History Of Deliberate Self-harm Research Articles

Young adults who self-harm: Barriers to and facilitators of seeking help

In Portugal, the lifetime prevalence of DSH in adolescents is situated between 16% and 35% (Duarte et al., 2020a; Gouveia-Pereira et al., 2016). Help-seeking is an important facilitator to stop these behaviors, although it is known that most individuals who engage in self-harm do not ask for help (Rowe et al., 2014). Study one (n = 222) examines the differences between two groups of young adults with a history of deliberate self-harm (participants who asked for help and participants who did not ask for help) regarding these behaviors’ severity and diversity, suicidal ideation, and family conflicts. Participants completed a self-report questionnaire which included an open-ended question focused on the reasons that may or may not contribute for seeking help. Significant differences between the two groups were found for all variables and are further discussed, followed by a qualitative analysis concerning the help-seeking motives. Study two (n = 110) used a self-report questionnaire to analyze the expectations of young adults with a history of deliberate self-harm concerning their social support network and the role of healthcare workers when they asked or thought about asking for help. These expectations included contents related with problem-solving, confidentiality, understanding and trust, support, and unburdening.Identifying facilitators and barriers to help-seeking can be a relevant step in planning and managing interventions within deliberate self-harm. Future directions and limitations are discussed.

Associations between problematic internet use, life satisfaction, and deliberate self-harm among Chinese adolescents: A multi-centered longitudinal study

IntroductionProblematic Internet use (PIU), which is associated with deliberate self-harm (DSH), has become a common problem among adolescents. Life satisfaction (LS) may be able to mitigate the negative influences of PIU and DSH. But the longitudinal associations among them are yet to be well-researched. MethodsA longitudinal study with three-wave data collection involving 6092 adolescents was carried out in China. PIU, LS, and DSH were assessed using the Young Internet Addiction Test, the Satisfaction with Life Scale, and the Deliberate Self-Harm Inventory Nine-Item Version, respectively. A cross-lagged model was used to analyze the longitudinal interactions between them. Generalized Estimating Equations were adopted to identify their influential factors. ResultsThe prevalence of single DSH behaviors from wave 1 to wave 3 was 5.04%, 5.00%, and 4.67%, and the repeated DHS from wave 1 to wave 3 was 2.9%, 3.2%, and 3.4%, respectively. Bidirectional longitudinal predictive associations were revealed between PIU and LS (p＜0.001), and LS and DSH (p＜0.001). DSH could longitudinally predict PIU (p＜0.001). Gender and age were associated with PIU, LS, and DSH (p＜0.001), and PIU was influenced by ethnicity (p＜0.001). ConclusionPIU and LS, LS and DSH were associated bidirectionally. Adolescents with more severe DSH behaviors were inclined to become addicted to the Internet, and adolescents with a history of DSH had a higher risk of recurring DSH. Parents, schools, and administrators need to improve the LS of adolescents, with a particular focus on older, female adolescents.

Predictive modelling of deliberate self-harm and suicide attempts in young people accessing primary care: a machine learning analysis of a longitudinal study

PurposeMachine learning (ML) has shown promise in modelling future self-harm but is yet to be applied to key questions facing clinical services. In a cohort of young people accessing primary mental health care, this study aimed to establish (1) the performance of models predicting deliberate self-harm (DSH) compared to suicide attempt (SA), (2) the performance of models predicting new-onset or repeat behaviour, and (3) the relative importance of factors predicting these outcomes.Methods802 young people aged 12–25 years attending primary mental health services had detailed social and clinical assessments at baseline and 509 completed 12-month follow-up. Four ML algorithms, as well as logistic regression, were applied to build four distinct models.ResultsThe mean performance of models predicting SA (AUC: 0.82) performed better than the models predicting DSH (AUC: 0.72), with mean positive predictive values (PPV) approximately twice that of the prevalence (SA prevalence 14%, PPV: 0.32, DSH prevalence 22%, PPV: 0.40). All ML models outperformed standard logistic regression. The most frequently selected variable in both models was a history of DSH via cutting.ConclusionHistory of DSH and clinical symptoms of common mental disorders, rather than social and demographic factors, were the most important variables in modelling future behaviour. The performance of models predicting outcomes in key sub-cohorts, those with new-onset or repetition of DSH or SA during follow-up, was poor. These findings may indicate that the performance of models of future DSH or SA may depend on knowledge of the individual’s recent history of either behaviour.

