Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department

Patterns of health service use for children with mental disorders in an Australian state population cohort

OBJECTIVES

The rate of mental health services provided to children and young people is increasing worldwide, including in Australia. The aim of this study was to describe patterns of hospital and ambulatory mental health service use among a large population cohort of adolescents followed from birth, with consideration of variation by age, sex and diagnosis.

METHODS

Characteristics of services provided for children with mental disorder diagnoses between birth and age 17.5 years were ascertained for a population cohort of 85,642 children (52.0% male) born between 2002 and 2005, from 'Admitted Patients', 'Emergency Department' and 'Mental Health Ambulatory' records provided by the New South Wales and Australian Capital Territory Health Departments.

RESULTS

A total of 11,205 (~13.1%) children received at least one hospital or ambulatory health occasion of service for a mental health condition in the observation period. More than two-fifths of children with mental disorders had diagnoses spanning multiple categories of disorder over time. Ambulatory services were the most heavily used and the most common point of first contact. The rate of mental health service contact increased with age across all services, and for most categories of mental disorder. Girls were more likely to receive services for mental disorders than boys, but boys generally had an earlier age of first service contact. Finally, 3.1% of children presenting to mental health services experienced involuntary psychiatric inpatient admission.

CONCLUSIONS

The extent of hospital and ambulatory-based mental healthcare service among children emphasises the need for primary prevention and early intervention.

Path to Suicidality in Korean Adolescents: Mediating Role of Self-Esteem, Somatic Symptoms, and Self-Harm Amid Depressive Symptoms

This study explored the relationship between depressive symptoms and suicidality among community-dwelling adolescents aged 10-18 years, examining whether self-esteem, somatic symptoms, and self-harm mediate this relationship. Utilizing a pre-existing dataset from a nationwide adolescent mental health survey conducted in Korea in 2021, data were collected using several standardized self-administered instruments: the Korean version of Rosenberg's self-esteem scale, Korean Children's Somatization Inventory, Korean version of the Self-Harm Inventory, Mental Health Screening for Depressive Disorders, and Mental Health Screening for Suicide Risk. A path model was constructed and validated, followed by path analysis to assess the effects. Data from 6689 adolescents, including 5937 students and 752 out-of-school adolescents, revealed that 18.7% were in the suicidality group, 11.8% experienced depressive symptoms, 57.9% exhibited somatic symptoms, and 27.4% engaged in self-harm. Depressive symptoms had a positive direct effect on suicidality (β = 0.166, p < 0.001, 95% confidence interval = 0.159-0.172). Bootstrapping tests showed a statistically significant indirect effect of self-esteem, somatic symptoms, and self-harm on the relationship between depressive symptoms and suicidality (β = 0.021, 95% confidence interval = 0.013-0.029). Our findings suggest that self-esteem, somatic symptoms, and self-harm mediate the relationship between depressive symptoms and suicidality, and comprehensive mental health management strategies addressing these factors are recommended.

Study on the correlation between suicidal ideation and ABI3BP gene、DPYSL2 gene methylation in pediatric bipolar disorder with depressive episode

Patients with bipolar disorder have a higher risk of suicide than the general population. This study aimed to explore the correlation between suicide and gene methylation, as screened by genome-wide scanning, in children and adolescents with bipolar disorder. A total of 45 children and adolescents with bipolar disorder were divided into a suicidal ideation group (n = 41), a non-suicidal ideation group (n = 4), a low-risk group (n = 12), and a middle-to-high-risk group (n = 33). A pre-experiment was conducted on the suicidal ideation (n = 6) and non-suicidal ideation groups (n = 4). Blood samples were scanned using an Illumina HD 850K microarray, and methylation levels were analysed. Differential methylation sites among the sample groups were screened from the original data, and genes related to suicide were identified. Methylation of the ABI3BP and DPYSL2 genes was detected by pyrophosphate sequencing and statistically analysed. There was a significant difference in age between the low- and middle-risk groups. The results of GO analysis for the suicidal ideation and non-suicidal ideation groups showed that the differential methylation sites were mainly involved in the interferon-γ-mediated signalling pathway, with the main signalling pathways being the inflammatory bowel disease (IBD) pathway and type 1 diabetes mellitus (T1DM) pathway. There were significant differences in the methylation of ABI3BP, HLA-DQB1, HLA-DRB1, AUTS2, SP3, NINJ2, DPYSL2, and other genes between the suicidal and non-suicidal ideation groups. There was also a statistically significant difference in the gene methylation levels between the two groups. However, there was no significant difference in the degree of methylation of the ABI3BP and DPYSL2 genes between the low- and middle-to-high-risk groups. These results suggest that suicidal ideation is correlated with the methylation levels of differentially methylated genes in children with bipolar disorder. However, the severity of suicide risk in paediatric patients with bipolar disorder may not be correlated with the degree of methylation of the ABI3BP and DPYSL2 genes. Therefore, further validation was required.

The effects of family environment cognition and its difference perceived by adolescents and their parents on the treatment effect of non-suicidal self-injury behaviors in adolescents: a 1-year prospective cohort study

Introduction

Family environment is the primary environment for adolescent growth and development, which is believed to have an important impact on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents. This study aimed to explore the effects of family environment cognition and cognitive differences perceived by adolescents and their parents on the treatment effects of NSSI in adolescents and to provide more potential perspectives for NSSI treatment.

Methods

A one-year prospective longitudinal sub-cohort investigation was carried out among 199 adolescents engaged in NSSI and one of their important guardians from the Longitudinal Psychosomatic Disease Study (LoPDS). The NSSI behaviors of adolescents were evaluated at 3 months, 6 months and 1 year after enrollment. The family environment scale (FES) and NSSI Behavior Questionnaire were used as assessment tools for family environment and adolescents NSSI behaviors. Multiple linear regression was used to investigate the role of family environment perception difference in the treatment effect of adolescent NSSI.

Results

After one year of follow-up, the perceived self-injury impulse score in recent 2 weeks, self-injury impulse frequency in recent 2 weeks, total number of self-injury in recent 2 weeks decreased significantly. The higher the adolescent family cohesion (Beta: 1.130, 95% CI: 0.886,1.373; p=0.032), parental family expressiveness (Beta: 0.818, 95% CI: 0.375,1.260; p=0.037) and parental family active-recreational orientation score (Beta: 0.609, 95% CI: 0.236,0.981; p=0.048), the better the treatment effect. However, higher adolescent family conflict (Beta: -0.838, 95% CI: -1.377,-0.298; p=0.024) were associated with lower treatment outcomes. The greater the cognitive difference between parents and adolescents in family cohesion (Beta: -1.307, 95% CI: -2.074,-0.539; p=0.014) and family conflict(Beta: -0.665, 95% CI: -0.919,-0.410; p=0.037), the worse the therapeutic effect of NSSI might be.

Discussion

There were certain differences in the cognition of family relationships between parents and adolescents, and subjective family relationship cognition and cognitive differences had a significant effect on the treatment effect of NSSI in adolescents. Helping them identify the cause of cognitive differences and conducting systematic family therapy from the points of difference may be another perspective to improve the treatment effect of NSSI in adolescents.

Mental health emergency admissions in the paediatric emergency department

AIM

To evaluate the demographic characteristics, diagnoses and length of stay of mental health emergency attendance to the paediatric emergency department (ED), to determine the burdens these patients brought to the paediatric ED and to the national economy by examining hospital costs.

METHODS

This retrospective observational study was conducted in a tertiary hospital's paediatric ED in Turkey. Data were obtained from the electronic medical record system from January 2018 to January 2020.

RESULTS

A total of 142 admissions were included of whom 60% were female. The mean age was 15.2 ± 1.8 years, 50% of cases were suicide attempts and 19% were alcohol intoxications. The majority (85.9%) of patients were discharged from the emergency observation unit. Among the diagnostic groups, the mean age was higher in patients with a history of substance abuse. There was a female predominance among patients who were admitted due to suicide attempts. Among the diagnostic groups, the duration of hospital stay and cost of hospitalization were higher in patients who were followed up with a diagnosis of suicide attempt.

