Incidence Of Deliberate Self-harm Research Articles

Deliberate self-harm: Case identification and incidence estimate upon data from national patient registry.

BackgroundPatient registry is a valuable source for identification of deliberate self-harm (DSH) incidents on a population basis; however, little research has provided sufficient details that could inform best utilization of this complicated data source for DSH research and statistics. In this study we want to use data from the Norwegian Patient Register to delineate a diagnostic coding system to identify medically treated DSH incidents, to profile general characteristics of these incidents, and to estimate incidence rate of DSHs in the national population of Norway.MethodsWe obtained all records of patient contacts to somatic hospitals and emergency centers due to external causes from 2008 through 2013. For each contact, we retrieved clinical data on primary and comorbid diagnoses, urgency of contact, etc., alongside with personal general information. After careful mining, the data were further processed following a multi-step analytic strategy. Descriptive analysis was used to profile DSH incidents and to estimate incidence rates and corresponding 95% confidence intervals.FindingsFrom 1 459 384 eligible incident contacts for emergency injury treatment, we identified 13 533 incidents that had a recorded diagnosis of DSH, i.e., with a supplemental code of X6n. Upon delineation of these recorded DSHs, we devised a diagnostic coding system to identify all possible DSH incidents. This yielded a total of 38 433 incidents to be considered as likely incidents of DSH (adjusted incidents)–a number that is 2.84 times higher than that of the recorded DSH incidents during the study period. While the proposed diagnostic system captured more incidents by males and old adults, the adjusted DSHs remained more common in females than males, and occurred most frequently within young people of 18–21 years. These incidents imply about 6400 DSH incidents from 5100 persons per year and correspond to a yearly cumulative incidence rate of 121.0 (95% CI: 113.4–128.2) per 100000 population over 10 years old with particularly high rates in teenage girls of 15–19 years old (296.1/100000) and females and males of 20–24 years old (282.5 and 178.8/100000, respectively).ConclusionThe insightful details of data processing and the rich findings from this study underscore the importance of patient registry in studying and reporting DSH incidents on a population level.

Before the damage is done: Early childhood hyperactivity difficulties in adolescents with deliberate self-harm - findings from the DALSC cohort.

Background:Deliberate self-harm (DSH) is a growing issue among Danish adolescents, and a dramatic increase in the incidence of DSH has been observed since the turn of the millennium. The importance of early childhood factors on later development has been established, but research on the trajectories of DSH is still scarce, and longitudinal studies are much needed.Method:Participants were 3,291 children and their mothers from The Danish Longitudinal Survey of Children (DALSC), a Danish population-based birth cohort from 1995. Logistic regression and mediation analyses were used to examine significant early childhood determinants of self-harming behavior in adolescence.Results:The study found that 17.9% of the children had a history with DSH at the age of 18 years. A significant relationship was found between the likelihood of DSH at the age of 18 years and hyperactivity difficulties assessed through the Strengths and Difficulties Questionnaire (SDQ) at 3 and 7 years of age. Using a mediation model, it is documented that difficulties in peer relationships at the age of 11 years is a partial mediator explaining 19% of the variation.Limitations:i) a vague definition of self-harm in the questionnaires; ii) lack of sample representation as children of lower socio-economic groups have lower participation rates, and only Danish-ethnicity children have been sampled; iii) possibility of omitted variable bias.Conclusion:The adolescents engaging in DSH are experiencing a more complex range of psychosocial problems than those who do not have experience with DSH. The main finding of the study is that hyperactivity as a risk factor for the development of DSH in adolescence can be identified as early as 3–7 years of age. This relationship between the very early occurring hyperactivity and later DSH, to the best of our knowledge, has not previously been described.

Deliberate self-harm: A perspective

Recent years have seen an alarming increase in the incidence of deliberate self-harm (DSH). It has come to be a significant health issue and a pressing problem faced by clinicians in emergency settings as well as psychiatrists. However, it is often very difficult to ascertain the pathology underlying such behavior, thereby making it difficult to manage it. It significantly burdens an already ailing healthcare system as a large number of individuals try it at least once in their life, and a significant percentage of these are found to repeatedly engage in such behavior. A better understanding of DSH is essential for effective management of this behavior.

