Act Of Self-harm Research Articles

Psychosocial factors of deliberate self-harm in Afghanistan: a hospital based, matched case-control study.

Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide. We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan. A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics of the participants, history of domestic violence, drug abuse and details about the act of deliberate self-harm, including the methods used. To assess depression and anxiety, we used the WHO self-reporting questionnaire (SRQ-20). Matched odds ratios with 95% confidence interval using conditional logistic regression were used to determine statistically significant associations between psychosocial factors and deliberate self-harm. Family conflicts, domestic violence, interpersonal arguments and living in extended families were found to be significantly associated with deliberate self-harm. In Afghanistan, deliberate self-harm appears to be predominately related to interpersonal problems and family conflicts. About two-thirds of females and more than half of males scored positive for depression, yet none were receiving treatment for this. These findings have important policy implications for mental health and suicide prevention programmes in the country.

Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?

ObjectiveThis study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm. MethodsThis register study included 16,235 cases in the ages 16–24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome. ResultsIn cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04–1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year. ConclusionsThis study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.

Identification of novel genome-wide associations for suicidality in UK Biobank, genetic correlation with psychiatric disorders and polygenic association with completed suicide.

BackgroundSuicide is a major issue for global public health. Suicidality describes a broad spectrum of thoughts and behaviours, some of which are common in the general population. Although suicide results from a complex interaction of multiple social and psychological factors, predisposition to suicidality is at least partly genetic.MethodsOrdinal genome-wide association study of suicidality in the UK Biobank cohort comparing: ‘no suicidality’ controls (N = 83,557); ‘thoughts that life was not worth living’ (N = 21,063); ‘ever contemplated self-harm’ (N = 13,038); ‘act of deliberate self-harm in the past’ (N = 2498); and ‘previous suicide attempt’ (N = 2666).OutcomesWe identified three novel genome-wide significant loci for suicidality (on chromosomes nine, 11 and 13) and moderate-to-strong genetic correlations between suicidality and a range of psychiatric disorders, most notably depression (rg 0·81).InterpretationThese findings provide new information about genetic variants relating to increased risk of suicidal thoughts and behaviours. Future work should assess the extent to which polygenic risk scores for suicidality, in combination with non-genetic risk factors, may be useful for stratified approaches to suicide prevention at a population level.FundUKRI Innovation-HDR-UK Fellowship (MR/S003061/1). MRC Mental Health Data Pathfinder Award (MC_PC_17217). MRC Doctoral Training Programme Studentship at the University of Glasgow (MR/K501335/1). MRC Doctoral Training Programme Studentship at the Universities of Glasgow and Edinburgh. UKRI Innovation Fellowship (MR/R024774/1).

Profile of organo phosphorous poisoning at a tertiary medical centre in Jharkhand, India

Background: Poisoning is the most common method, employed for the act of deliberate self-harm. The wide availability, lack of rules and regulations for the sale of pesticides resulted in wide spread use of Organophosphate as one of the most common poison used for deliberate self-harm.Methods: In this study, authors aim to find out clinical profile with respect to different O.P. compounds, prognosis and outcome of each patient in relation to the delay in getting medical attention. Present study objective is to find out if there is any specific clinical finding which can predict bad outcome.Results: Out of 344 cases, 189 cases had type 1 respiratory failure, while in 34 cases type II respiratory failure present. 61 cases expired and out of these 61 cases 47 cases died within 24 hours and 11 cases died in next 48 hours.Conclusions: Maximum number of cases were in the age group of 21 - 30years. The maximum number of deaths were in the first 72 hours. Number of cases were more in males as compared to females. Chances of survival was better in persons who reached early to the hospital.

Referral pathways between the mental health services and Jigsaw.

To examine similarities and differences in the demographic and clinical profiles of young people (15-25 years of age) referred between the mental health services (MHS) and Jigsaw Galway. A retrospective chart review was conducted of clinical files of individuals attending secondary MHS who had been referred to or from Jigsaw Galway over a 5-year period. Differences in demographic and clinical data between individuals referred to or from Jigsaw Galway were compared. A recent act of self-harm was more prevalent in individuals referred from Jigsaw to the adult MHS (p=0.02). No other demographic or clinical differences were detected between individuals attending Jigsaw Galway and the MHS. Education sessions for clinical staff working in primary care, Jigsaw Galway and the MHS are suggested to support clinicians in choosing the best referral pathway, which may more optimally address young people's mental health difficulties.

Blurred Boundaries - A Qualitative Study of How Acts of Self-Harm and Attempted Suicide Are Defined by Mental Health Practitioners.

There is no commonly accepted definition of the term self-harm, and there is an ongoing debate about whether or not it should include acts of attempted suicide. The use of this language in clinical practice has not previously been explored. To investigate if, and how, practitioners distinguish between acts of self-harm and attempted suicide, and present any implications for practice. We conducted semistructured interviews with a random sample of 18 frontline practitioners from 10 mental health wards and completed a thematic analysis of interview data. Most participants described self-harm and attempted suicide as distinct behaviors. Characteristics of the act, disclosures of intent, and the level of distress observed were commonly used to differentiate between self-harm and attempted suicide. Very few participants believed that people who self-harm may also feel suicidal. Practitioners confidently described two different behaviors, yet self-harm and attempted suicide were often conflated, revealing the challenges and complexities associated with the separation of these acts in clinical practice. Clinicians working in other settings or disciplines may have different views. Participants' accounts may not be an accurate representation of what happens in practice. This study adds to a body of evidence which argues against the dichotomous separation of these behaviors into acts of suicidal and nonsuicidal self-harm.Our findings suggest there is no common understanding of the boundaries between self-harm and attempted suicide among frontline clinicians. The language currently used, and consequent practice, particularly with regard to risk assessment, is problematic. Efforts should be made to operationalize terms around suicidal behavior and to incorporate these into training for clinical staff.

Assessment and Management of Self Harm in Emergency Departments in Ireland: The National Clinical Programme

In 2014, more than 11,000 people came to Irish general hospital Emergency Departments following self-harm. It is known that up to 15% of patients who present following self-harm leave the Emergency Department (ED) without a bio-psycho-social (BPS) assessment of risk and need, and 17% will repeat their self-harm act within 3 months.Self-harm is the single biggest risk factor for completed suicide, increasing the risk of suicide 40-fold, as compared to the general population. Suicide is now the commonest cause of death for young men (aged 15-24 years) and middle aged men (45-54 years). Alcohol consumption is implicated in more than 37% of cases of self-harm and half of those who die by suicide have had a history of alcohol abuse in the final year of their lives.Diversity with regard to assessment procedures and management in health settings, as well as feedback from families bereaved by suicide, have led to repeated calls for the development and resourcing of an effective response for people who present to health services having engaged in self-harm.The aim of this National Clinical Care Programme (NCP) for the Assessment and Management of Patients Presenting to Emergency Departments following Self-harm is to develop a standardised and effective process for the assessment and management of individuals of all age ranges, including children, adolescents, adults and older adults, who present with self-harm to ED.It refers to the mental health/bio-psycho-social assessment and initial management of both risk and need following self-harm, in the acute hospital Emergency Department, from time of presentation to discharge.This NCP requires that all patients presenting to ED with self-harm (including suicidal ideation and intent) receive standardised triage, bio-psycho-social assessment and assertive follow up by skilled clinicians.Family/carers will be included in the assessment and follow up process. The quality of the programme will be monitored through a set of key metrics.The objectives of this programme are to:- Improve the assessment and management of all individuals who present to ED with self-harm- Improve access to appropriate interventions at times of personal crisis- Ensure rapid and timely linkage to appropriate follow-up care- Optimise the experience of families and carers in trying to support those who present with self-harm.The Clinical Programme started in December 2014 and has now been implemented in 16 of the targeted 21 hospitals in Ireland with 24 hour EDs. This was done by the deployment of Mental Health Clinical Nurse Specialists to the Emergency Departments. As well as assessment, their role has included on-site training for non-mental health ED staff to improve integrated care. Data reflecting the objectives of the Clinical Programme has been collected and will be presented and discussed.

A rare presentation of Potassium Iodate toxicity

Introduction Potassium Iodate is a compound used for nutritional supplementation in table salt and administered to individuals exposed to radioactive iodine. Toxicity to Potassium Iodate is not a common presentation to the emergency room. In this case report, we present a young man who was brought to the ED after deliberate oral ingestion of Potassium Iodate, who then had a remarkable clinical course in the hospital. Case description A 26-year-old Sri Lankan male was referred to the Emergency department as a case of ST elevation MI from the primary health centre, where he had presented with diarrhoea. In the Emergency, he admitted to have consumed a handful of potassium iodate powder, 17 hours prior to presentation to ED, as an act of deliberate self-harm. He then had complains of cramping abdominal pain, loose stools and vomiting. He was also complaining of visual disturbances, in the form of seeing everything with a greyish tinge. On initial assessment of patient, he was talking, with a patent airway, had no evidence of any respiratory distress and had stable haemodynamics and GCS of 14/15. Visual acuity was 6/6 but stated everything appears grey. ECG showed ST elevation and tall T waves in chest leads, reciprocal changes of ST depression in III, aVF with prolonged PR and QRS interval. Echocardiogram was done which showed no regional wall motion abnormality. Labs showed high potassium (K-7.6meq/L). Other notable results were CPK of 3909U/L, myoglobin more than 5000ng/ml, high sensitive Troponin T - 220ng/L, Troponin I - 1.8ng/L, Leukocytosis of 34500/uL with neutrophilia, creatinine - 226umol/L, BUN - 6.07mmol/L, Sodium - 139meq/L, mixed respiratory and metabolic acidosis with normal anion gap and osmolar gap. Fibreoptic laryngoscopy looking for any features of corrosive damage to upper airway proved normal. Over few hours he developed methhaemoglobenaemia. Treatment was started for hyperkalemia but only had transient response to repeated medical management. Emergency hemodialysis was started to treat the hyperkalaemia. He was later admitted under the intensive care with input from renal team. He received hemodialysis for more than 3 weeks. He was also found to have only light perception in both eyes with bilateral vitreous hemorrhage and posterior vitreous detachment. Patient as of date has started to pass urine. He is off hemodialysis. He still has renal failure and is continuing treatment in the medical floor. Conclusion Though renal failure, hyperkalemia and retinopathy have been described in literature, the presentation and clinical course of this patient were unique in many ways including severe rhabdomyolysis leading to acute tubular necrosis and bilateral vitreous hemorrhage with posterior vitreous detachment.

A Study to Assess the Suicidal Behaviour among the Psychiatric Patients in a Tertiary Care Teaching Hospital, Guntur

Suicide attempt is a deliberate act of self harm with at least some intent of die that does not result in death. Such act has a wide range of medical seriousness. Individuals with psychiatric disorders are far more likely to commit suicide than the others. People who are psychologically disabled are often commit suicide from years of pain, frustration and depression. Spiritually they may perceive themselves as hopelessly damaged and lose all sense of purpose and meaning of life. Suicide is not a diagnosis or a disorder. it is a behaviour. Suicide is a worldwide, national, local and familial problem. 90% of people who kill themselves suffer from a diagnosable and preventable problem such as depression co-occurring mental and substance use disorders are common and potent combination among those who die by suicide.

A Descriptive Study of Feelings of Arrested Escape (Entrapment) and Arrested Anger in People Presenting to an Emergency Department Following an Episode of Self-Harm.

To explore the role of elevated feelings of anger and desires to escape (fight/flight), which are experienced as inhibited, blocked, and arrested (i.e., arrested anger and arrested flight/escape leading to feelings of entrapment). This descriptive study developed measures of arrested anger and arrested flight and explored these in the context of a recent self-harm event in people presenting to a Hospital's Emergency Department (ED). Fifty-eight individuals presenting to an ED following an act of self-harm were recruited. Participants completed newly developed measures of arrested flight, arrested anger and anger with self in regard to self-harm, and suicide intent and depression. Ninety-three percent of participants presented after self-poisoning. The majority (95%) reported having experienced high escape motivation that felt blocked (arrested flight) with 69% reporting feeling angry with someone but unable to express it (arrested anger). For many participants (53.7%), strong desires to escape from current situations and/or to express anger did not diminish immediately after the act. As with many studies, a select group of participants agreed to take part and we did not keep records of how many refused. There are no other validated measures of arrested escape and arrested anger and so for this study, our short item-focused measures rely on face validity. Arrested defenses of fight and flight, and self-criticism are common in those who have self-harmed and may continue after acts of self-harm. Many participants revealed that talking about their experiences of escape motivation and blocked anger (using our measures) was helpful to them. Feelings of entrapment and arrested anger are common in people who self-harmClinicians could benefit from increased awareness and measures of arrested flight and arrested angerDiscussing these concepts and experiences appears to be useful to people who have self-harmedFurther research is needed on how best to help people with such experiences.

Thoughts and feelings associated with parasuicide: A thematic analysis

This article seeks to shed more light on what influences an individual to take their own life. By interviewing individuals who have presented at a general hospital with an act of attempted suicide, their recollections of events running up to the act have been analysed by the research team and described in this article. Nobody can be certain of an individuals' exact motives when being assessed following an act of self-harm, but by using a validated suicide intent scale and clinician judgement together, the research can reasonably claim to have included those patients whose actions were clearly intent on suicide rather than self-harm with no strong desire to end one's life. Seven in-depth interviews were conducted 7–14 days after the initial presentation, time enough to ensure recollections are accurate while not being too close to the initial act of attempted suicide as to be viewed as too soon to expect someone to reflect on a traumatic episode. A comprehensive literature search and discussion section in the article enables the reader to learn more about the issue of suicide, which is fair to say generates much debate among psychiatric, psychological, and social commentators alike.