An observational study on deliberate self-harm in individuals with alcohol dependence syndrome.

Comorbidities in alcohol dependence syndrome (ADS) are often associated with poor treatment outcomes and high service utilization. Deliberate self-harm (DSH) in India is a silent epidemic. There is a shortage of research on individuals with ADS, psychiatric comorbidities, and DSH. To study DSH and psychiatric comorbidity in persons with ADS. A cross-sectional study of 1-year duration is conducted in out patient department/indoor patient department of a tertiary care hospital. Eighty-one individuals with ADS were selected purposefully. A semi-structured pro forma, the severity of alcohol dependence questionnaire, Mini-International Neuropsychiatric Interview (MINI), and Deliberate Self-Harm Inventory were administered for assessment. The statistical analysis used is as follows: correlation statistics and logistic regression. Most subjects were married, belonged to upper-middle socioeconomic status, had at least secondary education, and had moderate alcohol dependence severity. Almost 3/4th of the subjects had at least one lifetime psychiatric disorder. A past episode of major depressive disorder was found in 47%. Nearly 20% of study subjects had a history of DSH, which was significantly associated with unmarried status, and earlier age of alcohol dependence. Marital status, educational level, and age of onset of alcohol dependence explain 64.3% of the variance in DSH attempts. Suicidality was significantly related to the presence of DSH. The study found a high prevalence of psychiatric disorders and a history of DSH in individuals with ADS. The study confirmed the association between DSH and suicidality and indicated a specific subpopulation of ADS who need thorough clinical assessments to recognize these psychiatric comorbidities and DSH.

IMPLICATIONS OF CHILDHOOD TRAUMA ON SUICIDAL BEHAVIOR AND DELIBERATE SELF-HARM IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER

Traumatic experiences in the first years of life have an important role in the occurrence of major depression as well as many psychiatric diseases. The aim of this study is to investigate the relationship between childhood trauma (CT), suicidal behavior and deliberate self-harm (DSH) behavior in patients who are diagnosed with major depressive disorder (MDD). 106 patients who were admitted with depressive complaints to the psychiatry outpatient clinic of Recep Tayyip Erdogan University Training and Research Hospital in Turkey were included in the study. Sociodemographic and clinical features data form, Hamilton Depression Rating Scale (HAD-D), Childhood Trauma Questionnaire (CTQ-28) and Intentional Self-harm Questionnaire (DSHI) were applied to all of the cases. 86 (81.1%) of the cases were female and 20 (18.9%) were male. It was determined that 68.9% of the patients had CT, 49.1% had a history of DSH, and 52.1% had a suicide attempt history. It was determined that 75% of those with DSH behavior had a history of suicide attempt. There was a significant difference between the groups (p˂0.001). When the subtypes of CT, suicide ideation, suicide attempt and DSH behavior, were compared to each other, a significant relationship was found for all of the subtypes. A significant correlation was found between the number of CT and suicide attempts and DSH (p˂0.001). In this study, high levels of CT and its subtypes were found in patients with MDD. In the presence of CT and all of its subtypes, suicide attempt and DSH were significantly higher. In the follow-up of cases diagnosed with MDD, questioning CT is important in terms of suicide attempt and prevention of DSH.

