History Of Self-harm Research Articles

People in Custody With a Suicidal History: An Ideation-to-Action Perspective Involving Individuals Incarcerated in Two U.S. Jails

Objective Despite high suicide mortality in U.S. jails, little is known about the cognitive (ideation) and behavioral (attempt) spectrum of suicide risk in this population. Identifying factors associated with the development of suicidal ideation, as well as the translation of thoughts to acts of suicide, is important for suicide prevention. Method Using data from a cross-sectional study conducted in 2018–2019, we investigated suicidal ideation and attempt among 548 individuals incarcerated in jail in the United States. Specifically, we compared those with suicidal ideation (n = 212) to those without suicidal ideation (n = 336), as well as compared those who had experienced suicidal ideation and attempted suicide (n = 114) to those who thought about suicide without making an attempt (n = 98), on a range of sociodemographic and clinical factors. Results Over one-third (38.7%) of participants had a history of suicidal ideation, whereas 23.3% had attempted suicide. In the adjusted analyses, a family history of suicide (OR = 2.09), drug use (OR = 2.26), social support (OR = 0.61), and self-harm (OR = 24.93) were linked to suicidal ideation. No wish to live (OR = 5.26) and interpersonal violence while intoxicated (OR = 2.41) were associated with the progression from suicidal ideation to a suicide attempt. Conclusions Consistent with extant theoretical and empirical work, findings suggest that factors linked to the development of suicidal cognitions differ from those underlying the progression from suicidal ideation to a (non-lethal) suicide attempt. HIGHLIGHTS Suicidal risk is particularly high among individuals who are incarcerated in jail. Factors linked to suicidal ideation differ from those underlying acts of suicide. Ideators and attempters possess a different set of targets for intervention.

Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China.

Background: Forensic psychiatric patients have higher suicide risk than the general population. This study aimed to evaluate the extent of suicide risk and to explore the associated factors in forensic psychiatric inpatients in China.Methods: We conducted a cross-sectional study from 1st November, 2018 to 30th January, 2019 in the Forensic Psychiatric Hospital of Hunan Province, China. Patient's information on socio-demographic, clinical, and criminological characteristics was collected. The suicidality subscale of the MINI-International Neuropsychiatric Interview (M.I.N.I.), the Brief Psychiatric Rating Scale (BPRS), and the Severity of Illness of Clinical Global Impressions Scale (CGI-SI) were used to measure present suicide risks, psychiatric symptoms, and the severity of the patient's disease, respectively. Binary logistic regression models were used to examine factors associated with suicide risk.Results: Twenty-one percent (84/408) of the forensic psychiatric inpatients reported suicide risk. Logistic regression analysis suggested that self-harm history (OR:3.47, 95% confidence interval CI: 1.45–8.33), symptoms of anxiety-depression (OR:1.15, 95% CI:1.04–1.27), and more severe mental disorder (OR:1.42, 95% CI:1.08–1.87) were associated with elevated suicide risk, while insight disorder (OR:0.81, 95% CI:0.65–0.99) was related to decreasing suicide risk.Conclusion: The study supplied useful clinical information to recognize high suicide risk in forensic psychiatric inpatients and may aid the development of valuable strategies for preventing and reducing suicide events.

Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm

Background Individuals presenting to hospital with self-harm of high lethality or high suicidal intent are at high risk of subsequent suicide. Aim To examine factors associated with psychiatric admission and self-harm repetition following high-risk self-harm (HRSH). Method A cohort study of 324 consecutive HRSH patients was conducted across three urban hospitals (December 2014–February 2018). Information on self-harm repetition was extracted from the National Self-harm Registry Ireland. Logistic regression models examined predictors of psychiatric admission and self-harm repetition. Propensity score (PS) methods were used to address confounding. Results Forty percent of the cohort were admitted to a psychiatric inpatient setting. Factors associated with admission were living alone, depression, previous psychiatric admission, suicide note and uncommon self-harm methods. History of emotional, physical or sexual abuse was associated with not being admitted. Twelve-month self-harm repetition occurred in 17.3% of cases. Following inverse probability weighting according to the PS, psychiatric admission following HRSH was not associated with repetition. Predictors of repetition were recent self-harm history, young age (18–24 years) and previous psychiatric admission. Conclusion(s) Findings indicate that psychiatric admission following HRSH is not associated with repeated self-harm and reaffirms the consistent finding that history of self-harm and psychiatric treatment are strong predictors of repetition.

