Depressed suicide attempters with posttraumatic stress disorder

Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behavior. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure, and suicidal behavior. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm, and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.

Cannabis use and deliberate self-harm in adolescence: a comparative analysis of associations in England and Norway

The objective of this study was to test hypotheses on causality and selection regarding associations between cannabis use and deliberate self-harm (DSH) among adolescents. School surveys were conducted among 9,800 adolescents in England and Norway applying identical measures on deliberate self-harm, suicidal thoughts, cannabis use, and various potential confounders. Cannabis use was more prevalent in England than in Norway. It was associated with DHS, suicidal thoughts and various risk factors for DSH. However, these associations were stronger in Norway than in England. The adjusted associations between cannabis use and suicidal thoughts were non-significant in both countries. The adjusted cannabis-DSH association was non-significant in England but significant in Norway. Elevated risk of DSH in adolescent cannabis users seems to be mainly due to selection mechanisms. Thus the association is not likely to be direct but due to other shared contributory factors.

Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not

This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardised self-report questionnaire was completed by pupils aged 14-17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n=30,532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened.

Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study

BACKGROUND

Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people.

METHOD

Over 30,000 mainly 15- and 16-year-olds completed anonymous questionnaires at school in Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway. Study criteria were developed to identify episodes of self-harm; the prevalence of self-harm acts and thoughts, methods used, repetition, reasons given, premeditation, setting for the act, associations with alcohol and drugs, hospitalisation, and whether other people knew, were examined.

RESULTS

Self-harm was more than twice as common among females as males and, in four of the seven countries, at least one in ten females had harmed herself in the previous year. Additional young people had thought of harming themselves without doing so. More males and females in all countries except Hungary cut themselves than used any other method, most acts took place at home, and alcohol and illegal drugs were not usually involved. The most common reasons given were 'to get relief from a terrible state of mind' followed by 'to die', although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime.

CONCLUSIONS

Deliberate self-harm is a widespread yet often hidden problem in adolescents, especially females, which shows both similarities and differences internationally.

Cross-national comparisons of the association between alcohol consumption and deliberate self-harm in adolescents

How differences in drinking patterns may affect the impact of alcohol consumption on deliberate self-harm among adolescents is explored in this international comparative study. Schools in Australia, Belgium, England, Hungary, Ireland, the Netherlands, and Norway (N = 30,532) were surveyed. In all countries the risk of deliberate self-harm was significantly elevated among adolescents who reported some or numerous episodes of intoxication, controlling for confounding factors. The results support the assumption that intoxication is significantly related to the association between alcohol consumption and deliberate self-harm in adolescents.

Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?

OBJECTIVE

Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior.

METHOD

Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule.

RESULTS

The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated.

CONCLUSION

Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.

[Deliberate self harm in adolescents]

BACKGROUND

The multisenterstudy Child and Adolescent Self Harm in Europe aims at gaining more valid knowledge about the prevalence of deliberate self harm in adolescents and the factors associated with it. A new method was developed by which the adolescents' self-reported acts of deliberate self harm are included and categorised according to strict predefined criteria.

MATERIAL AND METHOD

4060 11th grade students (response rate 91.2 %) aged 15 and 16 in 36 Norwegian high schools filled in an anonymous self-report questionnaire.

RESULTS

266 (6.6 %) reported one or more acts of deliberate self harm that met the study criteria over the course of the previous twelve-month period. Cutting (74.1 %) and self-poisoning (16.9 %) were most prevalent. 14.7 % had been in contact with a hospital; 46.7 % of self-poisoning episodes but only 6.1 % of cutting episodes were treated in hospital. Deliberate self harm was more common in females than in males (10.2 % vs 3.1 %, odds ratio 3.5, 95 % CI 2.66 - 4.72). Multiple logistic regression showed significant associations for both sexes between deliberate self harm and low self-esteem, deliberate self harm by friends, serious conflicts with parents, or drug misuse. For girls, alcohol misuse, parents being divorced, being sexually abused, anxiety and impulsivity were also significant; so was deliberate self harm in the family for boys.

INTERPRETATION

Deliberate self harm among adolescents requires varied and intensified efforts.

[Psychosocial follow up after parasuicide at hospital departments in Norway]

BACKGROUND

Routines and standards of care for parasuicide patients in general hospitals in Norway were reviewed in relation to international and national recommendations.

MATERIAL AND METHODS

Telephone interviews were conducted with personnel at all Norwegian general hospitals with emergency units. 55 of a total of 58 hospitals participated (95%).

RESULTS

Two thirds of the hospitals reported that most parasuicide patients were routinely psychiatrically evaluated and then referred to psychiatric or community aftercare. At almost half of the hospitals (46%) the staff had not received any specific training in clinical management of parasuicide patients during the last three years. Structured collaboration with external aftercare providers was non-existent in 43% of the hospitals. Hospitals with projects aimed at psychosocial follow up of parasuicide patients or hospitals with a team or a person responsible for the follow-up, had, however, routines more in accordance with the recommendations than hospitals without projects or teams.

INTERPRETATION

The study shows great variations between Norwegian general hospitals in their routines and standards of care for psychosocial follow-up of parasuicide patients. Increasing the staff's competence, developing written routines and establishing mutually binding co-operation between the hospital and external caregivers are important areas for further development.

Life stress, social support and psychological distress in late adolescence: a longitudinal study

Questionnaire data from 211 adolescents and follow-up data recorded 18 months later were employed to test main effects and stress-buffering effects of negative life events, on-going stressors and social support from family and friends on mental health. Negative life events, change from baseline level of on-going adversities and social support all contributed significantly to subsequent symptom scores, although negative life events only reached borderline significance among boys. There was evidence in favour of the buffer hypothesis for boys: negative life events had a significantly stronger effect when social support from peers was low, and long-lasting adversities had a significantly stronger effect when social support from parents was low. Both these two-way interaction effects among boys were significantly different from the corresponding trends among girls. Since the scores on both the independent and dependent variables are based on subjective self-reports, the results may have been affected by various types of response bias. The probabilities of such bias effects are discussed.

Life stress, social support and psychological distress in late adolescence

Psychological distress in high-school students was examined in relation to negative life events, long-lasting adversities and perceived social support from the family, friends and the school class. Academic problems increased the symptom levels of psychological distress, and social support from family and social support from friends reduced the symptoms among males and females. For females, social support from school class-mates and problems with parents and friends also had direct independent effects on symptom levels. An effect of the total number of long-lasting adversities was significantly stronger for females than males. The buffer hypothesis was supported: both an increase in social support from parents and social support from peers reduced the effect of negative life events.