Exploring the suicidal continuum: Deliberate self-harm diversity and severity as predictors of suicidal ideation and suicide attempts

Deliberate self-harm (DSH) in adolescence is a predictor of suicidal thoughts and behaviors (STBs). However, there is still a lack of research systematizing the association between DSH and STBs. Therefore, our main goal was to analyze if DSH diversity and severity predicted suicidal ideation and suicide attempts.Our sample comprised 237 Portuguese adolescents and young adults with a history of DSH, from community (80.2%, n = 190) and clinical (19.8%, n = 47) settings, aged between 14 and 23 years (M = 17.31, SD=1.36).Results showed that DSH diversity and severity were significant predictors of suicidal ideation and suicide attempts.These results were further discussed, underlining the impact that DSH has for suicide risk and highlighting the need to address further variables to understand these suicidality trajectories.

Causal relationships between blood lipids and depression phenotypes: a Mendelian randomisation analysis.

The etiology of depression remains poorly understood. Changes in blood lipid levels were reported to be associated with depression and suicide, however study findings were mixed. We performed a two-sample Mendelian randomisation (MR) analysis to investigate the causal relationship between blood lipids and depression phenotypes, based on large-scale GWAS summary statistics (N = 188 577/480 359 for lipid/depression traits respectively). Five depression-related phenotypes were included, namely major depression (MD; from PGC), depressive symptoms (DS; from SSGAC), longest duration and number of episodes of low mood, and history of deliberate self-harm (DSH)/suicide (from UK Biobank). MR was conducted with inverse-variance weighted (MR-IVW), Egger and Generalised Summary-data-based MR (GSMR) methods. There was consistent evidence that triglyceride (TG) is causally associated with DS (MR-IVW β for one-s.d. increase in TG = 0.0346, 95% CI 0.0114-0.0578), supported by MR-IVW and GSMR and multiple r2 clumping thresholds. We also observed relatively consistent associations of TG with DSH/suicide (MR-Egger OR = 2.514, CI 1.579-4.003). There was moderate evidence for positive associations of TG with MD and the number of episodes of low mood. For HDL-c, we observed moderate evidence for causal associations with DS and MD. LDL-c and TC did not show robust causal relationships with depression phenotypes, except for weak evidence that LDL-c is inversely related to DSH/suicide. We did not detect significant associations when depression phenotypes were treated as exposures. This study provides evidence to a causal relationship between TG, and to a lesser extent, altered cholesterol levels with depression phenotypes. Further studies on its mechanistic basis and the effects of lipid-lowering therapies are warranted.

Intentional Poisoning in Pediatric Patients: Examining the Risk Factors.

Poisonings in children are common reasons for presentation to the emergency department and can potentially have serious complications. Our research aims to review risk factors leading to intentional self-poisoning. A retrospective medical record review of all intentional pediatric poisoning cases presenting to the Children's Emergency at National University Hospital, Singapore between January 2014 and December 2015 was performed. Eighty-seven cases of intentional poisonings were identified, 31 (36.5%) of which were with suicidal intent. The majority of cases were female (85.1%) and adolescents older than 16 years (93.1%). A known psychiatric history was present in 57.5% and 62 (71.3%) had a history of deliberate self-harm. Being diagnosed with a new psychiatric illness during that presentation was associated with a history of self-harm (adjusted odds ratio [Adj OR], 6.74; 95% confidence interval [CI]; 1.04-43.62; P = 0.045). Twenty-seven (31.0%) patients had a history of intentional poisoning, and 15 (17.2%) went on to have subsequent presentations for poisoning. Recurrent poisoning attempts were strongly associated with a known psychiatric history (Adj OR, 5.91; 95% CI, 1.62-21.58; P = 0.007) and a history of deliberate self-harm (Adj OR, 7.49; 95% CI, 1.38-40.66; P = 0.02). Deliberate overdosing on personal long-term medication was seen in 15 (35.7%) of 42, of which 12 (80%) of 15 were psychiatric medications. Known psychiatric history or a history of deliberate self-harm are risk factors for intentional poisoning. Appropriate risk stratification and preemptive interventions involving closer surveillance or cognitive behavioral programs are possible measures to prevent intentional self-poisoning, especially in these at-risk groups.