Deliberate self-harm among children with disabilities in China: a matched case-control study.

Study about deliberate self-harm (DSH) in children with different types of disabilities was scarce. This study compared the incidence and patterns of DSH between children with and without disabilities aged 6-17 years using a matched case-control study in Beijing. A total of 650 pairs of children with and without disabilities were surveyed. Characteristics of latest episode of self-harm within the 12 months were compared. Associations between disability status, sociodemographic factors, smoking, drinking, sleep problems, and self-harm were examined. Children with disabilities showed significant higher incidence of DSH than children without disabilities. Two groups differed significantly in terms of self-harm methods, body parts injured, premeditation, wishing to be known by others and help-seeking behavior. The adjusted OR for self-harm was 4.76 (2.99-7.55) for children with disabilities compared with children without disabilities. Children who slept fewer than 6 h per night, had difficulty falling asleep at night sometimes/often, and went to sleep after midnight 1 to 3 nights per month or at least once a week were at elevated risk of self-harm. This study highlights a strong relationship between disability, sleep problems, and DSH. Interventions to reduce self-harm should target disability and sleep problems as important risk factors.

Relationship Between Predictors of Incident Deliberate Self-Harm and Suicide Attempts Among Adolescents

PurposeData on the incidence of deliberate self-harm (DSH) and suicide attempts (SAs) are lacking in non-Western adolescents, and no studies have investigated differences in incident DSH and SA worldwide. This study aimed to investigate the incidence rates and relationships between predictors in DSH and SA. MethodsThe Taiwanese Adolescent Self-Harm Project was a longitudinal study of DSH among adolescents. We recruited 5,879 students from 14 senior high schools in northern Taiwan. Online questionnaires on sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use were assessed at baseline (T1) and at 1 year of follow-up (T2). Logistic regression analyses were performed to evaluate the predictors of incident DSH and SA. ResultsThe mean age was 16.02 years, and 56.73% of the cohort was female. At T1, the lifetime prevalence rates of DSH and SA were 25.04% and 3.50%, respectively. At T2, 4,331 (73.67%) students had completed follow-up assessments. The 1-year incidence rates of DSH and SA were 4.04% and 1.53%, respectively. The predictors of incident DSH included perceived family discord and more depressive symptoms at T1. The predictors of incident SA were lifetime suicide ideation, more depressive symptoms, and tobacco use at T1. ConclusionsThe incidence rates of DSH and SA were similar to those reported in Western countries. The predictors of incident DSH and SA were similar but not identical. Our results highlight the risk factors which should be considered in terms of early identification and intervention among adolescents to prevent suicidality.

Deliberate Self harm in Alcohol Dependent Outpatients in Tertiary Care Centre

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

Triglycerides as a biological marker of repeated re-hospitalization resulting from deliberate self-harm in acute psychiatry patients: a prospective observational study

BackgroundBiological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments.This study aimed to examine the incremental validity of lipid levels and platelet serotonin when combined with psychosocial factors in risk assessments for repeated admissions due to DSH.MethodsIn this prospective observational study of 196 acutely admitted patients, results of blood tests performed upon admission and the MINI Suicidal Scale and psychosocial DSH risk factor assessments performed at discharge were compared with the incidence of DSH recorded during the first 3 and 12 months after discharge.ResultsHigh triglyceride levels were found to be a significant marker for patients admitted 3 or more times due to DSH (repeated DSH, DSH-R) when tested against other significant risk factors. When all (9) significant univariate factors associated with 12-month post-discharge DSH-R were analyzed in a multivariate logistic regression, the MINI Suicidal Scale (p = 0.043), a lack of insight (p = 0.040), and triglyceride level (p = 0.020) remained significant. The estimated 12-month area under the curve of the receiver operator characteristic (ROC-AUC) for DSH-R was 0.74 for triglycerides, 0.81 for the MINI, 0.89 for the MINI + psychosocial factors, and 0.91 for the MINI + psychosocial factors + triglycerides. The applied multifaceted approach also significantly discriminated between 12-month post-discharge DSH-R patients and other DSH patients, and a lack of insight (p = 0.047) and triglycerides (p = 0.046) remained significant for DSH-R patients in a multivariate analysis in which other DSH patients served as the reference group (rather than non-DSH patients).ConclusionThe triglyceride values provided incremental validity to the MINI Suicidal Scale and psychosocial risk factors in the assessment of the risk of repeated DSH. Therefore, a bio-psychosocial approach appears promising, but further research is necessary to refine and validate this method.

