History Of Deliberate Self-harm Research Articles

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.

Brief report: Self-harm is associated with immature defense mechanisms but not substance use in a nonclinical Scottish adolescent sample

It has been unclear whether adolescent deliberate self-harm (DSH) is more associated with substance use or with characterological impairments. Multivariate determination of (N = 114 Scottish adolescents) ever engaging in DSH (Youth Risk Behavior Survey) from alcohol use, other substance use, and immature defense mechanism use (Defense Style Questionnaire; DSQ-40) revealed that a history of DSH was associated with more use of immature defense mechanisms by not with substance use or recent alcohol use. More research and clinical attention might be given to immature defense mechanisms in cases of DSH.

NEUROPSYCHOLOGICAL FUNCTIONING IN PRISONERS WITH AND WITHOUT SELF-INJURIOUS BEHAVIORS: Implications for the Criminal Justice System.

Neuropsychological functioning has not yet been investigated among prisoners who engage in self-injurious behaviors, specifically attempted suicide and nonsuicidal self-injury (NSSI). The purpose of this study was to investigate neuropsychological functioning in prisoners with and without histories of NSSI and attempted suicide. The sample consisted of 173 male prisoners referred for neuropsychological evaluation. Of participants, 56% reported a history of self-injury. Performance on the neuropsychological domains of intelligence, memory, attention, motor functioning, and executive functioning was assessed. No group differences were found among those with NSSI, with NSSI and suicide attempts, and with no history of deliberate self-harm, although functioning was poor in all domains. Implications of the high prevalence of self-injury in this prison sample, as well as implications of impaired functioning on the treatment of self-injurious behaviors, are discussed.

Pathways to episodes of deliberate self‐harm experienced by mentally ill men in a high‐secure hospital over the course of their lives: an exploratory study

PurposeThere is a dearth of research exploring pathways to episodes of deliberate self‐harm (DSH) within mentally ill men in high‐secure hospitals. This study aims to explore pathway(s) to episodes of self‐harm experienced by this group over the course of their life.Design/methodology/approachA total of seven men with a history of repetitive DSH participated in audio‐taped semi‐structured interviews. Transcribed interviews were analysed using grounded theory methods.FindingsTwo pathways to episodes of DSH emerged and were termed: the relief, and the response to mental health problems pathways. Participation within a dyadic suicide pact emerged as an unexpected theme.Research limitations/implicationsThere were a number of limitations within this study. Participants did not describe DSH episodes, which occurred within the high‐secure hospital and it was unclear as to the stage of their illness or whether co‐morbid difficulties were present during the episodes of DSH. Further research is required to substantiate the two pathways to episodes of DSH found within this study.Practical implicationsThe present study offers a theoretical framework for clinicians working with mentally ill men within high‐secure hospitals, who have a history of DSH and identifies the need to carefully assess each individual episode of DSH.Originality/valueThis study is the first to explore pathways to episodes of self‐harm as experienced by mentally ill men within a high‐secure hospital by interviewing patients directly.

Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females

There is limited information about psychological predictors of cosmetic surgery and how cosmetic surgery influences subsequent changes in mental health and overall appearance satisfaction. To date, there is a lack of studies examining this issue, whereby representative population samples are assessed at an age before cosmetic surgery is typically conducted and followed up after such surgery has commonly been performed. We obtained data from a survey study following 1597 adolescent females from a representative Norwegian sample over a 13-year period. Participants provided information on cosmetic surgery, appearance satisfaction, mental health, risky sexual behavior, drug use and conduct problems at two time-points (overall response rate 67%). Of all participants, 78 (4.9%) reported having undergone cosmetic surgery, of whom 71 were operated on during the course of the study and seven before the first data collection. Symptoms of depression and anxiety [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.07-2.57] and a history of deliberate self-harm (OR 2.88, 95% CI 1.46-5.68), parasuicide (OR 3.29, 95% CI 1.53-7.08) and illicit drug use (OR 2.46, 95% CI 1.07-5.82) predicted prospective cosmetic surgery. Moreover, those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). Patients' use of alcohol also increased more than among non-patients (t=2.47, p=0.01). A series of mental health symptoms predict cosmetic surgery. Cosmetic surgery does not in turn seem to alleviate such mental health problems.