Associations Between Adolescent Depression and Self-Harm Behaviors and Screen Media Use in a Nationally Representative Time-Diary Study.

Screen media use is associated with mental health problems among adolescents. However, few studies have examined screen media use using contemporaneous time diaries (rather than retrospective reports), compared associations across specific screen media activities or by gender, or examined associations with self-harm behaviors. Participants were 13- to 15-year-old adolescents completing time diaries (n = 4,252) for one weekday and one weekend day in the 2015 administration of the Millennium Cohort Study, a nationally representative birth cohort study of UK adolescents. Participants also completed a measure of depressive symptoms and reported whether they had engaged in self-harm in the last year. Girls who spent 2 + hrs/day, compared to < 2h/day, on digital media were more likely to self-harm (for social media use, adjusted relative risk [ARR] for self-harm = 1.46, 95% CI = 1.17, 1.82; for internet use, ARR = 1.80 [1.20, 2.70]). Girls spending more time on digital media were also more likely to be depressed (for social media, ARR = 1.29 [1.03, 1.63]; for internet use, ARR = 1.75 [1.19, 2.59]). Associations with gaming, texting/e-mailing, and TV/video watching among girls were mostly not significant. Associations for boys were mostly not significant. Girls who use digital media (especially social media and the internet) more hrs/day are more likely to have clinically significant levels of depressive symptoms and prior history of self-harm, though gaming, texting/e-mailing, and TV/video watching showed few associations. Screen media use was mostly not significantly associated with self-harm or depression among boys.

How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review.

Objectives:Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females.Method:Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal.Results:Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking.Conclusion:There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.

A cohort study of initial self-harm events: method-specific case fatality of index events, predictors of fatal and nonfatal repetition, and frequency of method-switching

Most studies evaluating self-harm repetition risk factors are from Asia and Europe, use cohorts of people who self-injure without differentiating incident and prevalent self-harm episodes, and do not stratify by suicide method. The current study uses an incident user design to (a) examine case fatality at index self-harm events and at each repeat event, by method, (b) describe method-switching, and (c) identify factors associated with repetition of self-harm among those who survive their index hospitalization. Specifically, this study reports psychiatric history and method-specific case fatality for the initial self-harm event among Utah residents with an index event in 2014 or 2015 and who have no history of prior self-harm in hospital records. For survivors of the index self-harm episode, we use Accelerated Failure Time models to identify risk factors for nonfatal repetition and separately for suicide. Key findings: 10,521 Utah residents with no 3-year self-harm hospital history experienced a 2014 or 2015 index event. Of the 9.5% with index deaths, 53.6% used firearms. Of the 90.5% who survived, 63.1% used drugs. Among the index nonfatal cases, over an average 1-year follow-up, 11.7% experienced a nonfatal repetition and 0.8% died by suicide. Most subsequent nonfatal repetitions (59.7%) and suicides (56.8%) had presented with an index drug poisoning; over half (56.8%) of those who died switched methods. For those who subsequently fatally self-harmed, most used poisoning by drugs (33.8%), hanging/strangulation (28.4%), or firearms (24.3%) in the terminal episode. Nonfatal repetition was associated with younger age, index cutting/piercing instruments, and past-year psychiatric and drug abuse diagnoses. Subsequent suicide was associated with male gender, older age, and index gas poisoning and hanging/suffocation. Of the 56 people who survived an index firearm event, none subsequently died by suicide during the study period.

Depression and Suicide-Risk Screening Results in Pediatric Primary Care.

Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches. From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10). Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription. Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.

