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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Chai Y, Luo H, Yip PS. Prevalence and risk factors for repetition of non-fatal self-harm in Hong Kong, 2002-2016: A population-based cohort study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 2:100027. [PMID: 34327378 PMCID: PMC8315465 DOI: 10.1016/j.lanwpc.2020.100027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/16/2020] [Accepted: 09/02/2020] [Indexed: 02/01/2023]
Abstract
Background A history of self-harm is strongly associated with future self-harm attempts. Large-scale Asian cohort studies examining risk factors for repeated self-harm are lacking. This paper reports on annual prevalence, cumulative risk, annual risk of non-fatal self-harm repetition, and risk factors among Hong Kong patients with a history of self-harm. Methods The Hong Kong Clinical Data Analysis and Reporting System (CDARS) provided all accident & emergency department and inpatient self-harm records between Jan 1, 2002 and Dec 31, 2016. Demographic and clinical characteristics were extracted. Annual prevalence, over-time cumulative and annual risks of non-fatal self-harm repetition were estimated, and the adjusted hazard ratios (HR; plus 95% CIs) of putative risk factors associated with repetition were estimated using Wei-Lin-Weissfeld (WLW) generalization of the Cox model for recurrent event analysis. Findings There were 127,801 self-harm episodes by 99,116 individuals. Annual prevalence of repeated self-harm, of all self-harms, ranged from 7•36% to 28•71% during the study period. Risk of self-harm repetition within one year of the index event was 14•25% (95% CI, 14•04%-14•46%). People with four or more previous self-harm episodes carried the highest risk of self-harm repetition (adjusted HR 4•81 [95% CI 4•46-5•18]). Significant risk factors for non-fatal self-harm repetition included male gender (1•08 [1•05-1•11]), older age (65+ years) (1•07 [1•01-1•13]), social welfare for payment (1•30 [1•27-1•34]), psychiatric admission (1•60 [1•50-1•72]), self-injury only (1•19 [1•15-1•23]), self-injury combined with self-poisoning (1•38 [1•24-1•53]), depression and bipolar disorders (1•09 [1•04-1•14]), personality disorders (1•18 [1•06-1•32]), substance misuse (1•31 [1•27-1•36]), and asthma (1•18 [1•02-1•36]). Interpretation Hong Kong self-harm patients with non-fatal self-harm events should be supported by effective, timely and ongoing aftercare plans based on their risk profiles, to reduce risk of self-harm reoccurrence. Funding Research Grants Council, General Research Funding: 17611619.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, Department of Computer Science, The University of Hong Kong, Pokfulam Road, Hong Kong, China
- Corresponding Author.
| | - Paul S.F. Yip
- Department of Social Work and Social Administration, Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
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Liu BP, Lunde KB, Jia CX, Qin P. The short-term rate of non-fatal and fatal repetition of deliberate self-harm: A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2020; 273:597-603. [PMID: 32560959 DOI: 10.1016/j.jad.2020.05.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) is often recurrent, but the reported rate of short-term repetition of DSH has varied greatly. This systematic review and meta-analysis aim to synthesize findings through providing pooled rate estimates and to explore their differences by age, gender, and other factors. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted to include longitudinal studies from 1999 to 2018. Random effects model was applied to pool rates of non-fatal and fatal repetition at 0.5, 1, 2, and 3 years intervals. RESULTS Of 9201 potentially eligible articles 76 studies were included for this systematic review and meta-analysis. The pooled rates of non-fatal repetition were 15.01%, 17.03%, 20.82%, and 24.20% during the 0.5-year, 1-year, 2-year, and 3-year follow-up, respectively. The corresponding rates of fatal repetition were 0.77%, 1.34%, 1.49% and 2.46%, respectively. When focusing on the 1-year follow-up, the pooled rate of fatal, not non-fatal, repetition was significantly higher in males than females. The rate of non-fatal DSH repetition was highest in middle-aged adults, while the rate of fatal repetition was highest among the elderly. Geographically, Europe had higher rate of non-fatal repetition whilst Asia had higher rate of repetition leading to death. LIMITATION Search was limited to English language and publication bias was observed. CONCLUSIONS Both non-fatal and fatal repetitions are common among people with DSH, but the rates differ considerably by gender, age and geographical location. These insights may guide provision of follow-up care and effort of suicide prevention for this high-risk population.