Social Representations about the Functions of Deliberate Self-Harm from Adults and Adolescents: A Qualitative Study

Abstract This study aimed to describe the social representations about the functions of deliberate self-harm and to compare these representations from adolescents with and without a history of deliberate self-harm and adults without a history of these behaviours. We conducted a qualitative study involving the thematic analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-harm consistent with the existing literature, namely interpersonal functions (Communication Attempt, Interpersonal Boundaries, Interpersonal Influence, and Peer Bonding) and intrapersonal functions (Affect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new functions not described in the literature were mentioned (Introspective Mechanism and Replacement of Suffering). Regarding the differences between the three groups, several disparities emerged. Overall, results revealed that the group of adults referenced more interpersonal functions, while both groups of adolescents emphasized intrapersonal functions. This study provides insight regarding the social representations about the functions of deliberate self-harm, also focusing on the differences between adolescents with and without a history of these behaviours and adults without a history of deliberate self-harm.

Social representations about the functions of deliberate self-harm: Adolescents and parents

IntroductionThe understanding of the social representations about the functions of deliberate self-harm can be an important factor for the comprehension of this phenomenon. Nonetheless, only a few studies focused on this topic and specifically on the social representations from adolescents with and without a history of deliberate self-harm and their parents. MethodsThis article presents two studies that analysed these representations. Study 1 compared the social representations from 411 Portuguese adolescents (219 females and 192 males, aged 12–19 years), from which 109 reported having a history of deliberate self-harm. Study 2 focused on the comparison of the social representations from 471 parents (265 mothers and 206 fathers, aged 33–62 years) of Portuguese adolescents. Of the parents in Study 2, 120 had children with a history of deliberate self-harm. ResultsIn Study 1, adolescents without a history of deliberate self-harm perceived most interpersonal functions as more relevant than adolescents with a history of these behaviours, while adolescents with a history of deliberate self-harm emphasized one intrapersonal function. In Study 2, no differences were found between parents of adolescents with and without a history of deliberate self-harm. However, results revealed differences between the representations of mothers and fathers in several intrapersonal functions. ConclusionsThis research provides important insight regarding the social representations about the functions of deliberate self-harm from adolescents with and without a reported history of these behaviours and their parents. The impact for clinical intervention and prevention programs is discussed.

Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan

ObjectivesThe aim of this study was to investigate differences and similarities in risk factors for deliberate self-harm (DSH) and suicidal attempt (SA), and the role of impulsivity among a group...

The relation of protective factors to deliberate self-harm among African-American adults: moderating roles of gender and sexual orientation identity

Background: Few studies have examined correlates of deliberate self-harm (DSH) among African-Americans. Moreover, most research on the correlates of DSH in general has focused on risk factors rather than protective factors.Aims: This study examined differences in perceived social support, religiosity (both spirituality and church attendance) and overall life satisfaction between African-Americans with and without a history of DSH, as well as the moderating roles of gender and sexual orientation in these relations.Method: Participants were 244 African-American university students who completed questionnaires.Results: Participants with (vs. without) DSH reported significantly lower levels of social support. Additionally, rates of DSH were significantly higher among participants who attended church irregularly versus regularly or rarely/never. However, the association between DSH and church attendance was significant only for women (vs. men) and LGBQ (vs. heterosexual) women. Further, gender moderated the relation between DSH and social support from both significant others and friends, with self-harming women (but not men) reporting less support than their non-DSH counterparts.Conclusions: Findings add to the literature on DSH among African-Americans, highlighting both social support and church attendance (depending on regularity) as potential protective factors within this population.

Risk factors of self-injury behavior among psychiatric inpatients

BackgroundSelf-injury behavior among mental patients has been recognized for several years, yet our understanding of its mechanisms and its risk factors remains limited.ObjectivesThis study aimed to assess the prevalence of deliberate self-harm (DSH) among psychiatric inpatients and to identify its association with personal and clinical factors.MethodsIt was a descriptive and analytic study. It included 87 psychiatric inpatients followed in the psychiatry department “C” at the Hedi Chaker University Hospital of Sfax in Tunisia. Barratt Impulsivity Scale (Bis11) and the 28-items Childhood Trauma Questionnaire (CTQ) were used to assess respectively impulsivity and child maltreatment.ResultsThe average age of patients was 29.32 ± 8 years. Most of them were male (75%) and single. Fifty-nine percent of patients had previously attempted suicide. A history of DSH was found in 60.9% of cases. The most frequent trauma types were emotional abuse and physical neglect with respectively 58.7% and 69.8%. Factors positively correlated with DSH were: male gender (P = 0.026), father alcoholism (P = 0.024), history of suicide attempts (P = 0.017), borderline personality (P = 0.00) and history of emotional abuse (P = 0.008) or physical abuse (P = 0.04) or neglect (P = 0.004). Score “Bis11” was significantly correlated with suicide attempts (P = 0.00) and presence of childhood abuse (P = 0.00) or neglect (P = 0.01).ConclusionDSH seems to be a prevalent problem among psychiatric inpatients. It concerns mainly patients with a history of child abuse and impulsive behavior such as suicidal attempts underlying borderline personality disorder. Patients with these risk factors warrant specific attention in mental health services.Disclosure of InterestThe authors have not supplied their declaration of competing interest.

Deliberate Self harm in Alcohol Dependent Outpatients in Tertiary Care Centre

Deliberate self harm (DSH) is a behavioral problem with significant clinical and public health importance. It is reported across several psychiatric illnesses like personality disorders, alcohol dependence syndrome (ADS) and affective disorders. A hospital based cross-sectional study was carried out to find the incidence of DSH in outpatients with alcohol dependence syndrome, to learn about the methods used for DSH and to describe the association of DSH with psychiatric co-morbidity in the study population. Data was collected from 100 consecutive outpatients with ADS using structured socio-demographic Performa and semistructured pre-validated DSH questionnaire. ADS and psychiatric co-morbidities were diagnosed by International Classification of Diseases Diagnostic criteria for research- Tenth Revision. (ICD-10 DCR) Incidence of DSH in them in 1 year was 25%. The commonest method of deliberate self-harm was consuming poison (76%). 84% had done DSH under intoxication.92% of them had stressful situation immediately before DSH. 48% had attempted DSH impulsively. 40% had past history of psychiatric disorder. 56% had past history of DSH. 56% had psychiatric co morbidities, of which Depressive disorders (39%) were the most common. 39% of patients with psychiatric co morbidity had past history of DSH. 16% with co morbid depressive disorder had attempted DSH in past 1 year. All patients presenting after deliberate self-harm need to be carefully screened for alcohol disorders and for co morbid psychiatric diagnoses. Abstaining from alcohol may be considered as a key to the resolution of deliberate self harm.

Pattern and trend of deliberate self harm at emergency department of Patan hospital, PAHS

Introduction: Deliberate self-harm is a major problem in the developing world. This study aims at observing the general pattern and sociodemographic variables related to it.
 Methods: Present study is a hospital based Prospective study which included all age group of patients with DSH. During study period ie from April 2010-to march 2011 AD, one hundred and six patients were seen in emergency department with history of deliberate self harm (DSH).
 Results: Study showed more female patients than male. Common age for DSH falls on fifteen to twenty five. House wife and students were mostly involved in DSH. Patients mostly used organ phosphorus compounds for DSH. Majority of patients discharged or admitted in medical ward, but six patients died despite of management in emergency department.
 Conclusion: DSH is a problem in our community which need to be studied more extensively.