Profile, referral pathways and re-attendance of psychiatric patients attending the emergency department: focus on suicidality &amp; self-harm

AimsThe number of patients presenting to Emergency Departments (EDs) in the UK with acute psychiatric issues is a major concern. This project aimed to explore the outcome of patients assessed by Mental Health Liaison Services (MHLS) in a large district general hospital ED in the UK, with a focus on patients with self-harm or suicidality.MethodData were extracted from electronic patient records on 100 consecutive attendees to MHLS in July 2020. Data were collected on demographics, index of multiple deprivation (IMD) by postcode, time and reason for attendance, known ICD-10 diagnoses, self-harm history, alcohol/substance misuse at time of presentation, recent psychosocial stressors and outcome of MHLS assessment. Assessments by MHLS in the preceding 12 months and reattendance to the service within 3 months following this assessment were also recorded.ResultThe sample included 44 male and 56 female patients, with a mean age of 35.3 years. 80.0% of patients were Caucasian. 67.0% lived in areas classed within the top 30% most deprived in the country, whilst 2.0% had no fixed abode. The majority (79.0%) of patients self-presented; outside of normal working hours (70.0%). The most common reasons for attendance were thoughts/intent of self-harm/suicide (50.0%), overdose (29.0%) and self-harm by laceration (7.0%).The majority (73.0%) of patients had a known psychiatric diagnosis, with the most frequent being depressive disorder (36.0%) and emotionally unstable personality disorder (15.0%). Almost half (48.0%) had a history of self-harm, and 40.0% were under the influence of alcohol/illicit substances upon presentation to ED. The most common psychosocial triggers were conflict with partner (26.0%) and stress due to the COVID-19 pandemic (19.0%).Following assessment, 24.0% of patients were discharged to their General Practitioner, 18.0% to the community mental health team; and 17.0% to the Crisis &amp; Home Treatment Team. A minority (13.0%) were admitted to a psychiatric hospital (10.0% informally, 3.0% under the Mental Health Act 1983).Approximately one in five (21.0%) patients re-attended to MHLS within 3 months. Out of 37 patients that had previously been assessed by MHLS in the preceding 12 months; 37.8% were reassessed within 3 months (p &lt; 0.01).ConclusionIn the studied sample, most (90%) of psychiatric patients attended ED for self-harm or suicide, and a significant proportion had repeat attendance. Socioeconomic deprivation, substance misuse, relationship difficulties and stress due to the COVID-19 pandemic were major issues, alongside diagnosed depression and personality disorder. Focussed support for these issues may decrease ED attendance due to self-harm/suicidality.

The Experience and Meaning of Repeated Self-Harm Among Patients Presenting to Irish Hospital Emergency Departments

Background Self-harm is a global public health concern in terms of increasing morbidity in addition to causing considerable financial implications for the health sector. Patients presenting with a history of self-harm are at increased risk of self-harm repetition and suicide. Research exploring the patient’s experience of engaging in multiple self-harm episodes is lacking. This study aimed to explore the experiences and meaning of self-harm repetition, among patients who presented to three urban hospital emergency departments in Ireland. Method A subset of participants with a history of five or more self-harm attempts from an ongoing study, ‘Improving Prediction and Risk Assessment of Self-Harm and Suicide’ was selected for this article. Interview transcripts from four participants were selected for analysis using Interpretative Phenomenological Analysis. The qualitative software package NVivo 11 was used to store and organise data into themes. Results Data were analysed based on four participants (two males and two females) ranging in age from 25 to 56 years. Three of the four participants reported a history of early traumatic emotional, physical and sexual abuse. Four superordinate themes were generated from the data, ‘Significance of self-harm to the person’, ‘Trajectory of self-harm progression’, ‘Impact of abuse in adult life’ and ‘The road to recovery’. Conclusion Self-harm was used as a coping mechanism for participants who experienced distressing life events such as emotional and sexual abuse. The qualitative themes identified in this study have implications for the development of adequate medical and mental health support systems for patients with histories of repeated self-harm.