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Cun-Xian Jia
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway.
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Hassanian-Moghaddam H, Sarjami S, Kolahi AA, Lewin T, Carter G. Postcards in Persia: A Twelve to Twenty-four Month Follow-up of a Randomized Controlled Trial for Hospital-Treated Deliberate Self-Poisoning. Arch Suicide Res 2017; 21:138-154. [PMID: 25774646 DOI: 10.1080/13811118.2015.1004473] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study reports the outcomes, during follow-up, of a low-cost postcard intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual treatment) versus usual treatment. Three binary endpoints at 12-24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting. There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13-0.27), (NNT 8, 6-13), and any suicide attempt (RRR 0.31, 0.06-0.50), (NNT 35, 19-195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05-0.51). Sustained, brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.
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Reydel T, Callahan JC, Verley L, Teiten C, Andreotti C, Claessens YE, Missud D, L'Her E, Le Roux G, Lerolle N. Routine biological tests in self-poisoning patients: results from an observational prospective multicenter study. Am J Emerg Med 2016; 34:1383-8. [PMID: 27117657 DOI: 10.1016/j.ajem.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied. MATERIALS AND METHODS This is a prospective multicentric observational study conducted in the emergency departments and intensive care units of 5 university and nonuniversity French hospitals. Adult self-poisoning patients without severely altered vital status on admission were prospectively included. RESULTS Routine biological test (serum electrolytes and creatinine, liver enzymes, bilirubin, blood cell count, prothrombin time) ordering and results were analyzed. A total of 1027 patients were enrolled (age, 40.2 ± 14 years; women, 61.5%); no patient died during the hospital stay. Benzodiazepine was suspected in more than 70% of cases; 65% (range, 48%-80%) of patients had at least 1 routine biological test performed. At least 1 abnormal test was registered in 23% of these patients. Three factors were associated with abnormal test results: age older than 40 years, male sex, and poisoning with a drug known to alter routine tests (ie, acetaminophen, NSAIDs, metformine, lithium). Depending on these factors, abnormal results ranged from 14% to 48%. Unexpected severe life-threatening conditions were recorded in 6 patients. Only 3 patients were referred to the intensive care unit solely because of abnormal test results. CONCLUSION Routine biological tests are commonly prescribed in nonsevere self-poisoning patients. Abnormal results are frequent but their relevance at bedside remains limited.
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Affiliation(s)
- Thomas Reydel
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France
| | | | - Laurent Verley
- Department of Emergency Medicine, Saint Malo Hospital, Saint Malo, France
| | - Christelle Teiten
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Christophe Andreotti
- Department of Emergency Medicine, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yann Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Principauté de, Monaco
| | - David Missud
- Clinical Research Center, Angers University Hospital, Angers, France
| | - Erwan L'Her
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Gael Le Roux
- Poison Center, Angers University Hospital, Angers, France
| | - Nicolas Lerolle
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France.
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Kwok CL, Yip PSF, Gunnell D, Kuo CJ, Chen YY. Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study. Br J Psychiatry 2015; 204:376-82. [PMID: 24482442 DOI: 10.1192/bjp.bp.113.130179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia. AIMS To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan. METHOD Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004-December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm. RESULTS In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7-10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05-1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm. CONCLUSIONS The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.
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Affiliation(s)
- Chi-Leung Kwok
- Chi-Leung Kwok, BSc (ActuarSc), Paul S. F. Yip, PhD, Hong Kong Jockey Club Center for Suicide Research and Prevention, and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; David Gunnell, MD, PhD, School of Social and Community Medicine, University of Bristol, UK; Chian-Jue Kuo, Taipei City Psychiatric Center, Taipei City Hospital, and School of Medicine, Taipei Medical University, Taipei, Taiwan; Ying-Yeh Chen, MD, ScD, Taipei City Psychiatric Center, Taipei City Hospital, and Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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Chen IM, Liao SC, Lee MB, Wu CY, Lin PH, Chen WJ. Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan. J Formos Med Assoc 2015; 115:364-71. [PMID: 26279174 DOI: 10.1016/j.jfma.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/PURPOSE Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. METHODS The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. RESULTS Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. CONCLUSION The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.