Deliberate self harm in children

To study the nature of deliberate self-harm (DSH) in children and to identify the associated factors. Child Guidance Clinic attached to the Department of Pediatrics of a teaching hospital in South India. Children with history of deliberate self harm who were referred to the CGC for psychological evaluation during a 10 year period. Children and parents were interviewed together and separately and details regarding age, sex, family and school environment, stresses and nature of self harm were documented. Psychiatric diagnosis was made based on DSM IV diagnostic criteria. Among the 30 children included in the study, 21 were boys and 9 were girls. Majority of children were between the ages of 11 and 13 years, the youngest being 6 years old. 76%of children had history of acute stressful life events and 62%of them had chronic ongoing stress. 62%of children had stress in the family and 41%had stress at school. Stress in the family included death of a parent, conflicts with parents or siblings, mental illness in the family, parental alcoholism and parental disharmony. Stress at school included conflicts with classmates, punishment or negative comments by teachers and learning problems. Psychiatric disorders were present in 52%of children, the commonest being depressive disorder. The commonest mode of DSH was self poisoning, and rat poison (zinc phosphide) was the commonest substance used. Deliberate self harm occurs in young children and the risk factors are comparable to those in adolescents.

Vulnerabilities to deliberate self‐harm among adolescents: The role of alexithymia and victimization

This study investigates vulnerabilities to deliberate self-harm (DSH) among adolescents, specifically focusing on peer victimization and alexithymia. Correlational survey design. Three hundred and twenty-five secondary school students completed self-report questionnaires asking their history of DSH and bullying, and scales assessing alexithymia and depression. Self-harming adolescents reported more victimization and alexithymic symptomology than participants who had never engaged in DSH. Alexithymia moderated, and partially mediated, the relationship between bullying and DSH. Bullying and DSH significantly co-varied when participants' alexithymia was moderate or high, but not when participants' alexithymia was low. The relationship between alexithymia and DSH was fully mediated by depression. The relationship between bullying and DSH was also moderated by depression. Depression moderated the relationship between alexithymia and DSH. The findings suggest stressors in the social environment (e.g. bullying) are more likely to facilitate DSH when an adolescent has poor emotion regulation and communication skills and when an individual is experiencing mood difficulties.

Internet Gamblers: A Latent Class Analysis of Their Behaviours and Health Experiences

In order to learn about the behaviours and health experiences of people who gamble on the Internet, we conducted an international online survey with respondents recruited via gambling and gambling-related websites. The mean (SD) age of the 4,125 respondents completing the survey was 35.5 (11.8) years, with 79.1% being male and 68.8% UK residents. Respondents provided demographic details and completed validated psychometric screening instruments for problem gambling, mood disturbances, as well as alcohol and substance misuse, and history of deliberate self harm. We applied latent class analysis to respondents' patterns of regular online gambling activities, and identified subgroups of individuals who used the Internet to gamble in different ways (L (2) = 44.27, bootstrap P = 0.07). We termed the characteristic profiles as 'non-to-minimal gamblers'; 'sports bettors'; 'casino & sports gamblers'; 'lottery players'; and 'multi-activity gamblers'. Furthermore, these subgroups of respondents differed on other demographic and psychological dimensions, with significant inter-cluster differences in proportion of individuals scoring above threshold for problem gambling, mood disorders and substance misuse, and history of deliberate self harm (all Chi (2)s > 23.4, all P-values <0.001). The 'casino & sports' and 'multi-activity-gamblers' clusters had the highest prevalence of mental disorder. Internet gamblers appear to be heterogeneous but composed of several subgroups, differing markedly on both demographic and clinical characteristics.

