Risk Of Deliberate Self-harm Research Articles

Triglycerides as a biological marker of repeated re-hospitalization resulting from deliberate self-harm in acute psychiatry patients: a prospective observational study

BackgroundBiological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments.This study aimed to examine the incremental validity of lipid levels and platelet serotonin when combined with psychosocial factors in risk assessments for repeated admissions due to DSH.MethodsIn this prospective observational study of 196 acutely admitted patients, results of blood tests performed upon admission and the MINI Suicidal Scale and psychosocial DSH risk factor assessments performed at discharge were compared with the incidence of DSH recorded during the first 3 and 12 months after discharge.ResultsHigh triglyceride levels were found to be a significant marker for patients admitted 3 or more times due to DSH (repeated DSH, DSH-R) when tested against other significant risk factors. When all (9) significant univariate factors associated with 12-month post-discharge DSH-R were analyzed in a multivariate logistic regression, the MINI Suicidal Scale (p = 0.043), a lack of insight (p = 0.040), and triglyceride level (p = 0.020) remained significant. The estimated 12-month area under the curve of the receiver operator characteristic (ROC-AUC) for DSH-R was 0.74 for triglycerides, 0.81 for the MINI, 0.89 for the MINI + psychosocial factors, and 0.91 for the MINI + psychosocial factors + triglycerides. The applied multifaceted approach also significantly discriminated between 12-month post-discharge DSH-R patients and other DSH patients, and a lack of insight (p = 0.047) and triglycerides (p = 0.046) remained significant for DSH-R patients in a multivariate analysis in which other DSH patients served as the reference group (rather than non-DSH patients).ConclusionThe triglyceride values provided incremental validity to the MINI Suicidal Scale and psychosocial risk factors in the assessment of the risk of repeated DSH. Therefore, a bio-psychosocial approach appears promising, but further research is necessary to refine and validate this method.

Antidepressant Class, Age, and the Risk of Deliberate Self-Harm: A Propensity Score Matched Cohort Study of SSRI and SNRI Users in the USA

Antidepressant Class, Age, and the Risk of Deliberate Self-Harm: A Propensity Score Matched Cohort Study of SSRI and SNRI Users in the USA

Antidepressant Dose, Age, and the Risk of Deliberate Self-harm

Antidepressant Dose, Age, and the Risk of Deliberate Self-harm

Self‐image in adolescents with deliberate self‐harm behavior

This study tested the hypothesis of a positive relation between deliberate self-harm and poor self-image in adolescents and investigated the relation between substance abuse (drugs, cigarettes, and alcohol) and deliberate self-harm. One-hundred thirteen high-school students, aged predominantly 16-18 years, responded to the 16-item version of the Deliberate Self-Harm Inventory, the 36-item Structural Analysis of Social Behavior, and single questions about use of drugs, cigarettes, and alcohol. The results showed a positive relation between deliberate self-harm and poor self-image, and between deliberate self-harm and cigarette smoking and alcohol consumption. These results imply that poor self-image and a large extent of substance use may be markers for identifying adolescents at risk for deliberate self-harm.

Systematic meta‐analysis of the risk factors for deliberate self‐harm before and after treatment for first‐episode psychosis

Attempted suicide and deliberate self-injury can occur before or after presentation with a first-episode of psychosis. The aim of the study is to identify the factors associated with suicide attempts or deliberate self-injury before and after treatment for first-episode psychosis. A systematic review and meta-analysis of controlled studies of factors associated with either suicide attempts or deliberate self-injury, referred to here as deliberate self-harm (DSH). The pooled proportion of patients who reported DSH prior to treatment for first-episode psychosis was 18.4% (95% Confidence Interval (CI) 14.4-23.3, N = 18 studies, I(2) = 93.8). The pooled proportion of patients with DSH during the period of untreated psychosis was 9.8%, (95% CI 6.7-14.2, N = 5 studies, I(2) = 58.9). The pooled proportion of patients committing DSH during periods of follow up of between 1 and 7 years was 11.4%, (95% CI, 8.3-15.5, N = 13 studies, I(2) = 89.2). Categorical factors associated with an increased risk of DSH were a prior history of DSH (OR = 3.94), expressed suicide ideation (OR = 2.34), greater insight (OR = 1.64), alcohol abuse (OR = 1.68) and substance use (OR = 1.46). Continuous variables associated with an increased risk of DSH were younger age of onset (Standardized Mean Difference (SMD) = -0.28), younger age at first treatment (SMD = -0.18), depressed mood (SMD = 0.49) and the duration of untreated psychosis (SMD = 0.20). Depressed mood and substance use were associated with DSH both before and after treatment, negative symptoms were associated with DSH after treatment but not before treatment. Positive symptoms and social and global functioning were not associated with DSH. Younger age and the duration of untreated psychosis were associated with DSH before treatment but not after treatment. Earlier treatment of first-episode psychosis and successful treatment of depression and substance use could prevent some episodes of DSH and might reduce suicide mortality in early psychosis.