Review: about one in five people with first-episode psychosis have a history of deliberate self-harm

Review: about one in five people with first-episode psychosis have a history of deliberate self-harm

Assessing the reasons for deliberate self-harm in young people

A history of deliberate self-harm (DSH) is one of the main indicators for suicide. There has been a rise in the number of presentations to emergency departments as a result of DSH, predominantly among 15 to 24 year olds. The main risk factors for this are risk-taking behaviour, substance misuse and interpersonal conflict, often occurring in combination in the 24 hours before the self-harm occurred. Studies of adolescents identify family, friends and school to be the main sources of support in preventing suicidal behaviour, proving more important than help from external agencies. Support and guidance for families and friends may therefore be valuable. Repeated presentation with DSH to the emergency department can signify an underlying problem that is not being identified or addressed, leading to recurrent crises. National early-intervention programmes involving screening for risk factors, and brief intervention in emergency departments, could be cost-effective interventions.

The uniqueness of negative urgency as a common risk factor for self-harm behaviors, alcohol consumption, and eating problems

Research suggests that self-control, affective lability, and negative urgency are associated with deliberate self-harm, problematic alcohol consumption, and eating problems. Few studies have fully examined how negative urgency might uniquely explain the effects of self-control and affective lability on these outcomes, as compared to other impulsivity-related traits. This was the goal of the current study. Of an initial group of 734 undergraduate students, 29% indicated a history of deliberate self-harm. These 215 individuals were randomly matched with a group of non-self-harmers (total N=430; mean age=22.36, SD=6.59; 76.2% female). Self-harmers showed higher rates of alcohol use (F(2, 186)=5.48, p<.001) and eating problems (F(2, 186)=7.74, p<.001). In a structural equation model, negative urgency was significantly associated with self-harming frequency (β=3.81, p<.001), variety of self-harm methods (β=5.79, p<.001), the number of years of self-harming (β=2.75, p<.001), problematic alcohol use (β=1.80, p<.05), and eating problems (β=3.99, p<.001). Negative urgency was positively associated with affective lability (β=7.71, p<.001) and negatively associated with self-control (β=−13.59, p<.001). Negative urgency is the only impulsivity-related trait that is a common risk factor associated with increased self-harm, problematic alcohol use, and eating problems.

Living Through Distress: A Skills Training Group for Reducing Deliberate Self-Harm

Dialectical Behaviour Therapy (DBT) is an evidence-based treatment effective in reducing deliberate self-harm. However, DBT is resource and time intensive, and few services are able to sustain a programme faithful to all aspects. Thus, modified or adapted versions of DBT have been developed, particularly for delivery in inpatient hospital settings. This study presents a description of the "Living Through Distress" (LTD) Group, which is based on the group skills training component of DBT. Participants (n = 114) were patients of a psychiatric hospital who attended the LTD group. The main inclusion criterion for the LTD group was a history of deliberate self-harm. The outcome measures were frequency of incidents of deliberate self-harm, levels of distress tolerance, and mean numbers of bed days per year. Upon completion of the group, there were significant reductions in participants' reports of deliberate self-harm and significant increases in their distress tolerance levels, which were maintained at 3-month follow-up. There was also a reduction in participants' mean number of inpatient days at 1-year and 2-year follow-up. Over 50% of participants had no admissions in the year subsequent to completing the group. As this study was not a randomized controlled trial, results must be interpreted with caution. However, the findings presented here are promising, and suggest that a briefer, less resource intense version of the group skills training component of DBT may be effective in reducing deliberate self-harm.

Problem-Based Review: Paracetamol Overdose

A 29-year old male presents to the emergency department 1h after an overdose of cocodamol. He admits to taking approximately 60 x 8/500mg tablets, with alcohol, over a 20 minute period. He has a past history of depression, treated by his GP with citalopram 20mg OD. He has no previous history of deliberate self-harm. His past medical history is otherwise unremarkable and he is not on any additional medications. He drinks approximately 40 units of alcohol per week. Physical examination is unremarkable, his pupils are normal diameter and his Glasgow Coma Scale is 15. He weighs 82kg.