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Affiliation(s)
- I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; National Suicide Prevention Centre, Taipei, Taiwan.
| | - Chia-Yi Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Hsien Lin
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Wei J Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Chang SS, Steeg S, Kapur N, Webb RT, Yip PSF, Cooper J. Self-harm amongst people of Chinese origin versus White people living in England: a cohort study. BMC Psychiatry 2015; 15:79. [PMID: 25880647 PMCID: PMC4409751 DOI: 10.1186/s12888-015-0467-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities. METHODS We conducted a prospective cohort study using self-harm presentation data (1997-2011) collected from three hospitals in the City of Manchester, which has the largest Chinese population across all UK Local Authorities. Rate ratios between the Chinese and White groups were calculated using Poisson regression models. Chi-square tests (or Fisher's exact tests), logistic regression, and log-binomial regression were used to examine differences in characteristics and clinical management between groups. RESULTS Ethnicity was known in the study cohort for 23,297 (87%) amongst 26,894 individuals aged 15 years and above. A total number of 97/23,297 (0.4%) people of Chinese ethnic origin presented with self-harm over the study period and 20,419 (88%) were White people. Incidence of self-harm in the Chinese group (aged 16-64 years) was less than one fifth of that found in White people (0.6 versus 3.2 per 1000 person-years; rate ratio 0.18, 95% confidence interval 0.13-0.24), and was particularly low amongst men of Chinese origin. Individuals of Chinese origin who presented with self-harm were younger, more likely to be female and students, and more likely to self-injure and describe relationship problems as a precipitant than White people. They were less likely to have clinical risk factors such as drug/alcohol misuse and receiving psychiatric treatment, and were rated to have lower risk of self-harm repetition by treating clinicians. CONCLUSION Future research needs to investigate whether the low incidence of self-harm presenting to hospitals amongst people of Chinese origin truly reflects a lower frequency of self-harm, or alternatively is due to markedly different post-episode help-seeking behaviours or student overrepresentation in this ethnic group. Relevant healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.
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Affiliation(s)
- Shu-Sen Chang
- Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei, 10055, Taiwan. .,The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Paul SF Yip
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR China
| | - Jayne Cooper
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
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Chen CY, Yeh HH, Huang N, Lin YC. Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people. J Adolesc Health 2014; 54:550-7. [PMID: 24332393 DOI: 10.1016/j.jadohealth.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Repeat suicidal behaviors in young people are a critical public health concern. The study investigates individual socioeconomic and episode-dependent clinical factors predicting repeat suicide attempts among youth by gender. METHODS Using a retrospective cohort study, we identified a total of 4,094 male and 3,219 female youths who had the index suicide episode at the ages of 15-24 years from the 1996-2007 National Health Insurance Research Database in Taiwan. The recurrence of suicide attempt was assessed within 1 year after the index suicide. Information pertaining to suicide management and postsuicide treatment was obtained from healthcare records. Repeated event survival analyses were used to estimate episode-dependent risk of suicide attempt. RESULTS The occurrence of repeat suicide attempts was more common in males, yet the phenomenon of risk aggravation appears more prominent in females. The estimate for peak hazard of the second repeat attempt was 2-fold higher than that of the first repeat event in males, and approximately 6-fold in females. Socioeconomic (e.g., labor market participation: adjusted Hazard Ratio [aHR] = 1.14, 95% CI = 1.01-1.28) and index suicide management characteristics (e.g., receiving treatment at clinic, aHR = 1.54, 95% CI = 1.19-1.99) were found to play important roles for repeat suicide attempts in males. For females, postsuicide treatment of mental disorders appears more influential. CONCLUSIONS The relationships between socioeconomic and clinical factors with repeat suicide attempts in young people vary by gender. School/workplace-based post suicide attempt consultation and clinical management for youth may be planned and delivered on a gender-appropriate basis.
