Self-harm Research Articles

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults

BackgroundNon-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement. MethodsWe characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18–30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image. ResultsTGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific. LimitationsThe OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups. ConclusionsInterventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BackgroundNon-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.MethodsA sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.ResultsThe reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and “The urge to cry quietly when faced with troubles“(NC10) were the key bridge nodes.ConclusionsThis study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BackgroundNon-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. MethodsNSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. ResultsThe enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were “cutting” (41.2 %) and “hitting” (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LimitationsAs a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. ConclusionOur study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Cybervictimization and Non-Suicidal Self-Injury Among Chinese College Students: an Exploration Through the Lens of Experiential Avoidance Model.

Non-suicidal self-injury (NSSI) is a growing public health concern among college students, with cybervictimization (CV) emerging as a significant contributing factor. Grounded in the experiential avoidance theory, this study investigates the mediating roles of cognitive fusion and negative emotions in the relationship between CV and NSSI, providing new insights into these key variables. A convenience sample of 457 undergraduate students (29% male; mean age 18.36±0.66 years) from two universities in Fujian Province participated in this study. Data were collected using the Cyberbullying Victimization Scale, Cognitive Fusion Questionnaire, Positive and Negative Affect Schedule, and Non-Suicidal Self-Injury Scale. Descriptive statistics and Pearson correlation analysis were conducted using SPSS 25.0, while the mediating effects were analyzed using Process 3.5. (1) Significant positive correlations were found among CV, cognitive fusion, negative emotions, and NSSI (p < 0.01). (2) CV was directly associated with NSSI (β = 0.22, p < 0.001) and positively predicted both cognitive fusion (β = 0.17, p < 0.001) and negative emotions (β = 0.15, p < 0.01). Additionally, cognitive fusion (β = 0.16, p < 0.01) and negative emotions (β = 0.11, p < 0.05) significantly predicted NSSI. (3) Mediation analyses revealed that cognitive fusion and negative emotions mediated the CV-NSSI relationship through three pathways: CV→cognitive fusion→NSSI (mediation effect = 0.026), CV→negative emotions→NSSI (mediation effect = 0.02), and CV→cognitive fusion→negative emotions→NSSI (mediation effect = 0.01). The study confirms that CV influences NSSI indirectly through cognitive fusion and negative emotions, supporting the experiential avoidance model. These findings underscore the importance of addressing cognitive and emotional processes in interventions aimed at reducing NSSI among college students.

A multi-modal assessment of self-knowledge in adolescents with non-suicidal self-injury: a research domains criteria (RDoC) study.

Adolescence is a critical period for brain development, consolidation of self-understanding, and onset of non-suicidal self-injury (NSSI). This study evaluated the RDoC (Research Domain Criteria) sub-construct of Self-Knowledge in relation to adolescent NSSI using multiple units of analysis. One hundred and sixty-four adolescents assigned female at birth (AFAB), ages 12-16 years with and without a history of NSSI entered a study involving clinical assessment and magnetic resonance imaging (MRI), including structural, resting-state functional MRI (fMRI), and fMRI during a self-evaluation task. For imaging analyses, we used an a priori defined Self Network (anterior cingulate, orbitofrontal, and posterior cingulate cortices; precuneus). We first examined interrelationships among multi-level Self variables. We then evaluated the individual relationships between NSSI severity and multi-level Self variables (self-report, behavior, multi-modal brain Self Network measures), then conducted model testing and multiple regression to test how Self variables (together) predicted NSSI severity. Cross-correlations revealed key links between self-reported global self-worth and self-evaluation task behavior. Individually, greater NSSI severity correlated with lower global self-worth, more frequent and faster negative self-evaluations, lower anterior Self Network activation during self-evaluation, and lower anterior and posterior Self Network resting-state connectivity. Multiple regression analysis revealed the model including multi-level Self variables explained NSSI better than a covariate-only model; the strongest predictive variables included self-worth, self-evaluation task behavior, and resting-state connectivity. Disruptions in Self-Knowledge across multiple levels of analysis relate to NSSI in adolescents. Findings suggest potential neurobiological treatment targets, potentially enhancing neuroplasticity in Self systems to facilitate greater flexibility (more frequently positive) of self-views in AFAB adolescents.

