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Badger K, Baez Caraballo P, Gibbs A, Messina L, Halpern M, Amesty S. Thoughts of self-harm in adolescents: Relationship with violence in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002711. [PMID: 38190375 PMCID: PMC10773958 DOI: 10.1371/journal.pgph.0002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Violence against adolescents is a pressing health problem with long-term implications for future physical and mental well-being, such as thoughts of self-harm, which have been associated with suicidal ideation and completion. However, much of the research has been conducted only in high-income countries. This study aimed to examine the correlation between violence against adolescents and self-harm thoughts in La Romana, Dominican Republic (DR). Cross-sectional survey data was collected at a community-based clinic from participants aged 13-20. Participants were recruited through the clinic's adolescent program and peer referral, and verbal consent was obtained. A survey solicited information about each participant's demographics, experiences with violence, and thoughts of harm to self or others. The survey was completed by 49 adolescents. The mean age was 16.78 (SD 2.34); 65% were female. We performed t-tests and Fisher's exact to investigate the relationship between demographics, reported violence experiences and having self-harm thoughts. About half (45%) had experienced physical violence, 76% had experienced emotional violence, and 12% had experienced sexual violence. The most common perpetrators of physical and emotional violence were classmates (12% and 24%), and the most common perpetrator of sexual violence was an ex-partner (4.1%). Ten participants (20.4%) had thought about harming themselves. Self-harm thoughts were significantly associated with being female (p = 0.025), employed (p = 0.05), and to a higher number of experiences of physical (0.029) and sexual violence (p = 0.023). The results of this study suggest a high prevalence of both violence and self-harm thoughts in adolescents in the DR. Interventions that address physical and sexual violence against adolescents may be particularly important. Particular attention should also be paid to screening for self-harm thoughts in female-identifying adolescents. Further research is needed to better understand the relationship between violence and self-harm thoughts in adolescents in the DR.
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Affiliation(s)
- Kelsey Badger
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
- Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | | | | | - Luz Messina
- Clínica de Familia, La Romana, Dominican Republic
| | - Mina Halpern
- Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Columbia University Mailman School of Public Health, New York, New York, United States of America
- Department of Medical Humanities and Ethics, Columbia University Irving Medical Center, New York, New York, United States of America
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2
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Watson RD, Walker KB. The Perspectives of Health Care Providers on Adolescent Non-Suicidal Self-Injury. Issues Ment Health Nurs 2023; 44:891-899. [PMID: 37699103 DOI: 10.1080/01612840.2023.2248499] [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: 09/14/2023]
Abstract
OBJECTIVE This study examined the perspectives and strategies of care providers when managing adolescent non-suicidal self-injury in residential and acute inpatient units throughout the Midwest region. NSSI frequency, intensity, duration, onset, method, location, and interventions were examined, among other topics including care provider attitudes, service delivery type, ways to reduce NSSI behaviors, and whether any NSSI-specific interventions are used in psychiatric settings. METHOD Surveys were disseminated to nurses, practitioners, and clinicians at psychiatric hospitals in the Midwest region. All questions used free text responses and were developed from the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the SOARS Model, and Clinician-Rated Severity of Non-suicidal Self-Injury Scale. RESULTS The findings underscored the high incidence of NSSI among adolescent patients, highlighting the urgent need for creating hospital trainings and best practices for NSSI, among other topics such as routine physical check-ins and enhanced NSSI-specific interventions. CONCLUSION There is a concerning gap in the number of NSSI-specific interventions used by care providers in psychiatric inpatient facilities in the Midwest region of the United States. The need for targeted treatment, training, and programming for adolescent NSSI is essential.
