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Huang YH, Chiou HC, Pan CH, Wang IS, Liao YT, Su SS, Chen CC, Kuo CJ. Healthcare Utilization, Physical and Psychiatric Comorbidities Before Self-Injurious Behavior in Patients with Asthma: A Nested Case-Control Study. J Asthma Allergy 2024; 17:411-420. [PMID: 38736905 PMCID: PMC11088374 DOI: 10.2147/jaa.s449337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
Background Patients with asthma experience more physical, psychological, and financial burdens; a link between asthma and suicidality has been reported in research. Purpose This study analyzed the medical utilization and comorbidity before their self-injurious behavior in patients with asthma. Methods We enrolled 186,862 patients newly diagnosed with asthma between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 500 case subjects had ever conducted self-injurious behaviors during the study period. Based on a nested case-control study, each case was matched with 10 controls derived from the asthma cohort to analyze differences between them and their medical use models. Results The results indicated that, compared to the control group, the cases presented higher frequencies of outpatient visits and hospitalizations. Regarding comorbidity, the cases had more cardiovascular diseases (adjusted odds ratio [aOR]=1.58; p<0.001), bipolar disorder (aOR=2.97; p<0.001), depression (aOR=4.44; p<0.001), and sleep disorder (aOR=1.83; p<0.001) than the controls. Conclusion The evidence-based information serves as a reference for medical staff to reduce the occurrence of self-injurious behavior in patients with asthma.
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Affiliation(s)
- Yen-Hsun Huang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Hsien-Chih Chiou
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - I-Shuan Wang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ya-Tang Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Tharp D, Goldstein EV, Medina RM, Brewer SC, Bakian AV, Coon H. Utah Latina/o/x suicide decedents less likely to die by firearm, even in rural areas: examining population-wide data from the Utah Office of the Medical Examiner. Front Public Health 2024; 12:1358043. [PMID: 38660351 PMCID: PMC11040675 DOI: 10.3389/fpubh.2024.1358043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Suicide death remains a significantly rarer event among Latina/o/x populations compared to non-Latina/o/x populations. However, the reasons why Latina/o/x communities experience relatively lower suicide rates are not fully understood. Critical gaps exist in the examination of Latina/o/x suicide death, especially in rural settings, where suicide death by firearm is historically more common within non-Latina/o/x populations. Method We tested whether the prevalence of Latina/o/x firearm suicide was meaningfully different in urban and rural environments and from non-Latino/a/x decedents when controlling for age, sex, and a social deprivation metric, the Area Deprivation Index. Suicide death data used in this analysis encompasses 2,989 suicide decedents ascertained in Utah from 2016 to 2019. This included death certificate data from the Utah Office of the Medical Examiner on all Utah suicide deaths linked to information by staff at the Utah Population Database. Results Compared to non-Latina/o/x suicide decedents, Latina/o/x suicide decedents had 34.7% lower adjusted odds of dying by firearm. Additionally, among the firearm suicide decedents living only in rural counties, Latina/o/x decedents had 40.5% lower adjusted odds of dying by firearm compared to non-Latina/o/x suicide decedents. Discussion The likelihood of firearm suicide death in Utah differed by ethnicity, even in rural populations. Our findings may suggest underlying factors contributing to lower firearm suicide rates within Latina/o/x populations, e.g., aversion to firearms or less access to firearms, especially in rural areas, though additional research on these phenomena is needed.
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Affiliation(s)
- Douglas Tharp
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Evan V. Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard M. Medina
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Simon C. Brewer
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Amanda V. Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
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Abstract
OBJECTIVE The use of sexual activity to self-injure has been proposed in research literature but remains underexplored. The purpose of this pilot study was to determine the feasibility of identifying sexual activity as self-injury in a U.S. college-based sample and to provide a preliminary examination of sexual activity as self-injury to inform future study on this topic. METHOD A cross-sectional descriptive pilot study was conducted to assess for recognition of and attitudes toward sexual behavior as self-injury and to identify participant-reported experiences of sexual activity to self-injure. RESULTS A total of 50 participants completed the online survey. Thirteen (26%) participants reported they had heard of the concept of "sex as self-injury." Six (12%) participants reported ever having used sexual activity to cause physical or psychological harm to themselves. Participants reported intentions for engaging in sexual activity to self-injure, including causing physical pain, reliving past self-harm or trauma, showing vulnerability, proving self-worth, pleasing or wanting to feel needed by their partner, and suicidal ideation. CONCLUSION Sexual activities have been used by some college students as a means of self-harm. Further research is needed to understand this phenomenon and clinicians should consider screening for this in patients who participate in dangerous sexual behaviors or self-injurious behaviors.
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Affiliation(s)
- Julie E Mellin
- Julie E. Mellin, MSN, APRN, PMHNP-BC, PhD Student, School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Cara C Young
- Cara C. Young, PhD, APRN, FNP-C, FAANP, Associate Professor, School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Muniyapillai T, Kulothungan K, Vignesh KNJ, Keerthi CMS, Godwyn SR, Shivashankari SB, Bhonsle BSR, Krishnakumar SP, Suresh SD. Suicide and its risk factors - An ecological study. J Educ Health Promot 2024; 13:84. [PMID: 38720684 PMCID: PMC11078457 DOI: 10.4103/jehp.jehp_940_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/28/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND There is tremendous variation in both the prevalence of suicide and the factors that contribute to its occurrence across geographic locations, cultures, and time. Therefore, the present study aims to identify the various socio-demographic risk factors and psychosocial stressors using population data. MATERIALS AND METHODS The countries that were included in the study were based on data from the World Health Organization. We considered the top ten suicide countries and the ten lowest suicide nations. We searched five global databases for the most recent socio-demographic data and data on psychosocial stressors during the period of August and September 2022. We analyzed the correlation between suicide rates and various factors, and we considered a P value of less than 0.05 to be statistically significant. RESULTS The correlation of suicide with sociodemographic factors like age (P 0.246), gender (male, P 0.357, and female, P 0.357), net enrolment rate (P 0.725), gender parity index (P 0.929), urban population percentage (P 0.571), marital status (male, P 0.345, and female, P 0.752), and literacy rate percentage (P 0.199) was not significant. The correlation of suicide with psychosocial stressors like unemployment percentage (P 0.552), alcoholism percentage (P 0.271), the prevalence of depression (P 0.523), the number of psychiatrists (P 0.605), the number of mental hospitals (r = -0.090, P 0.713), and the poverty rate percentage (P 0.538) were also not significant. CONCLUSION Suicide is a major public health issue, yet global suicide data is scarce. Sociodemographic factors like age, urbanization, and literacy rate were negatively correlated, whereas psychosocial stressors like unemployment, alcohol misuse, and poverty were positively correlated, but none were significantly associated.
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Affiliation(s)
- Tamilarasan Muniyapillai
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Karthikeyan Kulothungan
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - K Nawin Jai Vignesh
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - CM Sathya Keerthi
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Sherin Rosetta Godwyn
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - SB Shivashankari
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - B Shivanjali Raje Bhonsle
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Shanmuga Priya Krishnakumar
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Shivani Devi Suresh
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
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Kitagawa S, Sobue T, Zha L, Morishima T, Ohno Y, Miyashiro I. Suicide risk among patients with cancer by sex in Japan: A population-based study. J Epidemiol 2024:JE20230280. [PMID: 38462529 DOI: 10.2188/jea.je20230280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND In Japan, few studies have examined suicide risk for five-year relative survival rates for cancer sites. Since five-year relative survival rates differ by sex, we aim to examine suicide risk for patients with cancer separately for men and women. METHODS We estimated the risk of suicide among patients with cancer by sex in Japan compared to the general population, using standardized mortality ratios (SMRs). Patients with cancer diagnosed between January 1, 1985-December 31, 2013 and registered in the Osaka Cancer Registry were followed-up with for up to 10 years. The outcome was suicide death. In addition, cancer sites were classified into three prognosis groups based on five-year relative survival rates: good (> 70%), moderate (40-70%), poor (< 40%). RESULTS Among 623 995 patients with cancer observed for 2 349 432 person-years, 1210 patients died by suicide (867 men and 343 women). The SMRs were almost equal for men (1.66, 95% CI, 1.55-1.77) and women (1.65, 95% CI, 1.48-1.83). SMRs for cancer prognosis groups were 1.01 (95% CI, 0.84-1.22) for men and 1.47 (95% CI, 1.24-1.73) for women in the good group, 1.53 (95% CI, 1.39-1.68) for men and 1.74 (95% CI, 1.47-2.05) for women in the moderate group, and 2.54 (95% CI, 2.27-2.85) for men and 1.87 (95% CI, 1.43-2.46) for women in the poor group. CONCLUSIONS In this population, both sexes had higher suicide risk with poor prognosis, but the difference in SMRs between the good and poor groups was smaller for women than men.
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Affiliation(s)
- Shinichi Kitagawa
- Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Tomotaka Sobue
- Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Ling Zha
- Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | | | - Yuko Ohno
- Division of Health Science, Graduate School of Medicine, Osaka University
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute
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Moore TR, Lee S, Freeman R, Mahmoundi M, Dimian A, Riegelman A, Simacek JJ. A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities. Behav Modif 2024; 48:216-256. [PMID: 38197303 DOI: 10.1177/01454455231218742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.
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Affiliation(s)
- Timothy R Moore
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Seunghee Lee
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Rachel Freeman
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Maryam Mahmoundi
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Adele Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Amy Riegelman
- Social Sciences Libraries, University of Minnesota, Minneapolis, USA
| | - Jessica J Simacek
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
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Luz LS, Cassenote AJF, Valente EP, Mariani I, Lazzerini M, Lima CVTC, Giamberardino DD, Marques EDF, von Tiesenhausen HAV, Cabeça HLS, Damásio LCVDC, de Souza MA, de Souza PH, Rocha RNDM, Zaher-Rutheford VL, Ribeiro MLDB, da Silva AG, Gallo JHDS. Brazilian Physicians Mental Health: A Cross-Sectional Nationwide Study exploring factors associated with prevalence of suicide planning and attempts. Braz J Psychiatry 2024. [PMID: 38368551 DOI: 10.47626/1516-4446-2023-3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES To report suicide planning and attempts' in a lifetime among Brazilian physicians and to explore associated risk factors. METHODS A nation-wide, online survey based on the Tool for the Assessment of Suicide Risk and Satisfaction with Life Scale was conducted among Brazilian physicians (January 2018 - January 2019). Multivariate explored associations of demographics, psychological, and work-related factors on suicide planning and attempts reports. RESULTS Among 4,148 respondents, 1,946 (53.5%) were male, 2,527 (60.9%) were 30-60 years old, 2,675 (64.5%) had 2-4 work-contracts and 1,725 (41.6%) reported a weekly workload of 40-60 hours. Overall prevalence of suicide plans was 8.8% (n=364) and suicide attempts were reported by 3.2% (n=133) of respondents. Daily (AdjOR=7.857;95%CI 2.282-27.051, p=0.002) or weekly emotional exhaustion (AdjOR=7.953; 95%CI 2.403-26.324, p=0.001), daily frustration with work (AdjOR=3.093;95%CI 1.711-5.588, p<0.001), and being bisexual (AdjOR=5.083;95%CI 2.544-10.158, p<0.001) were significantly associated with higher odds of reports. Among extremely dissatisfied professionals 38.3% reported having made suicide planning and attempts, while among extremely satisfied only 2.8% reported it (p<0.001). CONCLUSIONS Brazilian physicians with a lifetime history of suicide planning and attempts presented a higher association with emotional exhaustion and frustration with work. Urgent actions are needed to promote professional protection policies and resilience.
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Affiliation(s)
- Leonardo Servio Luz
- Department of Specialized Medicine, Health Sciences Center, Federal University of Piauí, Teresina, PI, Brazil
| | - Alex Jones Flores Cassenote
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil. Santa Marcelina Hospital, São Paulo, SP, Brazil. Brazilian Federal Council of Medicine, Brazil
| | - Emanuelle Pessa Valente
- Institute for Maternal and Child Health Burlo Garofolo, WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health Burlo Garofolo, WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health Burlo Garofolo, WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy. Maternal Adolescent Reproductive and Child Health Care Centre, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Hideraldo Luis Souza Cabeça
- Brazilian Federal Council of Medicine, Brazil. Neurology Division, Ophir Loyola Hospital, PA, Brazil. Medical Residency Committee of Pará, PA, Brazil
| | | | - Milton Aparecido de Souza
- Brazilian Federal Council of Medicine, Brazil. Brasília Institute of Higher Education, Brasília, DF, Brazil
| | | | - Rosylane Nascimento das Mercês Rocha
- Brazilian Federal Council of Medicine, Brazil. Medical Residency Program in Occupational Medicine, School of Health Sciences, Brasília, DF, Brazil. National Association of Occupational Medicine, São Paulo, SP, Brazil
| | | | - Mauro Luiz de Britto Ribeiro
- Anhanguera-Uniderp University, MS, Brazil. State University of Mato Grosso do Sul, MS, Brazil. Medical Residency Program, Santa Casa de Campo Grande, MS, Brazil
| | - Antônio Geraldo da Silva
- Faculdade de Medicina da Universidade do Porto, Portugal. Faculdade de Medicina da Universidade Federal de Minas Gerais, MG, Brazil. Pós-doutorado em Medicina Molecular e Laboratorio de Psicologia Medica e Neuropsicologia, Faculdade de Medicina da UFMG, MG, Brazil
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Ansari N, Faraz F, Lamba AK, Tandon S, Dhingra S. A Multidisciplinary Approach to the Management of Unusual Bilateral Gingival Recession Due to a Factitious Nail-Scratching Habit: A Case Report. Cureus 2024; 16:e53439. [PMID: 38435182 PMCID: PMC10909244 DOI: 10.7759/cureus.53439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Self-inflicted gingival injuries have been reported in children and adolescents as a result of multiple factors such as accidental trauma, fingernail biting, sucking on objects such as pencils, or a nail-scratching habit. Management of these lesions requires a multidisciplinary approach that includes psychotherapy, behavioral counseling, and definitive treatment of oral soft tissue lesions. This paper illustrates the diagnosis and treatment of a 16-year-old male patient with a bilateral gingival recession in mandibular canines due to habitual nail scratching. A multidisciplinary approach for treatment included behavior and psychological counseling, topical application of anesthetic & antimicrobial gels, and surgical management of gingival recession defects using a modified lateral pedicle flap with and without an indigenously prepared amnion-chorion membrane. Excellent soft tissue health was found at a two-year follow-up.
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Affiliation(s)
- Nasreen Ansari
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Farrukh Faraz
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Arundeep K Lamba
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Shruti Tandon
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
| | - Sachin Dhingra
- Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, IND
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Beuschel JJ, Ng GI, Abaraoha JC, Fortuna RJ. Traumatic Self-Inflicted Ventricular Laceration: A Case of Smith-Lemli-Opitz Syndrome in an Adult. Cureus 2024; 16:e53613. [PMID: 38449995 PMCID: PMC10916526 DOI: 10.7759/cureus.53613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024] Open
Abstract
Adults with intellectual and developmental disabilities (IDD) are increasingly living into adulthood, highlighting the need for adult clinicians to expand their familiarity with congenital conditions. Smith-Lemli-Opitz syndrome (SLOS) is a rare autosomal recessive inborn error of cholesterol synthesis. SLOS is commonly diagnosed in childhood, but a number of adults with IDD progress into adulthood without a formal diagnosis. We present an 18-year-old male with a history of IDD and altered pain sensation who was hospitalized following a self-inflicted knife injury resulting in a traumatic ventricular septal defect. Over the following 15 years, the patient continued to exhibit self-injurious behaviors. At the age of 33, caregivers consented to further work-up of his intellectual disability, and whole-exome genetic sequencing revealed a diagnosis of SLOS. The clinical course of this patient represents a unique presentation of altered pain sensation, a delayed diagnosis of SLOS into adulthood, and the challenges of providing care to an adult with IDD. The case further highlights the importance of understanding the typical workup and management of genetic and congenital conditions arising in childhood.
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Affiliation(s)
- Jennifer J Beuschel
- Internal Medicine and Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Grace I Ng
- Internal Medicine and Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Joanna C Abaraoha
- Internal Medicine and Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Robert J Fortuna
- Internal Medicine and Pediatrics, University of Rochester Medical Center, Rochester, USA
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Buronfosse A, Robin M, Speranza M, Duriez P, Silva J, Corcos M, Perdereau F, Younes N, Cailhol L, Gorwood P, Pham-Scottez A. The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder. Front Psychiatry 2024; 14:1288195. [PMID: 38239907 PMCID: PMC10794764 DOI: 10.3389/fpsyt.2023.1288195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors. Methods We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients (N = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's t-tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ2-tests or exact Fischer tests, 5% significance threshold). Results The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, p = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, p = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm. Conclusion This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.
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Affiliation(s)
- Alice Buronfosse
- Centre Psychiatrique d’Orientation et d’Accueil, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Marion Robin
- Service de psychiatrie de l’adolescent et du jeune adulte, Institut Mutualiste Montsouris, Paris, France
| | - Mario Speranza
- Université Versailles Saint-Quentin, Université Paris-Saclay, Inserm U1018, CESP, Team DevPsy, Villejuif, France
- Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - Philibert Duriez
- Clinique des Maladies Mentales et de l’Encéphale, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm, Paris, France
| | - Jérôme Silva
- Centre Psychiatrique d’Orientation et d’Accueil, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Maurice Corcos
- Service de psychiatrie de l’adolescent et du jeune adulte, Institut Mutualiste Montsouris, Paris, France
| | | | - Nadia Younes
- Université Versailles Saint-Quentin, Université Paris-Saclay, Inserm U1018, CESP, Team DevPsy, Villejuif, France
- Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Lionel Cailhol
- Department of Psychiatry, Institut Universitaire de Santé Mentale de Montréal, CIUSSS of East Montreal, University of Montreal, Montreal, QC, Canada
| | - Philip Gorwood
- Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - Alexandra Pham-Scottez
- Centre Psychiatrique d’Orientation et d’Accueil, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
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Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Mann AJD, Tull MT, Gratz KL. Examining the Presence, Frequency, and Associated Characteristics of Nonsuicidal Self-Injury by Proxy: Initial Validation of the Nonsuicidal Self-Injury by Proxy Questionnaire (NSSIBPQ). Behav Modif 2024; 48:3-50. [PMID: 37599465 DOI: 10.1177/01454455231191710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Nonsuicidal self-injury (NSSI) by proxy is the intentional destruction of one's own body tissue through the elicitation of another being's actions. Despite its clinical relevance, research on NSSI by proxy is limited and there are no available measures of this behavior. This research aimed to characterize NSSI by proxy among young adults and provide preliminary data on the validity of a new self-report measure, the NSSI by Proxy Questionnaire (NSSIBPQ). Two nationwide community samples of young adults (one general community sample and one with a history of traditional NSSI and suicidality) completed online studies. NSSI by proxy was reported by 18% of the general community sample and 45% of the self-injuring sample. Findings support the clinical relevance of NSSI by proxy and its potential to meet criteria for an NSSI disorder diagnosis. Results also provide preliminary support for the internal consistency and convergent, discriminant, and concurrent validity of the NSSIBPQ.
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Lu J, Gao W, Wang Z, Yang N, Pang WIP, In Lok GK, Rao W. Psychosocial interventions for suicidal and self-injurious-related behaviors among adolescents: a systematic review and meta-analysis of Chinese practices. Front Public Health 2023; 11:1281696. [PMID: 38164448 PMCID: PMC10757980 DOI: 10.3389/fpubh.2023.1281696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Background Suicidal and self-injurious-related behaviors (SSIRBs) are a serious public health challenge in China. However, a comprehensive systematic review of psychosocial interventions for SSIRBs among Chinese adolescents has not been performed. To fill this gap, this systematic review and meta-analysis aimed to examine psychosocial interventions for SSIRBs among Chinese adolescents. Methods Eight international (PubMed, EMBASE, Cochrane Library, ScienceDirect, Clinical Trial, CINAHL, PsycINFO, and Web of Science) and four Chinese (Wanfang, SinoMed, CEPS, and CNKI) databases were searched from inception to 31 January 2023. Data extraction and quality assessment were independently conducted by two groups of researchers. Qualitative synthesis and meta-analysis were both used. Results The initial search yielded 16,872 titles. Of the 649 full texts reviewed, 19 intervention articles focusing on SSIRBs met the inclusion criteria. Thirteen out of the 19 included studies involved cognitive-behavioral therapy (CBT). Seven non-suicidal self-injury (NSSI) studies assessing self-injurious behaviors were included (six short-term studies and three long-term studies). Compared with long-term interventions [-1.30 (95% CI: -1.84, -0.76)], short-term psychosocial interventions had a higher standardized mean difference (SMD) value [1.86 (95% CI: -2.72, -0.99)]. Meta-regression showed an inverse relationship between the treatment response and sample size (slope = 0.068, Z = 2.914, p = 0.004) and proportion of females (slope = 1.096, Z = 5.848, p < 0.001). Subgroup analyses showed that compared with the "less than 1 month" group [-0.494 (-0.783, -0.205)], in the "immediate postintervention" group, the pooled estimate was significantly lower [-2.800 (-4.050, -1.550), p < 0.001]. Conclusion Our review systematically summarized the key characteristics and effectiveness of existing psychosocial interventions for SSIRBs among Chinese adolescents. Short-term psychosocial interventions for NSSI were significantly effective in reducing self-injurious behavior scores, especially in the immediate postintervention period. More favorable treatment responses could be observed in both male and small samples.
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Affiliation(s)
- Junjie Lu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Wanting Gao
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Zexin Wang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Nan Yang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Weng Ian Phoenix Pang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Grace Ka In Lok
- Macao Polytechnic University, Peking University Health Science Center-Macao Polytechnic University Nursing Academy, Macao, Macao SAR, China
| | - Wenwang Rao
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
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Oliveira MADN, da Silva EP, Sampaio AN, Mallagoli ISS, Barbosa DA, Domingos TDS, Belasco AGS. Sociodemographic factors associated with suicidal behavior at a federal public university in the Western Brazilian Amazon. Rev Bras Enferm 2023; 76Suppl 2:e20230102. [PMID: 38088661 PMCID: PMC10704696 DOI: 10.1590/0034-7167-2023-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/03/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to determine risk factors for suicidal behavior among students and employees of a federal public university in the Brazilian Western Amazon. METHODS an analytical cross-sectional study of survey and association between variables with a sample of 475 participants. Statistical analyzes were performed using the Mann-Whitney test, Pearson's chi-square test, likelihood ratio test or Fisher's exact test and a logistic regression model. A significance level of 5% was used (p-value< 0.05). RESULTS a higher proportion of suicidal behavior was found in younger participants, females, who had no religion or had one, but were non-practicing, who did not have children and/or had a monthly family income of less than two minimum wages. Lower proportions of suicidal behavior were identified in heterosexuals and/or married or in a stable relationship. CONCLUSION the study suggests a relationship between sociodemographic factors and suicidal behavior in the studied academic community.
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Affiliation(s)
| | - Evandro Piccinelli da Silva
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
- Universidade Federal do Acre. Cruzeiro do Sul, Acre, Brazil
| | - Aristeia Nunes Sampaio
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
- Universidade Federal do Acre. Rio Branco, Acre, Brazil
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Jasperson RA, Sullivan E, Goldstein EV. Employee attitudes toward suicide prevention and Counseling on Access to Lethal Means: initial findings from an academic medical center implementing the Zero Suicide framework. Front Public Health 2023; 11:1268300. [PMID: 38026388 PMCID: PMC10654743 DOI: 10.3389/fpubh.2023.1268300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Zero Suicide is a strategic framework designed to transform a healthcare system's suicide prevention activities. In 2020, University of Utah Health launched a Zero Suicide program and Counseling on Access to Lethal Means (CALM) training for its employees. In 2022, the healthcare system surveyed its workforce's attitudes toward suicide prevention and CALM. We sought to evaluate employees' attitudes and behaviors toward suicide prevention and CALM training following the launch of the Zero Suicide program. Methods A Zero Suicide Workforce Survey was administered online through REDCap to all University of Utah Health employees. The analytic sample included 3,345 respondents. We used two-portion z-tests to compare the proportions of respondents who (1) completed CALM training and (2) did not yet complete the CALM training because they felt it was irrelevant to their position by different employee characteristics. Results More than half of the respondents in the analytic sample were directly interacting with patients who may be at risk for suicide (57.6%). About 8.4% of the respondents had completed CALM training. Among those who had not yet completed CALM training, 9.5% indicated they did not think CALM was relevant to their job. Respondents knowledgeable about warning signs for suicide and respondents who were confident in their ability to respond when suspecting elevated suicide risk were significantly more likely to complete CALM training. Discussion This evaluation provides important insights from the workforce of a large academic medical center implementing a Zero Suicide program, including insights on opportunities for improving program implementation and evaluation.
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Affiliation(s)
- Rachael A. Jasperson
- Zero Suicide Program, University of Utah Health, Salt Lake City, UT, United States
| | - Emily Sullivan
- Zero Suicide Program, University of Utah Health, Salt Lake City, UT, United States
- Hunstman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
| | - Evan V. Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
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Torales J, Barrios I, Melgarejo O, Tullo-Gómez JE, Díaz NR, O'Higgins M, Maggi C, Adorno V, Medina A, Villalba-Arias J, González-Urbieta I, Caycho-Rodríguez T, Castaldelli-Maia JM, Ventriglio A. Suicides among adults in Paraguay: An 18-year national exploratory study (2004-2022). Int J Soc Psychiatry 2023; 69:1641-1648. [PMID: 37113070 DOI: 10.1177/00207640231169650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND The number of suicides has been increasing worldwide, year after year, becoming the fourth leading cause of death among young people between 15 and 29 years of age. AIM In this study, we explored the frequency and characteristics of suicides among the adult general population in Paraguay between 2004 and 2022, considering that suicide attempts and suicidal risk/ideation are frequent and relevant issues in the consultation activity, even if epidemiological evidence on the national rates of suicide is scarce. METHODS In this observational, descriptive, and exploratory study, official records of all deaths by suicide were reviewed and information analyzed. In addition, an attempt was made to predict the number of suicides in the next 5 years according to a mathematical modeling. RESULTS In the 18-year period, 5,527 suicides of adults were recorded. Patients' mean age was 36.8 ± 17 years old. A 76.77% of them were males, 77.44% were from an urban area and 25.98% from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation (all 67.6%). The expected number of national suicides in the following years from 2023 to 2027 will range between 462 and 530. Limitations include the lack of information regarding diagnoses and personal history in the suicide reports as well as the possibility of underreporting of national suicide cases. CONCLUSION Our results represent the first large national epidemiological report of suicides in Paraguay and may be of interest for mental health professionals and health authorities in order to reduce the suicide mortality rate within the country.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Statistics, School of Medical Sciences, Santa Rosa Campus, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | - Osvaldo Melgarejo
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Juan Edgar Tullo-Gómez
- General Directorate of Strategic Health Information, Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Noelia Ruiz Díaz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Carol Maggi
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Víctor Adorno
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Alicia Medina
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Jorge Villalba-Arias
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Psychiatry, School of Medical Sciences, Santa Rosa Campus, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | | | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil
- Department of Psychiatry, University of São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
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Torales J, Barrios I, Tullo-Gómez JE, Melgarejo O, Gómez N, Riego V, Navarro R, García O, Figueredo P, Almirón-Santacruz J, Caycho-Rodríguez T, Castaldelli-Maia JM, Ventriglio A. Suicides among Children and Adolescents in Paraguay: An 18-year National Exploratory Study (2004-2022). Int J Soc Psychiatry 2023; 69:1649-1657. [PMID: 37092764 DOI: 10.1177/00207640231169656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Suicide and suicide attempts are impacting events for patients and their relatives, and these behaviors are still taboo among adults and may be even more traumatic when involving children and adolescents. AIM In this study we aimed to describe suicide rates among children and adolescents in Paraguay over the last decades as well as associated factors such as sociodemographic characteristics and methods used for suicide. METHODS This was an observational and exploratory study describing the frequency and characteristics of suicide among children and adolescents in Paraguay between 2004 and 2022. Official records of all deaths by suicide were reviewed, and statistical analyses were performed. In addition, an attempt was made to predict the number of suicides in the next 5 years using a mathematical model based on simple linear regression. RESULTS In the 18-year period observed, 940 suicides among children and adolescents were recorded. The mean age was 15.05 ± 1.8 years old. Of these, 51.17% were male, 74.6% were from urban areas, and 22.2% were from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation, which all represented 75.3% of the cases. Our mathematical modeling based on simple linear regression determined that the expected yearly number of national suicides in the pediatric population for the following years, from 2023 to 2027, will range between 72 and 81. CONCLUSION This study is the first large national epidemiological report on the emerging issue of suicide among children and adolescents in Paraguay. It may be a relevant source of information for mental health professionals, health authorities, and decision makers to develop national prevention strategies and actions against suicide among youths.
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Affiliation(s)
- Julio Torales
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Statistics, School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray Campus, Santa Rosa del Aguaray, Paraguay
| | - Juan Edgar Tullo-Gómez
- General Directorate of Strategic Health Information, Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | | | - Nora Gómez
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Viviana Riego
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Rodrigo Navarro
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Pamela Figueredo
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - José Almirón-Santacruz
- Department of Child and Adolescent Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC., Santo André, SP, Brazil
- Department of Psychiatry, University of São Paulo. São Paulo, SP, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev 2023; 10:CD011769. [PMID: 37811711 PMCID: PMC10561353 DOI: 10.1002/14651858.cd011769.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Pharmacological interventions are frequently used for people with autism spectrum disorder (ASD) to manage behaviours of concern, including irritability, aggression, and self-injury. Some pharmacological interventions might help treat some behaviours of concern, but can also have adverse effects (AEs). OBJECTIVES To assess the effectiveness and AEs of pharmacological interventions for managing the behaviours of irritability, aggression, and self-injury in ASD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 11 other databases and two trials registers up to June 2022. We also searched reference lists of relevant studies, and contacted study authors, experts and pharmaceutical companies. SELECTION CRITERIA We included randomised controlled trials of participants of any age with a clinical diagnosis of ASD, that compared any pharmacological intervention to an alternative drug, standard care, placebo, or wait-list control. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were behaviours of concern in ASD, (irritability, aggression and self-injury); and AEs. Secondary outcomes were quality of life, and tolerability and acceptability. Two review authors independently assessed each study for risk of bias, and used GRADE to judge the certainty of the evidence for each outcome. MAIN RESULTS We included 131 studies involving 7014 participants in this review. We identified 26 studies as awaiting classification and 25 as ongoing. Most studies involved children (53 studies involved only children under 13 years), children and adolescents (37 studies), adolescents only (2 studies) children and adults (16 studies), or adults only (23 studies). All included studies compared a pharmacological intervention to a placebo or to another pharmacological intervention. Atypical antipsychotics versus placebo At short-term follow-up (up to 6 months), atypical antipsychotics probably reduce irritability compared to placebo (standardised mean difference (SMD) -0.90, 95% confidence interval (CI) -1.25 to -0.55, 12 studies, 973 participants; moderate-certainty evidence), which may indicate a large effect. However, there was no clear evidence of a difference in aggression between groups (SMD -0.44, 95% CI -0.89 to 0.01; 1 study, 77 participants; very low-certainty evidence). Atypical antipsychotics may also reduce self-injury (SMD -1.43, 95% CI -2.24 to -0.61; 1 study, 30 participants; low-certainty evidence), possibly indicating a large effect. There may be higher rates of neurological AEs (dizziness, fatigue, sedation, somnolence, and tremor) in the intervention group (low-certainty evidence), but there was no clear evidence of an effect on other neurological AEs. Increased appetite may be higher in the intervention group (low-certainty evidence), but we found no clear evidence of an effect on other metabolic AEs. There was no clear evidence of differences between groups in musculoskeletal or psychological AEs. Neurohormones versus placebo At short-term follow-up, neurohormones may have minimal to no clear effect on irritability when compared to placebo (SMD -0.18, 95% CI -0.37 to -0.00; 8 studies; 466 participants; very low-certainty evidence), although the evidence is very uncertain. No data were reported for aggression or self -injury. Neurohormones may reduce the risk of headaches slightly in the intervention group, although the evidence is very uncertain. There was no clear evidence of an effect of neurohormones on any other neurological AEs, nor on any psychological, metabolic, or musculoskeletal AEs (low- and very low-certainty evidence). Attention-deficit hyperactivity disorder (ADHD)-related medications versus placebo At short-term follow-up, ADHD-related medications may reduce irritability slightly (SMD -0.20, 95% CI -0.40 to -0.01; 10 studies, 400 participants; low-certainty evidence), which may indicate a small effect. However, there was no clear evidence that ADHD-related medications have an effect on self-injury (SMD -0.62, 95% CI -1.63 to 0.39; 1 study, 16 participants; very low-certainty evidence). No data were reported for aggression. Rates of neurological AEs (drowsiness, emotional AEs, fatigue, headache, insomnia, and irritability), metabolic AEs (decreased appetite) and psychological AEs (depression) may be higher in the intervention group, although the evidence is very uncertain (very low-certainty evidence). There was no evidence of a difference between groups for any other metabolic, neurological, or psychological AEs (very low-certainty evidence). No data were reported for musculoskeletal AEs. Antidepressants versus placebo At short-term follow-up, there was no clear evidence that antidepressants have an effect on irritability (SMD -0.06, 95% CI -0.30 to 0.18; 3 studies, 267 participants; low-certainty evidence). No data for aggression or self-injury were reported or could be included in the analysis. Rates of metabolic AEs (decreased energy) may be higher in participants receiving antidepressants (very low-certainty evidence), although no other metabolic AEs showed clear evidence of a difference. Rates of neurological AEs (decreased attention) and psychological AEs (impulsive behaviour and stereotypy) may also be higher in the intervention group (very low-certainty evidence) although the evidence is very uncertain. There was no clear evidence of any difference in the other metabolic, neurological, or psychological AEs (very low-certainty evidence), nor between groups in musculoskeletal AEs (very low-certainty evidence). Risk of bias We rated most of the studies across the four comparisons at unclear overall risk of bias due to having multiple domains rated as unclear, very few rated as low across all domains, and most having at least one domain rated as high risk of bias. AUTHORS' CONCLUSIONS Evidence suggests that atypical antipsychotics probably reduce irritability, ADHD-related medications may reduce irritability slightly, and neurohormones may have little to no effect on irritability in the short term in people with ASD. There was some evidence that atypical antipsychotics may reduce self-injury in the short term, although the evidence is uncertain. There was no clear evidence that antidepressants had an effect on irritability. There was also little to no difference in aggression between atypical antipsychotics and placebo, or self-injury between ADHD-related medications and placebo. However, there was some evidence that atypical antipsychotics may result in a large reduction in self-injury, although the evidence is uncertain. No data were reported (or could be used) for self-injury or aggression for neurohormones versus placebo. Studies reported a wide range of potential AEs. Atypical antipsychotics and ADHD-related medications in particular were associated with an increased risk of metabolic and neurological AEs, although the evidence is uncertain for atypical antipsychotics and very uncertain for ADHD-related medications. The other drug classes had minimal or no associated AEs.
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Affiliation(s)
- Michelle Iffland
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Nuala Livingstone
- Cochrane Evidence Production and Methods Directorate , Cochrane, London, UK
| | - Mikaela Jorgensen
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Donna Gillies
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
- Sydney, Australia
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Barclay N, Kelley KA, Brausch AM, Muehlenkamp JJ, Nadorff MR. Changes in the suicide risk behaviors of American college students over time: An analysis of three universities. Suicide Life Threat Behav 2023; 53:764-775. [PMID: 37515442 DOI: 10.1111/sltb.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Suicide-related behaviors are prevalent among college students, and several mental health problems associated with increased suicide risk have increased over time. Furthermore, notable cultural events (e.g., political changes, COVID-19) have occurred in the past decade, which likely impact trends in suicide-related behaviors. The current study examined how the prevalence of nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts has changed from 2012 to 2022 across three different universities. METHOD Archival datasets from multiple years of college student survey data were compiled, and different measures of NSSI, SI, and suicide attempts were dichotomized to assess prevalence. Chi-square goodness-of-fit tests were used to identify changes in suicide-related behaviors across time. RESULTS Results indicated significant increases in the prevalence of most behaviors across each university, with most increases occurring after 2018. Despite sharing a general trend of increased suicide-related behaviors, each university differed considerably in their respective trends between various timepoints, suggesting that unique factors may differentially contribute to growing risk among college students. CONCLUSION Overall, the current study identifies increasing trends in suicide-related behaviors over the past decade and highlights the value of investigating these behaviors at the university level.
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Affiliation(s)
- Nathan Barclay
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Karen A Kelley
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Amy M Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
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Quitério A, Mendes Abreu J, Saura A, Borges MI, Corte Real A. A Case Report of Extreme Oral Lesions: A Rare Indicator of Bullying-Associated Non-suicidal Self-Injury. Cureus 2023; 15:e44713. [PMID: 37809120 PMCID: PMC10552680 DOI: 10.7759/cureus.44713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Bullying has reached epidemic proportions, affecting one in three students worldwide. A pervasive issue that carries profound physical, mental, and social consequences, significantly increasing the risk of non-suicidal self-injury (NSSI) and suicidal behaviors among those who experience this type of harassment and hazing. While physicians and most caregivers are fully aware and competent in identifying signs of self-harming behavior such as scratching, cutting, or burning the skin, oral self-injury is often overlooked as a potential indicator and is associated with unintentional soft tissue biting or specific conditions. We present a rare case of a 14-year-old male who sought medical attention due to severe bilateral tongue ulcers, leading to his admittance to the emergency department (ED) with excruciating pain and feeding difficulties. In the reported case, although the traumatic biting of the tongue emerged as the most probable etiological factor, a specific underlying motive and contextual comprehension were initially absent. It was only after successfully establishing a foundation of trust with the patient, enabling an honest response, that it became evident that the observed lesions represented a manifestation of bullying-induced non-suicidal self-injury. However, patients rarely openly acknowledge intentional self-inflicted lesions and/or their experiences of bullying, underscoring the necessity to maintain vigilance for alternative indicators such as behavioral changes or a noticeable decline in academic productivity. The significance of this case also goes beyond its presentation, highlighting the largely unexplored issue of how a patient's dentofacial features can serve as substantial catalysts for bullying. Therefore, it is only through equally prioritizing awareness of uncommon signs, symptoms, and context that one can expedite early diagnosis and intervention, emphasizing the essential need for comprehensive and timely management of such cases.
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Affiliation(s)
- Anabela Quitério
- Maxilofacial Surgery Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - João Mendes Abreu
- Stomatology Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - André Saura
- Maxilofacial Surgery and Stomatology Department, Hospital Santo António - Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Maria Inês Borges
- Stomatology Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Ana Corte Real
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Forensic Dentistry Laboratory, University of Coimbra, Coimbra, PRT
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21
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O'Malley A, McIntyre A, McGilloway A, Doherty A, Hallahan B. The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital. Ir J Psychol Med 2023; 40:418-423. [PMID: 36794350 DOI: 10.1017/ipm.2023.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset. METHODS Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic. RESULTS A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic. CONCLUSIONS Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.
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Affiliation(s)
- A O'Malley
- School of Medicine, University of Galway, Galway, Ireland
| | - A McIntyre
- School of Medicine, University of Galway, Galway, Ireland
| | - A McGilloway
- School of Medicine, University of Galway, Galway, Ireland
| | - A Doherty
- Department of Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychiatry, Mater Hospital, Dublin, Ireland
| | - B Hallahan
- School of Medicine, University of Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
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22
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Wong BHC, Cross S, Zavaleta-Ramírez P, Bauda I, Hoffman P, Ibeziako P, Nussbaum L, Berger GE, Hassanian-Moghaddam H, Kapornai K, Mehdi T, Tolmac J, Barrett E, Romaniuk L, Davico C, Moghraby OS, Ostrauskaite G, Chakrabarti S, Carucci S, Sofi G, Hussain H, Lloyd ASK, McNicholas F, Meadowcroft B, Rao M, Csábi G, Gatica-Bahamonde G, Öğütlü H, Skouta E, Elvins R, Boege I, Dahanayake DMA, Anderluh M, Chandradasa M, Girela-Serrano BM, Uccella S, Stevanovic D, Lamberti M, Piercey A, Nagy P, Mehta VS, Rohanachandra Y, Li J, Tufan AE, Mirza H, Rozali F, Baig BJ, Noor IM, Fujita S, Gholami N, Hangül Z, Vasileva A, Salucci K, Bilaç Ö, Yektaş Ç, Cansız MA, Aksu GG, Babatunde S, Youssef F, Al-Huseini S, Kılıçaslan F, Kutuk MO, Pilecka I, Bakolis I, Ougrin D. Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2023; 62:998-1009. [PMID: 36806728 PMCID: PMC9933093 DOI: 10.1016/j.jaac.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. 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.
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Affiliation(s)
- Ben Hoi-Ching Wong
- East London NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom.
| | | | - Patricia Zavaleta-Ramírez
- Children's Psychiatric Hospital Dr. Juan N. Navarro., Servicios de Atención Psiquiatrica, Mexico City, Mexico
| | - Ines Bauda
- Medical University of Vienna, Vienna Austria
| | - Pamela Hoffman
- Yale Child Study Center, Child Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Patricia Ibeziako
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Laura Nussbaum
- Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tauseef Mehdi
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Jovanka Tolmac
- Harrow Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Omer S Moghraby
- King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Sara Carucci
- "A. Cao" Pediatric Hospital, "ARNAS G. Brotzu" Hospital Trust, Cagliari, Italy, and the University of Cagliari, Italy
| | - Gyula Sofi
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Haseena Hussain
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, United Kingdom
| | - Alexandra S K Lloyd
- Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | | | - Ben Meadowcroft
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Manish Rao
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Hakan Öğütlü
- Cognitive Behavioral Psychotherapies Association, Ankara, Turkey
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, London, United Kingdom; Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Isabel Boege
- ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Ravensburg, Germany, and University of Graz, Graz, Austria
| | | | - Marija Anderluh
- Child Psychiatry Unit, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | | | - Sara Uccella
- DINOGMI, University of Genoa, Genoa, Italy, and IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Marco Lamberti
- Child and Adolescent Psychiatry Unit, "Franz Tappeiner" Hospital, Merano, Italy
| | - Amy Piercey
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | - Varun S Mehta
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Jie Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University
| | | | | | - Farah Rozali
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Benjamin J Baig
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Isa M Noor
- Dr. Soeharto Heerdjan Teaching Mental Hospital, Jakarta, Indonesia
| | - Saori Fujita
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Narges Gholami
- Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
| | - Katie Salucci
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Öznur Bilaç
- Manisa Celal Bayar University, Manisa, Turkey
| | | | | | | | | | - Fatima Youssef
- Dubai Department of Medical Education, Dubai, United Arab Emirates
| | - Salim Al-Huseini
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | | | | | | | | | - Dennis Ougrin
- King's College London, United Kingdom; Queen Mary University of London
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23
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Dimian AF, Estes AM, Dager S, Piven J, Wolff JJ. Predicting self-injurious behavior at age three among infant siblings of children with autism. Autism Res 2023; 16:1670-1680. [PMID: 37439184 DOI: 10.1002/aur.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
Existing research suggests that self-injurious behavior (SIB) is a relatively common interfering behavior that can occur across the lifespan of individuals with autism spectrum disorder (ASD). We previously reported that SIB or proto-injurious SIB at 12 months was related to increased risk of SIB at 24 months among a preschool sample of children with a high familial likelihood for ASD (Dimian et al., 2017). In the present study, we extend these findings, examine SIB occurrence, and associated potential risk factors at 36 months. The present sample included 149 infants with an older sibling with ASD (65.8% male) who completed assessments at ages 12, 24, and 36 months. Descriptive analyses and binary logistic regression models were utilized. SIB was more prevalent among those children who received a diagnosis of ASD. Logistic regression indicated that presence of SIB, stereotypy, hyper- and hypo- sensory responsivity, and lower intellectual functioning at age 12 months significantly predicted the occurrence of SIB at 36 months. These findings have implications for understanding developmental processes culminating in persistent SIB and may inform prevention programming.
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Affiliation(s)
- Adele F Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Annette M Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Stephen Dager
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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24
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Wu B, Zhang H, Chen J, Chen J, Liu Z, Cheng Y, Yuan T, Peng D. Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review. Gen Psychiatr 2023; 36:e100946. [PMID: 37655114 PMCID: PMC10465892 DOI: 10.1136/gpsych-2022-100946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive. Aims To review present evidence related to the potential mechanisms of NSSI in MDD. Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality. Results A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study). Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.
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Affiliation(s)
- Baichuan Wu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifeng Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghong Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- General Psychiatry Editorial Office, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaye Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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25
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Auger N, Low N, Ayoub A, Chang J, Luu TM. Connection between maternal suicide attempt and chronic morbidity in children. Psychol Med 2023; 53:5091-5098. [PMID: 35837688 PMCID: PMC10476049 DOI: 10.1017/s0033291722002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal suicide attempts are associated with adverse psychosocial outcomes in children, but the association with chronic morbidity is poorly understood. We examined the relationship between maternal suicide attempt and risk of hospitalization for potentially preventable conditions in offspring. METHODS We analyzed a longitudinal cohort of 1 032 210 children born in Quebec, Canada between 2006 and 2019. The main exposure measure was maternal suicide attempt before or during pregnancy. Outcomes included child hospitalizations for potentially preventable conditions, including infectious diseases, dental caries, atopy, and injury up to 14 years after birth. We used adjusted Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal suicide attempt with risk of hospitalization for these outcomes. RESULTS Compared with no suicide attempt, children whose mothers attempted suicide had an increased risk of hospitalization for infectious diseases (HR 1.11, 95% CI 1.06-1.16), dental caries (HR 1.31, 95% CI 1.15-1.48), and injury (HR 1.16, 95% CI 1.03-1.31). Risk of hospitalization for any of these outcomes was greater if mothers attempted suicide by hanging (HR 1.46, 95% CI 1.22-1.75), had their first attempt between the age of 25 and 34 years (HR 1.27, 95% CI 1.13-1.42), and had 3 or more attempts (HR 1.56, 95% CI 1.27-1.91). Maternal suicide attempts were more strongly associated with child hospitalization before 10 years of age. CONCLUSIONS Children whose mothers have a history of suicide attempt have an elevated risk of hospitalization for potentially preventable conditions.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Jungmin Chang
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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26
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Romeu D, Guthrie E, Mason SM. Understanding prehospital care for self-harm: views and experiences of Yorkshire Ambulance Service clinicians. Emerg Med J 2023; 40:482-483. [PMID: 36792341 DOI: 10.1136/emermed-2022-212983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Daniel Romeu
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Department of Liaison Psychiatry, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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27
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Karakuła-Juchnowicz H, Banaszek A, Juchnowicz D. Use of the opioid receptor antagonist - naltrexone in the treatment of non-suicidal self-injury. Psychiatr Pol 2023:1-14. [PMID: 37605331 DOI: 10.12740/pp/onlinefirst/161954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
AIM The aim of the study was to review the existing research, conducted on animal and human models, regarding the possibility of using low doses of naltrexone (LDN) in treatment of non-suicidal self-injury (NSSI). METHOD The available Polish - and English-language literature on NSSI was reviewed. Relevant studies were identified through an electronic search of PubMed/MEDLINE and Google Scholar databases using the following keywords: non-suicidal self-injury, NSSI, naltrexone, LDN, self-injury, self-harm, and time descriptors 1982-2022. The review was based on information reported in original papers, review articles and case reports. The quality of the article was assessed using the six-point Scale for the Assessment of Narrative Review Articles (SANRA). RESULTS Studies conducted on animal models show that use of LDN can prevent habitual self-injury. As far as the possibility of clinical use of LDN in treatment of NSSI is concerned, results of a relatively small number of studies conducted so far confirm the efficacy of using naltrexone 25-50 mg/day to decrease or eliminate self-injurious behaviors in NSSI patients. CONCLUSIONS The use of LDN in treatment of NSSI seems to be a promising clinical option, whose efficacy, however, needs to be corroborated in a larger number of randomized placebo-controlled clinical trials.
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Affiliation(s)
| | - Agnieszka Banaszek
- Studenckie Koło Naukowe przy I Klinice Psychiatrii, Psychoterapii i Wczesnej Interwencji, Uniwersytet Medyczny w Lublinie
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28
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Hagopian LP, Falligant JM, Frank-Crawford MA, Yenokyan G, Piersma DE, Kaur J. Simplified methods for identifying subtypes of automatically maintained self-injury. J Appl Behav Anal 2023. [PMID: 37249167 DOI: 10.1002/jaba.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Subtypes of automatically maintained self-injurious behavior (SIB) have been defined based on response patterns observed during the functional analysis, which are thought to reflect each subtype's distinct mechanisms. Current practice for identifying subtypes involves using structured criteria to identify whether SIB is automatically maintained, followed by the application of additional criteria to identify the subtype. We describe a series of studies directed at simplifying these methods to facilitate wider application of the subtyping model in research and practice. In Studies 1 and 2, we demonstrate the accuracy of modified criteria using the level of differentiation of SIB across the play and no-interaction conditions at distinguishing between two subtypes (i.e., Subtypes 1 and 2). We then demonstrate visual analysis (without structured criteria) can accurately identify SIB as automatically maintained in Study 3, which can be used in combination with level of differentiation to enable application of the subtyping model in practice.
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Affiliation(s)
- Louis P Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle A Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gayane Yenokyan
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Drew E Piersma
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jasmeen Kaur
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
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29
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Frackowiak J, Mazur-Kolecka B. Intraneuronal accumulation of amyloid-β peptides as the pathomechanism linking autism and its co-morbidities: epilepsy and self-injurious behavior - the hypothesis. Front Mol Neurosci 2023; 16:1160967. [PMID: 37305553 PMCID: PMC10250631 DOI: 10.3389/fnmol.2023.1160967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Autism spectrum disorder (ASD) is associated with enhanced processing of amyloid-β precursor protein (APP) by secretase-α, higher blood levels of sAPPα and intraneuronal accumulation of N-terminally truncated Aβ peptides in the brain cortex - mainly in the GABAergic neurons expressing parvalbumin - and subcortical structures. Brain Aβ accumulation has been also described in epilepsy-the frequent ASD co-morbidity. Furthermore, Aβ peptides have been shown to induce electroconvulsive episodes. Enhanced production and altered processing of APP, as well as accumulation of Aβ in the brain are also frequent consequences of traumatic brain injuries which result from self-injurious behaviors, another ASD co-morbidity. We discuss distinct consequences of accumulation of Aβ in the neurons and synapses depending on the Aβ species, their posttranslational modifications, concentration, level of aggregation and oligomerization, as well as brain structures, cell types and subcellular structures where it occurs. The biological effects of Aβ species which are discussed in the context of the pathomechanisms of ASD, epilepsy, and self-injurious behavior include modulation of transcription-both activation and repression; induction of oxidative stress; activation and alteration of membrane receptors' signaling; formation of calcium channels causing hyper-activation of neurons; reduction of GABAergic signaling - all of which lead to disruption of functions of synapses and neuronal networks. We conclude that ASD, epilepsy, and self-injurious behaviors all contribute to the enhanced production and accumulation of Aβ peptides which in turn cause and enhance dysfunctions of the neuronal networks that manifest as autism clinical symptoms, epilepsy, and self-injurious behaviors.
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Spanggård A, Rohde C, Østergaard SD. Risk factors for suicide among patients having received treatment with electroconvulsive therapy: A nationwide study of 11,780 patients. Acta Psychiatr Scand 2023; 147:333-344. [PMID: 36744379 DOI: 10.1111/acps.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/30/2022] [Accepted: 01/29/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite the putative anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide due to the severity of their underlying mental illness. We aimed to quantify this risk and to identify risk factors for suicide among patients receiving ECT. METHODS Using nationwide Danish registers, we identified all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. Firstly, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Secondly, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional hazards regression. RESULTS A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients having received ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR) = 44.48, 95%CI = 31.12-63.59). Among those having received ECT, the following characteristics were associated with suicide: Male sex (adjusted HRR (AHRR) = 2.32, 95%CI = 1.63-3.30), medium-term higher education (AHRR = 2.64, 95%CI = 1.57-4.44); long-term higher education (AHRR = 3.16, 95%CI = 1.68-5.94), history of substance use disorder (AHRR = 1.51, 95%CI = 1.01-2.26) and history of intentional self-harm/suicide attempt (AHRR = 4.18, 95%CI = 2.76-6.32). CONCLUSIONS Those who are male, have obtained medium-/long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide following ECT. These findings may guide clinical initiatives to reduce suicides.
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Affiliation(s)
- Anders Spanggård
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kjær JN, Holm T, Ellegaard T, Madsen S, Lorentzen E, Christensen AB, Bliksted V, Mors O, Dolmer S. A feasibility study of the transdiagnostic self-injury interview. Nord J Psychiatry 2023:1-10. [PMID: 36988197 DOI: 10.1080/08039488.2023.2192212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES The Transdiagnostic Self-injury Interview (TSI) is a new measure that assesses the onset, frequency, methods, and severity of non-suicidal self-injury. The aims were to demonstrate the feasibility of a TSI validation study, and to investigate TSI's criterion validity, clinical correlates, and interrater reliability. MATERIALS AND METHODS Recruiting sites were psychiatric in- and outpatient units. Feasibility targets included number of participants completing the study, TSI completion time, total participation time, participants experiencing exacerbation of symptoms, along with other targets. Criterion validity was evaluated using the Deliberate Self-Harm Inventory (DSHI). Clinical correlates were examined with the Columbia-Suicide Severity Rating Scale (C-SSRS), the Personal and Social Performance Scale, the Affective Lability Scale-18, and the Brief Trauma Questionnaire. Interrater reliability was evaluated with video recordings and written material. RESULTS Fifty participants were included. The majority were women (76%) and had a mean age of 31.3 years (SD: 10.4). Schizophrenia (44%) and schizoaffective disorder (18%) were the most prevalent diagnoses. TSI took an average 9.3 min to complete and the total participation time was on average less than one hour. One participant experienced an exacerbation of self-injury ideation (without the need of intervention). A significant correlation was found between TSI and DSHI (r: 0.94, p-value: < 0.001). TSI was correlated to C-SSRS ideation intensity and ideation frequency but not suicidal attempts. TSI was not significantly correlated to other measures. Interrater reliabilities were statistically significant. CONCLUSIONS The results support the feasibility of a TSI validation study, which is needed to validate TSI in different settings and across diagnoses.
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Affiliation(s)
- Jesper Nørgaard Kjær
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Regionspsykiatrien Midt, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Trine Ellegaard
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sissel Madsen
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Eva Lorentzen
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Vibeke Bliksted
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Signe Dolmer
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Morris SL, Lucia SM. Applying the evolutionary theory of behavior dynamics to model the subtypes of automatically reinforced self-injurious behavior. J Appl Behav Anal 2023; 56:442-457. [PMID: 36922699 DOI: 10.1002/jaba.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023]
Abstract
The delineation of the subtypes of automatically reinforced self-injurious behavior improved the utility of functional analysis results in predicting treatment efficacy. However, the mechanisms underlying subtype differences remain unclear and difficult to study in clinical populations. Morris and McDowell (2021) attempted to elucidate subtype differences by developing and evaluating models of the subtypes within the evolutionary theory of behavior dynamics. In the current study, we applied techniques from precision medicine to further evaluate the models developed by Morris and McDowell. This evaluation highlighted shortcomings of the existing models and suggested ways they could be improved. Thus, we conducted more extended modeling within the framework of precision medicine to identify models that were more quantitatively similar to available clinical data. Improved models that more closely approximate clinical data were identified. The implications of these models for research, practice, and further applications of the evolutionary theory of behavior dynamics are discussed.
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Affiliation(s)
- Samuel L Morris
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Sarah M Lucia
- Department of Psychology, Southeastern Louisiana University, Hammond, LA, United States
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Brockdorf AN, Gratz KL, Messman TL, DiLillo D. Trauma Symptoms and Deliberate Self-Harm Among Sexual Violence Survivors: Examining State Emotion Regulation and Reactivity as Dual Mechanisms. Psychol Violence 2023; 13:23-33. [PMID: 37284068 PMCID: PMC10241447 DOI: 10.1037/vio0000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective Posttraumatic stress disorder (PTSD) symptoms have been associated with elevated rates of deliberate self-harm, including among women who have experienced sexual violence (SV); however, processes underlying this association have not been widely examined. Because a common function of deliberate self-harm is to reduce negative internal states, SV survivors may use self-harm to cope with impairments in broader affective processes associated with PTSD symptoms. To test this hypothesis, the present study examined the role of two aspects of emotional responding (i.e., state emotional reactivity and emotion dysregulation) as mechanisms between greater PTSD symptoms and risk for future deliberate self-harm among SV survivors. Method Participants were 140 community women with a history of SV who completed two waves of data collection. At baseline, participants reported on their PTSD symptoms, as well as state emotional reactivity and state emotion dysregulation following a standardized laboratory stressor task (i.e., the Paced Auditory Serial Addition Task [PASAT-C]). Participants then completed a self-report measure of deliberate self-harm 4 months later. Results Results from a parallel mediation analysis indicated that greater state emotion dysregulation, but not state emotional reactivity, mediated prospective associations between more severe PTSD symptoms at baseline and greater risk for deliberate self-harm 4-months later. Conclusions Applied to the context of survivors' daily lives, these findings underscore the importance of deficits in emotion regulation during times of distress in predicting risk for later deliberate self-harm.
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Affiliation(s)
| | | | | | - David DiLillo
- Department of Psychology, University of Nebraska–Lincoln
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Thorn P, La Sala L, Hetrick S, Rice S, Lamblin M, Robinson J. Motivations and perceived harms and benefits of online communication about self-harm: An interview study with young people. Digit Health 2023; 9:20552076231176689. [PMID: 37252260 PMCID: PMC10214072 DOI: 10.1177/20552076231176689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Background Self-harm behaviour is prevalent among young people and online communication about self-harm is frequent. These online communications are associated with potential harms and potential benefits. To date, few studies have explored the motivations and mechanisms involved in youth online communication about self-harm. Objective This study aimed to explore why young people communicate online about self-harm and the perceived benefits and harms of these communications. Methods Twenty young people aged between 18 and 25 years completed an online interview. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes. Results Four main themes are reported: (1) crossing from offline to online-the double-edged affordances of social media: young people engaged in online communication about self-harm because they were unable or unwilling to speak about their experiences in offline contexts. Online spaces afforded anonymity and peer support, which were associated with benefits and harms; (2) user-generated is not quite the same as user-resonated: perceptions were influenced by whether the young person created or viewed or responded to the content. Written and visual content had pros and cons; (3) it's not just you, it's mostly me-individual characteristics influence perceptions: age and mental state influenced perceptions and behavior; and (4) beyond individuals-parameters are protective: leadership and platform policies and procedures aided safety. Conclusions Online communication about self-harm is neither entirely helpful nor harmful. Perceptions are influenced by individual, social, and systematic factors. Evidence-based guidelines are needed to increase young people's online self-harm literacy and help them build effective communication skills to buffer psychological and potentially physical harm.
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Affiliation(s)
- Pinar Thorn
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Louise La Sala
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah Hetrick
- Department of Psychological Medicine, The
University of Auckland, Auckland CBD, Auckland, New Zealand
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Linthicum KP, Ribeiro JD. Suicide plan prevalence, recurrence, and longitudinal association with nonfatal suicide attempt. Suicide Life Threat Behav 2022; 52:1062-1073. [PMID: 35851502 DOI: 10.1111/sltb.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Each year, millions of people develop suicide plans. These plans are assumed to indicate imminent suicide risk, yet this has rarely been tested. The present study seeks to address two questions: (1) how prevalent are specific thoughts of suicide plans among individuals with a history of suicidal thoughts and behaviors and (2) do suicide plans confer risk of future suicide attempts in the short term? METHODS Secondary data analysis was performed on a longitudinal dataset (N = 1021). Prevalence and frequencies of suicide planning features (i.e., method, time, place) at baseline and 3, 14, and 28 days post-baseline were calculated. Logistic regressions were conducted to assess whether suicide plans confer risk of suicide attempts across a 28-day follow-up period. RESULTS Suicide planning more commonly involved thoughts of method than place and/or time. High variability in suicide planning was evident and thoughts of suicide plans frequently recurred. Contrary to assumptions, suicide plans displayed weak associations with nonfatal suicide attempt across the 28-day follow-up period. CONCLUSIONS Suicide plans appear heterogeneous in nature. They do not appear to play a strong role in predicting nonfatal suicide attempts. Re-evaluation of the central role that suicide plans occupy within clinical risk assessments may be warranted.
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Affiliation(s)
- Kathryn P Linthicum
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Zelkowitz RL, Cole DA, Sterba SK, Liu Q, Lau AS, Trung LT, Weiss B. Latent profile analyses of disordered eating behaviors and nonsuicidal self-injury among Vietnamese adolescents. Int J Eat Disord 2022; 55:1721-1732. [PMID: 36165444 DOI: 10.1002/eat.23813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area. METHOD Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership. RESULTS A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation. DISCUSSION DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI. PUBLIC SIGNIFICANCE Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - David A Cole
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Sonya K Sterba
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Qimin Liu
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lam T Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Bahr Weiss
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
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Stark I, Rai D, Lundberg M, Culpin I, Nordström SI, Ohlis A, Magnusson C. Autism and self-harm: A population-based and discordant sibling study of young individuals. Acta Psychiatr Scand 2022; 146:468-477. [PMID: 35867636 DOI: 10.1111/acps.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Self-harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total-population and family-based data, we investigated whether autism per se is a risk factor for self-harm independently of psychiatric comorbidities and how it differs from self-harm in non-autistic individuals. METHODS We used The Stockholm Youth Cohort, a total-population register study, including all residents in Stockholm County aged 0-17 years between 2001 and 2011.Study participants were followed from age 10 to 27 for hospital admissions because of self-harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95% confidence intervals (CI). RESULTS In all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self-harm (RR 5.0 [95% CI 4.4-5.6]). The risk increase was more pronounced for autism without intellectual disability and particularly high for self-cutting 10.2 [7.1-14.7] and more violent methods 8.9 [5.2-15.4]. The association between autism and self-harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors. CONCLUSION Self-harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self-harmers.
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Affiliation(s)
- Isidora Stark
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Michael Lundberg
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol, UK.,Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Anna Ohlis
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Cecilia Magnusson
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
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Robillard CL, Legg NK, Ames ME, Turner BJ. Support for a Transdiagnostic Motivational Model of Self-Damaging Behaviors: Comparing the Salience of Motives for Binge Drinking, Disordered Eating, and Nonsuicidal Self-Injury. Behav Ther 2022; 53:1219-32. [PMID: 36229118 DOI: 10.1016/j.beth.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022]
Abstract
Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, Mage = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.
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Northrup JB, Goodwin MS, Peura CB, Chen Q, Taylor BJ, Siegel MS, Mazefsky CA. Mapping the time course of overt emotion dysregulation, self-injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study. Autism Res 2022; 15:1855-1867. [PMID: 35751466 PMCID: PMC9560956 DOI: 10.1002/aur.2773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/06/2022] [Indexed: 12/28/2022]
Abstract
Challenges with emotion dysregulation, self-injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross-sectional correlations of parent-report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real-time could add to our understanding of the context and function of these behaviors. The present study examined the real-time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co-occurrence. Both SIB and aggression co-occurred with overt emotion dysregulation at above-chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co-occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross-recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression. LAY SUMMARY: This study provides insight into how overt emotion dysregulation (i.e., visible distress), aggression, and self-injury unfold in real-time for autistic individuals. Participants were 53 autistic youth staying in a psychiatric hospital. Research staff observed participants in everyday activities on the hospital unit and noted instances of aggression, self-injurious behavior, and emotion dysregulation. Results suggest that aggression and self-injury sometimes occur with visible signs of distress but also often occur without visible distress. In addition, observable distress was more common in the moments after these behaviors than in the moments before.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Christine B Peura
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Qi Chen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Briana J Taylor
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Matthew S Siegel
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Mann AJD, Tull MT, Gratz KL. Hiding in the open: Consideration of nonsuicidal self-injury by proxy as a clinically meaningful construct. Suicide Life Threat Behav 2022; 52:1024-1036. [PMID: 35794810 PMCID: PMC9796142 DOI: 10.1111/sltb.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/17/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
Nonsuicidal self-injury (NSSI) is defined as the deliberate destruction of one's own body tissue without suicidal intent and for purposes not socially sanctioned. However, this definition limits the understanding and assessment of NSSI by excluding a clinically relevant form of NSSI that is both self-driven and associated with self-injurious intentions: NSSI by proxy. Specifically, we propose that NSSI by proxy be defined as the intentional destruction of one's own body tissue through the elicitation of another being's (e.g., human, animal) actions, wherein the agency of the person being injured is a critical facet of the behavior. We review the literature supporting the clinical relevance of this behavior, as well as its similarities to traditional NSSI. Next, we propose four behaviors that may be conceptualized as NSSI by proxy, and identify two other behaviors that warrant further investigation. Finally, we identify future directions for research in this area and implications for the assessment and treatment of NSSI.
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Affiliation(s)
| | | | - Kim L. Gratz
- Department of PsychologyUniversity of ToledoToledoOhioUSA
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Zarzar TR, Rosen DL, Mayo JP, O'Connell MG, Catlett TL, Reed JG, Williams JB, Sheitman BB. Clozapine Reduces Recurrent Suicidal and Self-Injurious Behavior in Treatment-Refractory Incarcerated Individuals. J Correct Health Care 2022; 28:329-335. [PMID: 36178970 DOI: 10.1089/jchc.21.02.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This retrospective review examines clozapine's effects on treatment-refractory incarcerated individuals (N = 23) with recurrent thoughts of self-harm and/or self-injurious behavior. Emergent suicide risk assessments and days on suicide watch were assessed for the 3 months pre- and post-clozapine treatment. Total suicide assessments fell from 73 pre- to 14 post-clozapine, with a median of 2 assessments (interquartile range [IQR]: 1,5) pre-clozapine compared with 0 (IQR: 0,1) post-clozapine (p < 0.0001). Total days on suicide watch decreased from 104 days pre- to 32 post-clozapine, with a median of 3 days (IQR: 0,9) pre-clozapine compared with 0 (IQR: 0,0) post-clozapine (p = 0.0012). Emergency room visits and medical hospitalizations decreased substantially for all months of treatment. Clozapine treatment was associated with marked reductions in self-injurious thoughts and behaviors in high-risk incarcerated individuals.
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Affiliation(s)
- Theodore R Zarzar
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David L Rosen
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James P Mayo
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Maria G O'Connell
- North Carolina Department of Public Safety - Prisons, Raleigh, North Carolina, USA
| | - Terri L Catlett
- North Carolina Department of Public Safety - Prisons, Raleigh, North Carolina, USA
| | - John G Reed
- North Carolina Department of Public Safety - Prisons, Raleigh, North Carolina, USA
| | - Joseph B Williams
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Brian B Sheitman
- North Carolina Department of Public Safety - Prisons, Raleigh, North Carolina, USA
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Bulut NS, Arpacıoğlu ZB. Acute onset psychosis with complex neurobehavioural symptomatology following the intramuscular injection of hyoscine butylbromide: a case report with an overview of the literature. Eur J Hosp Pharm 2022; 29:294-297. [PMID: 33376193 PMCID: PMC9660700 DOI: 10.1136/ejhpharm-2020-002583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
Different compounds of hyoscine (scopolamine) are widely used for the treatment of a variety of conditions, ranging from motion sickness to colic spasms and smoking cessation. In some rare conditions, the administration of scopolamine may lead to severe idiosyncratic reactions, including central anticholinergic intoxication syndrome. Here, we present a young female patient who progressively developed a series of complex neuropsychiatric symptoms including ataxia, slurred and rambling speech, stereotypic movements, vivid visual and auditory hallucinations, and self-mutilative behaviours in the days following the injection of hyoscine butylbromide in the emergency room to treat her menstrual cramps. Referred to psychiatry, detailed screening of her medical records and collateral information from the family revealed that the neurobehavioural manifestations were indeed preceded by severe peripheral anticholinergic toxicity, which were mostly overlooked during the initial evaluations. Started on olanzapine treatment, the patient's symptoms gradually subsided over time, though it took several weeks to achieve full clinical recovery.
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Affiliation(s)
- Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Beyza Arpacıoğlu
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Senna S, Schwab B, Melo HM, Diaz AP, Schwarzbold ML. Social cognition and suicide-related behaviors in depression: a cross-sectional, exploratory study. Braz J Psychiatry 2022; 44:639-643. [PMID: 36709452 PMCID: PMC9851751 DOI: 10.47626/1516-4446-2021-2407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the association between social cognition and previous suicide attempts and non-suicidal self-injurious behavior in adults with unipolar depressive disorders. METHODS Seventy-two patients undergoing outpatient treatment for unipolar depression were enrolled in this cross-sectional study. Theory of mind was assessed using the Hinting Task and the Revised Reading the Mind in the Eyes Test. Empathy was evaluated using the Interpersonal Reactivity Index. Lifetime suicide attempts and non-suicidal self-injurious behavior were assessed using the Columbia Suicide Risk Rating Scale. Participants with and without these suicide-related outcomes were compared in terms of social cognition. RESULTS Patients with previous suicide attempts performed worse on the Reading the Mind in the Eyes Test (p = 0.017). Patients with a history of non-suicidal self-injurious behavior were younger (p = 0.005), had a younger age at first depressive episode (p = 0.017), and scored higher on personal distress in the Interpersonal Reactivity Index (p = 0.027). Only personal distress remained independently associated with non-suicidal self-injurious behavior in multivariable analysis (p = 0.038). CONCLUSION Among patients with depression, those with previous suicide attempts or non-suicidal self-injurious behavior showed worse social cognition. These results encourage future research on social cognition deficits as clinical markers of suicide-related behaviors and as targets for interventions.
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Affiliation(s)
- Sofia Senna
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil,Instituto de Psiquiatria de Santa Catarina, São José, SC, Brazil,Correspondence: Sofia Senna Gonçalves, Av. Engelberto Koerich, 333, Colônia Santana, CEP 88123-300, São José, SC, Brazil. E-mail:
| | - Bianca Schwab
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Hiago M. Melo
- Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, SC, Brazil
| | - Alexandre P. Diaz
- Louis A. Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marcelo L. Schwarzbold
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Cutler GJ, Bergmann KR, Doupnik SK, Hoffmann JA, Neuman MI, Rodean J, Zagel AL, Zima BT. Pediatric Mental Health Emergency Department Visits and Access to Inpatient Care: A Crisis Worsened by the COVID-19 Pandemic. Acad Pediatr 2022; 22:889-891. [PMID: 35351651 PMCID: PMC8957359 DOI: 10.1016/j.acap.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Gretchen J Cutler
- Children's Minnesota Research Institute, Children's Minnesota (GJ Cutler), Minneapolis, Minn.
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota (KR Bergmann), Minneapolis, Minn
| | - Stephanie K Doupnik
- Division of General Pediatrics, PolicyLab, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (SK Doupnik), Philadelphia, Pa
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (JA Hoffmann), Chicago, Ill
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School (MI Neuman), Boston, Mass
| | | | - Alicia L Zagel
- Fairview Pharmacy Services (AL Zagel), Minneapolis, Minn
| | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles (BT Zima), Los Angeles, Calif
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Abstract
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article (a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, (b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and (c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy Jiang
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA;
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Abstract
Co-occurrence of nonsuicidal self-injury (NSSI) and suicide attempts (SA) might occur because they share common risk factors, or alternatively because one leads to the other. Using search terms salient to NSSI and SA, we screened 555 studies to identify 17 that presented temporal data about NSSI and SA. Much of the evidence indicates that NSSI predates SA, especially among females and individuals with depressive symptoms, or diagnosed with borderline personality disorder or mood disorders. However, in some studies, associated risk factors likely accounted for the effect. Greater NSSI frequency to a threshold increases risk for later SA. Findings suggest that the behaviors have common predisposing factors, but that there is also a potent gateway effect whereby NSSI precedes SA.
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Forbes CN, Tull MT, Chapman AL, Dixon-Gordon KL, Gratz KL. Implicit Associations of Nonsuicidal Self-Injury with Relief in Posttraumatic Stress and Depressive Disorders. Arch Suicide Res 2022; 26:565-580. [PMID: 32866425 DOI: 10.1080/13811118.2020.1811182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives. METHOD A subset of participants from our previous study (N = 109) completed diagnostic interviews and the laboratory-based DSH-Relief Implicit Association Test (IAT). RESULTS Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder. CONCLUSIONS Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.
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Kasal A, Kuklová M, Kågström A, Winkler P, Formánek T. Suicide Risk in Individuals With and Without Mental Disorders Before and During the COVID-19 Pandemic: An Analysis of Three Nationwide Cross-Sectional Surveys in Czechia. Arch Suicide Res 2022; 27:671-685. [PMID: 35322761 DOI: 10.1080/13811118.2022.2051653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on suicidal thoughts and behavior has been widely hypothesized but remains largely unexplored at the population-level. We aimed to assess changes in suicide risk (SR) in people with and without mental disorders, before and during the COVID-19 pandemic in Czechia. METHODS We analyzed data from three nationwide cross-sectional surveys of Czech adults (November 2017, May and November 2020). For the 2017 data collection, we employed paper and pencil interviewing, while for the two 2020 data collections, we used a mixed computer-assisted web interviewing and computer-assisted telephone interviewing approach. All samples were representative in terms of age, gender, education, and area of residence for the Czech adult population (18+). We used the Mini International Neuropsychiatric Interview to screen for mental disorders and SR. We calculated weighted prevalence rates with 95% confidence intervals (95% CI). RESULTS When compared to baseline, we found a 4% and 6% increase in SR in individuals without mental disorders in pandemic surveys (1.95% (1.45%; 2.44%) vs. 6.29% (5.28%; 7.30%) and 8.42% (7.19%; 9.65%)). Relative to baseline, SR in people with major depressive episode or anxiety disorders was elevated in May and November 2020 (22.35% (17.64%; 27.06%) vs. 36.68% (32.45%; 40.91%) and 38.88% (34.51%; 43.25%)). CONCLUSIONS We found substantially increased SR in both people with and without mental disorders, however, these changes could be partially related to differing data collection methods used in the baseline and subsequent surveys. Ongoing prevention, monitoring and evaluation of nationwide suicidality is warranted.HIGHLIGHTSWe found that suicide risk substantially increased during the pandemicSuicide risk was elevated in both individuals with and without mental disordersOur findings support increased suicide monitoring and prevention.
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Munasinghe S, Page A, Sperandei S, Gaur P, Ferdousi S, Mannan H, Brakoulias V. Trends in Primary Mental Health Care Service Use and Subsequent Self-Harm in Western Sydney Australia: Policy and Workforce Implications. Int J Environ Res Public Health 2022; 19. [PMID: 35329072 DOI: 10.3390/ijerph19063382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023]
Abstract
Background: This study investigated the trends in primary mental health care (PMHC) service use and hospital-treated self-harm in Western Sydney (Australia). Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Results: There was a substantial increase in referrals from 2016. The majority of referrals were females (60.9%), those aged <45 years (71.3%), and those presenting with anxiety or affective disorders (78.9%). Referrals of those at risk of suicide increased from 9.7% in 2013 to 17.8% in 2018. There were 264 (2.2%) cases of subsequent hospital-treated self-harm, with higher rates among those at risk of suicide and those who attended <6 sessions. The number of HCPs per referral also increased from 2013, as did waiting times for treatment initiation. Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand.
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Chang TH, Yu CH, Yiang GT, Chang HY, Sim JY. Characteristics of children and adolescents presenting to the emergency department with self-inflicted injury: Retrospective analysis of two teaching hospitals. Pediatr Neonatol 2022; 63:131-8. [PMID: 34711528 DOI: 10.1016/j.pedneo.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Data on Taiwanese adolescents with self-inflicted injuries are limited. We describe the epidemiology of children and adolescents visiting the emergency department for self-inflicted injuries in two geographically distinct teaching hospitals. METHODS Medical records of children 0-18 years old who visited the emergency department of Taipei Tzu Chi Hospital and Chi Mei Medical Center, Tainan between 2016 and 2019 coded with relevant diagnoses were reviewed. Visits with documented self-inflicted injury were included. RESULTS During the 4-year period, 62 children made 74 emergency visits for self-inflicted injury. A total of 88% of visits were made by children with a psychiatric diagnosis, with depressive disorders being the most common (57%). Interpersonal relationship issue was cited as a trigger for self-harm in 49% of visits. Adjusted for annual visit volumes, self-harm visits per 10,000 pediatric emergency visits increased nearly 5 fold between 2016 and 2019, with the most prominent increase in the final year. Poisoning was the most common mechanism of injury and was frequently used by females, as compared to males who tended to jump from heights. Up to 96% of adolescents with previous self-harm seen at the emergency department had sought psychiatric help in the past year. Urban-rural inequity in mental health resource utilization was observed. CONCLUSIONS Visits to the emergency department for self-inflicted injuries among children and adolescents increased, most remarkably in 2019, for both hospitals. Intentional poisoning with prescription and over-the-counter medications was the most common method. There was a high prevalence of psychiatric disorders in our study population. As the emergency department is likely the first point of medical contact for such visits, emergency personnel should be trained appropriately on managing such patients.
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