Differentiating army suicide attempters from psychologically treated and untreated soldiers: A demographic, psychological and stress-reaction characterization

BackgroundSuicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military. MethodsThis study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18–21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50). ResultsSuicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters. ConclusionsYoung soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach.

Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report

Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide.

Self-harm and the positive risk taking approach. Can being able to think about the possibility of harm reduce the frequency of actual harm?

Background. This article presents the results of an audit of self-harming across three women's units over a period of 6 years. All three units use a positive risk-taking approach to self-harm whereby the risk that this behaviour presents is considered in an effort to reduce actual harm.Aims. To explore patterns and frequency of self-harm across three units within a women's service.Method. Incidents of deliberate self-harm were collected from incident forms completed across the units from 2004 to 2009.Results. Frequency graphs show a reduction of self-harm over the course of admission, and parametric analyses show that there was a significant difference in the frequency of self-harm during the first and last 3 months of admission.Conclusions. These results are discussed within a psychoanalytical framework, with particular reference to relational security and the value of positive risk-taking.

Suicidal Behaviours among Polish Youth in Light of the following Papers: Suicidal Behaviour in Children and Adolescents. Parts 1 and 2

Dear Editor: It appears from the literature reviews by Dr Margaret M Steele and Dr Tamison Doey1'2 that, both in America and in Europe, a broad definition of attempted suicide (AS) prevails, interchangeably replaced by deliberate self-harm (DSH), which is not, however, informative as to whether any suicidal intentions are associated with a self-harm action.3 Polish studies4 suggest that psychiatric patients with multiple DSH incidents without suicidal intentions differ from AS patients, for example, by personality profiles and emotional intelligence levels, what prompts an immediate assumption that differentiation between these 2 groups of patients is of therapeutic significance. Data from questionnaire enquiries, targeting more than 3000 school students in the Lodz Region (from 2002 to 2006), have demonstrated that DSH in history is really associated with high suicidal risk. Students with confirmed DSH reported suicidal thoughts (in lifespan) twice as often as those without DSH. Regarding other suicidal, risk-related factors, for example, psychiatric therapy, self-destruction acts in a closed environment, violence records, substance addiction, law violation, feeling sadness, fear or hopelessness, and a lack of impulse control should focus clinicians' attention, while prompting appropriate therapy.5 According to Polish standards (see the review),2 any teenager who has AS should be referred for psychiatric examination; this is rather difficult in practice with 1 psychiatrist per 40 000 population at a developmental age in the Lodz Region, while to European standards there is an assumption of 1 psychiatrist per 25 000 population. The second part of the report by Dr Steele and Dr Doey2 is an example of a scientific thesis combined with a practical approach. The presented knowledge on the management of suicidal patients may be a kind of guideline, especially for Polish psychiatrists. National questionnaire enquiries, addressing practising psychiatrists, have revealed that over 50% have faced at least 1 suicidal case among their patients. In that group, two-thirds of the psychiatrists evaluated their qualifications as low. Despite Poland's accession to the European Union in 2004, no suicide prevention program has been implemented at the central level. It may then be assumed that the to-date unconfirmed efficacy of hospital therapy for minors who have AS, as indicated by the authors of the report, should rather be accounted for by methodological impediments. Following the standards of the American Academy of Child and Adolescent Psychiatry,6 hospitalization is the standard response in cases of identified high suicidal risk in youth. Some controversy may arise from questioning the efficacy of the so-called no-suicide contract. According to some suicidologists, such a contract is a consequence of a long-term process of developing a strategy to suppress suicidal prompts in crisis situations, among others, by building new relations and developing new solutions. In Poland, the internationally accepted view (presented in the review1) that suicidal behaviours in children may be elevated by medications of the selective serotonin reuptake inhibitors group has reduced the number of minors medically treated for depression. Prediction of the consequences, which may emerge from such therapeutic decisions, such as their effect on the prevalence of suicidal behaviours in this population of Polish adolescents, is rather difficult owing to the lack of an AS register at the central level. …

Deliberate Self-harm and Relationship to Alcohol Use at an Emergency Department In Eastern Taiwan

Suicide incidence has increased dramatically in recent years in Taiwan. In 2004, 3,468 lives were lost due to suicide and the total mortality was 15.3/100,000. It is well known that alcohol drinking raises the risk of deliberate self-harm (DSH), especially among psychologically distressed subjects. This study investigated the characteristics of DSH patients and their association with acute alcohol drinking. Since 2004, an injury surveillance system has been set up in a medical center, collecting the minimal information recommended by the World Health Organization. Attending nurses collected information and assessed each injured patient as to whether he/she smelled of alcohol. Medical records of DSH injuries were reviewed for confirmation of any prior DSH and any known mental disorder was checked. Of 11,837 injuries, 123 (1.0%) were DSH. Those who were first-time DSH patients (n = 115) were studied. About half of the patients were female and 83.5% were aged between 20 and 54 years. More than half of the DSH incidents occurred at home and 80.1% cases were stabbing or cutting injuries. Injuries were defined as alcohol-related based on the report of "alcohol odor'' or "intoxicated'' by the nurse or a positive blood alcohol test. In total, 55 (47.8%) DSH injuries were found to be alcohol-related. The proportion of alcohol-related injuries was highest (60.0%) in the age range 45-64 years. Of those patients who tested positive for alcohol (n = 21), the mean blood alcohol concentration was 211.2 mg/dL (standard deviation, 79.1). Most subjects were discharged from the emergency department (75.7%). Only 20 DSH patients (17.1%) went on to receive a psychiatric consultation. DSH is not uncommon in eastern Taiwan. Half of our cases were associated with alcohol use. Males had the same risk of injuring themselves and were more likely than females to adopt "severe" methods to injure themselves. Further studies into the causes of DSH or parasuicide attempts are needed. Psychiatric consultation is essential in caring for DSH patients and in preventing suicide. ADSH injury also offers an opportunity to recognize alcohol problems.

Measured Response to Identified Suicide Risk and Violence: What You Need to Know About Psychiatric Patient Safety

Within inpatient psychiatric settings exists evidence of a significant risk of violent incidents and incidents of deliberate self-harm. One of the most hidden and preventable mental health problems is the fact that approximately 1,500 suicides take place annually in inpatient hospital facilities throughout the United States. This article focuses on the advantages and disadvantages of risk and suicide assessment procedures while attempting to answer the following questions: What degree of risk currently exists on inpatient psychiatric facilities for harm to self and others? What can be done within the physical environment to protect the psychiatric patient? We discuss a combined risk and quality proactive approach to risk reduction through a safety equation integrating patient assessment, physical environment, program safety, and patient component to formalize a systems approach to the at-risk patient. [Brief Treatment and Crisis Intervention 5:121‐141 (2005)]

The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study.

Geographic variations in the incidence of deliberate self-harm (DSH) and suicide have been shown to be associated with area-based measures of socio-economic deprivation and social fragmentation. Previous studies have been subject to methodological limitations. None has investigated whether ecological associations are reflected in characteristics of individuals involved in suicidal behaviour. DSH patients presenting to a general hospital between 1985 and 1995 and suicides (including open verdicts) from the same catchment area were studied. Mean annual rates of DSH and suicide by gender were calculated for electoral wards. The wards were amalgamated into 20 groups according to their ranking for socio-economic deprivation (Townsend) and social fragmentation scores. Associations of these variables with DSH and suicide rates were investigated. Characteristics of DSH patients living in ward groups with the highest and lowest socio-economic deprivation and social fragmentation scores were compared. Socio-economic deprivation was associated with DSH rates among males (r = 0.89) and females (r = 0.87). After controlling for social fragmentation the associations remained relatively strong, particularly in young males. Associations with social fragmentation in both genders (males, r = 0.83; females, r = 0.86) were attenuated after controlling for socio-economic deprivation. For suicide, the only significant association was with socio-economic deprivation in males (r = 0.79), but this was attenuated after controlling for social fragmentation. The characteristics of individual DSH patients reflected those of the areas where they lived. Reducing socio-economic deprivation and its associated problems may be an important strategy in the prevention of suicidal behaviour, especially in young men.

Deliberate self-harm and antidepressant drugs. Investigation of a possible link.

It is not clear if the frequency of deliberate self-harm (DSH) is the same in patients taking different pharmacological classes of antidepressant drugs. To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event. This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as number of DSH events per 10 000 prescriptions of each antidepressant. Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P<0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline. Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.

Are recent increases in deliberate self-harm associated with changes in socio-economic conditions? An ecological analysis of patterns of deliberate self-harm in bristol 1972-3 and 1995-6.

The incidence of deliberate self-harm (DSH) in Britain has increased markedly over the last 30 years. Reasons for this rise are not clear. We have investigated whether changes in the social and economic environment underlie any of the recent increase in DSH incidence. An ecological analysis was used to assess associations between changes in census-based measures of the social and economic environment--the Townsend Deprivation Index and a three-factor social fragmentation index--and changes in age- and sex-specific hospital attendance rates for DSH for the 28 wards of the city of Bristol between 1972-3 and 1995-6. There were significant cross-sectional associations between the Townsend Index and rates of DSH in both males and females in both time periods. Increases in Townsend Index were also associated with increases in DSH. This association was statistically significant at the 5% level in 25-34 year-old females. Associations with the social fragmentation index were weak, although our index was based on rather limited data. This analysis suggests that changes in levels of socio-economic deprivation may influence area-specific patterns of DSH and such changes may have contributed to recent rises in DSH.

Does initial management affect the rate of repetition of deliberate self harm? Cohort study

In the year following presentation to hospital after deliberate self harm, up to 25% of people repeat the act.1 A range of sociodemographic and psychological factors has been shown to...

Contagion of Deliberate Self-Harm Among Adolescent Inpatients

ObjectiveTo explore the quantitative importance and clinical features of deliberate self-harm (DSH) contagion in a closed adolescent psychiatric unit. MethodThe authors investigated with statistical methods and a sociogram whether acts of DSH were clustered during a 12-month study period. Twelve subjects were involved in acts of DSH, and their mean length of hospitalization during the study period was about 90 days. Six adolescents with four or more contagion incidents were interviewed. ResultsDSH incidents were clustered during the study period (p <.05). Most DSH incidents were skin cutting committed by depressed female subjects with borderline personality disorder. The majority of DSH contagion can be understood in terms of small-group rites for feelings of togetherness. ConclusionsEven a majority of DSH events in closed adolescent units may be triggered by contagion, and DSH can spread to previously DSH-naive adolescents.

Characteristics of childhood sexual abuse and adult psychopathology in female psychiatric patients.

The present study investigated the relationship of characteristics of childhood sexual abuse and subsequent psychopathology. Referrals to a female psychiatrist in private practice in an urban working class area provided 73 adult female subjects who reported having been sexually abused in childhood. Data were collected on age at onset, duration, physical invasiveness of the abuse, violence, and the number and relationship of abusers. Having had multiple abusers in childhood was significantly (p < 0.01) associated with every outcome measure of severe psychopathology: an initial Global Assessment Functioning score of 50 or below; both single and repeated incidents of deliberate self-harm; overdose; self-mutilation; and psychiatric hospital admission. Notably, having had multiple abusers was the only characteristic showing a reliable independent association with any of these measures. Subjects who had had multiple abusers were significantly more likely to have an earlier age of onset and longer duration of abuse, and to have experienced violent abuse.

A Study of the Relationship between the Patterns of Planned Activity and Incidents of Deliberate Self-Harm within a Regional Secure Unit

Within a 77-bed Regional Secure Unit, there has been an increase in the number of patients admitted who deliberately do themselves harm, although this Is generally not the primary reason for admission. During this 9-month study, 307 incidents of self-harm were recorded on the clinic's information system; a subgroup of seven patients was responsible for 77.5% of these incidents. Whilst there is a perception among rehabilitation staff that activity has a role in reducing the incidence of deliberate self-harm, this study Identifies no correlation between the patterns of structured activity and the patterns of deliberate self-harm. This does not suggest, however, that occupational therapy is ineffective with this client group, particularly given the potentially addictive nature of deliberate self-harm behaviour even after problem resolution. The study identifies areas for further research, focusing on qualitative rather than quantitative study.