The relationship between alexithymia and self-harm: The mediating role of mindfulness

Self-harm, defined as any act of self-injury, irrespective of motivation, is a phenomenon which can have serious consequences for the individual, as well as significant public health costs. Many correlational studies have established a significant association between self-harm and alexithymia, a cognitive deficit in emotion processing, characterised by a difficulty identifying and describing feelings and an externally orientated thinking style. The current study investigated whether this relationship is explained by low levels of dispositional mindfulness. An opportunity sample of 325 community-based adults completed an online survey measuring their history of self-harm, alexithymia (Toronto Alexithymia Scale) and mindfulness (Five Facets of Mindfulness Questionnaire). Alexithymia was significantly higher among participants with a history of self-harm, compared with participants with no history of self-harm. All mindfulness facets were significantly lower among participants with a history of self-harm except the facet Observe which was significantly higher in that group. A multiple mediation analysis found that the mindfulness facets Non-judge and Non-react were positive, significant mediators of the relationship between alexithymia and self-harm, but the facet Observe suppressed the relationship. The relationship between alexithymia and self-harm can be explained in part by deficits in mindfulness skills, particularly the ability to accept emotional experience without judgment or reaction. Conversely, the external orientation of alexithymia may itself be protective against self-harm, through the avoidance of excessive introspection. Thus, merely learning to observe inner experience, without the ability to understand and accept that experience, may have adverse consequences.

Identifying the causes of self-harm in adolescent girls in the socio-cultural context of Kermanshah

Introduction: Due to the harmful nature of self-harm, studying in this field is especially important in adolescents. The objective of this study was to identify the causes of self-harm in adolescent girls in the socio-cultural context of Kermanshah. Methods: This qualitative and phenomenological study was conducted in 2017 and the participants in the study were 21 adolescent girls with a history of self-harm that were selected using snowball sampling method-. Collaizi’s seven-step method was used for qualitative analysis of texts. Results: The semantic units of the interviews were categorized into 135 conceptual codes. The themes related to the causes of self-harm were classified into three categories: a. Family- related factors including poor verbal communication among family members, neglect and lack of love, discrimination between the sexes, parental control, type of family upbringing, threats from the mother, fear of the father, being indifferent, and etc., b. Environmental factors and conditions including taking friends as role models, being fashionable, being provoked by sad songs, being influenced by violent movies death of the relatives, taking role models from cyber space, etc., and c. Individual Factors including finding grandeur, proof of courage, loneliness, nervousness, interest in experiencing, impulsiveness, relationship with the opposite sex, emotional failure, and drawing attention. Conclusion: The results of this study revealed that adolescents see self-harm as a way to get rid of negative emotions or get back their neglected rights. Having disputes with parents, being overwhelmingly influenced by friends and peers, and having severe mental conditions all play a significant role in causing self-harm.

Factors associated with suicide attempts among Australian transgender adults

BackgroundTransgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies.MethodsUsing a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide.ResultsOf 928 participants, 73% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.54 (1.04, 2.28), p = 0.03), had a diagnosis of depression (aOR 3.43 (2.16, 5.46), p < 0.001), desired gender affirming surgery in the future (aOR 1.71 (1.134, 2.59), p = 0.01), had experienced physical assault (aOR 2.00 (1.37, 2.93), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.22), p = 0.007).ConclusionSuicidality is associated with desiring gender affirming surgery in the future, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable access to gender affirming care, particularly surgical interventions, are potential areas of intervention.

Risk factors for intimate partner violence and abuse among adolescents and young adults: findings from a UK population-based cohort.

Background: Approximately one-third of young people in the UK have suffered intimate partner violence and abuse (IPVA) on reaching adulthood. We need interventions to prevent IPVA in this population, but there is a lack of evidence on who is at greatest risk. Methods: We analysed questionnaire data from 3,279 participants of the Avon Longitudinal Study of Parents and Children population-based birth cohort. We estimated the prevalence of IPVA victimisation and perpetration by age 21, by sex, demographic, parenting, mental health, externalising behaviour (e.g. smoking), educational, employment, and adverse childhood factors. Results: Overall, 29% of males and 41% of females reported IPVA victimisation, with 20% and 25% reporting perpetration, respectively (16% and 22% both). The most common type of IPVA was emotional, followed by physical, then sexual. History of anxiety, self-harm, anti-social behaviour, cannabis or illicit (non-cannabis) drug use, or risky sexual behaviour among males and females were associated with a 50% increase in likelihood of IPVA (victimisation or perpetration). Males reporting depression, sexual abuse (not by an intimate partner), witnessing domestic violence, or parental separation were also more likely to experience IPVA. Extreme parental monitoring, high academic achievement during adolescence, and NEET (not being in education, employment, or training) status in young adulthood were associated with reduced risks of IPVA. Conclusions: A range of demographic, mental health, and behavioural factors were associated with increased prevalence of IPVA victimisation or perpetration. Further study of likely complex pathways from these factors to IPVA, to inform primary prevention, is needed.

Attachment Patterns in Children and Adolescents With Gender Dysphoria.

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

Risk factors for intimate partner violence and abuse among adolescents and young adults: findings from a UK population-based cohort

Background: Approximately one-third of young people in the UK have suffered intimate partner violence and abuse (IPVA) on reaching adulthood. We need interventions to prevent IPVA in this population, but there is a lack of evidence on who is at greatest risk. Methods: We analysed questionnaire data from 3,279 participants of the Avon Longitudinal Study of Parents and Children population-based birth cohort. We estimated the prevalence of IPVA victimisation and perpetration by age 21, by sex, demographic, parenting, mental health, externalising behaviour (e.g. smoking), educational, employment, and adverse childhood factors. Results: Overall, 29% of males and 41% of females reported IPVA victimisation, with 20% and 25% reporting perpetration, respectively (16% and 22% both). The most common type of IPVA was emotional, followed by physical, then sexual. History of anxiety, self-harm, anti-social behaviour, cannabis or illicit (non-cannabis) drug use, or risky sexual behaviour among males and females were associated with a 50% increase in likelihood of IPVA (victimisation or perpetration). Males reporting depression, sexual abuse (not by an intimate partner), witnessing domestic violence, or parental separation were also more likely to experience IPVA. Extreme parental monitoring, high academic achievement during adolescence, and NEET (not being in education, employment, or training) status in young adulthood were associated with reduced risks of IPVA. Conclusions: A range of demographic, mental health, and behavioural factors were associated with increased prevalence of IPVA victimisation or perpetration. Further study of likely complex pathways from these factors to IPVA, to inform primary prevention, is needed.

Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study.

BackgroundA priority for health services is to reduce self-harm in young people. Predicting self-harm is challenging due to their rarity and complexity, however this does not preclude the utility of prediction models to improve decision-making regarding a service response in terms of more detailed assessments and/or intervention. The aim of this study was to predict self-harm within six-months after initial presentation.MethodThe study included 1962 young people (12–30 years) presenting to youth mental health services in Australia. Six machine learning algorithms were trained and tested with ten repeats of ten-fold cross-validation. The net benefit of these models were evaluated using decision curve analysis.ResultsOut of 1962 young people, 320 (16%) engaged in self-harm in the six months after first assessment and 1642 (84%) did not. The top 25% of young people as ranked by mean predicted probability accounted for 51.6% - 56.2% of all who engaged in self-harm. By the top 50%, this increased to 82.1%-84.4%. Models demonstrated fair overall prediction (AUROCs; 0.744–0.755) and calibration which indicates that predicted probabilities were close to the true probabilities (brier scores; 0.185–0.196). The net benefit of these models were positive and superior to the ‘treat everyone’ strategy. The strongest predictors were (in ranked order); a history of self-harm, age, social and occupational functioning, sex, bipolar disorder, psychosis-like experiences, treatment with antipsychotics, and a history of suicide ideation.ConclusionPrediction models for self-harm may have utility to identify a large sub population who would benefit from further assessment and targeted (low intensity) interventions. Such models could enhance health service approaches to identify and reduce self-harm, a considerable source of distress, morbidity, ongoing health care utilisation and mortality.