CONCLUSIONS

Mental health problems are frequent in the paediatric ED. We determined that the most common cause of attendance in paediatric emergencies was suicide attempts, and the length of hospital stay and hospital cost were higher in this diagnostic group. Although further research is necessary to determine national trends in paediatric mental health problems in the paediatric ED, screening strategies and early detection and interventions in primary healthcare may allow more effective care for childhood mental health problems.

Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020

OBJECTIVE

The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020.

METHODS

This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data.

RESULTS

There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions.

CONCLUSIONS

Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: a latent variable mediation analysis

BACKGROUND

Childhood and peer experiences can influence adolescents' perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents' NSSI.

METHODS

A cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI.

RESULTS

The SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI.

CONCLUSION

In future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior.

The Association Between Media Exposure to Non Suicidal Self-Injury and Emergency Department Visits for Self-Harm

OBJECTIVE

This study aimed to evaluate the association between media exposure to non suicidal self-injury (NSSI) and emergency department (ED) visits due to self-harm in Korea, specifically before and after the initial broadcast of the song Barcode, which has an explicit focus on NSSI.

METHOD

We used the national emergency department information system to obtain data related to ED visits due to self-harm between January 1, 2014, and December 31, 2018. Using interrupted time series regression analysis, we assessed the monthly ED visits due to self-harm before and after the media exposure to NSSI on March 30, 2018. In addition, self-harm methods were assessed.

RESULTS

A total of 35,928,834 visits to ED were identified, of which 115,647 were due to self-harm. ED visits due to self-harm showed a significant step increase in the 10- to 14-year-old (β = 0.883, p = .001), 15- to 19-year-old (β = 2.941, p < .001), 20- to 24-year-old (β = 1.997, p = 0.002), and 25- to 29-year-old (β = 1.438, p = .029) age groups, before and after the media exposure to NSSI. The most pronounced increase was observed in male participants aged 20 to 24 years (β = 1.790, p = .012) and female participants aged 15 to 19 years (β = 5.158, p < .001). Self-harm by cutting has increased significantly in participants aged 10 to 29 years, and self-harm by poisoning has also increased significantly in participants aged 10 to 19 and 25 to 29 years.

CONCLUSION

ED visits due to self-harm increased significantly, especially in adolescents and young adults, following the exposure to NSSI. Responsible media reporting on NSSI and appropriate guidelines would help prevent a further increase in self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Increased Right Dorsolateral Prefrontal Cortex Connectivity During Emotion Recognition Task in Adolescents With Self-Injurious Behavior: A Functional Near-Infrared Spectroscopy Study

OBJECTIVE

Research on neural correlates in the prefrontal cortex (PFC) associated with self-injurious behavior has mainly been performed in adults. However, studies on adolescents are scarce. We aimed to investigate the activation and connectivity of the PFC between adolescents with self-injurious behavior (ASI) and psychiatric controls (PC) using functional near-infrared spectroscopy (fNIRS).

METHODS

We used an emotion recognition task during fNIRS to assess 37 adolescents (23 with self-injurious behavior and 14 PC) between June 2020 and October 2021 and compared connectivity and activation between the two groups. We also measured adverse childhood events (ACE, Adverse Childhood Experiences) and performed a correlation analysis of channel activation according to ACE total scores.

RESULTS

The difference in activation between the groups was not statistically significant. The connectivity of channel 6 was statistically significant. The interaction between channel 6 and the ACE total score showed statistical significance between the two groups(t[33] -2.61; p=0.014). The ASI group showed a negative correlation with the total ACE score.

CONCLUSION

This is the first study to investigate PFC connectivity using fNIRS in ASI. It has the implication of a novel attempt with a practically useful tool to uncover neurobiological differences among Korean adolescents.

Influence of academic stress and school bullying on self-harm behaviors among Chinese middle school students: The mediation effect of depression and anxiety

Objective

The purpose of this study was to explore the relationship between academic stress, school bullying and self-harm behaviors among Chinese middle school students and to further explore the impact of anxiety and depression on this relationship.

Methods

The students (aged 12-16 years) in a middle school in Changsha city were invited to respond to a questionnaire through an online platform. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess the severity of anxiety and depressive symptoms, respectively. The experience of being bullied, academic stress, and self-harm behaviors were assessed using several questions on the basis of previous studies.