P03-297 - Differences and similarities of number of life events among patients admitted after attempted suicide

ObjectiveTo examine associations between current diagnostic profile, suicidal intent, functional impairment and history of deliberate self harm (DSH) and life events among patients admitted to a general hospital after an act of attempted suicide.Materials and methodsParticipants (n = 86) were patients consecutively admitted to a general hospital emergency care unit over the inclusion period of 26 months after an act of attempted suicide. They were interviewed within 2 days using the EPSIS protocol, the MINI and SCID-II interviews and a range of scales measuring life events (Brugha's scale), depression (MADRS), alcohol abuse (AUDIT), substance abuse (DAST), suicidal intent (SIS) and functioning levels (GAF). Simple regression analyses (linear and logistic) and t-tests were used in data analyses.ResultsMen [4.9(2.6)] reported significantly more life events than women [3.6(2.0)], t(47.7) = 2.2, p &lt; .05. Functional impairment was inversely associated with the number of life events among men, explaining more than 25% of the variance, F = 10.2(1, 28), p &lt; .01. Number of life events was not associated with any diagnostic group, mean scores of depression severity, alcohol abuse, substance abuse, suicidal intent or with a history of an act of DSH.ConclusionsNot only did men report more life events, their functioning was also affected by number of life events, indicating vulnerability to psychosocial aspects beyond psychological or psychiatric aspects in men admitted to a general hospital after attempted suicide.

Personality and non-suicidal deliberate self-harm: Trait differences among a non-clinical population

Limited information is available on understanding why particular individuals engage in non-suicidal deliberate self-harm (DSH), especially among non-clinical populations. An array of personality traits, such as those included in the five-factor model of personality, may further an understanding of DSH. The purpose of this study was to examine personality traits among non-clinical groups with or without a history of DSH. College students ( N = 238) completed self-report measures of DSH and personality. Both multivariate (MANOVA, discriminant analysis) and univariate (ANOVA) statistical procedures supported the hypothesis that those with a history of DSH ( n = 59) had significantly higher levels of neuroticism and openness to experience, and significantly lower levels of agreeableness and conscientiousness. Contrary to expectations, there were no differences in extraversion between the two groups. These results indicate personality differences among those with a history of DSH, which with additional research, may prove to be risk factors or targets of intervention for future DSH or collateral problems.

P03-130 Cognitive functioning in schizophrenia patients with suicidal behavior

Introduction:Suicide is one of the leading causes of death for schizophrenia patients: 9-13% of these patients eventually commit suicide, at least 20-40% make suicide attempts and 1-2% go on to complete in their attempt within the next 12 months. Therefore, suicide in schizophrenia has long been a major area of concern and research efforts. Although neurocognitive deficits are seen as core to schizophrenia, the association between suicidality and neurocognition has received little attention. People with schizophrenia often have impaired working memory and lower IQ. in particular, deficits in long-term memory, working verbal memory, executive functioning, and vigilance have been consistently associated with poor functional outcome in this patient population.Aim:To evaluate the effect of depression in schizophrenia suicidal patients from the point of view of neuropsychological functions.Methodology:A clinical sample of 60 patients with schizophrenia was assessed. among them, 30 patients presented a life long history of deliberate self-harm. We performed the assessment of schizophrenia (PANSS, GAS), depression (MADRS), suicidal risk (SIS, BHS), and neuropsychological markers with CogTest battery.Results:Suicidal behaviour in schizophrenia patients was significantly correlated with negative symptoms (anhedonia) accompanied by poor global functioning and positive symptoms (delusions). Some neuropsychological markers (abstract thinking, reduced capacity to maintain information on-line, working memory, facial emotions discrimination) were significantly correlated with hopelessness.Conclusion:The most significant neuropsychological dysfunction is represented by working memory impairment which is present in schizophrenia patients with self-harm behaviour even if they have an intact IQ.

Deliberate Self-harm and Suicide in Adolescents

Deliberate self-harm (DSH) is a widespread yet often hidden problem in adolescents and young adults. Though most DSH can be classified as "non-suicidal self-cutting", some do go on to commit suicide. In this paper, deliberate self-harm is examined, including its prevalence, etiology, management, and future research directions using self-cutting and self-burning as examples. This article reviews recent literature to help understand what is known about self-cutting behavior and its potential relationship to suicide as well as provide direction for research. Research shows that different ecological factors at the individual, family, peer, and societal levels are related to deliberate self-harm. Although there is an association between some self-injurers and drug abuse (including alcohol abuse) as well as eating disorders, there are various subgroups of self-cutters and most are not at high risk for suicide. However, all acts of self-injury should be taken seriously by health care professionals and comprehensive therapy offered to any adolescent with a history of DSH. Future research directions on deliberate self-harm are also discussed.

Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences

Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality. To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation. A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation. The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation. The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.

The Influence of Cognitive Emotion Regulation Strategies and Depression Severity on Deliberate Self‐Harm

Elaborating on previous studies on emotion regulation and deliberate self-harm (DSH), in the present study we distinguish between strategies of cognitive content (e.g., suicidal cognitions of perceived burdensomeness, helplessness, poor distress tolerance) and cognitive process (e.g., nonacceptance of emotional responses, lack of awareness of emotional responses). Young women who harmed themselves (n = 85) were compared with young women without a history of DSH (n = 93) across a broad range of strategies. Significant group differences were found for all measures, even when depression severity was controlled for. In addition, logistic regression analyses showed that both cognitive content strategies and cognitive process strategies made significant independent contributions to the prediction of group membership. Controlling for depression severity, suicidal cognitions, and nonacceptance of emotional responses independently predicted DSH. The strong association between suicidal cognitions and DSH seems to indicate the important role of these cognitions in recurrent and chronic DSH. The strong association between nonacceptance of emotional responses and DSH underscores the notion that DSH can be a way to avoid emotional problems. These findings are discussed in relation to recent cognitive-behavioral interventions and specific therapeutic techniques to further insight into how these interventions might work.

The Relationship Between Emotion Dysregulation and Deliberate Self‐Harm Among Female Undergraduate Students at an Urban Commuter University

Despite the theoretical emphasis on the role of emotion dysregulation in deliberate self‐harm (DSH), few studies have examined this relationship. The present study sought to examine the role of emotion dysregulation in DSH by extending the findings of Gratz (2006) regarding the environmental (i.e. childhood maltreatment) and individual (i.e. emotional inexpressivity and affect intensity/reactivity) factors associated with DSH among 249 female undergraduates. Specifically, the present study examined whether emotion dysregulation (a) is associated with DSH above and beyond these other risk factors and (b) mediates the relationship between these risk factors and DSH. Findings indicate that overall emotion dysregulation distinguished women with frequent DSH from those without a history of DSH, adding reliably to the prediction of DSH status above and beyond maltreatment, inexpressivity, and affect intensity/reactivity. Moreover, among self‐harming women, emotion dysregulation accounted for a significant amount of additional variance in DSH frequency and mediated the relationship between emotional inexpressivity and DSH frequency. Results also suggest the particular relevance of two specific dimensions of emotion dysregulation to DSH: limited access to effective emotion regulation strategies and a lack of emotional clarity, each of which reliably improved the prediction of DSH status and accounted for unique variance in DSH frequency among self‐harming women above and beyond the other risk factors in the models. Results suggest the potential utility of teaching self‐harming women more adaptive ways of responding to their emotions, including nonavoidant strategies for modulating emotional arousal and the ability to identify, label, and differentiate among emotional states.

Motives and Suicide Intent Underlying Hospital Treated Deliberate Self‐Harm and Their Association with Repetition

The association between motives for deliberate self-harm (DSH), level of suicide intent, and history of DSH is poorly understood. As part of the WHO/EURO Multicentre Study on Suicidal Behavior, the Suicide Intent Scale, and the Motives for Parasuicide Questionnaire were administered to 146 patients presenting with DSH in the Cork region in Ireland. DSH patients reporting high suicide intent were more motivated to escape from their problem (M = 3.15, p < .001) compared to those with low suicide intent, who were more motivated to appeal to others (M = 1.61, p < .001) and to get a temporary break from their problem (M = 2.47, p < .001). Repeaters more often reported motives aimed at escape (M = 2.98, p < .01), revenge (M = .60, p < .005), and appeal (M = 1.43, p = <.05). Selfharming patients are characterized by ambivalence and struggle with aversive thoughts and situations. Therapeutic approaches should include distress management and coping strategies.