Predicting non-suicidal self-injury among Chinese adolescents: The application of ten algorithms of machine learning

Background and aimsHigh non-suicidal self-injury (NSSI) prevalence among adolescents is a global health issue. However, current prediction models for adolescent NSSI rely on a limited set of algorithms, resulting in biased predictions. Therefore, the aim of this study is to develop multiple machine learning models to enhance prediction accuracy and mitigate biases among Chinese adolescents. MethodsA total of 4487 junior and senior high school students in China were recruited. Multiple algorithms were included, such as logistic regression, decision tree, support vector machine, Naive Bayes, multi-layer perceptron, K-nearest neighbors, and ensemble learning algorithm like random forest, bagging, AdaBoost, and stacking to build predictive models. Data processing techniques, including standardization and the synthetic minority oversampling technique, were employed to optimize the predictive model. The model was trained on 70 % of the data, reserving 30 % for testing. ResultsThe ten prediction models achieved a good performance, with area under the receiver operating characteristic curve (AUC) scores above 0.700 in the test set. The stacking and random forest models achieved AUC scores of 0.904 and 0.898, respectively. The prediction performance of the Naive Bayes model was relatively poor. The top five important variables were resilience, bully, suicidal ideation, internet addiction, and depression. ConclusionsThe ensemble machine learning algorithm showed promising results predicting NSSI among adolescents. Such algorithms should be recommended for future NSSI research to enhance predictive accuracy. Identification of important features in NSSI prediction can help develop screening protocols and lay a foundation for clinical diagnosis and intervention in adolescent populations.

The Epidemiology of Genitourinary Self-inflicted Injuries: Analysis of the National Trauma Databank

ObjectivesTo provide insight into the epidemiologic characteristics and trends of genitourinary (GU) self-inflicted injury (SII). MethodsWe used data from the National Trauma Databank between 2017-2020. We described the characteristics of GU SII cases based on injured organ and then compared male and female injuries. ResultsWe identified 56,463 patients with SII, of which 1,508 (2.7%) had GU involvement. Most cases were male patients (77.3%) and white (70.6%). Median age was 35 years (IQR 26 – 50). The most commonly injured GU organs was kidney (43.4%), followed by scrotum / testes (22.5%), and penis (18.2%). Most cases (89.9%) represented a single-organ injury whereas 10.1% had two or more GU organs injured. Seventy-three of those with kidney injuries (11.2%) underwent nephrectomy. Only one patient performing GU SII had a diagnosis code for transsexualism but the majority (82.2%) suffered from pre-existing conditions of which 20.5% had three or more comorbidities. More than half the population (54.9%) had preexisting diagnosed mental or personality disorder. A non-GU co-injury was present in most cases (70.8%), most commonly affecting another abdominal organ (44.3%) or fractures (41.3%). A positive drug screen was found in 30.7% of cases. Most patients survived though 15.4% died. 94% of fatal cases had a concomitant non-GU injury. ConclusionsGU injuries account for 2.6% of all SII. These patients are often young white males with known mental or personality disorders. Kidneys were most common injuried and mortality was highest in cases of kidney and bladder injuries with multi-organ trauma involving non-GU organs.

Quo vadis DSM-6? An expert survey on the classification, diagnosis, and differential diagnosis of body-focused repetitive behaviors

BackgroundMany conditions we now call body-focused repetitive behaviors (BFRBs) have been subject to research for several decades, most notably trichotillomania and skin picking. However, the American Psychiatric Association did not combine these conditions into a single category, body-focused repetitive behavior disorder (BFRBD), until the fifth edition of the DSM (2013). Several aspects of the disorder remain uncertain and debatable. For example, ongoing debate surrounds which specific conditions fall under this diagnostic category and how to best differentiate BFRBs from conditions such as nonsuicidal self-injury (NSSI). The current article presents results from a study of experts' opinions on diagnostic criteria and descriptions, with the goal of refining the diagnostic criteria. MethodWe contacted experts on BFRB via various sources and invited them to an online survey on the phenomenology, classification, and differential diagnosis of BFRB. We also asked about possible alternative syndrome labels (e.g., body-focused habit). ResultsData from the final sample of 50 experts demonstrates that most experts agree with the present classification of BFRB as an obsessive-compulsive and related disorder and recommend retaining the labels BFRB or BFRBD. The experts considered the following conditions BFRB, with an agreement of over 60 %: trichotillomania, skin picking, dermatophagia, nail biting, and lip-cheek biting. Mixed results emerged for awake bruxism and thumb sucking in adults. In contrast, only a minority regarded night bruxism and knuckle cracking as BFRB. To differentiate BFRB from NSSI, the experts noted that the motive behind the urge (self-harm/injury versus release of tension) should be considered. Analyses of a sub-sample of experts with at least six years of clinical and/or research experience yielded results compatible with those of the entire sample. DiscussionThe survey supports the usefulness of the BFRB or BFRBD diagnostic entity. However, some criteria require further refinement. Future editions of the DSM should more explicitly delineate which conditions qualify as BFRB. Furthermore, it is important to give more attention to the primary motivation behind BFRB to distinguish it from NSSI and potentially from stereotypic movement behavior.