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Affiliation(s)
- Chuan-Yu Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Taipei, Taiwan.
| | - Hsueh-Han Yeh
- Center for Neuropsychiatric Research, National Health Research Institutes, Taipei, Taiwan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Nicole Huang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Chen Lin
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Magalhães APND, Alves VDM, Comassetto I, Lima PC, Faro ACME, Nardi AE. Atendimento a tentativas de suicídio por serviço de atenção pré-hospitalar. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo: Investigar as características das vítimas de tentativa de suicídio atendidas em serviço pré-hospitalar e os intervalos de tempo consumidos nessa fase de atendimento. Métodos: Estudo transversal utilizando dados da fase pré-hospitalar de atendimento às vítimas de tentativa de suicídio no município de Arapiraca, no ano de 2011. Para análise dos dados, foram realizados teste exato de Fisher, teste t de Student e regressão logística múltipla. Resultados: Foram atendidas 80 vítimas de tentativa de suicídio pelo serviço de atenção pré-hospitalar. As mulheres, com idade superior a dos homens, foram as que mais tentaram suicídio (n = 44, 55%), e a intoxicação por medicamentos foi o método mais utilizado (n = 44, 55%). As tentativas de suicídio ocorreram com maior frequência no outono (n = 29, 36,25%), no dia de domingo (n = 18, 22,5%), principalmente no período vespertino (n = 33, 41,25%). O tempo gasto para o atendimento pré-hospitalar variou entre 34,4 e 40,5 minutos. As variáveis que estiveram associadas às tentativas de suicídio por sexo foram idade (p = 0,03) e tempo de transporte (p = 0,01). Conclusão: Foram encontradas diferenças entre os sexos das vítimas de tentativa de suicídio atendidas pelo serviço de atenção pré-hospitalar. As mulheres apresentaram maior idade que os homens e o tempo de transporte foi maior em vítimas do sexo masculino, sugerindo maior gravidade nas tentativas de suicídio cometidas por esse grupo.
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Carroll R, Metcalfe C, Gunnell D. Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis. PLoS One 2014; 9:e89944. [PMID: 24587141 PMCID: PMC3938547 DOI: 10.1371/journal.pone.0089944] [Citation(s) in RCA: 363] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/25/2014] [Indexed: 02/03/2023] Open
Abstract
Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.
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Affiliation(s)
- Robert Carroll
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Wu CY, Huang HC, Wu SI, Sun FJ, Huang CR, Liu SI. Validation of the Chinese SAD PERSONS Scale to predict repeated self-harm in emergency attendees in Taiwan. BMC Psychiatry 2014; 14:44. [PMID: 24533537 PMCID: PMC3942520 DOI: 10.1186/1471-244x-14-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings. METHODS One hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the sixth month. The controls, 284 people without self-harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis. RESULTS The CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care. CONCLUSIONS The Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical applications.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan,Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
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Huang YC, Wu YW, Chen CK, Wang LJ. Methods of suicide predict the risks and method-switching of subsequent suicide attempts: a community cohort study in Taiwan. Neuropsychiatr Dis Treat 2014; 10:711-8. [PMID: 24833904 PMCID: PMC4015797 DOI: 10.2147/ndt.s61965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Suicide is a major public health concern. This study aimed to determine the predictors of repeated suicide attempts, focusing on whether lethality level of the suicidal method predicts the risk of subsequent suicide attempts. METHODS All consecutive individuals (N=2,070) with an episode of nonfatal self-harm registered in a surveillance database provided by the Department of Health of Keelung City Government in Taiwan from January 1, 2006 to December 31, 2010 were enrolled and followed up until the end of 2011. The earliest attempt recorded in the database was defined as the index attempt. Subjects were classified according to suicide method into low-lethal and high-lethal groups. Data on time of and methods chosen for subsequent suicide attempts during the follow-up period were analyzed. RESULTS Of the total people screened for the study, 18.1% made a repeated suicide attempt. Subjects in the high-lethal group were more likely to be male; aged 35-64 years; and single, divorced, or widowed. Compared to other time intervals, most subsequent suicide attempts occurred within 6 months from the index attempt. The independent predictors for repeated suicide attempts were the use of low-lethal methods in the index attempt and being 35-49 years old. Using high-lethal methods and being older than 50 years were associated with changing suicide method for the second attempt. CONCLUSION Lethality level of former suicidal method could predict repeated suicide attempts and changing of suicide methods. Further clarification is needed on whether a higher risk of repeat attempts is associated with higher rates of suicide mortality.
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Affiliation(s)
- Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Wen Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung and Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chung CH, Pai L, Kao S, Lee MS, Yang TT, Chien WC. The Interaction Effect Between Low Income and Severe Illness on the Risk of Death by Suicide After Self-Harm. CRISIS 2013; 34:398-405. [DOI: 10.1027/0227-5910/a000218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Previous Western studies have reported that the prevalence of death by suicide within 1 year after self-harm was 0.5–2%; however, no studies have focused on the Far East. Aims: To calculate the prevalence of death by suicide after self-harm over different lengths of follow-up time and to determine the predictors of death by suicide after self-harm. Method: Our study was based on 3,388 inpatients hospitalized between 2000 and 2007 in any of the 1,230 hospitals in Taiwan. Death by suicide after self-harm among the members of this cohort was tracked after 3 months, 6 months, and 1–8 years. The tracking continued until December 31, 2008. We analyzed the prevalence and risk factors of death by suicide after self-harm using Cox’s regression model. Results: Of the 3,388 individuals with a history of self-harm included in the study, 48 (1.4%) died by suicide after self-harm within 3 months and 97 (2.9%) within 1 year. In all, 144 (4.3%) died by suicide after self-harm within 8 years. The predictors of death by suicide were violent methods (such as hanging, drowning, firearms, and jumping), low income, and severe illness. Moreover, an interaction effect was noted between low income and severe illness on the outcome (death by suicide). Conclusion: It seems that effective healthcare for individuals who engage in self-harming behavior would benefit from supplementing medical care with social assistance, such as the support of a social worker.
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Affiliation(s)
- Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, Republic of China
| | - Lu Pai
- Taiwan Injury Prevention & Safety Promotion Association, Taiwan, Republic of China
| | - Senyeong Kao
- School of Public Health, National Defense Medical Center, Taiwan, Republic of China
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taiwan, Republic of China
| | - Tsung-Tsair Yang
- Department of Psychiatry and Mental Health Center, Cardinal Tien Hospital, Taiwan, Republic of China
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taiwan, Republic of China
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15
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Chen WJ, Shyu SS, Lin GG, Chen CC, Ho CK, Lee MB, Chou FHC. The predictors of suicidality in previous suicide attempters following case management services. Suicide Life Threat Behav 2013; 43:469-78. [PMID: 23638619 DOI: 10.1111/sltb.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a "willingness to receive mental health services during a crisis," "social support," "a history of mental disorders," and "a history of suicide," could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39-0.86, 0.36-0.83, 2.41-6.10, 1.03-2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow-up. The findings of our study could help clarify future strategies for suicide prevention.
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Affiliation(s)
- Wei-Jen Chen
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Graduate Institute of Counseling psychology and Rehabilitation counseling, National Kaohsiung Normal University, Kaohsiung, Taiwan
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16
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Chen WJ, Ho CK, Shyu SS, Chen CC, Lin GG, Chou LS, Fang YJ, Yeh PY, Chung TC, Chou FHC. Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters. BMC Psychiatry 2013; 13:191. [PMID: 23865947 PMCID: PMC3720180 DOI: 10.1186/1471-244x-13-191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/12/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period. METHOD A randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 participants (139 males, 234 females; age: 39.8 ± 14.0 yrs.). The control group consisted of 388 participants (113 males, 275 females; age: 40.0 ± 16.0 yrs.). A survival analysis was used to test the effectiveness of the crisis postcard intervention for the prevention of suicide reattempts. Per-protocol and intention-to-treat analyses were conducted. RESULTS The intention-to-treat analysis indicated that the crisis postcard had no effect (hazard ratio = 0.84; 95% CI = 0.56 - 1.29), whereas the per-protocol analysis showed a strong benefit for the crisis postcard (hazard ratio = 0.39; 95% CI = 0.21 - 0.72). CONCLUSION Although the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention. Further studies need to be conducted to clarify whether this type of intervention can reduce subsequent suicidal behaviour, with a particular focus on reducing the rate of loss to follow-up.
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Affiliation(s)
- Wei-Jen Chen
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan,Graduate Institute of Counselling Psychology and Rehabilitation Counselling, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Chi-Kung Ho
- Kaohsiung City Government Bureau of Health, Kaohsiung, Taiwan
| | - Shi-Sen Shyu
- Graduate Institute of Counselling Psychology and Rehabilitation Counselling, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Cheng-Chung Chen
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan
| | - Guei-Ging Lin
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan
| | - Li-Shiu Chou
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan
| | - Yun-Ju Fang
- Kaohsiung City Government Bureau of Health, Kaohsiung, Taiwan
| | - Pin-Yang Yeh
- Kaohsiung City Government Bureau of Health, Kaohsiung, Taiwan
| | - Tieh-Chi Chung
- Institute of Health Care, Meiho University, Neipu, Pingtung, Taiwan
| | - Frank Huang-Chih Chou
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan,Institute of Health Care, Meiho University, Neipu, Pingtung, Taiwan
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17
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Fleet D, Mintz R. Counsellors' perceptions of client progression when working with clients who intentionally self-harm and the impact such work has on the therapist. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2012.698421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Wang SM, Chou YC, Yeh MY, Chen CH, Tzeng WC. Factors associated with quality of life after attempted suicide: a cross-sectional study. J Clin Nurs 2013; 22:2150-9. [PMID: 23441824 DOI: 10.1111/jocn.12148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Shu-May Wang
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan China
| | - Yu-Ching Chou
- School of Public Health; National Defense Medical Center; Taipei Taiwan China
| | - Mei-Yu Yeh
- Department of Nursing; Chang Gong University of Science and Technology; Taoyuan Taiwan China
| | - Chih-Hao Chen
- Department of Health; Taipei City Government; Taipei Taiwan China
| | - Wen-Chii Tzeng
- Department of Nursing; Tri-Service General Hospital; Taipei Taiwan chaina
- School of Nursing; National Defense Medical Center; Taipei Taiwan Roc
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Watanabe N, Nishida A, Shimodera S, Inoue K, Oshima N, Sasaki T, Inoue S, Akechi T, Furukawa TA, Okazaki Y. Deliberate self-harm in adolescents aged 12-18: a cross-sectional survey of 18,104 students. Suicide Life Threat Behav 2012; 42:550-60. [PMID: 22889157 DOI: 10.1111/j.1943-278x.2012.00111.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Little is known about accurate prevalence and associated factors of deliberate self-harm (DSH) among adolescents in Asian countries. In this study, the prevalence and associated factors of DSH among adolescents in Japan were examined. Data were derived from a cross-sectional survey using an anonymous self-report questionnaire and enrolling 8,620 adolescents aged 12-15 and 9,484 aged 15-18. DSH in the previous 12 months was reported by 3.3% (95% CI, 2.9-3.7) of junior and 4.3% (3.9%-4.7%) of senior high school respondents. The prevalence was more than four times as high among girls as among boys for both age groups. DSH was further strongly associated with having suicidal thoughts, having depression/anxiety symptoms, and having used recreational drugs. These associated factors were similar for both sexes and for both older and younger teenagers. A substantial minority of adolescents present with DSH, even among those aged 12-15. The prevalence of DSH in Japan was in the lower ranges of those reported for Western countries. The identified associated factors were not dissimilar from those reported in the West.
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Affiliation(s)
- Norio Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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20
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Chung CH, Lai CH, Chu CM, Pai L, Kao S, Chien WC. A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan. BMC Public Health 2012; 12:744. [PMID: 22950416 PMCID: PMC3488309 DOI: 10.1186/1471-2458-12-744] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%–15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1–8 years), to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. Methods We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1–8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. Results Of the 39,875 individual study samples, 3,388 individuals (8.50%) were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15–1.76). The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23–2.04) or cutting or piercing (RR = 1.36, 95% CI = 1.02–1.82), and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48–1.75). Conclusions The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.