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Affiliation(s)
- Ronnie D Watson
- College of Health, Ball State University, Muncie, Indiana, USA
| | - Khirey B Walker
- School of Communications, Elon University, Elon, North Carolina, USA
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El Nagar ZM, Barakat DH, Rabie MAEM, Thabeet DM, Mohamed MY. Relation of Non-Suicidal Self-Harm to Emotion Regulation and Alexithymia in Sexually Abused Children and Adolescents. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:431-446. [PMID: 35254212 DOI: 10.1080/10538712.2022.2047855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Child sexual abuse is a global issue affecting children. It burdens the entire society physically and mentally. It can cause eating disorders and non-suicidal self-injury in abused people (NSSI). Emotion regulation (ER) is an important etiological link between purging, NSSI, and abusive experiences. We interviewed 80 people, ranged in age from 13 to 20, of whom 62.5% had CSA, versus 30 healthy controls. The Toronto Alexithymia Scale, an eating disorders clinical interview, the Difficulties in Emotion Regulation Scale (DERS) to assess emotion dysregulation, the Self-punishment Scale to assess NSSI, the Mini-Kid for children under the age of 18, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) for those aged 18 and older were given to victims. CSA was found in 62.5% of the participants. Emotional dysregulation was strongly linked to CSA. Descriptive and identifying difficulties in feelings and externally oriented thinking (p0.001, p0.03, p0.001) were found to be associated with the development of alexithymia. CSA participants had higher NSSI than controls, with 28% having severe self-punishment symptoms (P0.001). Finally, CSA is common in kids and teens. It has negative effects on future generations' mental and physical health. All of these conditions can lead to alexithymia.
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Townsend ML, Jain A, Miller CE, Grenyer BFS. Prevalence, Response and Management of Self-harm in School Children Under 13 Years of Age: A Qualitative Study. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-021-09494-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractResearch suggests that the incidents of self-harm among young people are increasing and age of onset of self-harm is decreasing. There is limited understanding of how widespread the problem of self-harm among younger school students is, and how schools respond to these incidents. This study used an in-depth qualitative approach to understand self-harm in children under 13, and how elementary schools respond including typical actions, support for the child and parental involvement. School psychologists in New South Wales, Australia (n = 17; 78% females), completed in-depth interviews detailing types of self-harm, prevalence and frequency, and how these incidents were managed, including student intervention approaches and participation of parents. Thematic analysis of interviews was conducted. Psychologists estimated the prevalence of self-harm in their schools was 6.5% and was increasing, with an average age of onset of 10.8 years. Self-harm was most often understood as a coping mechanism associated with anxiety, stress and being bullied. Six themes emerged from the interviews. School psychologists reported that self-harm occurs less frequently in primary school children than high school children, but noted these behaviours still require early intervention. Participants felt they were limited in the support they can provide students who self-harm, and wanted more training for all school staff and parents in identifying and responding to student self-harm. School psychologists are important in identification and management of self-harm, and they report they need further support in helping children who are engaging in self-harm behaviours. Upskilling teachers and parents may assist in reducing rates of self-harm among children.
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Reen GK, Bailey J, McGuigan L, Bloodworth N, Nawaz RF, Vincent C. Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis. Eur Child Adolesc Psychiatry 2021; 30:1173-1186. [PMID: 32719945 PMCID: PMC8310847 DOI: 10.1007/s00787-020-01607-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.
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Affiliation(s)
- Gurpreet K Reen
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK.
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK.
| | - Jill Bailey
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Lorna McGuigan
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Natasha Bloodworth
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Patient Safety Collaborative, Oxford Academic Health Science Network, Oxford, OX4 4GA, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
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Hirot F, Huas C, Durand D, Godart N. The Evaluation of Therapeutic Residential Care for Adolescents and Young Adults in France: A Systematic Review. Front Psychiatry 2021; 12:609365. [PMID: 34093257 PMCID: PMC8173203 DOI: 10.3389/fpsyt.2021.609365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
Early psychosocial rehabilitation of young people presenting mental disorders is a major challenge. In France, the therapeutic residential care called "soins-études," combining care and educational provision, in the Fondation Santé des Etudiants de France (FSEF) can have a role in this rehabilitation. After recalling the history and the concept underpinning soins-études in psychiatry, we performed a systematic review of the literature based on the PRISMA statement via a search for quantitative studies on soins-études facilities. Eleven quantitative studies on 10 different samples of young people hospitalised in psychiatry in FSEF were identified between the opening of the first unit in 1956 and 2016. The young people involved were mostly aged 16-20 years, which reflects the curricula covered in the FSEF establishments. These young people generally presented severe chronic psychiatric disorders. Their previous care trajectory had lasted for more than 3 years and 24-55% of them had attempted suicide at least once. Their stays lasted more than 6 months. Depending on the severity of the disorders, 44-63% of the young people were considered to have improved at discharge. The contribution of soins-études appears valuable for these young people, since there was a clinical improvement for 54-74% of them 1-15 years after their hospitalisation, with resumption of schooling, professional training or entry into employment in 60-75% of the cases. These results are compared with data in the international literature concerning therapeutic residential care, and lines for future research are identified.
