Deliberate Self Research Articles

The timing of deliberate self harm behaviour.

To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide. A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done. The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays. Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the 'broken promise' effect.

Integrated Care Pathway for Children Who Attempt Deliberate Self Harm

Integrated Care Pathway for Children Who Attempt Deliberate Self Harm

Assessing risk following deliberate self harm

Assessing risk following deliberate self harm

Incidence and prevalence of domestic violence in a UK emergency department

Background: American and Australian studies indicate that domestic violence is common among patients attending for emergency care. It is not clear whether this applies to patients attending emergency departments in...

Gender and perversion--what constitutes a "bad mother".

There is a need for reconsidering the conceptualisations of female perverse behavior, especially in connection with motherhood. Based on case material obtained through psychoanalytic psychotherapy with female patients from a psychosomatic gynecological outpatient clinic, the characteristics of the psychic structure of these patients who presented symptoms of deliberate self harm and of misusing and mistreating their children, are outlined. Another common trait is the embeddedness of their perverse behavior in a generational chain of transmission. Female patients who mistreat their children had been victims of traumatising experiences in their own biography, inflicted by their mothers and directed towards their bodies. Female perverse behavior, therefore, is fundamentally different from male perversion: the perverse act in women is aimed against themselves and/or their children. Currently used diagnostic statistical manuals lack categories to describe this symptomatology adequately. Further research is requested to understand a mother's perverse actions and thus develop treatment strategies, without marginalizing these patients.

Impact of a newly opened prison on an accident and emergency department

Objective: To determine the impact of a newly opened prison on an accident and emergency (A&E) department. Method: A new category B prison opened in April 1999, the first privately...

Trusting the Record

This paper aims to contribute to a longstanding interest in documents and paperwork in healthcare work through an examination of everyday work with patient records in a clinic. An ethnographic study of record keeping practices in a deliberate self harm clinic was conducted to consider the role that document work plays in the development of trust in the routine social interactions of a working division of labor. Issues of trust are seen to play central roles within the complexities of organizational working and some consequent implications for the deployment and use of electronic medical record systems are considered.

Deliberate self harm in adolescents: self report survey in schools in England

Objective: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it.Design: Cross sectional survey using anonymous self report questionnaire.Setting: 41 schools in England.Participants: 6020...

Deliberate self harm in adolescents is more common than reported

Deliberate self harm in adolescents is more common than reported

Effect of general hospital management on repeat episodes of deliberate self poisoning: cohort study

Provision of services in the United Kingdom for patients who deliberately poison themselves is variable, and many patients leave hospital without adequate assessments.1 This may reflect the equivocal research evidence...

Deliberate self harm patients with depressive disorders: treatment and outcome

Background: Depression is the most common psychiatric disorder in deliberate self-harm (DSH) patients and in those who commit suicide. The aim of this study was to examine the treatment received by DSH patients with depression and their progress following DSH. Methods: A representative sample of 106 patients with an ICD-10 depressive episode who presented to a general hospital following an episode of DSH were investigated in terms of their treatment before and after the episode and their outcome at follow-up. Results: Prior to the index episode of DSH, 39 patients (36.8%) were receiving treatment from the psychiatric services and a further 35 (33.0%) were receiving treatment for mental health problems from their general practitioner. Fifty-two patients (49.1%) were receiving antidepressants (in therapeutic dosages in 93.6%). After the episode of DSH 94 patients (88.7%) were offered treatment with the psychiatric services, either as a new referral or continuation of treatment they were receiving prior to DSH. Of the patients who were followed-up, 36.3% remained in contact with the psychiatric services, 52.3% showed poor compliance with recommended treatment and 60.2% no longer fulfilled the diagnostic criteria for depression. Almost one-third reported a further episode of DSH during the follow-up period. Limitations: The nature and quality of non-physical treatments provided by the psychiatric services was not investigated. Reports of the treatment provided by general practitioners, the timing of improvement in symptoms and compliance with treatment largely relied on patients’ self report. Conclusions: All patients presenting following DSH need to be carefully screened for depressive illness. Randomised controlled studies need to be conducted on DSH patients with depression to determine which treatments are effective.