Results

A total of 1,313 middle school students completed the study, and 3.40% and 4.10% of them reported suicide attempts (SAs) and non-suicidal self-injury (NSSI), respectively. Univariate logistic regression analysis revealed that anxiety symptoms (OR = 1.23, 95% CI: 1.18-1.28; OR = 1.25, 95% CI: 1.19-1.31), depressive symptoms (OR = 1.20, 95% CI: 1.16-1.25; OR = 1.26, 95% CI: 1.20-1.31), school bullying (OR = 3.8, 95% CI: 2.11-6.89; OR = 2.76, 95% CI: 1.39-5.47), and academic stress (OR = 2.20, 95% CI: 1.27-3.80; OR = 3.80, 95% CI: 1.20-7.25) were common factors of NSSI and SAs. In addition, depressive symptoms showed a mediating effect on the association of school bullying and academic stress with SAs or NSSI, and anxiety symptoms showed a mediating effect on the association of school bullying and academic stress with NSSI only.

Conclusion

Appropriate strategies are needed to reduce academic pressure and prevent school bullying. Meanwhile, negative emotions such as depression and anxiety should be evaluated and intervened in to prevent self-harm behaviors among middle school students.

Development and validation of a prediction nomogram for non-suicidal self-injury in female patients with mood disorder

Background

Non-suicidal self-injury (NSSI) is a highly prevalent behavioral problem among people with mental disorders that can result in numerous adverse outcomes. The present study aimed to systematically analyze the risk factors associated with NSSI to investigate a predictive model for female patients with mood disorders.

Methods

A cross-sectional survey among 396 female patients was analyzed. All participants met the mood disorder diagnostic groups (F30-F39) based on the Diseases and Related Health Problems 10th Revision (ICD-10). The Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test were used to assess the differences of demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses was then used to identify the risk factors of NSSI. A nomogram was further used to construct a prediction model.

Results

After LASSO regression selection, 6 variables remained significant predictors of NSSI. Psychotic symptom at first-episode (β = 0.59) and social dysfunction (β = 1.06) increased the risk of NSSI. Meanwhile, stable marital status (β = -0.48), later age of onset (β = -0.01), no depression at onset (β = -1.13), and timely hospitalizations (β = -0.10) can decrease the risk of NSSI. The C-index of the nomogram was 0.73 in the internal bootstrap validation sets, indicated that the nomogram had a good consistency.

Conclusion

Our findings suggest that the demographic information and clinical characteristics of NSSI can be used in a nomogram to predict the risk of NSSI in Chinese female patients with mood disorders.

A Pre-Adolescent and Adolescent Clinical Sample Study about Suicidal Ideation, Suicide Attempt, and Self-Harming

Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (M_age = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal-Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.

Self-Transcendence Mediates the Relationship between Early Trauma and Fatal Methods of Suicide Attempts

BACKGROUND

Early trauma is known to be a risk factor of suicide-related behavior. On the other hand, people who attempt suicide using a fatal method are reported to be more likely to complete suicide. In this study, we assumed that early trauma affects an individual's temperament and character and thereby increases the risk of a fatal method of suicide attempts.

METHODS

We analyzed 92 people with a history of previous suicide attempts. We compared the Temperament and Character Inventory-Revised scores between the groups with and without early trauma, and between the groups with and without a history of suicide attempt using fatal methods through an analysis of covariance with age, sex, and presence of a psychiatric history as covariates. A mediation analysis was conducted of the relationship between early trauma and fatal methods of suicide attempt with self-transcendence as a mediator.

RESULTS

Higher self-transcendence was reported in the fatal group (27.71 ± 13.78 vs. 20.97 ± 12.27, P = 0.010) and the early trauma group (28.05 ± 14.30 vs. 19.43 ± 10.73, P = 0.001), respectively. The mediation model showed that self-transcendence mediates the relationship between early trauma and fatal methods of suicide attempt. The 95% confidence intervals for the direct and indirect effect were (-0.559, 1.390) and (0.026, 0.947), respectively.

CONCLUSION

Self-transcendence may mediate the relationship between early trauma and fatal methods of suicide attempt. Self-transcendence may be associated with unhealthy defenses and suicidal behavior for self-punishment and may constitute a marker of higher suicide risk.