, UK
| | - Claire Henderson
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Dennis Ougrin
- King's College London, Child and Adolescent Psychiatry Department, Institute of Psychiatry, London, UK
| | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Paul Moran
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
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Pavarin RM, Fioritti A, Fontana F, Marani S, Paparelli A, Boncompagni G. Emergency Department Admission and Mortality Rate for Suicidal Behavior. CRISIS 2014; 35:406-14. [DOI: 10.1027/0227-5910/a000282] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.
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Affiliation(s)
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
| | | | - Silvia Marani
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
| | | | - Giancarlo Boncompagni
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy
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30
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The role of the general dental practitioner in managing patients who self-harm. Br Dent J 2014; 217:503-6. [DOI: 10.1038/sj.bdj.2014.955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 11/08/2022]
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Horton M, Wright N, Dyer W, Wright-Hughes A, Farrin A, Mohammed Z, Smith J, Heyes T, Gilbody S, Tennant A. Assessing the risk of self-harm in an adult offender population: an incidence cohort study. Health Technol Assess 2014; 18:1-151, vii-viii. [PMID: 25348581 DOI: 10.3310/hta18640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-harm is common among prisoners, particularly female prisoners. In 2007, concerned about the rising incidence, the prison service introduced a care-planning system called Assessment, Care in Custody, and Teamwork (ACCT). To date, it does not incorporate a standardised diagnostic test to estimate the risk of future self-harm. OBJECTIVE To identify potential screening instruments, or items from those instruments, to predict the risk of self-harm among prisoners. PARTICIPANTS Prisoners who had been assigned to an ACCT during the recruitment period. DESIGN A multistage prospective cohort study. Following a pilot study, instruments were administered to prisoners by interview at baseline, and followed up for 6 months (or until point of release if this was sooner) to ascertain self-harm status. Instruments were assessed for unidimensionality, scalability (Mokken) and quantitative structure (Rasch). Area under the curve (AUC) analysis was used to examine the ability of instruments and/or their items to predict future self-harm. Cox proportional hazards regression models were used to examine the multivariate predictive ability of the scales and various sociodemographic and sentencing factors. SETTING Three prisons (including one women's prison) in northern England. MAIN OUTCOME MEASURES A set of standardised questionnaires, including the Prison Screening Questionnaire (PriSnQuest), Revised Borderline Symptom List-23 (frequency-based responses) (BSL-23-F), Self-Harm Inventory (SHI), Patient Health Questionnaire (PHQ-9) and the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with sociodemographic and sentencing data. RESULTS In total, 450 prisoners consented to participate in the study, of whom 26% were female. The mean age of participants was 31.2 years. Over half of male prisoners recruited were on remand, compared with just over one-fifth (22.6%) of female prisoners. The average tariff of those sentenced was 41 months, of which 14.7 months, on average, had been served. Just over one-third of ACCTs had been initiated because of a known self-harm event, and over one-quarter (27.8%) of participants self-harmed during the follow-up period. Thus, almost half (46.7%) of those entered into the study were reported to have self-harmed, either from their index ACCT, or subsequently, or both. Cutting was the most frequent behaviour (51%). All screening instruments showed some evidence of unidimensionality, and four out of five showed scaling criteria consistent with ordinal scaling, so verifying the validity of the cut points. However, many showed gender bias and failure to fit the Rasch measurement model. While a resolution was made in most cases, both ordinal raw scores and latent interval scale estimates failed to show predictive value when applied within AUC analysis (0.491-0.566) or adjusted Cox proportional hazards models. However, good predictive values were shown for gender-specific sets of items, thus providing easily applied screening indexes. CONCLUSIONS While four out of five potential screening instruments were found to have acceptable psychometric properties within this setting, their predictive validity of all instruments was poor under AUC analysis. Gender-specific item sets were put together to form two screening indexes with formative indicators which gave reasonable AUC values, particularly so for females. The indexes provide identification of low-medium-high risk of self-harm, and so may help to inform potential care pathways and decisions to sign prisoners off from the ACCT. Future work should concentrate on refining a set of predictive screening items among different offender populations and investigating the time point at which this set of items should be administered. Future work may also look at the different magnitudes of risk as indicators for care pathways. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mike Horton