Minerva: June 2002

A 28 year old patient with a history of personality disorder and deliberate self harm presented to casualty having swallowed a radio aerial. Three weeks before this, he had swallowed more objects including stationery. The patient was asymptomatic and an abdominal x ray showed air throughout the bowel, the aerial in four sections, and pens in the region of the stomach. No foreign bodies were seen in either the small or large bowel. The patient had to undergo a laparotomy as endoscopy was unsuccessful. Foreign bodies retrieved included two pens, six sections of a radio aerial, a pen refill, and a pencil. Ingestion of foreign bodies is uncommon when done with the intent to cause self damage; liquids such as caustic agents, detergents, poisons, etc, are more common. Corneal tattoos provide an interesting solution for disfiguring corneal scars. Varying shades of drawing ink can be put into the anterior corneal stroma by using punctures made by a conventional spatula needle. For a week after the operation patients notice a moderate sensation of a foreign body and have conjunctival redness, but they seem happy with the results ( British Journal of Ophthalmology 2002;86:397-9). Oxidative stress increases significantly in people undergoing dialysis and is a risk factor for accelerated …

General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial

Objectives: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm.Design: Cluster randomised controlled trial in which 98 general...

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...

Prevalence of major depression in deliberate self-harm individuals in Harare, Zimbabwe.

To investigate the prevalence of major depression in deliberate self-harm individuals. A cross sectional descriptive study. Three tertiary health care centres in Harare, Zimbabwe. Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose. The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals. The prevalence of major depression was 20.7% (n=80, 95% CI=16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI=57.2-66.8) of the subjects with DSH were aged < or = 30 years. Significant differences (P<0.05) were found between DSH subjects with and without major depression related to age, education, life events and number of previous attempts. The most predictive factors associated with DSH risks are age, depression, recent loss, divorced, loss of job and history of previous attempts. Further studies are needed to address some causes of DSH.

Review: problem solving treatment after deliberate self harm improves depression, hopelessness, and personal problems

Source Citation Townsend E, Hawton K, Altman DG, et al. The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depressi...

Brief psychodynamic interpersonal therapy after deliberate self poisoning reduced suicidal ideation and deliberate self harm

Source Citation Guthrie E, Kapur N, Mackway-Jones K, et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ. 2001 Jul 21;323:135-8. 11463679

Brief psychodynamic interpersonal treatment after deliberate self poisoning reduced suicidal ideation and deliberate self harm

Guthrie E, Kapur N, Mackway-Jones K , et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ2001 Jul 21; 323 : 135 –8 . [OpenUrl][1][Abstract/FREE Full...

Identification of Youth who have Deliberately Self Poisoned – A Medical Records Audit in University Teaching Hospitals

A descriptive, cross sectional, retrospective audit of admission records and hospital casualty cards were undertaken to determine the accuracy of identification of cases of deliberate self-poisoning (DSP) among youth admitted and presenting for self poisoning. To investigate the rate of admission for poisoning presentations. From 1,260 cases of poisoning, aged 10–25 years, admitted to three university teaching hospitals in Sydney during 1991 to 1994, a sample of 167 medical record files was reviewed. From 11,100 presentations of 10–25 year olds to the emergency rooms of two of these hospitals in the same period, a random sample of 1,200 was reviewed. The diagnostic code of Deliberate Self Poisoning (DSP) admissions is low in sensitivity (50% were wrongly coded as accidental) and high in specificity (only one was wrongly coded as deliberate). Alcohol overdose, lack of DSP identification, and past or present history of a mental health problem were associated. The misclassification rate if generalizable to other settings, suggests that DSP admission rates may be underestimated by 100%.

Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.