Deliberate Self-harm in Nondepressed Substance-dependent Patients

The lifetime diagnosis of substance dependence syndrome is a major risk factor for attempting suicide. The systematic study of various risk factors of suicide in substance-dependent patients in Indian population will have far-reaching implications about the understanding of disorder. The objective was to study the sociodemographic and clinical factors associated with deliberate self-harm (DSH) in nondepressed substance-dependent patients. Participants included 60 male inpatients (30 patients with DSH and 30 without DSH) fulfilling International Classification of Diseases, Tenth Revision Diagnostic Criteria for Research for substance dependence syndrome, aged between 18 and 60 years, with Hamilton Depression Rating Scale score fewer than 7. They were assessed using Addiction Severity Index, Presumptive Stressful Life Event Scale, State-Trait Anger Expression Inventory, Lubben Social Network Scale, International Personality Disorder Examination, Risk Rescue Rating Scale, and Global Assessment of Functioning. Patients with DSH had significantly higher rates of opioid dependence (P < .05), risk of isolation (P < 0.001), the number of life events (P < 0.001), anger trait and anger expression (P < 0.001), personality disorder (P < 0.05), the number of substance use problems and lower social functioning (P < 0.001), as compared with those without DSH (P < 0.001). There was no significant correlation between Risk Rescue Rating Scale with sociodemographic and clinical variables. The study demonstrated that patients with opioid dependence, high risk of isolation, the greater number of life events, higher anger trait and anger expression, personality disorder, low social functioning, and greater number of substance use problems have risk for DSH.

Recent exposure to others’ suicidal thoughts increases the risk of deliberate self-harm in adolescents

Recent exposure to others’ suicidal thoughts increases the risk of deliberate self-harm in adolescents

Youth on the Virtual Edge

Research shows clear links between lesbian, gay, bisexual, and transgender (LGBT) youth and deliberate self-harm (DSH), but there is a lack of research investigating the social context of young LGBT people's lives and helping to explain the higher DSH risk. In this article, we report on a small-scale methodological study intended to test the feasibility of online qualitative interviews for investigating young people, sexual and gender identity, and emotional distress. There are many methodological dilemmas arising from researching such sensitive issues with marginalized groups. The study reported here was designed to examine (a) sampling diversity in terms of sexuality, gender identities, and class; and (b) the type of data produced. We found that a virtual methodology was effective in recruiting young LGBT participants who might otherwise not take part in research. Online interviewing successfully produced in-depth, "immediate" data that potentially gave access to insights that might not emerge through face-to face interviews.

Suicide and deliberate self-harm in Oxford University students over a 30-year period

To determine whether rates of suicide and self-harm in university students differ from those in other young people. We obtained information on Oxford University students who died by suicide or presented to hospital following deliberate self-harm (DSH) between 1976 and 2006 from official records and a General Hospital monitoring system in Oxford. Rates of suicide and self-harm in the students and in other young people in the general population were calculated from university, local and national population figures. Forty-eight Oxford University students (32 males and 16 females) died by suicide. Most (N=42) were aged 18-25years. The suicide rate did not differ from that of other people in this age group in England and Wales (SMR 105.4; 95% CI 75.2, 143.4). There was evidence of clustering of methods of suicide over time. During the same period, 602 students (383 females and 219 males) presented to the General Hospital following DSH. Most (90.7%) were aged 15-24years, in which age group rates of DSH (per 100,000) during term-time were lower than in other young people in Oxford City (females: 206.5 vs. 285.6, z=-5.03, p<0.001; males: 75.9 vs. 111.2, z=-4.35; p<0.001). There was an excess of student DSH episodes in the main exam term. Contrary to earlier findings and popular belief, suicide rates in Oxford University students do not differ from those in other young people. Rates of DSH are significantly lower than in other young people. Risk of DSH may increase around the time of examinations.

Cannabis Use and Deliberate Self-Harm in Adolescence: A Comparative Analysis of Associations in England and Norway

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

Emotion regulation as a mediator of the relation between emotion socialization and deliberate self-harm.

This study examined (a) whether retrospective reports of specific parent responses to sadness (i.e., reward, punishment, neglect, override, magnification) were related to deliberate self-harm (DSH) and (b) whether difficulties regulating emotions (i.e., difficulties monitoring, evaluating, and modifying emotions) mediated those relations. One hundred eighteen college students completed measures of parental emotion socialization, emotion regulation difficulties, and DSH. Parental reward and override of sadness were directly related to lower DSH scores. Parental punishment and neglect of sadness were related to higher DSH scores, and these associations were mediated by difficulties evaluating emotions. In other words, parental punishment and neglect of sadness may place individuals at risk for DSH by fostering negative evaluations of emotional experiences and the belief that nothing can be done to effectively manage emotions.

The Seasonal Risk for Deliberate Self-Harm

Groups at seasonal risk for deliberate self-harm (DSH) vary according to their geographic location. It is unknown, however, if seasonal risk factors for DSH are associated with place of birth or place of residence as these are confounded in all studies to date. In order to disaggregate place of birth from place of residence we examined general and seasonal risk factors for DSH in three different population birth groups living in Western Australia: Australian Aborigines, Australian born non-Aborigines, and UK migrants. We found Aborigines are at much higher general risk for DSH than non-Aborigines, but are not at seasonal risk, whereas non-Aboriginal Australians and UK migrants are. For UK migrants, this is only found for females. For all groups at seasonal risk this peaks during the austral (southern hemisphere) spring/summer. Furthermore, non-Aboriginal Australians and UK migrants show a consistent pattern of increased case fatality with increasing age. In contrast, case fatality does not increase with age among Australian Aborigines. Overall, despite living in the same environment, the three birth groups show different patterns of seasonal risk for DSH. In particular, the sex difference found between UK migrants and non-Aboriginal Australian birth groups suggests that predisposition toward seasonal risk for DSH is established early in life, but when present this is expressed according to local conditions.

Pathways from adolescent deliberate self‐poisoning to early adult outcomes: a six‐year follow‐up

Prospective studies show that the adult outcomes of adolescents who deliberately harm themselves are marked by high rates of adversity and psychiatric disorders. The goal of this study was to identify pathways linking childhood risk factors to early adult outcomes of suicidal adolescents. A clinical sample of 158 adolescents who deliberately poisoned themselves was followed up six years later. Eighty per cent of the cohort (n = 126) were interviewed in early adulthood using a battery of standardised measures of psychopathology and social functioning. Multivariate mediation path analysis identified four pathways linking child and adolescent risk factors to adverse outcomes in early adulthood. Family dysfunction, conduct disorder and hopelessness contributed to the risk of high adversity in early adulthood indirectly through its effect on other risk domains, including dropping out of school and adopting adult roles at a younger age. Hopelessness not only predicted dropping out of school but also independently contributed to the risk of chronic major depressive disorder in early adulthood. Child sexual abuse independently predicted high adversity and chronic major depression over and above the influence of hopelessness. Juvenile onset major depression independently predicted chronic major depression in early adulthood. A substantial proportion of the effects of child sexual abuse and hopelessness on the risk of deliberate self-harm in early adulthood was mediated by high adversity and the duration of major depression. However, chronic major depression was the only risk factor independently associated with deliberate self-harm in adulthood once correlation with adversity was taken into account. Chronic major depressive disorder is central to deliberate self-harm repetition. However, adult outcomes of suicidal adolescents are also dominated by the accumulating effects and consequences of other childhood risk factors, including child sexual abuse and adolescent hopelessness.

Deaths from all causes in a long-term follow-up study of 11583 deliberate self-harm patients

Deliberate self-harm (DSH) may be associated with increased risk of death from a variety of causes, not just suicide. A follow-up study of 11,583 DSH patients who presented to a general hospital over a 20-year period was conducted to examine risk of death from a range of causes during a follow-up period of between 3 and 23 years. Deaths were identified through national death registries. Expected numbers of deaths were calculated from national death statistics. The number of deaths (1,185, 10.2%) was 2.2 times the expected number, the excess being significantly greater in males than females. Suicides were 17 times more frequent than expected and undetermined causes of death and accidental poisonings 15 times more frequent. Significantly more than expected numbers of deaths from most natural causes were found, including respiratory disease, circulatory, neurological, endocrine, digestive, skin and musculoskeletal and connective tissue disorders, and symptoms, signs and ill-defined conditions. Deaths due to accidents other than poisoning were more frequent than expected in both genders and homicides more frequent in males. In addition to increased risk of suicide, DSH patients are at increased risk of dying from a wide range of other causes. Possible explanations include lifestyle factors, physical disorders contributing to initial risk of DSH, and social disadvantage. The findings are relevant to clinical management and evaluation of outcome and health-care costs associated with DSH.

Schizophrenia and Deliberate Self‐Harm: A Systematic Review of Risk Factors

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.

In This Issue

In This Issue

Staff knowledge and attitudes towards deliberate self-harm in adolescents

This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowlege, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients ( B=−0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents.

Group treatment plus usual care decreased the risk of deliberate self harm in adolescents who repeatedly harm themselves

Wood A, Trainor G, Rothwell J , et al. Randomized trial of group therapy for repeated deliberate self-harm in adolescents. J Am Acad Child Adolesc Psychiatry2001 Nov; 40 : 1246...

Repetition of self harm

Background deliberate self-harm (DSH) has been associated with many factors. Thisstudy assesses the predictive value with respect to repetition of DSH of prospective data collected in structured nursing and medical notes. Method characteristics of patients attending Walsgrave Hospital NHS TrustEmergency Admissions Unit who are subsequently assessed by Mental Health Service personnel were identified and explored in a prospective study. Results several variables appeared to be related to risk of DSH, but by logistic regression previous psychiatric history (PPH) and previous overdose (PO) were the only predictive variables for DSH. Conclusions DSH may be predicted by PPH and PO.

Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection.

The study was aimed at evaluating the risk of deliberate self-harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV-seropositive (HIV+) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV+ subjects with a past psychiatric history showed a 7.7-fold increase in the relative risk of DSH, and HIV+ subjects with a history of DSH showed a 5-fold increase in the relative risk of DSH compared with HIV+ individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV+ individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome.