History Of Self-harm Research Articles

Advancing early detection of suicide? A national study examining socio-demographic factors, antecedent stressors and long-term history of self-harm

BackgroundA range of factors including mental disorders, adverse events and history of self-harm are associated with suicide risk. Further examination is needed of the characteristics of suicides which occur without established risk factors, using national surveillance systems. MethodsData on all suicides in Ireland from 2015 to 2017 were drawn from the Irish Probable Suicide Deaths Study (IPSDS). Variables examined included socio-demographics, psychiatric history and precipitant stressors. Suicide data were linked with data on prior self-harm from the National Self-Harm Registry Ireland (NSHRI). Latent Class Analysis (LCA) was used to identify sub-groups of suicide cases. ResultsOf the 1809 individuals who died by suicide, 401 (22.2 %) had a history of hospital-treated self-harm. Four distinct profiles of suicides were identified. One group was marked by high levels of prior self-harm and mental health conditions. Two of the groups included few individuals with a history of self-harm but had notably high levels of mental health conditions. These two groups had relatively high levels of reported chronic pain or illness but differed in terms of socio-demographics. The final group, predominantly male, had markedly low levels of mental health conditions or self-harm but high levels of personal stressors and substance use. LimitationsThe use of coronial data may be limited by bias in the collecting of information from the deceased's family members. ConclusionsA sub-group of suicide cases exists without any psychiatric or self-harm history but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings and should promote mental health literacy.

Formulation and systemic therapy.

A 33-year-old woman with a long history of chronic plaque psoriasis attended a dermatology follow-up clinic. She had a past medical history of depression and self-harm, and was taking sertraline. Her treatment history included narrowband ultraviolet B phototherapy, ciclosporin and methotrexate. She was currently on topical therapy only. On assessment in clinic, the psoriasis was poorly controlled. We discuss which suitable systemic treatment option to try next.

Intensive Exposure Therapy for an Individual With History of Self-Harm and Suicidality

Practitioners may hesitate to treat patients with a history of nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) using exposure therapy due to concerns that exposures will increase these risk-related behaviors. However, when NSSI/STBs are exacerbated by distress associated with anxiety disorders or obsessive-compulsive disorder (OCD), lack of treatment can worsen disability. This case report describes the treatment of a 14-year-old gender-fluid individual with symptoms of multiple anxiety disorders, OCD, and borderline personality disorder (including emotion dysregulation, chronic suicidality, and NSSI). Treatment involved dialectical behavioral therapy (DBT) for “stage one” of treatment, including maintaining behavioral control over self-harm and suicidal behaviors, followed by intensive exposure and response prevention (ERP) during “stage two” of treatment. Upon discharge, the client had maintained an absence of NSSI/STBs, demonstrated reductions in anxiety and OC symptoms, observed further decreased familial accommodation, and improved daily functioning. In addition, the client’s parents exhibited an improved capacity to regulate their own emotions (before responding to the client), more validating responses, and reduction in familial accommodation. This case report supports the feasibility, efficacy, and safety of exposure therapy for individuals in “stage two” of DBT and highlights the role of exposure as an important emotion regulation strategy to reduce OCD and anxiety symptoms in patients with a history of self-harm and suicidality. Challenges, successes, and future directions are discussed.

Historiografia e empatia: ações da Psicologia Escolar Crítica sobre as práticas de automutilação

Abstract Objective Intervention research in the field of Critical School Psychology based on historiographical assumptions. The objective was to investigate the current meanings of non-suicidal self-harm in educational environments. Method In the workshops, psychology students were prepared to put themselves in the shoes of a person with a history of non-suicidal self-harm. Later, these students wrote narratives about that person's past, their current experiences and future expectations. Results Aspects highlighted in the literature about the history of non-suicidal self-injury were also configured in the current meanings about self-mutilation described in the narratives of Psychology students. Psychology students modified their meanings about non-suicidal self-injury to empathize with people with this experience. Conclusion As the historiographical approach aims to explain current situations anchored in past events, it favors the planning of actions for educational environments committed to ethical and political aspects. The focus on empathy associated with a historiographical perspective on educational processes can be a way to design actions in the field of Critical School Psychology, given its commitment to the humanization of contemporary society.

Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care

BackgroundEmergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care.MethodsData on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses.ResultsThere were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history).ConclusionThe NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.

Autistic Characteristics in a Nationally Representative Clinical Sample of Adolescents Seeking Medical Gender-Affirming Treatment in Norway.

Several studies have reported on the intersection of autism and gender incongruence (GI) in clinical populations. This study aims to investigate autistic characteristics and registered autism spectrum diagnoses (ASD) in a clinical cohort of 83 adolescents referred to the National Gender Team for Children and Adolescents in Norway during 2020. Parents completed the Social Responsiveness Scale (SRS). Background information and registered psychiatric diagnoses were extracted from patient files. The results showed that 25% of the participants scored within the clinical range on the SRS: 27.4% of adolescents who were assigned female at birth (AFAB) and 19.0% of adolescents who were assigned male at birth (AMAB). AFAB had significantly higher scores on SRS Total Scale and the Social Motivation and Autistic Mannerisms subscales compared to the female norm group. AMAB had higher scores on the Social Motivation subscale and lower scores on the Social Awareness subscale, compared to the male norm population. Information from patient files revealed that 67.5% had one or more registered psychiatric diagnosis. 9.6% had received an ASD diagnosis, all AFAB. 18.1% had received an attention deficit hyperactivity disorder (ADHD) diagnosis. The most common psychiatric diagnoses were depression (25.3%) and anxiety disorders (18.1%). Further, 44.6% had a history of self-harm, and 15.7% had a history of a suicide attempt. The results showed an overrepresentation of ASD diagnoses and autistic characteristics measured by SRS for AFAB. There was an overrepresentation of psychiatric diagnoses for both the AFAB and the AMAB group in this study sample. Implications for treatment and future research are discussed.

Management of foreign body ingestion in adults: Time to STOP and rethink endoscopy

Abstract Background and study aims Foreign body ingestion is a common cause for Emergency Department presentation. In adults, foreign body ingestion is more common in patients with underlying psychiatric comorbidity, the elderly, alcohol intoxication, and in prisoners. This study reviewed the management of patients presenting to a tertiary hospital with foreign body ingestion. Patients and methods A retrospective review of patients presenting with foreign body ingestion to a tertiary hospital in Melbourne, Victoria, was undertaken from January 2017 to December 2021. Data collected included patient demographics, type of foreign body, length of stay, imaging modalities, management strategies, and complications. High-risk ingestion was defined as sharp objects, length >5 cm, diameter >2.5 cm, button battery and/or magnet ingestion or esophageal as per international guidelines. Results A total of 157 presentations by 63 patients with foreign body ingestion occurred between 2017 and 2021 (50% male; median age 30 years). Of the patients, 56% had underlying psychiatric comorbidities. The majority of presentations occurred in prisoners (65%). The most commonly ingested objects were batteries (23%), alleged drug-containing balloons (17%), razor blades (16%), and miscellaneous (40%). High-risk ingestion occurred in approximately two-thirds of presentations. Conservative management was the most common approach in 55% of patients. Complications, defined as perforation, bowel obstruction or fistula formation, did not occur in this cohort despite more than half presenting with high-risk ingestions. Thirty-day re-presentation rates were high (31%) and that was most common in patients with intentional ingestion, underlying mental health disorders, and a documented history of self-harm. Conclusions Conservative management for patients presenting with recurrent high-risk foreign body ingestion was safe in appropriately selected cases. Re-presentation is common and poses significant challenges for health care providers.

The influence of peer non-suicidal self-harm on young adults' urges to self-harm: experimental study.

To test the hypothesis that exposure to peer self-harm induces adolescents' urges to self-harm and that this is influenced by individual suggestibility. We recruited 97 UK-based adults aged 18-25 years with a recent history of self-harm, measuring baseline suggestibility (Resistance to Peer Influence; RPI) and perceived ability to control urges to self-harm (using an adapted item from the Self-Efficacy to Resist Suicidal Action scale; SEASA) before and after two self-harm vignettes featuring named peers from the participant's social network (to simulate exposure to peer non-suicidal self-harm) and after a wash-out exposure. We used paired t-tests to compare mean SEASA scores pre- and post-exposure, and linear regression to test for an association between RPI and change in SEASA scores pre- and post-exposure. Perceived ability to control urges to self-harm was significantly reduced following exposure to peer self-harm (t(96) = 4.02, p < 0.001, mean difference = 0.61; 95% CI = 0.31, 0.91), but was not significantly different from baseline after exposure to a wash-out. We found no association between suggestibility and change in urges to self-harm after exposure to peer self-harm. Our findings support social influences on self-harm in a sample of young adults, regardless of their individual degree of suggestibility.

Antecedents, clinical and psychological characteristics of a large sample of individuals who have self-harmed recruited from primary care and hospital settings in Pakistan.

Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries. To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan. This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed. Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals. Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.

Factors associated with suicide attempt risk in adolescent inpatient psychiatric care: toward a practical model

Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13–18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.

Relationship of Maternal Age and Adverse Childhood Experiences (ACEs) with Traumatic Sequelae in Commercially Sexually Exploited Youth

The impact of early maternal age on several outcomes (e.g., mental health issues, delinquency, aggression, impulsivity, victimization, and interpersonal difficulties) has been studied since the late 1980s. Research has demonstrated links between exposure to adverse childhood experiences (ACEs) and trauma-related outcomes such as substance abuse, interpersonal and self-directed violence, and sexual risk-taking, to name a few. The current study analyzed the incidence of ACE exposure and mental health outcomes (e.g., suicidal behaviors or self-harm, psychiatric hospitalizations, and substance use) as related to early maternal age in youth known to have experienced trafficking or sexual abuse. General demographics and incidence of various experiences and clinical presentations (e.g., ACE exposure, age of mother at birth of youth, and age at first birth), and history of self-harm, substance use, and psychiatric hospitalization, were examined in a sample of 225 youth referred for services subsequent to experiences of sex trafficking or exploitation. Relationships between ACE exposure and maternal age related to mental health outcomes were also examined. Trafficked and exploited youth reported rates of ACE exposure and poor mental health outcomes at far greater rates than the general population. Significant findings were related to early maternal age and engaging in self-harm or suicidal behaviors. Previously anticipated mediational analyses were not conducted due to the sample size and lack of correlations. Findings highlight the significant ACE exposure and high needs of exploited, trafficked, and abused youth and related mental health outcomes, emphasizing the need for early and comprehensive preventive and therapeutic interventions.

Mental health and suicide risk among homosexual males in Bangladesh.

Homosexual individuals are at high risk of suicide, but there is a shortage of data from developing countries to confirm this. Estimates on mental health and suicide risk among male homosexuals in Bangladesh are needed to generate awareness and to plan services accordingly. We assessed mental health and suicidal behavior of 102 self-identified homosexual males from a community-based organization that works with the sexual minority population. One-third of the participants (32.4%) had experienced attempted suicide, and almost half (47.1%) had a history of suicidal ideation and self-harm (40.2%). Compared to a heterosexual sample, homosexual males had poorer mental health as they scored higher on Beck Hopelessness Scale (Cohen's d = 0.29) and General Health Questionnaire (GHQ) (Cohen's d = 0.57). The results revealed positive correlations between self-harm, suicidal ideation and suicide attempt scores. Participants with history of suicide attempt, suicide ideation and self-harm reported worse general health, more social dysfunction, and severe depression than those without such history. Suicidality and mental health conditions among homosexual males in Bangladesh have appeared to be alarming. Given the concerns, we offer some recommendations for practitioners and social workers who are serving this population in Bangladesh.

Evaluation of Characterized Depressive Disorder in Children and Adolescents: A Study of 79 Cases

Depression in children and adolescents is a major mental health concern, being the leading cause of illness and disability in children over ten years old. It increases the risk of suicide, affects education, social interactions, and contributes to obesity, tobacco, and substance use. The aim of this study was to highlight the sociodemographic and clinical profile of depression in young individuals, identify risk factors, and discuss appropriate therapeutic options. We conducted a retrospective descriptive and analytical study, using a questionnaire completed jointly by children with characterized depressive disorder and their parents. The study included 79 participants. Statistical analysis was performed using Jamovi version 2.3.21.0 and Microsoft Excel 2021. We found a predominance of females, with an average age of 13.5 years. Antecedents of self-harm and family history of psychiatric disorders were risk factors for suicidal ideation. Common symptoms included sleep disturbances (89.9%), irritability (83.5%), and mood sadness (70.9%). Depression had a significant impact, with 88.6% experiencing social withdrawal and 81% showing decreased school engagement, reflecting the multidimensional effects of depression. Pharmacotherapy was used in 82.3% of cases. However, therapeutic adherence was only good in 60.4% of cases. In summary, this study provides crucial insights into the characteristics, risk factors, and treatments of depression in young individuals within a specific hospital setting. It reinforces knowledge while emphasizing the importance of early and personalized intervention to counteract negative consequences during this critical age.

Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm.

Prior self-harm represents the most significant risk factor for future self-harm or suicide. To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.

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.

A comparison of inpatient suicides in Australian psychiatric and non-psychiatric hospital units between 2009 and 2018

Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides.

Cognitive emotion regulation strategies among emerging adults with different self-harm histories

BackgroundSelf-injurious behaviors have a high prevalence in emerging adulthood. People who engage in self-injury report more emotion regulation difficulties than their peers without self-injury. However, there is little research on how use of emotion regulation strategies varies over brief periods among emerging adults with differing self-harm histories. The current study examined variability in cognitive emotion regulation strategies between emerging adults with no self-harm, previous suicide attempts, or non-suicidal self-injury (NSSI). MethodsForty-one racially and ethnically diverse participants, ages 18–27, completed measures of cognitive emotion regulation once daily for one week. ResultsData collected from 5 of these days were analyzed due to missing data on days 6 and 7. Growth curve analyses revealed differences in trajectories of rumination, acceptance, and catastrophizing, depending on self-harm histories. Specifically, participants with previous NSSI displayed increases in rumination, acceptance, and catastrophizing over time, compared to peers with a previous suicide attempt. LimitationsThe study design was limited by lack of assessment of self-harm during the daily diary, a limited assessment period of only one week, and distal time period of group classification. ConclusionsThese findings suggest that while emerging adults with NSSI histories use more emotion regulation strategies, they may need assistance in selecting when and how to use specific strategies.

The Clinical Interview for Borderline Personality Disorder for Adolescents (CI-BOR-A): Development, acceptability and expert panel evaluation.

Borderline personality disorder (BPD) is a severe mental disorder with marked impulsivity, instability, emotional dysregulation and self-harm. These features tend to develop over time and can be identified in adolescence. Early diagnosis is the first step to prevent the development of these features to a personality disorder. The purpose of this study was to develop the Clinical Interview for BPD for Adolescents (CI-BOR-A), a new instrument based on a sound clinical interview for BPD in youth (CI-BPD). We tested its acceptability with 43 adolescents and its content validity with the quantitative and qualitative evaluation of 23 experts in mental health. The CI-BOR-A is a hybrid semi-structured interview that considers both categorical and dimensional approaches of personality disorders of DSM-5-TR, including 16 items, decision tables for diagnosis, and an appendix to explore self-harm history further. Adolescents accepted the interview, and none refused to complete the assessment. The expert panel considered the interview relevant, clear, accurate and complete. Important feedback was provided in terms of structure and content to improve the CI-BOR-A quality. In general, the CI-BOR-A is a rigorous interview to assess BPD in adolescents and adds an important contribution to early detection in clinical and community settings.

Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)

BackgroundAssessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes.ObjectiveWe developed and validated a predictive model...

OA10 Factors associated with long-term opioid use in fibromyalgia patients newly started on an opioid: results from Clinical Practice Research Datalink

Abstract Background/Aims The impact of the opioid epidemic in North America has caused concern in the United Kingdom. Long-term opioid use is associated with several opioid-related harms and adverse outcomes. Fibromyalgia is frequently treated with opioids due to limited therapeutic options. Understanding what factors are associated with long-term opioid use in such patients is the first step in helping to develop targeted interventions for deprescribing. Therefore, the objective of this study was to (i) quantify the proportion of new opioid users with fibromyalgia who become long-term opioid users; and (ii) identify risk factors associated with long-term opioid use in fibromyalgia. Methods A retrospective cohort study was conducted using data from the Clinical Practice Research Datalink (CPRD). CPRD is a national database of electronic health records within primary care, representation of the general population. Fibromyalgia patients without prior cancer who were new opioid users between 01/Jan/2006 and 31/Aug/2021 were included. Long-term opioid use was defined as at least 3 opioid prescriptions issued within a 90-day period, or ≥ 1 opioid prescription lasting at least 90 days, in the first year of follow-up. Logistic regression analysis and a random forest model were used to identify risk factors related to long-term opioid use. Compared to logistic regression, random forest variable importance measures covered both the effects of individual predictor variables as well as multivariate interactions with other predictor variables. In the random forest model, the mean decrease accuracy (MDA) index to measure the variables’ importance was used; the larger the value of the mean decrease accuracy, the more important the variable is. Results Of the 28,552 fibromyalgia patients who were new opioids users, 7,375 (26%) became long-term opioid users in the first year. In the fully adjusted logistic regression model, suicide and self-harm (adjusted odds ratio [aOR]: 1.98, 95% confidence interval (CI): 1.72-2.27, p &amp;lt; 0.001), substance use disorder (aOR: 2.07, 95%CI: 1.62-2.66, p &amp;lt; 0.001), most deprived (Index of Multiple Deprivation (IMD) quintile 5/most deprived, aOR: 1.98, 95%CI: 1.69-2.33, p &amp;lt; 0.001, compared with quintile 1/least deprived), obesity (aOR: very severely obese, OR: 2.35, 95%CI: 1.76-3.18, p &amp;lt; 0.001) and mean daily morphine milligram equivalents (MME) at the initiation (High (120-199 MME/day): aOR: 34.81, 95%CI: 18.00-78.05, p &amp;lt; 0.001 compared to mean daily MME: Low (&amp;lt;50 MME/day)) were associated with higher risk of long-term opioid use. The three most important variables using the random forest model were mean MME/day at initiation (MDA 140), history of suicide and self-harm (MDA 40) and IMD (MDA 30). Conclusion Almost 1 in 4 patients with fibromyalgia starting opioids became a long-term opioid user in this nationally representative dataset within the first year. The dose of initial opioid prescription, high deprivation score, history of suicide and self-harm, substance use disorder and obesity were associated with long-term opioid use. Disclosure M. Feng: None. C. Ramirez Medina: None. Y. Huang: None. D. Jenkins: None. M. Jani: None.