Episode Of Deliberate Self-harm Research Articles

Outcomes for university students following emergency care presentation for deliberate self-harm: a retrospective observational study of emergency departments in England for 2017/2018

ObjectivesIdentify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm.DesignRetrospective cross-sectional observational study.SettingPatients visiting 129 public...

Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study

BackgroundPsychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. AimTo examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. MethodData from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008–2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. ResultsAltogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. LimitationsData was restricted to variables available in the registers. ConclusionsPsychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.

Psychiatric care following deliberate self-harm and prospective mortality: evidence from a national cohort of patients in routine care

IntroductionPsychiatric care following self-harm treatment is pivotal in patients´ life both in short- and long-terms.ObjectivesTo examine follow-up psychiatric care received by patients treated for deliberate self-harm (DSH), and to assess the influence of psychiatric referral and treatment attendance on risk for subsequent mortality.MethodsNationwide registries were interlinked to follow all DSH patients for data on personal socioeconomic status, clinical features of DSH, psychiatric treatment and cause of death. Data were analyzed with Logistic regression and cause-specific survival analysis.Results The study identified 43153 patients involving 69569 DSH episodes. Of these patients 15.7% were referred or transferred to psychiatric services and 51.0% attended psychiatric treatment within subsequent 3 months. Evidently, prior psychiatric history and psychiatric comorbidities had strong influence on both referral and attendance to psychiatric healthcare, personal socioeconomic status also deviated the likelihoods. During the follow-up, 7041 patients died from suicide (n=911) or other causes (n=6130). While suicide risk was highly associated with male gender, middle age, and particularly, prior and coexisting psychopathologies, other cause mortality was strongly associated with old age and socioeconomic disadvantages. Meanwhile, a referral to psychiatric services was associated with suicide risk, and the risk was particularly high for patients who received the referral but did not attend psychiatric treatment. The observed effect was more pronounced during the early years, and in patients of young or middle age and those with a clear intent of self-harm.ConclusionsThe insightful findings highlight the importance of patients´ attendance and engagement in follow-up psychiatric care on risk for subsequent mortality.DisclosureNo significant relationships.

Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study

Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18–35 years during the period 2008–2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention.

Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm With Prospective Mortality in Norwegian Patients

Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. Socioeconomic characteristics, psychiatric history, and clinical features of DSH. Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.

Study on suicidal intent and its relationship with psychiatric morbidity in cases of deliberate self-harm

Background: Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that is uniquely associated with suicidal behavior because of high levels of psychiatric co-morbidity. The present study was planned to undertake on suicidal intent in such deliberate self-harm patients. Aims: The aim is to determine the suicidal intent and to assess the relationship with psychiatric morbidity in patients of deliberate self-harm Settings: Patients of deliberate self-harm. Design: Cross-sectional study. Materials and Methods: The sample consisted of 50 patients of deliberate self-harm admitted during study period of 6 months in appropriate in-patient unit for observation and necessary intervention, who fulfils inclusion criteria. A semi structured pro forma was used for collection of socio-demographic data, case history and Beck's Suicide intent scale was used which is designed to assess the severity of intention to die associated with an episode of deliberate self-harm. Statistical Analysis Used: Descriptive statistics such as mean, standard deviation, and percentage was used to present the data. To assess the relationship between the suicidal intent and psychiatric morbidity, Chi-square test was used. A P Results: Self poisoning (80%) was found to be the most common method employed in deliberate self-harm. 74% of the deliberate self-harm attempts were impulsive in nature. Altercation with the spouse (30%) was the most common precipitating factor. Psychiatric morbidity was found to be associated with suicidal intent (P = 0.0068). Conclusions: In conclusion, even with low intent to harm self we have to be careful while examining the patients of psychiatric morbidity. They are at risk of attempting harm to self. We cannot ignore the patients just on the basis of low intent to harm self.

Should we increase the focus on diet when considering associations between lifestyle habits and deliberate self-harm?

BackgroundDespite increasing awareness of high rates of physical illness and poor lifestyle behaviours among patients with a history of repeated deliberate self-harm (DSH), there is little research on specific lifestyle factors that are potentially problematic for this group. This paper aims to explore the relationship between lifetime repeated DSH and certain lifestyle factors, including balanced meals, eating breakfast, consumption of ‘junk’ food, weight, exercise, substance/alcohol use, smoking and social support, in a cohort of patients who presented to the Emergency Department (ED) with suicidal ideation or DSH.MethodsFrom 2007 to 2016, data from lifestyle and mental health measures were collected from 448 attenders at an outpatient clinic for DSH or suicidal ideation following ED presentation. Lifestyle behaviours (Fantastic Lifestyle Checklist) and mental health (Depression and Anxiety Stress Scale), clinical diagnosis and number of previous DSH episodes were measured on arrival. The associations between lifestyle variables and the number of lifetime DSH episodes were examined.ResultsSex, age, depression symptoms, poor diet, and smoking were all associated with a higher average number of deliberate self-harm episodes across the lifespan. There were non-significant positive trends for the other poor lifestyle behaviours. There was no association between DSH episodes and diagnosis of depression or anxiety disorder. In a multiple linear regression model, the only factors that remained significant were age, smoking and eating balanced meals, however, the relationship between smoking and lifetime DSH was moderated by more immediate DSH behaviours.ConclusionIn this sample of patients referred to a service following presentation to the ED with acute mental health concerns, balanced meals and smoking were the lifestyle behaviours that were found to have the strongest independent association with repeated DSH across the lifespan.

Exploring behaviours of concern including aggression, self-harm, sexual harm and absconding within an Australian inpatient mental health service.

Patients admitted to mental health services may exhibit behaviours of concern (BOCs) such as aggression, self-harm, absconding and sexual harm. BOCs can lead to restrictive interventions, which have adverse effects on patients, carers and staff. This paper aims to explore the nature and outcome of BOCs within an adult inpatient mental health setting. A retrospective audit was conducted at a metropolitan inpatient service between 1 August 2016 and 31 July 2017. The frequency, nature and outcomes of BOC episodes were described and thematic analysis was used to summarise BOC antecedents. A BOC was documented for 179 (18.2%) patients who also showed high rates of drug abuse, homelessness and longer admission. Most self-harm and sexual harm events occurred outside of normal business hours. Medications and verbal de-escalation were commonly used interventions. Episodes of deliberate self-harm were likely to result in patient and staff injury or mechanical restraint, whereas aggression was associated with seclusion. Mental state, care engagement, physiological stress and situational stressor were identified as BOC antecedents. Multiple forms of BOCs were experienced with mental state, physical and interpersonal contributors identified. Improving multidisciplinary input into early assessment and treatment of BOC causes is needed to improve safety.

Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study.

A large number of people present each day at hospitals for non-fatal deliberate self-harm (DSH). Examination of the short-term risk of non-fatal recurrence and mortality at the national level is of major importance for both individual medical decision-making and global organisation of care. Following the almost exhaustive linkage (96%) of two national registries in France covering 45 million inhabitants (i.e. 70% of the whole population), information about hospitalisation for DSH in 2008-2009 and vital status at 1 year was obtained. Individuals who died during the index hospital stay were excluded from analyses. Over 2 years, 136,451 individuals were hospitalised in medicine or surgery for DSH. The sample comprised 62.8% women, median age 38 in both genders, with two peaks at 16 and 44 years in women, and one peak at 37 years in men. The method used for DSH was drug overdose in 82.1% of cases. Admission to an intensive care unit occurred in 12.9%. Following index hospitalisation, 71.3% returned home and 23.7% were transferred to a psychiatric inpatient care unit. DSH recurrence during the following year occurred in 12.4% of the sample, within the first 6 months in 75.2%, and only once in 74.6%. At 1 year, 2.6% of the sample had died. The overall standardised mortality ratio was 7.5 but reached more than 20 in young adults. The causes were natural causes (35.7%), suicide (34.4%), unspecified cause (17.5%) and accident (12.4%). Most (62.9%) deaths by suicide occurred within the first 6 months following index DSH. Violent means (i.e. not drug overdose) were used in 70% of suicide cases. Concordance between means used for index DSH and for suicide was low (30% overall), except for drug overdose. Main suicide risk factors were older age, being male, use of a violent means at index DSH, index admission to an intensive care unit, a transfer to another medical department or to a psychiatric inpatient unit, and recurrence of DSH. However, these factors had low positive predictive values individually (below 2%). Non-fatal DSH represent frequent events with a significant risk of short-term recurrence and death from various causes. The first 6 months following hospital discharge appear to be a critical period. Specific short-term aftercare programs targeting all people with a DSH episode have to be developed, along other suicide prevention strategies.

Deliberate self-harm in adolescents in Southern Sri Lanka; a hospital based Study

Introduction: Little is known about adolescents who engage in deliberate self-harm (DSH). Therefore, using data from medical and police records of the Teaching Hospital Karapitiya, we examined patterns of DSH among young people. Methods: We examined records of episodes of DSH for 2001 and for the 5 year period from 2006 through 2010. Data on 1720 individuals between 10 and 18 years old were gathered. Results: There was a striking increase from 2001 to 2010 in admissions of young people with DSH. In 2001, there were 137 cases; in 2010, the number had nearly tripled (N=391). Case fatality rates were low; in 2001, it was 8%; in 2010, it was 0.25%. Comparing 2001 to 2010, cases involving poisons decreased from 58% to 46%; cases involving medicinal overdoses increased from 41% to 54%. Adolescents rarely used other methods. In 2001 and in each year from 2006 to 2010, adolescents aged 15-18 years accounted for at least 85% of the sample, and there were three times more girls than boys. Conclusion: Decreases in suicides have been substantial; nonetheless, rates of non-fatal DSH have climbed. We call for research on antecedents and correlates of DSH in groups at high risk, such as older adolescent girls.

T68. Hope and Borderline-Personality Disorder as Predictors of Study Drop-Out Among Inpatient Youth Receiving Psychotherapy Treatment for an Episode of Deliberate Self-Harm

T68. Hope and Borderline-Personality Disorder as Predictors of Study Drop-Out Among Inpatient Youth Receiving Psychotherapy Treatment for an Episode of Deliberate Self-Harm

The Self-help Online against Suicidal thoughts (SOS) trial: study protocol for a randomized controlled trial

BackgroundSuicidal thoughts are common, causing distress for millions of people all over the world. However, people with suicidal thoughts might not access support due to financial restraints, stigma or a lack of available treatment offers. Self-help programs provided online could overcome these barriers, and previous efforts show promising results in terms of reducing suicidal thoughts. This study aims to examine the effectiveness of an online self-help intervention in reducing suicidal thoughts among people at risk of suicide.The Danish Self-help Online against Suicidal thoughts (SOS) trial is a partial replication of a previously conducted Dutch trial.Methods and designA randomized, waiting-list controlled trial with 1:1 allocation ratio will be carried out. A total of 438 people with suicidal thoughts will be recruited from the Danish suicide hotline, The Lifeline’s, website and allocated to the intervention condition (N = 219) or the control condition (N = 219).The intervention condition consists of a 6-week, Internet-based self-help therapy intervention. The format of the intervention is self-help, but the participants can be guided by the trial manager. The control condition consists of a waiting-list assignment for 32 weeks.The primary outcomes are frequency and intensity of suicidal thoughts. Secondary outcome measures include depressive symptoms, hopelessness, worrying, quality of life, costs related to health care utilization and production loss. Number of deliberate self-harm episodes, suicides and deaths will, as well as the participant’s evaluation of the intervention and the experience of negative effects, be investigated. Assessments will be conducted over the intervention website through self-report questionnaires at baseline, 2 weeks, 4 weeks, 6 weeks and 32 weeks (6 months post intervention).DiscussionIf we find the intervention to be linked to reductions in suicidal thoughts, this will strengthen the evidence that online self-help interventions are relevant tools for people with suicidal thoughts.Trial registrationClinicalTrials.gov, NCT02872610. Registered on 9 August 2016.

Incidence Rates of Deliberate Self-Harm in Denmark 1994-2011.

. Background: The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented. Aim: To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records. Method: A register study based on all individuals recorded with an episode of deliberate self-harm or probable deliberate self-harm in nationwide registers during 1994–2011. Results: A substantial difference in the rates of deliberate self-harm and probable deliberate self-harm was noted for both genders. The average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI = 129.6–131.8) per 100,000 and 86.9 (95% CI = 86.0–87.8) per 100,000, respectively. The rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9–142.3) per 100,000 in 1994 to 152.7 (95% CI = 147.8–157.5) in 2011. For a subgroup of younger women aged 15–24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4–2.7). The most frequently used method was self-poisoning. Conclusion: The rates of deliberate self-harm and probable deliberate self-harm differed significantly. An increased incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed.

Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: A population-level record linkage study in Western Australia.

The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old). We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.

Is Case Management Effective for Long-Lasting Suicide Prevention?

Case management services have been implemented in suicide prevention programs. To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan. The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study. Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established. Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.

Mental health nurses' dispositional decision-making for people presenting to the emergency department with deliberate self-harm: an exploratory study.

There is no clear treatment pathway for people presenting to Australian emergency departments with deliberate self-harm. To explore variations in mental health nurses' disposition decisions for patients following risk assessment for deliberate self-harm. A survey was distributed to mental health nurses. This survey comprised demographic items and questions in response to nine vignettes describing episodes of deliberate self-harm. Dispositional decision and reasoning were also sought for each vignette. Poor levels of agreement for disposition were found. There was a lack of consensus regarding dispositional outcomes. This suggests a high level of subjectivity in decision-making which needs to be taken into account within clinical governance.

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial.

BackgroundAs lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.MethodsWe carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.ResultsOf 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.ConclusionsThe present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.Trial registrationClinicalTrials.gov identifier: NCT00927550

Deliberate Self-Harm in Substance Use Disorder Patients-A Study at Tertiary Level Hospitals in Bangladesh

Introduction: Deliberate Self-harm is a term introduced to describe patients who injure themselves by self-mutilation (e.g. cutting the skin) but usually do not wish to die. Studies show that about 4 percent of all patients in psychiatric hospitals have cut themselves; the female-to-male ratio is almost 3 to 1. Self-injury is found in about 30 percent of all abusers of oral addiction substances and 10 percent of all intravenous drug users admitted to substance-treatment units. These patients are usually in their 20s and may be single or married. Most cut delicately, not coarsely, usually in private with a razor, blade, knife, broken glass or mirror. The wrists, arms, thighs and legs are most commonly cut; the face, breasts and abdomen are cut infrequently. Most persons who cut themselves claim to experience no pain and give reasons, such as anger at themselves or others, relief of tension and the wish to die. Methods: It was an explorative descriptive cross sectional study aimed to explore the pattern of deliberate self harm among substance use disorder patients in three selected hospital. The research design was Quantitative in nature. The study sites were Central Drug Addiction Treatment Centre, Dhaka; Combined Military Hospital, Dhaka Cantonment, Dhaka and Modern Psychiatric Hospital, Dhaka. The study population was Substance abusers seeking advice or getting treatment in Central Drug Addiction Treatment Centre, Dhaka; Combined Military Hospital, Dhaka Cantonment, Dhaka and Modern Psychiatric Hospital, Dhaka. Results: The mean age of onset of taking drugs was 24 to 42 years with the SD ± 6.83. The range was in between 12 and 57 years and adolescents were greatly involved in self harm. Many of them used more than one substance; among them 56% mentioned about Cannabis. Among all the respondents 52 of them reported that they use substances several times daily. Regarding the route of administration, among all the respondents, they have history of using multiple routes for administering the substances. 73% of them reported that they use substances by smoking. In this study it was revealed that, the substance users follow several methods for self harm. Among them, cutting, burning, scratching, stabbing etc are noteworthy. 39% of the substance users harmed themselves by cutting in the first episode which follows same trends in next episodes. Conclusion: Deliberate self harm is a behavior that over the time becomes compulsive and addictive. Finding out the causes of deliberate self harm among substance related disorders will help us choose an appropriate remedy of this non-fatal but repetitive and distressing behavior which may lead to completed suicide. Systematic mental health assessments in the emergency department of following an episode of deliberate self-harm may improve detection of mental disorders. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18728 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 63-74

Can early follow-up after deliberate self-harm reduce repetition? A prospective study of 325 patients

BackgroundPatients who deliberately harm themselves often repeat their self-destructive acts. The objective of this study was to assess whether a follow-up visit within 10 days to a psychiatric consultant could reduce the frequency of repeated deliberate self-harm (DSH). MethodsA cohort of 325 consecutive DSH patients attending two large emergency departments in Stockholm, Sweden, were included and followed for 6 months. Any visit to a psychiatric consultant within 10 days was registered as an early follow-up. Repeated DSH episode within 6 months among the 325 patients was detected via nationwide registers.Main outcome measure: Repeated DSH within 6 months. ResultsAt 6 months follow-up 22 (24%) of 92 patients with an early follow-up had repeated their DSH acts compared to 58 (25%) of 233 patients without an early follow-up (OR 1.06 (95% CI: 0.60–1.85) p-value 0.85). After adjustment for possible confounders, multivariable analysis showed an OR of 1.22 (95% CI: 0.62–2.38, p-value 0.56). LimitationsEarly follow-up was registered as any visit to a psychiatric consultant and no information regarding actions taken at the visit were obtained. ConclusionAfter adjusting for other factors associated with repetition there was an association of patients who were offered and thereafter attended an early follow-up visit and a decreased risk of repeated DSH.

Retrospective Identification of Episodes of Deliberate Self-Harm from Emergency Room Registers in General Hospitals: An Example from Shanghai

The objective of this study was to assess the feasibility of using currently available emergency department (ED) records to retrospectively ascertain the prevalence and characteristics of episodes of medically treated deliberate self-harm (DSH). Discussions with ED staff identified 10 ED diagnoses in persons 12 years of age or older that were commonly used for episodes of DSH and another 7 injury-related diagnoses that could, under specific conditions, be acts of DSH. A retrospective analysis of the ED registry of one large general hospital in Shanghai for 2007 to 2010 identified all cases with one of these diagnoses. Diagnosis-specific algorithms based on the characteristics of each case were applied to classify cases as “probable DSH,” “possible DSH” or “probably not DSH.” The 1,495 cases of DSH identified accounted for 0.2% of all ED admissions over the 4 years; only 6 of them (0.4%) had an ED diagnosis of “suicide attempt.” Three ED diagnoses—overdose of medication, fall from height, and pesticide ingestion—accounted for 1,275 (85.3%) of the DSH cases. There were substantial differences in the characteristics of male and female cases of DSH and a 43% drop in the proportion of ED admissions for DSH over the 4 years. In locations where it is not feasible to develop prospective registries of suicide attempts treated in EDs, retrospective analysis of ED records that use algorithms to classify the intentionality of injuries can provide estimates of the prevalence and characteristics of medically treated episodes of DSH.