Adverse event reporting of combining SGLT2 inhibitor and GLP1 receptor agonist: a real-world study from FAERS

Background and AimsWe evaluate whether the combination of sodium-glucose cotransporter-2 inhibitor(SGLT2i) and glucagon-like peptide-1 receptor agonist(GLP1RA) disproportionally increases the reporting of adverse events compared with SGLT2i or GLP1RA monotherapy in the FDA adverse event reporting system (FAERS). Methods and ResultsAdverse events related to SGLT2i and GLP1RA were screened and selected, then data from the FAERS was underwent thorough disproportionality analysis. The proportional reporting ratio(PRR) of SGLT2i-related adverse events were compared between patients using SGLT2i alone and those using both SGLT2i and GLP1RA. Similarly, the PRR of GLP1RA-related adverse events were compared between patients using GLP1RA alone and those using both SGLT2i and GLP1RA. The results showed that the PRR of SGLT2i-related adverse events including diabetic ketoacidosis(DKA), ketosis, reproductive tract adverse events, urinary tract infection, and other adverse events, decreased in individuals using both SGLT2i and GLP1RA compared with those using SGLT2i alone, and the signal of fracture was not detected. Likewise, the PRR of GLP1RA-related adverse events including gastrointestinal adverse events, gallbladder and biliary tract disease, pancreatitis, and other adverse events, decreased in individuals using both SGLT2i and GLP1RA compared with those using GLP1RA alone, the PRR of hyperlipasaemia and hyperamylasaemia increased in the combination therapy and no signal of depression, suicidal and self-injurious behaviour was detected. ConclusionAdverse events reporting are not disproportionally higher among those using both SGLT-2i and GLP1RA compared with SGLT2i or GLP1RA monotherapy.

Inaccuracies Exist in Trauma Registry Data Regarding Shooting Intent for Pediatric Firearm Injuries

BackgroundInstitutional trauma registries, which contribute data to the National Trauma Data Bank, are a fundamental resource for trauma research, though may have significant deficits in data accuracy. We hypothesize that inaccuracies in shooting intent exist at institutional registries of pediatric trauma centers. MethodsPediatric firearm injuries (ages 0–17 years) in a single county between 2018 and 2020 were identified from three Level I trauma centers. Demographics and Ecodes were extracted from each registry and shooting intent was compared to retrospective review of the hospital records, including bystander as a category. ResultsOf 410 pediatric firearm injuries included, the majority were male (84%), non-Hispanic Black (45%) or Hispanic White (40%), and 15–17 years old (69%). Compared to final reviewer designations, the trauma registry's assault category showed high sensitivity (88.5%), but low specificity (67%), and only 78% accuracy. The trauma registry's accidental category was less sensitive (88%) but more specific (88%), with an accuracy of 88%. The most specific and accurate intention category was intentional self-harm, which had 79% sensitivity, 99.5% specificity, and 99% accuracy. Bystander shootings were most commonly categorized as assault (75%), followed by accidental (18%). ConclusionSignificant inaccuracies in coding of pediatric firearm shooting intent exist in trauma registries. Additionally, there is no Ecode for bystander shootings, which overestimates other intent categories. Our study highlights the importance of improving the accuracy of firearm injury data collection to provide a better understanding of firearm injuries at a national level to inform targeted prevention efforts specific to shooting types. Level of evidenceIII.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

Profile and Outcome of Patients Presenting to the Emergency Department with Yellow Phosphorus Poisoning

ABSTRACT Background: Yellow phosphorus-containing rodenticide poisoning as a means of deliberate self-harm is being widely encountered in South India. Hence, a comprehensive study delineating its profile and patient outcome is required to implement measures to control the persistent threat. Materials and Methods: This is a single-center, retrospective observational study of all patients presenting to the emergency department with a history of consumption of yellow phosphorus rodenticide poisoning between 2014 and 2020. Institutional review board approval was obtained before commencement. Results: During the study period, 164 patients who presented with consumption of yellow phosphorous were included in the analysis. The mean age with standard deviation of patients was 27.5 (10.6) years, with a female preponderance (87/164: 53.1%). N-acetyl cysteine (NAC) was administered in 87.2% (143/164), and its administration within 48 h of poison consumption showed a significant correlation with good outcomes (72.3% vs. 50%; OR: 0.38; 95% CI: 0.18–0.80; P-value = 0.012). Altered sensorium, hypoxemia, transaminitis, hyperbilirubinemia, and hypoalbuminemia had significant correlations with bad outcomes. The in-hospital mortality rate was 9.7% (16/164), and 21.4% (35/164) of the patients left against medical advice. Conclusion: Yellow phosphorous poisoning is associated with significant mortality. NAC given within 48 h of patient presentation had a significant correlation with good outcomes.

