Common Method Of Self-harm Research Articles

Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022.

Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.

A Study to Assess the Prevalence of Non-suicidal Self Injury and Reasons for that Behaviour among Adults and their Coping

Introduction: Non-Suicidal self-injury (NSSI) is both highly comorbid with suicidality among
 adolescents and a significant predictor of suicide attempts (SAs) in adolescents.A broad variety of different functions can underlie acts of Non-suicidal self-injury (NSSI).
 Aims: To study prevalence and characteristics of Non-suicidal self-injury (NSSI) and functional purpose of that behaviour among Adults and their level of coping.
 Study Design: Cross-sectional Analytical study.
 Place and Duration of Study: The study is conducted in central medical university, Gujarat, India over a period of 30 days.
 Methodology: Study was conducted among students of Central Medical University.195 participants were enrolled by consecutive random sampling. They were given a Google form to fill out Demographic details. The form also has an Inventory for NSSI (ISAS) to assess their NSSI behaviour and Brief Resilient Coping Scale (BRCS) to assess coping.
 Results: Out of 195 participants, prevalence of NSSI behaviour is 49(25.12%). Among these 20(40.82%) are male & 29(59.18%) are female. Among sociodemographic data type of family is statistically significant(P value- 0.039). Mean age at which participants start self-harming is16.6 ± 2.89 years. During NSSI behaviour 51.02% of participants always feel pain and 16.32% of participants do not feel pain. Prevalence of NSSI behaviour is higher in 3rd or higher birth order (33.33%) compare to 1st(28.31%) and 2nd (19.67%).The most common method of self-harm was cutting (65.3%), followed by banging (61.22%) or hitting self. The most common functional reason for self-harm was affect regulation followed by self-punishment. of participants who are having NSSI behaviour. In this study we found that there is a statistically significant difference between various resilience coping and NSSI behavior.(P- 0.0008).
 Conclusion: The most common method of self-harm is cutting and functional purpose for this behavior is affect regulation. Individual with low resilient coping have higher chances of NSSI behavior and similarly high resilient coping is protective for NSSI behavior.

Changes of attention-related brain activity over 6 months after acute organophosphate pesticide poisoning: a prospective follow-up study

Context Ingestion of organophosphate (OP) pesticides is a common method of self-harm in developing countries. Apart from acute cholinergic effects, limited evidence implicates OP poisoning in long-term neurocognitive deficits. However, prospective neurophysiological evidence of long-term deficits is scarce in humans. We aimed to determine long-term cognitive changes of acute OP pesticide self-poisoning in a prospective follow-up study, using event-related potentials (ERPs), an electroencephalographic index of cognitive functioning. Methods We recruited 203 patients (147 men) hospitalised with OP pesticide ingestion (OP group; all had significant erythrocyte cholinesterase inhibition) and 50 patients (23 men) with paracetamol overdose (control group) as a means of self-harm. We recorded their ERPs and behavioural performance in a selective attention task at three post-exposure time points: on discharge from hospital (around 14 days post-ingestion), 6 weeks and 6 months post-ingestion. We compared the reaction time and ERP components of the two groups at each time point, adjusting for sex, age, education and comorbid depression in multiple regression models. Results OP group had significantly slower reaction times than the control group on discharge and at 6 weeks, but not at 6 months. On discharge, the OP group also showed significantly prolonged latency of the parietal P3b component, signifying delayed attentional processing. P3b amplitudes were also significantly smaller in the OP group on discharge and at 6 months. Within the OP group, greater clinical severity of poisoning was associated with smaller P3b amplitudes. Early pre-attentive cortical processing (as indexed by N1 ERP component) showed no significant intergroup differences. Conclusions Acute OP pesticide poisoning was associated with impaired behavioural and neurophysiological indices of selective attention. These deficits outlast the cholinergic phase of intoxication. The neurobehavioral impairment disappears over months, but neurophysiological deficits seem to last even after 6 months. This impairment could potentially compromise the performance and safety of patients for months following clinical recovery.

Nature and drivers of suicide in a rural community of Western Maharashtra

Context: The National Crime Records Bureau reports that 134,516 deaths result from suicide in India every year. Maharashtra accounts for 13.4% of the total reported suicides. Aims: This documentation study in the framework of a community mental health program (CMHP) aimed to identify local features of suicide in a rural community, namely sociodemographics and drivers of suicide. Settings and Design: The study was conducted in a community of rural Purandhar block in Western Maharashtra from January 2014 to March 2016 where a CMHP was ongoing since 2013. Data were collected as a part of process documentation through its local community health workers (CHWs). Subjects and Methods: CHWs involved in the program were interviewed, and data were analyzed manually. Results: Seventeen completed and seven attempted suicides who were not a part of the ongoing CMHP among the population were documented. Majority were men under 30 years of age. Pesticide consumption was the most common method of self-harm, and domestic strains were the major driver for suicides. Conclusions: The local pattern of suicidal behavior and its context are relevant for consideration in suicide prevention plans responsive to culture-specific features of suicide.

Stocks of paracetamol products stored in urban New Zealand households: A cross-sectional study

BackgroundIntentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance.ObjectiveThis cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol.MethodsRandom cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated.ResultsA total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0–54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically.ConclusionsThis study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.

Cleistanthus collinus poisoning affects mitochondrial respiration and induces oxidative stress in the rat kidney

Cleistanthus collinus is a poisonous shrub used for deliberate self-harm in rural areas of South India and intake of boiled decoction of leaves is a common method of self-harm. Distal renal tubular acidosis (dRTA) is an important clinical symptom observed in C. collinus poisoning, and renal V-ATPases may be potential targets of damage. However, a lack of understanding of molecular mediators involved hampers medical management, which is mainly supportive. We hypothesized that C. collinus poisoning induces renal oxidative stress; probably by inducing mitochondrial uncoupling, which compromises V-ATPase activity to ultimately produce dRTA. This was tested by exposing renal BBMV, kidney cells in culture, and Wistar rats to C. collinus poisoning. Exposure to C. collinus aqueous extract resulted in significant elevations in the lipid peroxidation marker, conjugated dienes, in cell culture and in vivo. A significant decrease in mitochondrial respiratory control ratio was observed in kidneys from C. collinus-treated animals suggesting that mitochondrial oxidative phosphorylation is uncoupled. This was accompanied by significant increase in ADP levels and a decrease in proton pump activity. Thus, these results demonstrate that C. collinus poisoning induces oxidative stress which influences proton pump activity, probably due to feedback inhibition by elevated ADP levels because of mitochondrial dysfunction in the rat kidney.

Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.

A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide. Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected. The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months. Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.

Intentional Self-harm in Children and Adolescents: A Study from Psychiatry Consultation Liaison Services of a Tertiary Care Hospital.

Objective:The objective of this study was to evaluate the socio-demographic and the clinical profile of children and adolescents presenting with Intentional self-harm.Materials and Methods:Records of all children and adolescents (≤19 years) seen by the consultation liaison (CL) services during the period of 2000-2012 were screened. Patients with a diagnosis of intentional self-harm (at the time of assessment) were taken up for this study. Data was extracted from the records, to study the socio-demographic and clinical profile.Results:During the study period, 101 patients aged ≤19 years and diagnosed with intentional self-harm at the time of admission were evaluated by the psychiatry CL services in various emergency and medical surgical wards. In the study population, females (N = 61; 60.4%) outnumbered males. The age of the patients ranged from 12 to 19 with a median and mean of 17.0 years (standard deviation-1.6 years; interquartile range 16-18 years). Children and adolescent with self harm were more commonly females, from nuclear families, middle socio-economic status and Hindu by religion. The common method of self-harm in adolescents is by ingestion of insecticides (65%) and the self-harm behavior was often precipitated by interpersonal problems in the family context. About one-fifth of the patients have psychiatric morbidity.Conclusion:Findings suggest that the most common method of intentional self-harm in children and adolescents is consumption of insecticides and precipitated by interpersonal problems in the family context.