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Nat Wright
- HMP Leeds Health Care Department, Leeds, UK
| | - Wendy Dyer
- Department of Sociology and Criminology, University of Durham, , UK
| | - Alex Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Jamie Smith
- North East Offender Health Commissioning Unit, Durham University Science Park, County Durham, UK
| | - Tom Heyes
- Brampton Primary Care Medical Centre, Rotherham, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Alan Tennant
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Carroll R, Metcalfe C, Gunnell D. Hospital management of self-harm patients and risk of repetition: systematic review and meta-analysis. J Affect Disord 2014; 168:476-83. [PMID: 25128754 DOI: 10.1016/j.jad.2014.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/21/2014] [Accepted: 06/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking. METHODS We undertook a systematic review to investigate whether between study differences in reported clinical management of self-harm patients were associated with the risk of repeat self-harm and suicide. RESULTS Altogether 64 prospective studies were identified that described the clinical care of self-harm patients and the incidence of repeat self-harm and suicide. The proportion of a cohort psychosocially assessed was not associated with the recorded incidence of repeat self-harm or suicide; the incidence of repeat self-harm was 16.7% (95% CI 13.8-20.1) in studies in the lowest tertile of assessment levels and 19.0% (95% CI 15.7-23.0) in the highest tertile. There was no association of repeat self-harm with differing levels of hospital admission (n=47 studies) or receiving specialist follow-up (n=12 studies). In studies reporting on levels of hospital admission and suicide (n=5), cohorts where a higher proportion of patients were admitted to a hospital bed reported a lower incidence of subsequent suicide (0.6%, 95% CI 0.5-0.8) compared to cohorts with lower levels of admission (1.9%, 95% CI 1.1-3.2). LIMITATIONS In some analyses power was limited due to the small number of studies reporting the exposures of interest. Case mix and aspects of care are likely to vary between studies. DISCUSSION There is little clear evidence to suggest routine aspects of self-harm patient care, including psychosocial assessment, reduce the risk of subsequent suicide and repeat self-harm.
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Affiliation(s)
- R Carroll
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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Abstract
AbstractObjectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.
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Thomas KH, Davies N, Metcalfe C, Windmeijer F, Martin RM, Gunnell D. Validation of suicide and self-harm records in the Clinical Practice Research Datalink. Br J Clin Pharmacol 2014; 76:145-57. [PMID: 23216533 PMCID: PMC3703237 DOI: 10.1111/bcp.12059] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022] Open
Abstract
AIMS The UK Clinical Practice Research Datalink (CPRD) is increasingly being used to investigate suicide-related adverse drug reactions. No studies have comprehensively validated the recording of suicide and nonfatal self-harm in the CPRD. We validated general practitioners' recording of these outcomes using linked Office for National Statistics (ONS) mortality and Hospital Episode Statistics (HES) admission data. METHODS We identified cases of suicide and self-harm recorded using appropriate Read codes in the CPRD between 1998 and 2010 in patients aged ≥15 years. Suicides were defined as patients with Read codes for suicide recorded within 95 days of their death. International Classification of Diseases codes were used to identify suicides/hospital admissions for self-harm in the linked ONS and HES data sets. We compared CPRD-derived cases/incidence of suicide and self-harm with those identified from linked ONS mortality and HES data, national suicide incidence rates and published self-harm incidence data. RESULTS Only 26.1% (n = 590) of the 'true' (ONS-confirmed) suicides were identified using Read codes. Furthermore, only 55.5% of Read code-identified suicides were confirmed as suicide by the ONS data. Of the HES-identified cases of self-harm, 68.4% were identified in the CPRD using Read codes. The CPRD self-harm rates based on Read codes had similar age and sex distributions to rates observed in self-harm hospital registers, although rates were underestimated in all age groups. CONCLUSIONS The CPRD recording of suicide using Read codes is unreliable, with significant inaccuracy (over- and under-reporting). Future CPRD suicide studies should use linked ONS mortality data. The under-reporting of self-harm appears to be less marked.
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Affiliation(s)
- Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Giner L, Blasco-Fontecilla H, Mercedes Perez-Rodriguez M, Garcia-Nieto R, Giner J, Guija JA, Rico A, Barrero E, Luna MA, de Leon J, Oquendo MA, Baca-Garcia E. Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison. J Affect Disord 2013; 151:474-483. [PMID: 23859005 DOI: 10.1016/j.jad.2013.06.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.