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Affiliation(s)
- Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City 11490, Taiwan, Republic of China
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Lu YJ, Chang HJ, Tung YY, Hsu MC, Lin MF. Alleviating psychological distress of suicide survivors: evaluation of a volunteer care programme. J Psychiatr Ment Health Nurs 2011; 18:449-56. [PMID: 21539691 DOI: 10.1111/j.1365-2850.2010.01687.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The crisis level in the worldwide suicide rate has revealed a severe suicide problem in Taiwan that is now well above the world average of 16 per 100,000 individuals. Many countries have relied on suicide care volunteers training programmes to conduct suicide prevention programmes. However, there is a dearth of research evaluating the effect of volunteers on psychological distress and the impact of volunteer experience level. An evaluation of the impact of experienced and novice volunteers in alleviating psychological distress of suicide survivors was conducted. A supervised programme trained 15 volunteers at Years 1 and 2. Year 1 volunteers completed 400 h of service with continuing education. Programme evaluation occurred after Year 2 volunteers had completed training. Eighty-two suicide survivors were recruited. With 60 suicide survivors completing 3 month of volunteer care, a significant group difference with time interaction in suicide survivors who exhibited moderate to severe distress between the veteran care and novice care groups was found. Compared with novice volunteers, veteran volunteers with at least 1 year of experience are more effective with suicide survivors reporting higher psychological distress.
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Affiliation(s)
- Y-J Lu
- Municipal Fusing Junior High School, Tainan City, Taiwan
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22
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Greydanus DE, Apple RW. The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts. J Multidiscip Healthc 2011; 4:183-9. [PMID: 21811385 PMCID: PMC3141836 DOI: 10.2147/jmdh.s11569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide.
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Affiliation(s)
- Donald E Greydanus
- Pediatrics and Human Development; College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Chen VCH, Tan HKL, Chen CY, Chen THH, Liao LR, Lee CTC, Dewey M, Stewart R, Prince M, Cheng ATA. Mortality and suicide after self-harm: community cohort study in Taiwan. Br J Psychiatry 2011; 198:31-6. [PMID: 21200074 DOI: 10.1192/bjp.bp.110.080952] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about outcomes after self-harm in East Asia. AIMS To investigate mortality after self-harm in a Taiwanese population. METHOD Between 2000 and 2003, 1083 individuals who self-harmed were identified through a population self-harm register in Nantou County, Taiwan, and followed until 2007 for date and cause of death on a national mortality database. RESULTS In total, 145 individuals died, 48 through suicide. The risks of all-cause and suicide mortality in the first year were 4.7% and 2.1% respectively, representing 8- and 131-fold age- and gender-standardised increases. Male gender and older age were independent risk factors for both suicide and non-suicide mortality. Use of more lethal methods in the index episode was associated with higher mortality but this was accounted for by gender. CONCLUSIONS Results in this sample support the recommendation that people with a history of recent self-harm should be a major target for suicide prevention programmes.
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Affiliation(s)
- Vincent C H Chen
- Department of Psychiatry, Chung San Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Psychosocial assessment and repetition of self-harm: the significance of single and multiple repeat episode analyses. J Affect Disord 2010; 127:257-65. [PMID: 20684848 DOI: 10.1016/j.jad.2010.05.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 05/04/2010] [Accepted: 05/04/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Self-harm is a common reason for presentation to the Emergency Department. An important question is whether psychosocial assessment reduces risk of repeated self-harm. Repetition has been investigated with survival analysis using various models, though many are not appropriate for recurrent events. METHODS Survival analysis was used to investigate associations between psychosocial assessment following an episode of self-harm and subsequent repetition, including (i) one repeat, and (ii) recurrent repetition (≤5 repeats) using (a) an independent episodes model, and (b) a stratified episodes model based on a conditional risk set. Data were from the Multicentre Study on Self-harm in England, 2000 to 2007. RESULTS Psychosocial assessment following an index episode of self-harm was associated with a 51% (95% CI 42%-58%) decreased risk of a repeat episode in persons with no psychiatric treatment history, and 26% (95% CI 8%-34%) decreased risk in those with a treatment history. For recurrent repetition, assessment was associated with a 57% (95% CI 51%-63%) decreased risk of repetition assuming independent episodes, and 13% (95% CI 1%-24%) decreased risk accounting for ordering and correlation of episodes by the same person (stratified episodes model). All models controlled for age, gender, method, history of self-harm, and centre differences. LIMITATIONS Some missing data on psychiatric treatment for non-assessed patients. CONCLUSIONS Psychosocial assessment appeared to be beneficial in reducing the risk of repetition, especially in the short-term. Findings for recurrent repetition were highly dependent on model assumptions. Analyses should fully account for ordering and correlation of episodes by the same person.
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