Illicit tranquilliser use and dependence among female opiate users

This study determined the predictors of 12-month dependence on illicit tranquillisers among female opiate users attending three services in Glasgow, Scotland, UK. Twelve-month drug dependence was measured using the Diagnostic Interview Schedule. The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. 60% (159/266) had used illicit tranquillisers in the past 30 days, and 50% (132/266) met criteria for 12-month dependence on illicit tranquillisers. Polydrug use, injecting drug use, childhood and adulthood abuse, adverse life experiences and current and previous mental health problems were associated with 12-month dependence on illicit tranquillisers. Using multiple logistic regression, polydrug use in last 30 days (OR 3.2, 95% CI 1.5 - 7.0), history of deliberate self-harm (OR 2.5, 95% CI 1.4 - 4.4), history of injecting drug use (OR 2.5, 1.2 - 5.2) and likely to need treatment for current neurotic symptoms (CIS-R > or = 18) (OR 2.4, 95% CI 1.3 - 4.4) predicted 12-month dependence on illicit tranquillisers. Drug users in general and female drug users in particular who are using illicit tranquillisers are also particularly likely to have psychiatric symptoms requiring treatment. Mental health problems should be assessed and monitored among this client group and counselling and psychosocial support should be provided when indicated.

Deliberate self-harm patients of no fixed abode

International studies report high rates of deliberate self-harm (DSH) and suicide in the homeless. Little is known about DSH among homeless people in the UK and their subsequent risk of death from suicide and non-suicidal causes. We have carried out a study of no fixed abode (NFA) patients using data collected through the Oxford Monitoring System for Attempted Suicide. We describe the demographic and clinical characteristics of NFA DSH patients and the findings of a mortality follow-up study of a cohort of these patients. Between July 1988 and December 2002, 10,346 persons presented following 17,352 DSH episodes. Of these persons, 374 (3.6%) were of NFA. Compared with domiciled DSH patients, NFA patients were more likely to be male, single, unemployed, to have been a recent victim of violence and violent towards others, to have a criminal record and to have a personality disorder. More NFA patients faced problems with drugs and alcohol, social isolation, finances, the law and housing and had received psychiatric treatment within the previous 12 months. Substantially more NFA patients had a past history of DSH and re-presented with a further episode of DSH within 12 months. In the cohort of DSH patients who presented between January 1978 and December 1997 and who were followed up until December 2000, mortality from probable suicide and from all causes was approximately double that of domiciled patients. NFA DSH patients are a vulnerable group of patients at high risk of DSH repetition and with increased mortality from all causes. Good liaison between medical and psychiatric services is important. Specialist services may need to be developed to meet the particular needs of this patient group.

Suicide in depressive disorders: A retrospective case-control study of 127 suicides

Background Depressive disorders are associated with a significant risk of suicide. Inpatient status and recent discharge from hospital have been identified as times of high risk of suicide within the course of illness. Method A matched retrospective case control study of 127 patients with depression requiring inpatient care who died by suicide as inpatients or in the 12 months following discharge from hospital. Single and multivariable conditional logistic regression identified independent risk and protective factors for suicide. Results A history of deliberate self harm is a significant risk factor for suicide in patients with depression (OR 6.96; 95% CI 3.41–14.19), as is living alone (OR 2.11; 95% CI 1.15–3.87) and paid employment (OR 2.80; 95% CI 1.48–5.32). Admission to hospital during social crisis is associated with a reduction in suicide risk (OR 0.43; 95% CI 0.24–0.75). Limitations This is a retrospective case-control study, using clinical data not originally collected for research purposes. Conclusions General population risk factors for suicide are less predictive of suicide in patients with depression requiring inpatient treatment. Clinicians need to be aware of factors which increase or reduce the risk of suicide in this group.

Understanding resolution of deliberate self harm: qualitative interview study of patients' experiences

ObjectiveTo explore the accounts of those with a history of deliberate self harm but who no longer do so, to understand how they perceive this resolution and to identify potential...