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Affiliation(s)
- Lucas Giner
- Department of Psychiatry, University of Seville, Seville, Spain
| | | | - M Mercedes Perez-Rodriguez
- Department of Psychiatry, Mount Sinai School of Medicine, and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center New York, NY, USA
| | - Rebeca Garcia-Nieto
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, IIS, CIBERSAM, Madrid, Spain
| | - Jose Giner
- Department of Psychiatry, University of Seville, Seville, Spain
| | - Julio A Guija
- Department of Psychiatry, University of Seville, Seville, Spain; Department of Psychiatry, Institute of Legal Medicine, Seville, Spain
| | - Antonio Rico
- Department of Pathology, Institute of Legal Medicine, Seville, Spain
| | - Enrique Barrero
- Department of Pathology, Institute of Legal Medicine, Seville, Spain
| | - Maria Angeles Luna
- Department of Pathology, Institute of Legal Medicine, Ciudad Real and Toledo, Toledo, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, IIS, CIBERSAM, Madrid, Spain; Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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Gunnell D, Hawton K, Bennewith O, Cooper J, Simkin S, Donovan J, Evans J, Longson D, O'Connor S, Kapur N. A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
ObjectivesTo carry out a programme of linked research studies aimed at improving the management of self-harm, reducing the incidence of suicide and providing reliable data to evaluate the impact of theNational Suicide Prevention Strategy for England(2002).MethodsThere were four research streams: (1) we studied inquest records from 12 coroners and Ministry of Justice data to assess the accuracy of official suicide statistics; (2) we used Office for National Statistics mortality statistics, data from the Multicentre Study of Self-harm in England, national liver unit data, prescription data and patient interviews to assess (a) the impact of paracetamol (acetaminophen) pack size restrictions (1998), (b) the impact of withdrawal of co-proxamol in 2007 and (c) the relative toxicity in overdose of commonly used antidepressants; (3) we carried out 3-month audits of self-harm management in 32 hospitals to investigate variations between hospitals and the impact of management on repeat self-harm; and (4) we developed and piloted letter-based contact interventions aimed at reducing self-harm.Key findings(1) Between 1990 and 2005, the proportion of researcher-defined suicides given a verdict of suicide by the 12 coroners studied decreased by almost 7%, largely because of the increased use of misadventure/accident verdicts for deaths thought, on clinical review, to be suicides. Use of narrative verdicts increased markedly. Coroners who gave more narrative verdicts also gave fewer suicide verdicts, and geographical variations in the use of narrative verdicts appeared to distort reliable assessment of small-area differences in suicide rates. 2(a) UK legislation to reduce pack sizes of paracetamol was followed by a 43% reduction in number of deaths and a 61% reduction in registrations for liver transplantation over the next 11 years. Paracetamol overdoses were often impulsive and some were influenced by media (including the internet); sales outlets appeared mostly to be adhering to sales guidance. Smaller pack sizes of paracetamol for sale in Ireland compared with England did not result in a smaller number of tablets being taken in overdose. There was no clear evidence of an effect of the legislation on prescribing of non-steroidal anti-inflammatory drugs, nor on resulting gastrointestinal bleeds. 2(b) Withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010 based on previous trends, with no evidence of substitution by poisoning with other analgesics. 2(c) Of the tricyclic antidepressants, dosulepin and doxepin had the greatest toxicity. Citalopram was more toxic than other selective serotonin reuptake inhibitors. (3) There was marked variation between hospitals in the management of self-harm; effects of this variation on patient outcomes were unclear, although psychosocial assessment may have been associated with reduced repetition. Levels of specialist assessment remained static between 2001–2 and 2010–11, but service quality appeared to improve. (4) Findings of two pilot randomised controlled trials suggested that, although it would be feasible to scale up these interventions to full trials, these interventions might have low generalisability and be of limited benefit to patients.ConclusionWithin the context of the strengths and limitations of the individual studies, this research programme has made significant additions to the evidence base related to suicide and self-harm prevention in the UK.Study registrationA pilot study of a contact and information based intervention to reduce repeat self-harm; ISRCTN65171515.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - O Bennewith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Cooper
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - S Simkin
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - J Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Evans