From Traditional Management of Mental Illness to Self-Mutilation of the Penile: A Case Report

Introduction: Self-mutilation of the external genitalia is rare. It occurs most often on a psychotic ground. Case Report: Mr. P.O. 25-year-old, a dress maker, admitted to the urological emergency for self-section of the penile. The patient had cut his penile with a razor blade and the amputated distal extremity had been thrown in the water closet. The patient was admitted 19 hours after the act of self-harm. Clinical examination had found a stable hemodynamic status, a section of the penile at its root. Psychiatrically schizophrenia evolving for 08 months was diagnosed. An attempt of penile reconstruction was performed. The patient benefited serum and tetanus vaccine, antibiotic and neuroleptics. The parents asked to go home against medical advice the 5th day. Conclusion: The management of self-mutilation of external genitalia is multidisciplinary including surgery and psychiatry.

Ведущие механизмы самоповреждающего поведения у подростков: по материалам мониторинга в образовательных организациях

The behavior of self-harm is prevalent among adolescents. Most research on the topic has focused either on qualitative investigation of hospitalized teens or on quantitative research of non-clinical population. There combination of these approaches is considered very promising, yet it is extremely rare. The present article investigates the behavior of self-harm without suicidal intention in non-clinical population. The participants were 604 students of Moscow schools (7—11 grades). 22% participants reported at least 1 act of deliberate self-harm in the lifetime period (54% — single episode, 46% multiple episodes of self-harm). 100 adolescents with a history of non-suicidal self-harm were further assessed with Clinical In- ventory, which reflected the gradation of the key suicide markers. Clinical assess- ment revealed three major mechanisms of self-harm development: stressful (20%), depressive (45%), and psychopathological (35%). Further distinction among impulsive and reflective led to description of 6 groups, each having specific clini- cal picture, dynamics, motives, personal patterns and attitude towards self-harm. Understanding of leading mechanism of antivital behavior is essential for effecting crisis intervention and psychological counseling of adolescents in the aftermath of self-harm or suicidal attempts. Comparative analysis of these results with data on clinical population reveals several differences.

Trends in Self-Harm in Kuala Lumpur, 2005–2011

Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007–2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6–8 or 8–13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.

Self-harm in young people: Prevalence, associated factors, and help-seeking in school-going adolescents.

Adolescent self-harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help-seeking for self-harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self-harm in an urban region in Ireland, and to investigate help-seeking behaviours for self-harm. This was a cross-sectional study of 856 school-going adolescents, employing an anonymous self-report questionnaire. A lifetime history of self-harm was reported by 12.1% of adolescents. Factors independently associated with self-harm included exposure to self-harm of a friend/family member. Professional help-seeking was uncommon prior to (9%) and after (12%) self-harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self-harm act. These findings indicate that self-harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the 'tip of the iceberg' of adolescent self-harm. Identifying the prevalence of self-harm and associated factors, in addition to help-seeking behaviours, in young people is important to determine the preventative programmes to target 'at-risk' groups. Mental health nurses have an important and increasing role to play in such school-based initiatives.

Dermatitis artefacta: A review of five cases: A diagnostic and therapeutic challenge

Dermatitis artefacta (DA) is a self-inflicted dermatological condition where the underlying motive is to assume a sick role. The act of self-harm is to discharge the inner sense of isolation and emotional distress, which is too great to endure. We, hereby, report five interesting cases of DA with varied presentations, using diverse and innovative means for inflicting injury/injuries. Rarity may be attributed to masquerading presentation, leading to misdiagnosis and paucity of awareness among the physicians. Lack of proper identification of the underlying psychiatric disturbances may be the major cause of the loss of follow-ups. Here, we were fortunate enough to identify the emotional need of most of the patients. A flexible, nonconfrontational yet strong therapeutic rapport is required to improve the therapeutic outcomes.

Differences between suicide and non-suicidal self-harm behaviours: a literary review.