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Affiliation(s)
- France Hirot
- Centre de Recherche en Épidémiologie et Santé des Populations, INSERM, UMR 1018, Université Paris-Saclay, Hôpital Paul Brousse, VillejuifCedex, France
- Service hospitalo-universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte, Fondation Santé des Etudiants de France, Paris, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Caroline Huas
- Centre de Recherche en Épidémiologie et Santé des Populations, INSERM, UMR 1018, Université Paris-Saclay, Hôpital Paul Brousse, VillejuifCedex, France
- Service hospitalo-universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte, Fondation Santé des Etudiants de France, Paris, France
| | - Damien Durand
- Directeur national des études et de la pédagogie de la Fondation Santé des Etudiants de France, Paris, France
- Inspecteur d'académie - inspecteur pédagogique régional, spécialité établissements et vie scolaire, Ministère de l'Education Nationale (French Minister of National Education), Paris, France
| | - Nathalie Godart
- Centre de Recherche en Épidémiologie et Santé des Populations, INSERM, UMR 1018, Université Paris-Saclay, Hôpital Paul Brousse, VillejuifCedex, France
- Service hospitalo-universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte, Fondation Santé des Etudiants de France, Paris, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
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Nawaz RF, Reen G, Bloodworth N, Maughan D, Vincent C. Interventions to reduce self-harm on in-patient wards: systematic review. BJPsych Open 2021; 7:e80. [PMID: 33858560 PMCID: PMC8086389 DOI: 10.1192/bjo.2021.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Incidents of self-harm are common on psychiatric wards. There are a wide variety of therapeutic, social and environmental interventions that have shown some promise in reducing self-harm in in-patient settings, but there is no consensus on the most appropriate means of reducing and managing self-harm during in-patient admissions. AIMS To review interventions used to reduce self-harm and suicide attempts on adolescent and adult psychiatric in-patient wards. METHOD A systematic literature search was conducted between 14 March 2019 and 25 January 2021 using PsycINFO and Medline (PROSPERO ID: CRD42019129046). A total of 23 papers were identified for full review. RESULTS Interventions fell into two categories, therapeutic interventions given to individual patients and organisational interventions aimed at improving patient-staff communication and the overall ward milieu. Dialectical behaviour therapy was the most frequently implemented and effective therapeutic intervention, with seven of eight studies showing some benefit. Three of the six ward-based interventions reduced self-harm. Two studies that used a combined therapeutic and ward-based approach significantly reduced self-harm on the wards. The quality of the studies was highly variable, and some interventions were poorly described. There was no indication of harmful impact of any of the approaches reported in this review. CONCLUSIONS A number of approaches show some promise in reducing self-harm, but the evidence is not strong enough to recommend any particular approach. Current evidence remains weak overall but provides a foundation for a more robust programme of research aimed at providing a more substantial evidence base for this neglected problem on wards.
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Affiliation(s)
- Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, UK; Patient Safety Collaborative, Oxford Academic Health Science Network, UK; and Department of Psychiatry, University of Cambridge, UK
| | - Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Natasha Bloodworth
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Daniel Maughan
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
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8
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Kipoulas E, Berzengi A, Kyriakopoulos M. Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit. Eur Psychiatry 2020; 64:e1. [PMID: 33323142 PMCID: PMC8057375 DOI: 10.1192/j.eurpsy.2020.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions. Methods A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children’s unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge. Results A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children’s self-harm/suicidality. Conclusions Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.