Re‐presentation and suicide rates in emergency department patients who self‐harm

To investigate adult presentations to North Shore Hospital, Auckland, New Zealand, following deliberate self-harm, determine re-presentation and suicide rates and investigate the characteristics of those patients who re-present. Retrospective review of a cohort of adult patients presenting to North Shore Hospital Emergency Care Centre in Auckland, New Zealand, with deliberate self-harm between 1 January 2001 and 31 August 2002, using data from the National Minimum Data Set and Hospital Discharge Database. The re-presentation rate was calculated as the percentage of patients presenting a second time within 1 year of their index presentation. The suicide rate was calculated as the percentage of patients with a coroner's verdict of suicide within 1 year of their index presentation of deliberate self-harm. There were 1055 presentations by 754 people during the presentation period. Of these 754 people, 136 presented for a second time within a year of the index case (136/754 [18.0%, 95% CI 15.5-21.0]). Eight of the seven hundred and fifty-four people went on to commit suicide within 1 year (8/754 [1.1%, 95% CI 0.5-2.1]). Self-poisoning was the most common method of self-harm. Minor tranquillizers were used more commonly in the group who re-presented. Re-presentation and suicide rates in our study were similar to previously published rates. Further research is needed to identify strategies to reduce re-presentations and excess mortality in all people who deliberately self-harm.

Improvement in Survival after Paraquat Ingestion Following Introduction of a New Formulation in Sri Lanka

BackgroundPesticide ingestion is a common method of self-harm in the rural developing world. In an attempt to reduce the high case fatality seen with the herbicide paraquat, a novel formulation (INTEON) has been developed containing an increased emetic concentration, a purgative, and an alginate that forms a gel under the acid conditions of the stomach, potentially slowing the absorption of paraquat and giving the emetic more time to be effective. We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following its introduction into Sri Lanka.Methods and FindingsClinical data were prospectively collected on 586 patients with paraquat ingestion presenting to nine large hospitals across Sri Lanka with survival to 3 mo as the primary outcome. The identity of the formulation ingested after October 2004 was confirmed by assay of blood or urine samples for a marker compound present in INTEON. The proportion of known survivors increased from 76/297 with the standard formulation to 103/289 with INTEON ingestion, and estimated 3-mo survival improved from 27.1% to 36.7% (difference 9.5%; 95% confidence interval [CI] 2.0%–17.1%; p = 0.002, log rank test). Cox proportional hazards regression analyses showed an approximately 2-fold reduction in toxicity for INTEON compared to standard formulation. A higher proportion of patients ingesting INTEON vomited within 15 min (38% with the original formulation to 55% with INTEON, p < 0.001). Median survival time increased from 2.3 d (95% CI 1.2–3.4 d) with the standard formulation to 6.9 d (95% CI 3.3–10.7 d) with INTEON ingestion (p = 0.002, log rank test); however, in patients who did not survive there was a comparatively smaller increase in median time to death from 0.9 d (interquartile range [IQR] 0.5–3.4) to 1.5 d (IQR 0.5–5.5); p = 0.02.ConclusionsThe survey has shown that INTEON technology significantly reduces the mortality of patients following paraquat ingestion and increases survival time, most likely by reducing absorption.

Fatal injury in Eastern Sri Lanka, with special reference to cardenolide self-poisoning with Cerbera manghas fruits

Objective. Self-poisoning with plant seeds or fruits is a common method of self-harm in South Asia. While most deaths follow ingestion of Thevetia peruviana (yellow oleander) seeds, other plants are locally common. During review of fatal injuries seen in a teaching hospital in eastern Sri Lanka, we noted cases of fatal self-poisoning with Cerbera manghas (sea mango, pink eyed cerbera, odollam tree) fruits. Methods. We reviewed the post-mortem records of the Batticaloa Teaching Hospital and extracted data on all cases of fatal injury. Results. During 2001 and 2002, 315 post mortems for injury were performed in Batticaloa Teaching Hospital. Intentional self-harm was responsible for 48.6% of cases. While T. peruviana was responsible for 33 deaths, C. manghas self-poisoning caused seven deaths. C. manghas cases had typical features of cardenolide poisoning with cardiac dysrhythmias and hyperkalemia. In the absence of pacing facilities and anti-digoxin Fab, management involved administration of atropine and of insulin and dextrose to lower serum potassium concentrations. Conclusions. C. manghas self-poisoning has only previously been reported from Kerala and Tamil Nadu in south India. While uncommon in other parts of Sri Lanka, it has become a common method of self-harm in one east coast district, accounting for 20% of fatal self-harm with plants in one hospital. Management was inadequate with the available resources, emphasising the need for an affordable antitoxin for plant cardenolide poisoning.

“Near-fatal” deliberate self-harm: characteristics, prevention and implications for the prevention of suicide

Background: There have been few studies of the most serious cases of deliberate self-harm (DSH). These cases represent an important clinical problem. They may also be suitable as a “proxy” for suicide in research studies. Method: We developed a definition of “near-fatal” deliberate self-harm (NFDSH) and identified all cases attending accident and emergency departments in an urban area during an 18-month period. We compared them to less severe DSH on social and clinical characteristics, and examined their initial clinical management. We compared their age and gender profile with that of completed suicides. NFDSH cases who agreed to be interviewed were asked about their experiences of seeking help and their views on prevention of suicide. Results: 158 cases were identified, 8% of all DSH. The most common method of self-harm was self-poisoning. The most common psychiatric diagnosis was depression. Compared to less severe DSH, near-fatal cases had higher rates of several social and clinical risk factors for suicide and showed evidence of greater suicidal intent. Forty-one percent were allowed home following assessment. Most admissions lasted 2 days or less. The age and gender profile was closer to that of suicide than in DSH generally. Few subjects agreed to be interviewed; those who did described poor previous experiences of services. Limitations: We did not assess each case of DSH individually but applied a workable definition of NFDSH. Firm conclusions cannot be drawn from the qualitative part of the study because of the low rate of agreement to interview. Conclusions: NFDSH is an important clinical phenomenon associated with indicators of high suicide risk. This high risk is frequently not reflected in clinical management. Further studies of NFDSH could contribute to what is known about suicide prevention but the reluctance of NFDSH subjects to be interviewed may be a difficulty for future research.

Suicide and self‐harm in Tasmanian children and adolescents

To examine rates of suicide by Tasmanians less than 20 years of age, to compare them with rates for Australia as a whole, and to report a clinical study of child and adolescent self-harm in Tasmania. Australian Bureau of Statistics data on suicides by 0-19-year-olds in Tasmania and Australia and population estimates were used to calculate and compare suicide rates for the period 1965-1991. The self-harm study involved 36 females and 16 males presenting to the accident and emergency department of a general hospital. They were studied by means of structured interview and scales of personal/family functioning and beliefs. Controls were individually matched with patients with no psychiatric condition. During 1965-1991, the suicide rate in Tasmanian males aged 15-19 years was higher than that of mainland Australian males and had increased during the last 10 years of this period. Suicide rates for males, both in Tasmania and mainland Australia, were higher than the corresponding rates for females. Among females aged 10-14 years or 15-19 years, the rates for Tasmania were not different from those of the mainland counterparts. The rate for 15-19-year-old Tasmanian females was higher during the last decade of the study period than in earlier years. Common motivations for self-harm were to die or to escape an impossible situation, rather than to attract the attention of others. Most adolescents had serious personal and interpersonal problems, usually involving family dysfunction, including parental separation, physical abuse and lack of a family confidant, when compared with controls. Ingestion of medication (most frequently paracetamol) was the most common method of self-harm. The suicide rate in 15-19-year-old Tasmanian males is higher than the mainland rate and rising. Self-harm in adolescence is associated with serious personal and interpersonal problems which must be identified before effective counselling can begin. The formation of multidisciplinary teams for the immediate assessment and support of self-harming adolescents and their parents is recommended.