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
| | - D Longson
- Manchester Mental Health and Social Care Trust, Manchester, UK
| | - S O'Connor
- Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
| | - N Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
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Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, Gunnell D, Kapur N. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ 2013; 346:f403. [PMID: 23393081 PMCID: PMC3567205 DOI: 10.1136/bmj.f403] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the long term effect of United Kingdom legislation introduced in September 1998 to restrict pack sizes of paracetamol on deaths from paracetamol poisoning and liver unit activity. DESIGN Interrupted time series analyses to assess mean quarterly changes from October 1998 to the end of 2009 relative to projected deaths without the legislation based on pre-legislation trends. SETTING Mortality (1993-2009) and liver unit activity (1995-2009) in England and Wales, using information from the Office for National Statistics and NHS Blood and Transplant, respectively. PARTICIPANTS Residents of England and Wales. MAIN OUTCOME MEASURES Suicide, deaths of undetermined intent, and accidental poisoning deaths involving single drug ingestion of paracetamol and paracetamol compounds in people aged 10 years and over, and liver unit registrations and transplantations for paracetamol induced hepatotoxicity. RESULTS Compared with the pre-legislation level, following the legislation there was an estimated average reduction of 17 (95% confidence interval -25 to -9) deaths per quarter in England and Wales involving paracetamol alone (with or without alcohol) that received suicide or undetermined verdicts. This decrease represented a 43% reduction or an estimated 765 fewer deaths over the 11¼ years after the legislation. A similar effect was found when accidental poisoning deaths were included, and when a conservative method of analysis was used. This decrease was largely unaltered after controlling for a non-significant reduction in deaths involving other methods of poisoning and also suicides by all methods. There was a 61% reduction in registrations for liver transplantation for paracetamol induced hepatotoxicity (-11 (-20 to -1) registrations per quarter). But no reduction was seen in actual transplantations (-3 (-12 to 6)), nor in registrations after a conservative method of analysis was used. CONCLUSIONS UK legislation to reduce pack sizes of paracetamol was followed by significant reductions in deaths due to paracetamol overdose, with some indication of fewer registrations for transplantation at liver units during the 11 years after the legislation. The continuing toll of deaths suggests, however, that further preventive measures should be sought.
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Affiliation(s)
- Keith Hawton
- University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, UK
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Suicidal Career in Severe Depression among Long-Term Survivors: In a Followup after 37-53 Years Suicide Attempts Appeared to End Long before Depression. DEPRESSION RESEARCH AND TREATMENT 2013; 2013:610245. [PMID: 24455226 PMCID: PMC3884969 DOI: 10.1155/2013/610245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
Abstract
Objective. To describe the suicidal career in the long-term course of severe depression. Subjects and Method. Seventy-five former in-patients were interviewed by telephone about course of depression and suicide attempts 37-53 years after index admission. Medical records were read in many cases. Results. 29 subjects had attempted suicide, 13 repeated, 10 made severe, and 13 violent attempts. The risk of suicide attempt decreased by 10% for every decade spent depressed. Suicide attempts were made early in course of depression, and more time was spent depressed after suicide attempts than before. Conclusions. A healing process of the suicidal career, which may occur long before the end of the last depressive episode (sometimes decades), is proposed.
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Brådvik L. Last suicide attempt before completed suicide in severe depression: an extended suicidal process may be found in men rather than women. Arch Suicide Res 2013; 17:426-33. [PMID: 24224675 DOI: 10.1080/13811118.2013.803003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to compare the time from last suicide attempt to suicide in men and women with major depressive disorder with melancholic and/or psychotic features. The case records of 100 suicide victims with severe depression were evaluated. All suicide attempts during the course of depression were noted. The time from last suicide attempt to suicide was compared as well as the occurrence of suicide attempt during the last depressive episode, by gender. Male suicide attempters made fewer suicide attempts than women during their last depressive episode before suicide (8% versus 37%). Men appeared to have a more extended suicidal process from suicide attempt to completed suicide, which ought to be considered in the after-care.