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Affiliation(s)
- Eleftherios Kipoulas
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Azi Berzengi
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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9
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Özlü-Erkilic Z, Wenzel T, Kothgassner OD, Akkaya-Kalayci T. Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186498. [PMID: 32906614 PMCID: PMC7557370 DOI: 10.3390/ijerph17186498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
Abstract
Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Türkan Akkaya-Kalayci
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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Hansson K, Malmkvist L, Johansson BA. A 15-year follow-up of former self-harming inpatients in child & adolescent psychiatry - a qualitative study. Nord J Psychiatry 2020; 74:273-279. [PMID: 31799887 DOI: 10.1080/08039488.2019.1697747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Self-harm is common among adolescents, and is even more frequent among psychiatric populations. The aim of this study was to increase knowledge and understanding of different aspects of life for adults who, when adolescents, had engaged in severe self-harm during inpatient stays.Material and methods: Individual semi-structured interviews were held with seven former inpatients with a history of severe self-harm during inpatient stay in their adolescence. The interviews were analysed using a qualitative method, and the results were described in the form of categories and sub-categories.Results: Five categories, with 16 sub-categories, were found to be related to the former patients' experiences of their lives. At the time of the interviews, the subjects were in their early thirties and had no ongoing self-harm. In childhood they had experienced a dysfunctional relationship with one or both of their parents, and self-harm was one of several destructive behaviours. Friendships outside the unit were difficult during adolescence. Soon after admission to the psychiatric inpatient unit, relationships with other patients became important and contributed to them wanting to stay at the unit. Meaningful relationships and being part of a social context with healthy expectations were seen as important factors for stopping self-harm at a later stage. The subjects' experiences of their life today ranged from not enjoying it to accepting their current situation.Conclusion: These findings are based on a small sample, but they indicate the importance of relationships and the social context in contributing to and then ending self-harm.
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Affiliation(s)
- Kristian Hansson
- Department of Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Skåne University Hospital, Malmö, Sweden
| | - Lars Malmkvist
- Department of Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Skåne University Hospital, Malmö, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden.,Department of Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Skåne University Hospital, Malmö, Sweden
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Grattan RE, Lara N, Botello RM, Tryon VL, Maguire AM, Carter CS, Niendam TA. A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis. J Clin Med 2019; 8:E1082. [PMID: 31340527 PMCID: PMC6678563 DOI: 10.3390/jcm8071082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms-such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior-for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12-35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Natalia Lara
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Renata M Botello
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Valerie L Tryon
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Adrienne M Maguire
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA.
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12
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Borschmann R, Stark P, Prakash C, Sawyer SM. Risk profile of young people admitted to hospital for suicidal behaviour in Melbourne, Australia. J Paediatr Child Health 2018; 54:1213-1220. [PMID: 29779227 DOI: 10.1111/jpc.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/22/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
AIM Self-harm and suicidal behaviour is most prevalent during adolescence, but little is known about the risk profile of adolescents admitted to hospital for suicidal behaviour. Young people who self-harm are at an increased risk of mortality compared to those who do not self-harm; adolescents admitted to hospital for suicidal behaviour are particularly at risk. The aim of this study was to generate a risk profile of adolescents admitted to hospital with suicidal behaviour. METHODS We conducted a 12-month retrospective audit of adolescent admissions to the mental health inpatient unit at a tertiary children's hospital in Melbourne, Australia. Routinely collected data were used to generate a risk profile. RESULTS We found that 212 of 271 (78.2%) admissions were due to suicidal behaviour. Of these, 107 (51%) adolescents were diagnosed with one or more mental disorders at discharge, most commonly major depressive disorder. Beyond known distal determinants of health risk, the proximal risk profile of these adolescents included factors relating to gender, substance use, prior mental health diagnoses and prior admission to hospital. Poor sleep was also a risk factor, with 159 (75%) reporting a recent history of sleeping problems. CONCLUSIONS The very high proportion of admissions to the mental health inpatient unit due to suicidal behaviour reinforces the importance of finding effective methods of identification of the risk processes underpinning suicidal behaviours to reduce the unnecessary waste of young lives by suicide.