According to the current information of WHO, suicide is one of the 20 most common causes of death in the whole population. Suicides constitute one of the most common causes of death amongst teenagers. Apart from suicide, another significant, however much less known phenomenon is the non-suicidal self-injury. Despite the fact that we know much less about self-harm than about suicide, the results of research during the last years indicate that self-harm occurs more frequently in the population of adolescents – suicides constitute 10% in the population of teenagers, and 7-14% of adolesncets report to have performed a self-harm act at least once in their live. The last transnational research shows that the frequency of self-destructive behaviours in adolescents is at the level of 24% of the whole population, which might indicate an intensification of this phenomenon. In some cases self-injury takes place with a clear intention of committing suicide, or a self-destructive act, which often precedes a suicidal attempt long before the final decision to carry it out. Nevertheless, In the majority of cases self-injury is not performed with the intention of death. Therefore a question might be posed: do self-harm acts constitute a separate category of behaviours, or do they inevitably lead to a suicidal death? When answering this question, we ought to take a closer look at both phenomena to have a better knowledge about their etiology, risk factors, and to understand when they co-occur, and when they belong to different categories of self-aggressive behaviours.

Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992-2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17,034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65-0·82) and death by any cause (0·62, 0·47-0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77-0·91; absolute risk reduction [ARR] 2·6%, 1·5-3·7; numbers needed to treat [NNT] 39, 95% CI 27-69), deaths by suicide (OR 0·75, 0·60-0·94; ARR 0·5%, 0·1-0·9; NNT 188, 108-725), and death by any cause (OR 0·69, 0·62-0·78; ARR 2·7%, 2·0-3·5; NNT 37, 29-52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented. Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm. Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.

Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: A cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India

BackgroundRates of self harm are high in south India, but little is known about the relationship between antecedent behaviour, suicidal intent and method. AimsTo identify clinical, social and behavioural antecedents preceding an act of self-harm. Methods200 participants, consecutively presenting with deliberate self harm to a hospital in south India, were interviewed. Socio-demographic and clinical characteristics were recorded, together with behaviours preceding self-harm. The Pierce Suicidal Intent Scale and Mini International Neuropsychiatric Inventory were administered. ResultsPesticide poisoning was the most common method, especially amongst men, in rural areas, and amongst professionals. No particular antecedent behaviour or activity appears to be associated with higher levels of suicidal intent. Absenteeism from work was the most commonly reported change of behaviour in the month preceding an act of self-harm. Unskilled labourers and professionals had significantly greater suicidal intent (adjusted for age, gender and method) than skilled labourers and the unemployed. There were no differences in suicidal intent between different methods. Rural dwellers had significantly greater suicidal intent compared to urban dwellers, irrespective of the method. Major Depressive Disorder was associated with significantly greater suicidal intent compared with other diagnoses and no diagnosis. ConclusionsAmongst people who harm themselves in south India, professionals and unskilled labourers, rural residents, and people with current major depressive disorder have higher levels of suicidal intent. Severity of suicidal intent does not appear to influence choice of method of self-harm. Behaviours predictive of self-harm in the west may not be relevant in south India.

Self-harm in young adolescents (12–16 years): onset and short-term continuation in a community sample

BackgroundTo investigate the prevalence of self-harm in young adolescents and factors associated with onset and continuity over a one year period.MethodProspective longitudinal study. Participants were young adolescents (n = 3964) aged 12–16 years attending 8 secondary schools in the Midlands and South West of England.ResultsOver a one year period 27% of young adolescents reported thoughts of self-harm and 15% reported at least one act of self-harm. Of those who self-harmed, less than one in five (18%) had sought help for psychological problems of anxiety or depression. Compared with boys, girls were at increased risk of developing thoughts (OR 1.61, 95% CI 1.26-2.06) and acts (OR 1.40, 95% CI 1.06-1.84) of self-harm, particularly amongst those girls in school year 9 (aged 13/14, thoughts adjusted Odds Ratio (aOR) 1.97, 95% CI 1.27-3.04; acts aOR 2.59, 95% CI 1.52-4.41). Of those reporting thoughts of self-harm at baseline, 60% also reported these thoughts at follow-up. Similarly 55% of those who reported an act of self-harm at baseline also reported that they had self-harmed at follow-up. Insecure peer relationships increased the likelihood that boys and girls would develop self-harming behaviours, as did being bullied for boys. Low mood was associated with the development of self-harming thoughts and behaviours for boys and girls, whilst a strong sense of school membership was associated with a reduced risk of developing thoughts of self-harm for boys and increased the likelihood of self-harming thoughts and behaviours ceasing for girls.ConclusionSelf harm in young adolescents is common with one in four reporting self-harming thoughts and one in six engaging in self-harming behaviour over a one year period. Self-harm is already established by 12/13 years of age and for over half of our sample, self-harming thoughts and behaviour persisted over the year. Secure peer and strong school relationships were associated with less self-harm. Few seek help for psychological problems, suggesting a need to increase awareness amongst all professionals who work with young adolescents about self-harm and associated risk factors.