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Affiliation(s)
- Louise Brådvik
- a Department of Clinical Sciences, Division of Psychiatry , Lund University , Lund , Sweden
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Abstract
BACKGROUND Attempted suicide is a common clinical problem in a general hospital setting. It has a serious clinical and socio-economical impact too. AIMS To study the psychosocial, psychiatric, and personality profile of the first suicide attempters in a general hospital. SETTINGS AND DESIGN Cross-sectional, hospital-based, descriptive study. MATERIALS AND METHODS All the consecutive cases of first suicide attempt (n=100) treated in a general hospital were studied to know the clinical profile. Variables related to socio-demographic characteristics, family background, suicide characteristics, psychiatric morbidity, and comorbidity were analyzed. Risk-Rescue rating was applied to know the medical seriousness of the suicide attempt. Presumptive stressful life event scale was utilized to calculate life events score. Structured clinical interview (MINI Plus) and semi-structured clinical interview (IPDE) were used for axis-I and axis-II (personality) diagnoses. The results were analyzed using appropriate statistical measures. RESULTS Family history of psychiatric illnesses (31%) and suicide (11%) were noted. Insecticides and pesticides were the most common agents (71%) employed to attempt suicide. Interpersonal difficulties (46%) were the most frequent stressor. Overall medical seriousness of the suicide attempt was of moderate lethality. 93% of the suicide attempters had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders, and substance-related disorders, with axis-I disorders (89%), personality disorders (52%), and comorbidity of psychiatric disorders (51.6%). CONCLUSION Individuals who made first suicide attempt were young adults, had lower educational achievement; overall seriousness of the suicide attempt was of moderate lethality, high prevalence of psychiatric morbidity, personality disorders, and comorbidity, and had sought medical help from general practitioners.
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Affiliation(s)
- K. Nagaraja Rao
- Department of Psychiatry, JJM Medical College, Davanagere, Karnataka, India
| | - Ranganath R. Kulkarni
- Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Shamshad Begum
- Department of Psychiatry, JJM Medical College, Davanagere, Karnataka, India
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Adolescents who self-harm: professional staff knowledge, attitudes and training needs. J Adolesc 2012; 35:1307-14. [PMID: 22705150 DOI: 10.1016/j.adolescence.2012.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/01/2012] [Accepted: 05/07/2012] [Indexed: 11/21/2022]
Abstract
This study aimed to investigate professional staff attitudes and knowledge about adolescents who engage in self-harming behaviour and to identify training needs. Previous research has suggested that medical and health care staff perceptions may reinforce the stigma associated with such behaviour and therefore jeopardise the effectiveness of interventions. To date, no available research exists on the views of school teachers. Participants recruited for the study were 120 qualified professionals working within an Accident and Emergency Department (A&E), Child & Adolescent Mental Health Services (CAMHS) and a Secondary School, based within the West Midlands, United Kingdom. Results demonstrated statistically significant differences between the groups. CAMHS staff were more knowledgeable and felt more effective than either A&E staff or teachers, whereas A&E staff expressed more negative attitudes. 95% of all staff reported that they would benefit from further training. These findings are discussed in relation to practice issues.
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Yip PSF, Hawton K, Liu K, Liu KS, Ng PWL, Kam PM, Law YW, Wong TW. A study of deliberate self-harm and its repetition among patients presenting to an emergency department. CRISIS 2012; 32:217-24. [PMID: 21940251 DOI: 10.1027/0227-5910/a000069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH). AIMS To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong. METHODS A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford. RESULTS The majority of patients in Hong Kong were female (male:female ratio of 1:2.4), young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck's Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford. CONCLUSIONS The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.
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Affiliation(s)
- Paul S F Yip
- The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong.
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Ghio L, Zanelli E, Gotelli S, Rossi P, Natta W, Gabrielli F. Involving patients who attempt suicide in suicide prevention: a focus groups study. J Psychiatr Ment Health Nurs 2011; 18:510-8. [PMID: 21749557 DOI: 10.1111/j.1365-2850.2011.01697.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study is to gain insight into the individual experiences of patients who attempt suicide in order to better understand the reasons for and emotions behind a suicide attempt, thus also gaining insight, through the patients' own input, into the risk and protective factors which might influence possible repeat attempts and the attitude towards the assistance they receive. Two focus groups were conducted involving 17 participants, all hospitalized at the time of research for attempting suicide. The patients proved themselves competent, even expert in indicating reasons for, risk factors of and prevention strategies for suicide. The main findings suggest that the relational factor represents a key point both as a trigger for the suicide attempt and for promoting the communication of the intent or for preventing a repeat suicide attempt, as interpersonal relationships and an empathic environment were, in essence, what was perceived as therapeutic and protective and enabled the expression of thoughts and self-understanding. Accordingly psychotherapy, non-specific relationship 'monitoring' after discharge and tutored self-help groups have been suggested. Feasibility and implementing methods as well as the role of the nurse for such interventions were discussed.
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Affiliation(s)
- L Ghio
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy.
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Buykx P, Ritter A, Loxley W, Dietze P. Patients Who Attend the Emergency Department Following Medication Overdose: Self-reported Mental Health History and Intended Outcomes of Overdose. Int J Ment Health Addict 2011. [DOI: 10.1007/s11469-011-9338-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hatcher S, Sharon C, House A, Collings S, Parag V, Collins N. The ACCESS study a Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in people who present to hospital after self-harm: study protocol for a randomised controlled trial. Trials 2011; 12:135. [PMID: 21615951 PMCID: PMC3117717 DOI: 10.1186/1745-6215-12-135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who present to hospital after intentionally harming themselves pose a common and important problem. Previous reviews of interventions have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and regular written communications after the self-harm attempt may be an effective treatment. This protocol describes a large pragmatic trial of a package of measures which include problem solving therapy, regular written communication, patient support, cultural assessment, improved access to primary care and a risk management strategy in people who present to hospital after self-harm using a novel design. METHODS We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enroll a large representative cohort of patients. The main outcome will be hospital attendance following repetition of self-harm, in the 12 months after recruitment with secondary outcomes of self reported self-harm, hopelessness, anxiety, depression, quality of life, social function and hospital use at three months and one year. DISCUSSION A strength of the study is that it is a pragmatic trial which aims to recruit large numbers and does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. However the primary analysis is a true intention to treat analysis of everyone randomised which includes both those who consent and do not consent to participate in the study. This provides information about how the intervention will work in practice in a representative population which is a major advance in this study compared to what has been done before. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000641291.
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Affiliation(s)
- Simon Hatcher
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private bag 92019, Auckland, New Zealand
| | - Cynthia Sharon
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private bag 92019, Auckland, New Zealand
| | - Allan House
- Leeds Institute of Health Sciences, The University of Leeds, Leeds, UK
| | - Sunny Collings
- Social Psychiatry & Population Mental Health Research Unit, University of Otago, Wellington, New Zealand
| | - Varsha Parag
- Clinical Trials Research Unit, School of Population Health, The University of Auckland, New Zealand
| | - Nicola Collins
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private bag 92019, Auckland, New Zealand
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Haw CM, Hawton K. Problem drug use, drug misuse and deliberate self-harm: trends and patient characteristics, with a focus on young people, Oxford, 1993-2006. Soc Psychiatry Psychiatr Epidemiol 2011; 46:85-93. [PMID: 19936579 DOI: 10.1007/s00127-009-0170-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 11/03/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug misuse is related to self-harm and suicide. However, relatively little is known about deliberate self-harm (DSH) in patients with drug problems and whether drug misuse by DSH patients is increasing. METHODS We used data collected by the Oxford Monitoring System for Attempted Suicide to study the characteristics of DSH patients with drug problems who presented to the general hospital in Oxford between 1993 and 2006, and who underwent psychosocial assessment at their first presentation in the study period. We also studied trends in problem drug use and drugs misused over this period. RESULTS During the 14-year study period, 11,426 patients presented of whom 9,248 underwent psychosocial assessment and it was known whether or not they had a drug problem. Problem drug use was present in 805/9,248 (8.7%) patients. Problem drug use was more common in males (13.6%) than in females (5.3%). Problem drug users were younger, more likely to be socially disadvantaged, to have a personality disorder and comorbid alcohol problems and to have a further episode of DSH within a year. Problem drug use in young females was associated with higher suicidal intent scale (SIS) scores. During the study period, problem drug use and drug misuse increased in females, but not in males. Cannabis and cocaine misuse increased with time. CONCLUSIONS Provision of help for DSH patients with problem drug use is particularly challenging due to their complex social and clinical characteristics and increased risk of further self-harm, suicide and accidental death. It may require extensive liaison between different services. The increasing misuse of drugs by female DSH patients and the higher SIS scores of young females are of concern.
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Affiliation(s)
- Camilla M Haw
- St Andrew's Hospital, Billing Road, Northampton, NN1 5DG, UK.
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Mackay N, Barrowclough C. Accident and emergency staff's perceptions of deliberate self-harm: Attributions, emotions and willingness to help. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:255-67. [PMID: 16004659 DOI: 10.1348/014466505x29620] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The study applied Weiner's (1980, 1986) attributional model of helping behaviour to Accident and Emergency (A&E) staff's care of patients presenting with deliberate self-harm. It was hypothesized that where staff attributed precipitants of the act of deliberate self-harm to controllable, internal, and stable patient factors, then staff would display greater negative affect, less optimism, and less willingness to help the patient. DESIGN Using four hypothetical scenarios in a two-factor between-subjects design, contextual factors describing a self-harm patient were manipulated. METHOD Participants were 89 A&E medical and nursing staff. They were asked to rate attributions for the cause of the deliberate self-harm and their emotional responses, optimism for change, and willingness to help change the behaviour. Their general attitudes towards deliberate self-harm patients and perceived needs for training in the care of these patients were also assessed. RESULTS The findings were consistent with Weiner's attributional model of helping. The greater attributions of controllability, the greater the negative affect of staff towards the person, and the less the propensity to help. The higher the ratings of stability of outcome, the less staff optimism for the success of their input. Male staff and medical staff had more negative attitudes, and medical staff saw less need for further training. CONCLUSION Formulating A&E staff's responses to deliberate self-harm using a cognitive-emotional model offers the possibility of working with staffs' beliefs, emotions, and behaviour to improve the care and treatment of deliberate self-harm patients.
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Brådvik L, Berglund M. Repetition of suicide attempts across episodes of severe depression. Behavioural sensitisation found in suicide group but not in controls. BMC Psychiatry 2011; 11:5. [PMID: 21214896 PMCID: PMC3023739 DOI: 10.1186/1471-244x-11-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/07/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression. METHOD A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls. RESULTS The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls. CONCLUSION Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.
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Affiliation(s)
- Louise Brådvik
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University Hospital, Lund, Sweden.
| | - Mats Berglund
- Department of Clinical Alcohol Research, University Hospital MAS, Malmö, Lund University, Sweden
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Bergen H, Hawton K, Waters K, Cooper J, Kapur N. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000-2007. Br J Psychiatry 2010; 197:493-8. [PMID: 21119156 DOI: 10.1192/bjp.bp.110.077651] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres. AIMS To investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide. METHOD Data on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007. RESULTS Rates of self-harm declined significantly over 8 years for males in three centres (Oxford: -14%; Manchester: -25%; Derby: -18%) and females in two centres (Oxford: -2% (not significant); Manchester: -13%; Derby: -17%), in keeping with national trends in suicide. A decreasing proportion and number of episodes involved self-poisoning alone, and an increasing proportion and number involved other self-injury (e.g. hanging, jumping, traffic related). Episodes involving self-cutting alone showed a slight decrease in numbers over time. Trends in alcohol use at the time of self-harm and repetition within 1 year were stable. CONCLUSIONS There were decreasing rates of non-fatal self-harm over the study period that paralleled trends in suicide in England. This was reflected mainly in a decline in emergency department presentations for self-poisoning.
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Affiliation(s)
- Helen Bergen
- Centre for Suicide Research, University of Oxford, UK
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Zyoud SH, Awang R, Sulaiman SAS, Al-Jabi SW. A cross-sectional observation of the factors associated with deliberate self-poisoning with acetaminophen: impact of gender differences and psychiatric intervention. Hum Psychopharmacol 2010; 25:500-8. [PMID: 20737523 DOI: 10.1002/hup.1140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The objectives of this study were to determine the risk factors and life stressors that are prevalent among the acetaminophen deliberate self-poisoning (DSP) cases, to identify gender differences in the associated factors, and to determine the prevalence of psychiatric diagnosis and the patterns and types of psychotherapeutic interventions provided by psychiatrists. METHODS This is a cross-sectional study, a retrospective descriptive case review of hospital admissions for acetaminophen DSP. RESULTS There were 177 incidences of DSP during the study period. The mean age of the cases was 23.1 +/- 7.3 years and 84.1% of them were females. The risk factors were more significantly associated with males: chronic ethanol intake (p = 0.04), higher reported dose ingested (p = 0.01), higher latency time (p = 0.04) and longer hospital stay (p = 0.03). The most commonly reported psychotherapeutic interventions used by psychiatrists were psychoeducation of the patient, followed by referral to a psychiatric clinic, family psychoeducation and psychotropic medication. Sertraline (SSRI) was the most frequently prescribed antidepressant. CONCLUSIONS Males have been shown to use more toxic doses and to delay treatment due to high latency time. Most DSP patients have different life stressors and psychiatric diagnoses that may be associated with varying degrees of suicidal intent. All patients presenting following DSP need to be carefully screened for psychiatric illness. Randomized controlled studies need to be conducted on DSP patients with psychiatric illness to determine which treatments are effective.
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Affiliation(s)
- Sa'ed H Zyoud
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia.
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