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Affiliation(s)
- Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Mental Health, Melbourne School of Population of Global Health, Melbourne, Victoria, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Patrick Stark
- Mental Health Services, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Chidambaram Prakash
- Mental Health Services, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Huang YH, Liu HC, Tsai FJ, Sun FJ, Huang KY, Chiu YC, Huang YH, Huang YP, Liu SI. Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan. BMJ Open 2017; 7:e017949. [PMID: 29217724 PMCID: PMC5728252 DOI: 10.1136/bmjopen-2017-017949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate differences and similarities in risk factors for deliberate self-harm (DSH) and suicidal attempt (SA), and the role of impulsivity among a group of community adolescents. SETTING This is a cross-sectional study conducted at high schools in Northern Taiwan. DATA AND PARTICIPANTS We recruited grade 1 students from 14 high schools. A total of 5879 participants (mean age 16.02 years, female adolescents: 57.7%) completed the online assessment. OUTCOME MEASURES Participants completed online questionnaires about sociodemographic data, suicidality, history of DSH and SA, depressed mood, self-esteem, social support, family discord, impulsivity (Barratt Impulsiveness Scale Version 11 (BIS-11)) and the use of alcohol, tobacco and illicit drugs. A subsample was interviewed about lifetime SA, and the results were compared with those from the online questionnaires. RESULTS In our sample, 25% of the students had lifetime DSH and 3.5% had lifetime SA. Two hundred and seventy-two students received face-to-face interviews. The concordance between the online questionnaires and interviews in terms of ascertaining cases of SA was moderate (concordance rate 82.76%; kappa value 0.59). Similar risk factors for DSH/SA among the whole sample included female gender, lower academic performance, depression, substance use (tobacco and alcohol) and low self-esteem. The BIS-11 score was correlated with DSH. Factor 3 score of the BIS-11 (novelty seeking) was correlated with DSH in both boys and girls, whereas factor 2 score (lack of self-control) was correlated with SA in boys. Social support was a protective factor against SA among the female adolescents. Gender modulated the association of impulsivity and DSH/SA. Associations between impulsivity and DSH and SA were particularly strong among boys. CONCLUSIONS Risk factors for DSH and SA were similar, but not identical. Early identification of those at risk and appropriate interventions may be helpful.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
- Suicide Prevention Centre, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
- Suicide Prevention Centre, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Fang-Ju Tsai
- Department of Psychiatry, En Chu Kong Hospital, New Taipei City, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yu-Ching Chiu
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Yen-Hsun Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
- Suicide Prevention Centre, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
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Khan U, Hisam B, Zia N, Mir M, Alonge O, Jamali S, Hyder AA, Razzak J. Uncovering the burden of intentional injuries among children and adolescents in the emergency department. BMC Emerg Med 2015; 15 Suppl 2:S6. [PMID: 26692292 PMCID: PMC4682402 DOI: 10.1186/1471-227x-15-s2-s6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan. Methods The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries. Results Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders. Conclusion Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention.