Self-harm on roads: Register-based study of methods and characteristics of individuals involved

BackgroundSuicide on roads is receiving increased attention. However, there has been little research on non-fatal road-related self-harm. This study was conducted in order to investigate the characteristics of such acts. MethodInformation on non-fatal road self-harm was extracted from a self-harm monitoring system database of self-harm presentations to a major general hospital in England during 2005-2017. Patients were identified through being referred for psychosocial assessment by a clinical service and through scrutiny of medical records. ResultsDuring the 13-year study period 110 individuals (67 males, 43 females) presented to the hospital with road-related self-harm: 38 (34.5%) jumped from bridges, 34 (30.9%) jumped or lay in front of vehicles, 27 (24.5%) crashed vehicles and 11 (10.0%) jumped from moving vehicles. Crashing vehicles was more common in males and jumping from vehicles more common in females. In patients who received a psychosocial assessment, their most frequent problems were with a partner, employment and family members. Over half had been in psychiatric care and nearly two-thirds had a history of previous self-harm. Suicide intent was often high, especially in those who crashed a vehicle or jumped from a bridge. LimitationThe study was based on presentations to a single hospital. Some data were not available for non-assessed patients. ConclusionsRoad-related self-harm, while not common, more frequently involves males and the acts are often of high suicidal intent. The range of problems preceding this method of self-harm indicates that there needs to be a variety of aftercare interventions, adapted to each individual's situation.

Understanding the complexity of neurodevelopmental profiles of females in prison.

This paper aims to examine the relationship between patterns of functioning in four domains (attention and concentration; social and communication; coordination and organisation; and literacy and numeracy) in women in prison. Also, to consider potential associations between functioning and previous Neurodevelopmental Disorder (NDD) diagnoses, previous mental health diagnoses and history of head injury, self-harm and attempted suicide. Women in one Scottish prison were invited to participate; 87 consented. Women were screened for functional difficulties and asked about their relevant educational and medical history. Half of participants reported difficulties in one or more domains. All possible combinations of functional difficulties were found. Only eight women reported previous NDD diagnoses. Functional difficulties were significantly associated with history of self-harm, history of attempted suicide and mental health diagnoses. In total, 32% of women reported at least one head injury, but this was not significantly associated with functional difficulties. The sample was comparatively small and questions were self-report. Analyses were based on within-cohort comparisons due to a lack of appropriate general population data. There is a clear need for timely, practical and comprehensive profiling of females in the Justice System. Current systems do not appear to adequately identify women with functional difficulties or other adversity. Greater use of interdisciplinary working and shared training is indicated, as is a move from categorical diagnostic systems towards dimensional approaches. This study is the first to investigate associations between difficulties associated with NDDs, mental health difficulties and head injury in women in prison.

Predisposing, enabling and need factors associated with increased use and ongoing increased use of inpatient mental health care: A population-based longitudinal study.

The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.

The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study.

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders. We aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services. We conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million). The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate (by 1.21 referrals per day per day, 95% confidence interval [CI] 0.41–2.02). This acceleration was primarily for urgent or emergency referrals (acceleration 0.96, CI 0.39–1.54), including referrals to liaison psychiatry (0.68, CI 0.35–1.02) and mental health crisis teams (0.61, CI 0.20–1.02). The acceleration was significant for females (0.56, CI 0.04–1.08), males (0.64, CI 0.05–1.22), working-age adults (0.93, CI 0.42–1.43), people of White ethnicity (0.98, CI 0.32–1.65), those living alone (1.26, CI 0.52–2.00), and those who had pre-existing depression (0.78, CI 0.19–1.38), severe mental illness (0.67, CI 0.19–1.15), hypertension/cardiovascular/cerebrovascular disease (0.56, CI 0.24–0.89), personality disorders (0.32, CI 0.12–0.51), asthma/chronic obstructive pulmonary disease (0.28, CI 0.08–0.49), dyslipidemia (0.26, CI 0.04–0.47), anxiety (0.21, CI 0.08–0.34), substance misuse (0.21, CI 0.08–0.34), or reactions to severe stress (0.17, CI 0.01–0.32). No significant post-lockdown acceleration was observed for children/adolescents, older adults, people of ethnic minorities, married/cohabiting people, and those who had previous/pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm, or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.