Deliberate Self-harm In Children Research Articles

Deliberate Self-Harm Among Chinese Children with Different Types and Severity of Disabilities.

Background: The aims of this study were to determine the prevalence of deliberate self-harm (DSH) and to compare the risk of self-harm in Chinese children with different types and severity of disabilities. Methods: Participants were 1300 children aged 6–17 years in Beijing, China; 650 children with disabilities and 650 healthy peers matched on age, gender and residence district. Questionnaires were completed anonymously by parents or children if the age or disability made it necessary. The associations between the disability type, severity and DSH were examined using the Chi-square testing and logistic regression models. Results: Children with a single disability or multiple disabilities had statistically higher rates of DSH than children without disabilities (15.6% and 39.7% compared to 10.9%). The prevalence of DSH was associated with the severity of disability, being 36.2% among children with level 1 (the most severe) disability, 19.8% among children with level 2 disability, and 9.2% among children with level 3 + 4 disability. The multivariable odds ratio (OR) of DSH among children with any disability was statistically higher than that among children without a disability (OR = 2.40; 95% CI = 1.71, 3.36; p < 0.05). Children with multiple disabilities (OR = 6.89; 95% CI: 4.24–11.20) and level 1 severity of disability (OR = 6.11; 95% CI: 3.91–9.56) had the highest risk of DSH. Conclusions: This study clearly demonstrated associations between the severity and type of disability and DSH. This finding highlights the importance of DSH in children with disabilities, and underlines the importance of the prevention of DSH among a vulnerable pediatric population in China.

Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study.

Objectives:Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study.Methods:Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children’s clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors.Results:The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder.Conclusion:Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

Chemical burns in children: Aetiology and prevention

BackgroundChemical burns account for a small proportion of total burns in children, but may require specific first aid and different modes of prevention. MethodsA retrospective study between 2006 and 2012 of children ≤16 years treated with chemical burns at a specialist paediatric burn centre. Data were extracted from a prospectively maintained database. Results56 episodes of chemical burns occurred during the study period. The majority (54%) occurred in boys. There were 39 (72%) patients <10 years and 17 (39%) ≥10 years. Median total body surface area burnt was 1% with nine (16%) patients requiring skin grafting. Only 24 (45%) had adequate first aid. The majority (n=46, 82%) of chemical burns occurred in the domestic setting, especially in the <10 years age group (P=0.052). Non-intentional exposure of chemicals by an unattended child accounted for half of all (n=22, 49%) chemical burns <10 years of age. Eight (47%) burns in patients ≥10 years resulted from self-harm. The most common aetiological agents were household cleaners and aerosols in the younger and older age groups respectively. ConclusionChemical burns remain infrequent but potentially preventable. These burns mainly occur in the domestic setting due to non-intentional exposure of household chemicals in children <10, and due to deliberate self-harm in children ≥10. The use of child-resistant packaging, similar to that used for medications, and improved parental practices could help decrease the incidence of burns in children <10.

Deliberate self-harm in children and adolescents: an 11-year case note study.

To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour. All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning. During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%. Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.

Deliberate self-harm in children- a growing problem

Pattison and Kahan first described ‘deliberate self-harm’ as a syndrome in 1983 [1]. The typical pattern described was that of onset in late adolescence, multiple recurrent episodes, low lethality and harm deliberately inflicted upon body. Most authors distinguish between deliberate self-harm and suicide, based on the absence or presence of the apparent intent to kill oneself. While others use it as an all encompassing term that includes a wide range of behaviors ranging from attempted hanging to superficial cutting [2]. Regardless of the definition, it is known that a prior attempt of deliberate self-harm is one of the strongest predictors of future completed suicide [3]. While much has been talked about suicide attempts and acts of deliberate self-harm among adolescents, there is a relative paucity of research evidence regarding acts of deliberate selfharm amongst children under the age of 13 [4]. A study by Sourander, et al. [5] suggested that deliberate self-harm among children is a herald for self-harm behavior in adolescents

Responding to Young People who Self Harm

Deliberate Self Harm in Children and Young People may promote anxiety in families and professionals. My presentation describes how the confidence and competence of a Team can reduce such anxiety...

Deliberate self harm in children

To study the nature of deliberate self-harm (DSH) in children and to identify the associated factors. Child Guidance Clinic attached to the Department of Pediatrics of a teaching hospital in South India. Children with history of deliberate self harm who were referred to the CGC for psychological evaluation during a 10 year period. Children and parents were interviewed together and separately and details regarding age, sex, family and school environment, stresses and nature of self harm were documented. Psychiatric diagnosis was made based on DSM IV diagnostic criteria. Among the 30 children included in the study, 21 were boys and 9 were girls. Majority of children were between the ages of 11 and 13 years, the youngest being 6 years old. 76%of children had history of acute stressful life events and 62%of them had chronic ongoing stress. 62%of children had stress in the family and 41%had stress at school. Stress in the family included death of a parent, conflicts with parents or siblings, mental illness in the family, parental alcoholism and parental disharmony. Stress at school included conflicts with classmates, punishment or negative comments by teachers and learning problems. Psychiatric disorders were present in 52%of children, the commonest being depressive disorder. The commonest mode of DSH was self poisoning, and rat poison (zinc phosphide) was the commonest substance used. Deliberate self harm occurs in young children and the risk factors are comparable to those in adolescents.

A hospital-based study on trends in deliberate self-harm in children and adolescents

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Deliberate Self-harm in Children and Adolescents: A Qualitative Study Exploring the Needs of Parents and Carers

Deliberate Self-harm (DSH) is a serious public health problem and is becoming more prevalent among young people in Ireland. Research tends to focus on the DSH patient. However, parental involvement is recognized as an important factor in their child's prognosis. This study aimed to describe parents' and carers' experiences of self-harm in their child in order to identify their support needs. A focus group methodology was used to generate qualitative data. Representative participants whose children had engaged in suicidal behaviour were recruited from the Paediatric Emergency, Child and Adolescent Mental Health Teams and Family Support Services. Twenty-five participants attended the focus group meeting. A transcript-based conceptual analysis was conducted to identify and explore emerging themes. Participants expressed the need for support; information about suicidal behaviour in young people; skills for parenting an adolescent; and advice on managing further incidents. Parents described significant difficulties in family communication, in parent-child relationships, and in the area of discipline following self-harm. These findings support current research that identifies the need for service development and information for parents/carers of young people who self-harm.

Deliberate self‐harm by under‐15‐year‐olds: characteristics, trends and outcome

Relatively little information is available about the characteristics and long-term outcome of children and adolescents aged under 15 years who present to general hospitals because of deliberate self-harm (DSH). Information was collected on 710 consecutive under-15-year-olds presenting to a general hospital in central England with DSH over a 26-year period (1978-2003). Outcome in terms of death was investigated from national statistics in 464 cases presenting during the first 20 years of the study. Most individuals were aged 12-14 years. In this age group the female:male ratio was 6.5:1. Nearly all (680/710, 95.8%) had taken overdoses, over half of these episodes involving paracetamol (acetaminophen). Few had a history of prior (7.7%) or current psychiatric treatment (7.7%), although a quarter (150/559, 26.8%) had a history of previous DSH. Suicidal intent was usually low. The most frequent problems were difficulties in relationships with family members (77.3%) and with friends (38.9%), and school/study problems (37.9%). The long-term risk of suicide was low, 1.1% (N = 5) having died by probable suicide after a mean follow-up period of 11 years 2 months. DSH in children and young adolescents is usually related to life problems, is generally of low suicidal intent, and is associated with a relatively low long-term risk of suicide.

Suicide and deliberate self-harm in children and adolescents

Rates of deliberate self-harm (DSH) in children and adolescents are rising. Only a small proportion of episodes result in presentation to hospital. Paediatricians have an important role to play in preventing DSH in community and non-psychiatric settings through maintaining up-to-date knowledge of risk factors and considering clinical issues such as intent, motives and psychosomatic presentations. Current treatment options including the ongoing controversies surrounding the use of selective serotonin reuptake inhibitors are outlined, along with factors that influence help-seeking and prevention.

Deliberate Self Harm in Children and Adolescents

This study compared children and adolescents who had deliberately selfharmed (DSH) with those who had not using data routinely collected during assessment at a Child and Adolescent Mental Health Service (CAMHS). The DSH group consisted of 64 boys and 194 girls aged between 7 to 18 years. The control group consisted of 175 boys and 181 girls aged between 11 and 18. As in previous studies, there was a substantially higher proportion of girls who self-harmed or who had depressive symptoms when compared to boys. The study investigated the effectiveness of HoNOSCA as an assessment tool for DSH and compared it with other measures of seriousness of self-harm (BDI, PATHOS, clinician-based risk rating or previous episodes of self-harm). Comparisons of HoNOSCA-rated ‘self injury’ with other assessment tools showed advantages of the latter in detecting individuals at risk. The study also investigated whether DSH was linked to changes in family living and explored trigger or risk factors. The HoNOSCA item ‘Problems with family life and relationships’ was linked to self-harm as expected. However, there were no substantial differences between the groups for measures of family living. Analyses of risk factors showed background issues concerning breakdown of relationships and self esteem were relevant to DSH.

Suicide and deliberate self-harm in children and adolescents

Summary Rates of deliberate self-harm (DSH) in children and adolescents are rising. Only a small proportion of episodes result in presentation to hospital. Paediatricians have an important role to play in preventing DSH in community and non-psychiatric settings through maintaining up-to-date knowledge of risk factors and considering clinical issues such as intent, motives and psychosomatic presentations. Current treatment options, including controversies surrounding the use of selective serotonin reuptake inhibitors (SSRIs) are outlined, along with factors that influence help-seeking and prevention.

Deliberate self-harm in children and adolescents: a research update

We outline research developments in 2004 and early 2005 published in English language journals on deliberate self-harm among children and adolescents up to the age of 18 years. The main issue of concern in recent times has been the risk/benefit profile of using antidepressants, especially selective serotonin reuptake inhibitors, in depressed children and adolescents. Other important topics include treatment approaches, particularly cognitive behaviour therapy, dialectical behaviour therapy and multisystemic therapy, barriers to help seeking, the Internet and prevention. Rates of deliberate self-harm appear to be rising among young people. Risk factors associated with deliberate self-harm are becoming clearer and the evaluation of treatments is progressing. However, the recent conflicting evidence and guidelines regarding selective serotonin reuptake inhibitors and suicidality are presenting major difficulties for clinicians. The role of the Internet and initiatives to prevent suicidal behaviour in adolescents require further research.

Deliberate self-harm in children and adolescents: association with social deprivation.

It has been demonstrated that adult suicidal behaviour is associated with unemployment and social deprivation. The association between self-harm and social deprivation in young people is less clear. To examine the relationship between social deprivation and deliberate self-harm in children and adolescents in an UK district. Computer records of patients under 18 years of age presenting with self-harm at the district casualty department were analysed in Hull and East Yorkshire. The relationship with social deprivation was examined using Townsend scores. 730 young people presented with self-harm during a period of two years. Socio-economic deprivation was associated with overdose, self-injury, and poisoning by illicit substances. After controlling for the proportion of single parent households, moving households with children, and adult long-term sickness in each ward, partial correlations remained significant between overdose, self-injury, and Townsend scores. The results highlight the importance of socio-economic deprivation in the aetiology of deliberate self-harm in young people. Primary and secondary prevention programs cannot be successful without taking this into consideration.

Predicting repeat self-harm in children--how accurate can we expect to be?

The main objective of the study was to find which variables predict repetition of deliberate self-harm in children. The study is based on a group of children who took part in a randomized control trial investigating the effects of a home-based family intervention for children who had deliberately poisoned themselves. These children had a range of baseline and outcome measures collected on two occasions (two and six months follow-up). Outcome data were collected from 149 (92 %) of the initial 162 children over the six months. Twenty-three children made a further deliberate self-harm attempt within the follow-up period. A number of variables at baseline were found to be significantly associated with repeat self-harm. Parental mental health and a history of previous attempts were the strongest predictors. A model of prediction of further deliberate self-harm combining these significant individual variables produced a high positive predictive value (86 %) but had low sensitivity (28 %). Predicting repeat self-harm in children is difficult, even with a comprehensive series of assessments over multiple time points, and we need to adapt services with this in mind. We propose a model of service provision which takes these findings into account.

Deliberate self-harm in children: the nurse's therapeutic style.

This article examines child health nursing skills in the management of deliberate self-harm in children and young people. In order for education to be effective (i.e. so that it changes practice) it must address the belief systems of the practitioner. It is suggested that such belief systems are embedded in collectively held tribal stories. The more challenging the patient's behaviour, the more powerful the influence of the tribal narrative--possibly as a defensive strategy. The authors outline strategies aimed at increasing the range and depth of the therapeutic response to episodes of self-harm, and outline nursing interventions in the management of self-harming children.

Deliberate self-harm in children and adolescents

(2000). Deliberate self-harm in children and adolescents. International Review of Psychiatry: Vol. 12, No. 1, pp. 31-36.

Suicide and Deliberate Self-harm in Children and Adolescents. A Research Update

Suicide and Deliberate Self-harm in Children and Adolescents. A Research Update

Deliberate self harm in children and adolescents

Kathleen norgate reports on the findings of a survey of children admitted to hospital following deliberate self harm