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Whisenhunt JL, Chang CY, Brack GL, Orr J, Adams LG, Paige MR, McDonald CPL, O'Hara C. Self-Injury and Suicide: Practical Information for College Counselors. JOURNAL OF COLLEGE COUNSELING 2015. [DOI: 10.1002/jocc.12020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Catherine Y. Chang
- Department of Counseling and Psychological Services; Georgia State University
| | - Gregory L. Brack
- Department of Counseling and Psychological Services; Georgia State University
| | - Jonathan Orr
- Department of Counseling and Psychological Services; Georgia State University
| | | | - Melinda R. Paige
- Department of Counseling and Psychological Services; Georgia State University
- Now at Department of Counseling; Argosy University; Atlanta
| | | | - Caroline O'Hara
- Department of Counseling and Psychological Services; Georgia State University
- Now at Department of Counselor Education; University of Toledo
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Hannigan B, Edwards D, Evans N, Gillen E, Longo M, Pryjmachuk S, Trainor G. An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BackgroundInpatient child and adolescent mental health services are one part of a complex system, and exist to meet the needs of young people with the greatest mental health difficulties.ObjectivesThe research question was ‘What is known about the identification, assessment and management of risk (where “risk” is broadly conceived) in young people (aged 11–18 years) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’Data sourcesThe two-phase Evidence for Policy and Practice Information and Co-ordinating Centre approach was used. In phase 1, scoping searches were made using two databases with an end date of March 2013. Phase 2 centred on the search for citations relating to the risks to young people of ‘dislocation’ and ‘contagion’. Searches were made using 17 databases, with time limits from 1995 to September 2013. Websites were searched, a call for evidence circulated and references of included citations reviewed.Review methodsPriority risk areas for phase 2 were decided in collaboration with stakeholders including through consultations with young people and the mother of a child who had been in hospital. All types of evidence relating to outcomes, views and experiences, costs and cost-effectiveness, policies, and service and practice responses in the areas of ‘dislocation’ and ‘contagion’ for young people (11–18 years) using inpatient mental health services were considered. A staged approach to screening was used. Data were extracted into tables following guidance from the Centre for Reviews and Dissemination or tables developed for the review. Quality was assessed using appraisal checklists from the Effective Public Health Practice Project or the Critical Skills Appraisal Programme or devised by previous reviewers. No papers were excluded on the grounds of quality, and all materials identified were narratively synthesised.ResultsIn phase 1, 4539 citations were found and 124 included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found and 40 addressing the less obvious risks of ‘dislocation’ and ‘contagion’ were included, supplemented by 20 policy and guidance documents. These were synthesised using these categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis or economic evaluation. The importance to stakeholders of these less obvious risks contrasted with the limited quantity and quality of research capable of informing policy, services and practice in these areas.LimitationsIncluded studies were of variable quality. Data derived could not be used to inform an economic modelling of NHS costs or to analyse cost-effectiveness. Other limitations were the search for only English-language materials and the use of umbrella concepts (‘dislocation’ and ‘contagion’).ConclusionsThe less obvious risks are important, but little evidence exists to support their identification, assessment and management. This has implications for services, and a programme of research is recommended to generate new knowledge.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Ben Hannigan
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nicola Evans
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Mirella Longo
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Steven Pryjmachuk
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Gemma Trainor
- Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
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Shek DTL, Leung H. Positive youth development, life satisfaction, and problem behaviors of adolescents in intact and non-intact families in Hong Kong. Front Pediatr 2013; 1:18. [PMID: 24400264 PMCID: PMC3860885 DOI: 10.3389/fped.2013.00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/29/2013] [Indexed: 11/15/2022] Open
Abstract
This study investigated whether Chinese adolescents living in intact and non-intact families differed in their positive development, life satisfaction, and risk behavior. A total of 3,328 Secondary 1 students responded to measures of positive youth development (such as resilience and psychosocial competencies), life satisfaction, and risk behavior (substance abuse, delinquency, Internet addiction, consumption of pornographic materials, self-harm, and behavioral intention to engage in problem behavior). Findings revealed that adolescents growing up in intact families reported higher levels of positive developmental outcomes and life satisfaction as compared with adolescents from non-intact families. Adolescents in non-intact families also reported higher levels of risk behaviors than those growing up in intact families.
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Affiliation(s)
- Daniel T. L. Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Centre for Innovative Programmes for Adolescents and Families, The Hong Kong Polytechnic University, Hong Kong, China
- Kiang Wu Nursing College of Macau, Macau, China
- Department of Social Work, East China Normal University, Shanghai, China
- Department of Pediatrics, Division of Adolescent Medicine, Kentucky Children’s Hospital, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hildie Leung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Catledge CB, Scharer K, Fuller S. Assessment and Identification of Deliberate Self-Harm in Adolescents and Young Adults. J Nurse Pract 2012. [DOI: 10.1016/j.nurpra.2012.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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