Self-Injurios Behaviour in an Adult with Autism Spectrum Desorder

Self-injurious conduct is a highly maladaptive behaviour that is often associated with severe mental retardation and autism. Research has highlighted the complexity and multifactorial nature of the aetiology of the disorder. In this paper we present, after careful analysis, the treatment of an adult subject with autism spectrum disorder to reduce self-injurious behaviour and teach him more effective and less disabling ‘coping strategies’. The experimental design used is of the criterion-variant type. The analysis of the data showed that the goals set were achieved. In the post-treatment sessions, we achieved extinction of the target behaviour.

청소년의 스트레스가 자해행동에 미치는 영향: 사회적 지지에 의한 불안의 조절된 매개효과

The purpose of this study is to determine whether there is a moderated mediating effect of anxiety through social support in the process of stress influencing self-injury behavior. The subjects of the study were 5,937 elementary, middle, and high school students from the Korea Youth Policy Institute's ‘2021 Mental Health Survey of Teenagers’ data, and the adjusted mediation effect was verified using the Macro Process for SPSS program. The research results are as follows. First, as a result of examining the mediating effect of anxiety in the relationship between stress and self-injury behavior, it was confirmed that anxiety has a mediating effect in the process of stress affecting self-injury behavior. The results of a bootstrapping analysis to verify the significance of the indirect effect of anxiety, a mediator, showed that the mediation effect was statistically significant. Second, as a result of conducting a moderating effect analysis to determine whether social support plays a moderating role in the relationship between anxiety, which is a mediating variable, and self-injury behavior, which is a dependent variable, it was found that social support has a moderating effect in explaining the relationship between anxiety and self-injury behavior. appear. Third, as a result of analyzing the moderated mediation effect of anxiety through social support in the process of adolescent stress influencing self-injury behavior, the results showed that anxiety was moderated by social support in the process of adolescent stress influencing self-injury behavior. The effect was found to be significant. Based on these results, we proposed measures to manage stress, reduce anxiety, and expand the social support system as part of an effort to reduce self-injury behavior in adolescents.

A Study on Non-Suicidal Self-Injury in University Students: The Use of Implicit Association Tests

A Study on Non-Suicidal Self-Injury in University Students: The Use of Implicit Association Tests

Delphi Survey Study on Appropriate Interventions for Nonsuicidal Self-Injury Counseling Situations: Focused on the School Counseling Field

Delphi Survey Study on Appropriate Interventions for Nonsuicidal Self-Injury Counseling Situations: Focused on the School Counseling Field

Single and Unhoused Population at Risk for Self-Inflicted Burn Injury: A Retrospective Analysis of an Urban American Burn Center's Experience.

Despite the growing recognition of self-harm as a pressing public health issue, demographic risk factors of self-inflicted burn (SIB) injuries in the U.S. have not been extensively described. In this retrospective study, we seek to identify demographic risk factors and patterns associated with SIB injuries at an urban burn center. Charts were reviewed of patients admitted to a single American Burn Association (ABA)-verified burn unit between 2015 and 2023 with a history of SIB injury, identified with ICD10 code X76.XXXA. Descriptive statistics, Welch's t-test of unequal variances, and Chi-Squared-analysis were performed. A total of 3,212 patients were admitted to our institution for management of acute burn injury, with 94 (2.9%) patients who presented with SIB injury. SIB patients were more likely than the control cohort to be male (p = 0.035), single (p=0.008), unhoused (p < 0.001), live alone (p < 0.001), and have documented psychiatric diagnoses (72.3% vs. 2.1%, p < 0.001). They had larger %TBSA affected (p < 0.001) and higher rates of inhalation injury (p < 0.001). The SIB cohort also showed significantly higher rates of positive urine toxicology results, primarily for stimulants and opiates (p < 0.001). Patients with SIBs had longer hospital stays (21.7 ± 2.6 days vs. 12.0 ± 22.1 days, p = 0.006), higher rates of ICU admission (p < 0.001), and mechanical ventilation requirement (p < 0.001). Mental health support services, substance abuse rehabilitation programs, and community outreach need to be prioritized, especially targeting vulnerable populations such as the unhoused.

Advances in the Study of Patient Self-inflicted Lung Injury

Patient self-inflicted lung injury (P-SILI) is caused by excessive expansion of the lungs caused by excessive spontaneous breathing and the shear force caused by repeated alveolar atrophy and re-dilation in the gravity-dependent area. There are some benefits of keeping spontaneous breathing in patients with acute respiratory distress syndrome: 1. Reduce the need for sedation; 2. Exercise diaphragm function; 3. Improve the cardiopulmonary function of the patient. However, if the respiratory drive is too high, even with ventilator support, the patient will develop self-induced lung injury. In this review, the current pathophysiology of P-SILI and the indicators of monitoring respiratory drive and measures to reduce respiratory drive are systematically reviewed.

Traumatic Brain Injury in Admitted Patients with Ocular Trauma

To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma. In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student’s t and chi-squared tests and logistic regression analysis. Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients. TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors.