Method Of Self-harm Research Articles

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

BackgroundSelf-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10–25 years) in sub-Saharan Africa.MethodWe searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.ResultsSeventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% – 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% – 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% – 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5–14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% – 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.ConclusionVariation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital: Cohort study

Background: There is mixed evidence for whether psychosocial assessment following hospital presentation for self-harm reduces self-harm repetition. A possible reason is the differences in professional background of assessors (primarily psychiatrists and psychiatric nurses) due to variability in training and therapist style.Methods: Using data from the Oxford Monitoring System for Self-harm, we analysed data on patients making their first emergency department (ED) presentation for self-harm between 2000 and 2014, followed-up until 2015. Using logistic regression, we estimated the probability of repeat self-harm within 12 months, comparing: (i) patients receiving psychosocial assessment versus none, adjusting for age, gender, self-harm method, past self-harm presentation, and general hospital admission; and (ii) patients assessed by a psychiatric nurse versus those assessed by a psychiatrist, adjusting for age, self-harm method, time and year of presentation.Results: The 12,652 patients who had an index ED presentation for self-harm during the study period accounted for 24,450 presentations, in 17,303 (71%) of which a psychosocial assessment was conducted; in 9318 (54%) by a psychiatric nurse and in 7692 (45%) by a psychiatrist. We found a reduced probability of repeat self-harm presentation among patients receiving psychosocial assessment versus none (adjusted odds ratio [AOR] = 0.70; 95% CI = 0.65–0.75; p < 0.001), but no differences between patients assessed by a psychiatric nurse or a psychiatrist (AOR = 1.05; 95% CI = 0.98–1.13; p = 0.129).Limitations: Findings from a single hospital may not be generalizable to other settings.Conclusions: Short-term risk of repeat self-harm after psychosocial assessment for self-harm may not differ by the assessor's professional background.

Methods of deliberate self-harm in a tertiary hospital in South Africa.

BackgroundLittle is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm.AimThe aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA.SettingThe study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa.MethodData were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH.ResultsSelf-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH.ConclusionImproved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study

Self-harm is the strongest risk factor for subsequent suicide, but risk may vary. We compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and variations in area-level socioeconomic deprivation, and estimated the incidence of suicide by time after hospital attendance. In this ongoing Multicentre Study of Self-harm in England, the study population consists of individuals aged at least 15 years who had attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Information on method of self-harm was obtained through systematic monitoring in hospitals. Level of socioeconomic deprivation was based on the Index of Multiple Deprivation (IMD) characterising the area where patients lived, grouping them according to IMD quintiles. Mortality follow-up was up to Dec 31, 2015, resulting in up to 16 years of follow-up. We calculated incidence of suicide since first hospital presentation by follow-up period and estimated the association between individual factors (age, gender, method of self-harm, IMD, and number of non-fatal self-harm presentations to hospital) and suicide using mixed-effect models. Between Jan 1, 2000, and Dec 31, 2013, there were 92 177 presentations to the study hospitals by 51 108 individuals. 1325 patients involved in 1563 self-harm episodes were excluded from the study because they had missing information on gender, age, or mortality. The resulting study sample consisted of 90 614 hospital presentations by 49 783 individuals. By the end of follow-up on Dec 31, 2015, 703 patients had died by suicide. The overall incidence of suicide was 163·1 (95% CI 151·5-175·6) per 100 000 person-years, and 260·0 (237·4-284·8) per 100 000 person-years in men and 94·6 (83·3-107·4) per 100 000 person-years in women. The incidence of suicide was highest in the year following discharge from hospital (511·1 [451·7-578·2] per 100 000 person-years), particularly in the first month (1787·1 [1423·0-2244·4] per 100 000 person-years). Based on all presentations to hospital, men were three times more likely than women to die by suicide after self-harm (OR 3·36 [95% CI 2·77-4·08], p<0·0001). Age was positively related to suicide risk in both genders, with a 3% increase in risk for every one-year increase in age at hospital presentation (OR 1·03 [1·03-1·04], p<0·0001). Relative to hospital presentations after self-poisoning alone, presentations involving both self-injury and self-poisoning were associated with higher suicide risk (adjusted OR 2·06 [95% CI 1·42-2·99], p<0·0001], as were presentations after self-injury alone (adjusted OR 1·36 [1·09-1·70], p=0·007). Similarly, relative to self-harm by self-poisoning alone, attempted hanging or asphyxiation (adjusted OR 2·70 [1·53-4·78], p=0·001) and traffic-related acts of self-injury (adjusted OR 2·99 [1·17-7·65], p=0·022) were associated with greater risk of suicide. Self-cutting combined with self-poisoning was also associated with increased suicide risk (adjusted OR 1·36, [1·08-1·71], p=0·01). Compared with those patients living in the most deprived areas, those who lived in the least deprived areas (first national IMD quintile) had a greater risk of dying by suicide (adjusted OR 1·76 [1·32-2·34], p<0·0001) after adjusting for gender, age, previous self-harm, and psychiatric treatment, as did those living in the second least deprived areas (adjusted OR 1·64 [1·20-2·25], p=0·002). Patients attending hospital for self-harm are at high risk of suicide, especially immediately after hospital attendance. Certain patient characteristics and methods of self-harm, together with living in areas of low socioeconomic deprivation, can increase patients' subsequent suicide risk. However, while specific risk factors can be usefully integrated into the assessment process, individual factors have poor utility in predicting suicide, so the needs and risks of all patients should be assessed to develop appropriate aftercare plan, including early follow-up. UK Department of Health and Social Care.

Differences between medically treated and untreated non-fatal self-harm reported by hotline callers in China

BackgroundMany self-harmers do not present in hospitals due to the self-harm. It is still unclear on the differences between medically treated and untreated self-harm in China. This study described the differences of the two groups of self-harmers using the largest psychological aid hotline data.MethodsThe present observational study recruited 3,403 hotline callers who reported episodes of self-harm before the call. In routine assessment, information about the most recent episode of self-harm was collected, including the method of self-harm, the wish to die, goals of the self-harm, and any medical treatment (irrespective of psychological services) in the hospital. The callers were divided into two groups: those who received hospital-based medical treatment due to the most recent self-harm (treated self-harm callers) and those who did not (untreated self-harm callers).ResultsIn the most recent episode of self-harm, 65% (n = 2,217) of callers were untreated and 55% (1,226/2,217) of the untreated self-harm callers reported a wish to die. A total of 67% of the callers reported that their main goal of self-harm was to relieve suffering. The most common self-harm methods were using instruments (knife or rope) and overdosing on medicines. Compared with treated self-harm callers, the untreated self-harm callers were less likely to have a wish to die (OR = 0.57), engage in self-harm outside the home (OR = 0.71 and 0.78), and attribute their self-harm to romantic relationship problems (OR = 0.76); however, they were more likely to use instruments, to jump, or to choose other methods (OR = 3.73, 3.83, and 7.71, respectively).ConclusionsAmong hotline callers, many episodes of self-harm did not receive medical treatment, despite over half reporting a wish to die. Characteristics of self-harm behaviors were different between treated and untreated self-harm callers. Our findings suggest that more strategies should improve access to hospital-based medical treatment and coverage for post-intervention for self-harmers who are not presented in hospitals.

Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia

PurposeThe aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors.MethodsA retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015–2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups.ResultsWithin the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married.ConclusionsPreventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.

Self-harm in the Australian asylum seeker population: A national records-based study.

BackgroundSystematic research into self-harm in the Australian asylum seeker population is scarce, largely due to the lack of accessible data. The aim of this study was to examine the incidence and characteristics of self-harm across the Australian asylum seeker population, and to ascertain whether self-harm rates and characteristics vary by processing arrangements (i.e. community-based arrangements, community detention, onshore detention, offshore detention (Nauru), and offshore detention (Manus Island)), and gender.MethodsData relating to the incidence of self-harm, method(s) used to self-harm, processing arrangements, and gender were extracted from all self-harm incidents recorded as occurring among the Australian asylum seeker population between 1st August 2014 and 31st July 2015. Self-harm episode rates were calculated using the average estimated adult population figures for the 12-month period for each asylum seeker population.Results949 self-harm episodes were included in the analyses. Rates ranged from 5 per 1000 asylum seekers in community-based arrangements to 260 per 1000 asylum seekers in offshore detention in Nauru. Rates were highest among asylum seekers in offshore and onshore detention facilities, and lowest among asylum seekers in community-based arrangements and community detention. The most common methods of self-harm were cutting (37%), self-battery (26%), and attempted hanging (11%), with asylum seekers in held detention using a wider variety of methods than those in community-based arrangements and community detention.ConclusionsOur findings highlight the exceptionally high rates of self-harm among detained asylum seekers compared to rates observed in the general Australian population, and among asylum seekers in community-based settings. These findings point clearly to the deleterious impact of immigration detention, and warrant urgent attention.

Cleistanthus collinus poisoning affects mitochondrial respiration and induces oxidative stress in the rat kidney

Cleistanthus collinus is a poisonous shrub used for deliberate self-harm in rural areas of South India and intake of boiled decoction of leaves is a common method of self-harm. Distal renal tubular acidosis (dRTA) is an important clinical symptom observed in C. collinus poisoning, and renal V-ATPases may be potential targets of damage. However, a lack of understanding of molecular mediators involved hampers medical management, which is mainly supportive. We hypothesized that C. collinus poisoning induces renal oxidative stress; probably by inducing mitochondrial uncoupling, which compromises V-ATPase activity to ultimately produce dRTA. This was tested by exposing renal BBMV, kidney cells in culture, and Wistar rats to C. collinus poisoning. Exposure to C. collinus aqueous extract resulted in significant elevations in the lipid peroxidation marker, conjugated dienes, in cell culture and in vivo. A significant decrease in mitochondrial respiratory control ratio was observed in kidneys from C. collinus-treated animals suggesting that mitochondrial oxidative phosphorylation is uncoupled. This was accompanied by significant increase in ADP levels and a decrease in proton pump activity. Thus, these results demonstrate that C. collinus poisoning induces oxidative stress which influences proton pump activity, probably due to feedback inhibition by elevated ADP levels because of mitochondrial dysfunction in the rat kidney.

Patients with deliberate self-harm attended in emergency setting at a tertiary care hospital: A 13-month analysis of clinical-psychiatric profile.

Objectives To describe the pattern and clinical-psychiatric profile of patients presenting with deliberate self-harm attempt to an emergency setting. Methods The study involves the analysis of the case records of 109 consecutive patients with deliberate self-harm evaluated by the psychiatric emergency team at a premier, tertiary care hospital in India over a period of 13 months (January 2015–January 2016). Results Deliberate self-harm had a clinical prevalence of 16.4% (109/666) among total mental and behavioral emergencies attended in the same period. A large majority of attempters were in the age range of 18–39 years (84.4%), and females (58.7%) outnumbered males in total sample. Married females and unmarried males had significantly higher chances of attempting deliberate self-harm (χ2 = 6.57, p = 0.01). More than half (52.3%) of patients were found to have a diagnosable psychiatric illness at the time of presentation, most common being depressive disorder in 19.3% of overall sample. Past history of a psychiatric illness was evident in only 12.5% of patients. Common methods of deliberate self-harm were prescription drug/psychotropic overdose, poisoning with ingestion of phenyl cleaner or rat-killer poison. Significant gender differences were observed in the nature of precipitating events for deliberate self-harm, with interpersonal relationship problems being significantly more common in women (p = 0.03). Conclusion This study adds relevant and useful information on cross-cutting as well as gender-specific characteristics of patients presenting with deliberate self-harm attempt, from a developing country context. The study findings bear implications for designing interventions for primary and secondary prevention of such behavioral emergencies at a community level.

Demographic and psychosocial characteristics of self-harm: The Pakistan perspective

Self-harm is a major public health issue in Pakistan, yet the characteristics of those who self-harm are under-explored. This is a secondary analysis from a large randomized control trial on the prevention of self-harm, exploring demographic, clinical and psychological characteristics of people who self-harm in Pakistan. A total of 221 participants with a history of self-harm were recruited from medical wards of three major hospitals in Karachi. The Beck Scale for Suicidal Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Suicide Attempt Self Injury Interview (SASII) assessment scales were completed. The sample consisted predominantly of females (68.8%) in their 20′s. Interpersonal difficulties were most commonly reported as the main antecedent to the self-harm, followed by financial difficulties. Participants had high severity scores on BSI, BDI and BHS. Pesticide and insecticide use were (n = 167, 75.6%) the most common methods of self-harm. The findings indicate that some characteristics of those who self-harm in Pakistan are comparable to other populations. This may raise the possibility of common causal mechanisms and processes. Future research needs to examine the efficacy of interventions targeting these risk factors in reducing rates of self-harm and thus suicide.

Niyangala (Gloriosa Superba) Poisoning Complicated with SIADH

Abstract Background: Niyangala poisoning used to be a common method of deliberate self-harm among people living in rural areas of Sri lanka. It is a plant that grows in the wild and has no usage. All parts of this plant are poisonous.The toxic ingredient in Niyangala is Colchicine. Even though Colchicine poisoning is uncommon, it can lead to life threatening complications and be considered a toxicological emergency. It can cause severe gastroenteritis, abdominal pain, hypotension, electrolyte imbalance in the initial phase, as well as granulocytopenia, thrombocytopenia, clotting defects, hepatic insufficiency and renal failure after the first 24 hours. Case presentation: A 62-year-old male presented to our medical unit with several episodes of severe watery diarrhea 6 hours after the ingestion of 3 tubers of Niyangala. He also had epigastric pain, nausea and vomiting. He had eaten Niyangala after consuming alcohol and claimed it was after a dispute with his wife. On admission, the patient was in pain with some dehydration but he was afebrile. Discussion: SIADH consists of hyponatremia, inappropriately elevated urine osmolality (>100 mOsm/kg), and decreased serum osmolality in a euvolaemic patient. SIADH should be diagnosed when these findings occur in the setting of otherwise normal cardiac, renal, adrenal, hepatic, and thyroid function; in the absence of diuretic therapy; and in the absence of other factors known to stimulate ADH secretion, such as hypotension, severe pain, nausea, and stress. Conclusion: SIADH is a well-recognized complication of colchicine poisoning. We report for the first time SIADH after the ingestion of tubers of Gloriosa superba. Hyponatremia in a patient after poisoning with Gloriosa superba is usually attributed to severe diarrhea which is a common and dominant clinical feature often managed with fluid replacement.

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.

Method of self-harm and risk of self-harm repetition: findings from a national self-harm registry.

Risk of self-harm repetition has consistently been shown to be higher following self-cutting compared to intentional drug overdose (IDO) and other self-harm methods. The utility of previous evidence is limited due to the large heterogeneous method categories studied. This study examined risk of hospital presented self-harm repetition according to specific characteristics of self-harm methods. Data on consecutive self-harm presentations to hospital emergency departments (2010-2016) were obtained from the National Self-Harm Registry Ireland. Associations between self-harm method and repetition were analysed using survival analyses. Overall, 65,690 self-harm presentations were made involving 46,661 individuals. Self-harm methods associated with increased repetition risk included minor self-cutting, severe self-cutting, multiple drug IDOs involving psychotropic drugs and self-harm by blunt object. Minor self-cutting was the method associated with highest repetition risk (adjusted hazard ratio (AHR) 1.38, 95% CI 1.31-1.45). Risk of repetition was comparable following IDOs of four or more drugs involving psychotropic drugs (AHR = 1.29, 95% CI 1.20-1.39), severe self-cutting (AHR 1.25, 95% CI 1.16-1.34) and blunt object (AHR = 1.23, 95% CI 1.07-1.42). Information was not available on suicide or other causes of mortality. Self-harm method and the associated risk of repetition should form a core part of biopsychosocial assessments and should inform follow-up care for self-harm patients. The observed differences in repetition associated with specific characteristics of IDO underline the importance of safety planning and monitoring prescribing for people who have engaged in IDO.

NATIONAL STUDY OF EMERGENCY DEPARTMENT VISITS AND FOLLOW-UP TREATMENT FOR ATTEMPTED SUICIDE IN OLDER ADULTS

Little information is available about the mental health care received by U.S. older adults after suicide attempts. This retrospective cohort analysis examined 2015 Medicare claims for adults aged 65 years and older who presented to emergency departments (ED) for self-harm (N=15,891). Adjusted risk ratios (ARR) were estimated for discharge disposition, ED recognition of mental disorder, and 30-day follow-up mental health outpatient visits. Most patients (76.8%) were hospitalized. Lower likelihoods of hospitalization were observed for African American patients (ARR=0.84, p<.0001), recent medical ED users (ARR=0.92, p=.001), and patients with only one medical comorbidity (ARR=0.91, p=.001). Hospitalization was associated with recent depression (ARR=1.09, p=.004) and recent psychiatric inpatient care (ARR=1.12, p=.003). Among patients discharged to the community (n=3,681), 48.4% received a mental disorder diagnosis. ED recognition of a mental disorder was associated with age 65–69 years (ARR=1.54, p<.0001) and 70–74 years (ARR=1.23, p=.0004), any recent mental disorder (ARR=1.55, p=.008), and recent mental health care in ED (ARR=1.59, p<.0001), inpatient (ARR=1.32, p=.001), and outpatient (ARR=1.49, p<.0001) settings but inversely related to male sex (ARR=0.89, p=.002) and high lethality self-harm methods (ARR=0.80, p=.001). Only 9.6% of community discharged patients received follow-up outpatient mental health care within 30 days, which was most strongly predicted by prior outpatient mental health care (ARR=6.67, p<.0001). Most older adult Medicare beneficiaries who present to EDs with self-harm are hospitalized. Of those who are discharged to the community, a substantial proportion are not diagnosed with mental disorder in the ED or receive timely follow-up mental health care.

Cardiac arrhythmias, electrolyte abnormalities and serum cardiac glycoside concentrations in yellow oleander (Cascabela thevetia) poisoning – a prospective study

Background: Consumption of yellow oleander (Cascabela thevetia) is a popular method of intentional self-harm in South India.Objectives: The objectives of this study were to identify the cardiac arrhythmias and electrolyte abnormalities in yellow oleander poisoning and to identify the association between electrolyte abnormalities, cardiac glycoside concentrations at admission and the severity of cardiotoxicity. This study was also designed to identify clinical and biochemical parameters at presentation which predict serious arrhythmias and determinants of mortality.Materials and methods: This was a prospective study among 192 patients who attended our Emergency department after consuming yellow oleander seeds. Patients were monitored with serial ECGs. Serious cardiac arrhythmias included sinus bradycardia <40/min, sinus arrest/exit block, second or third degree AV block, atrial tachyarrhythmias and ventricular tachyarrhythmias. Serum sodium, potassium, magnesium, total calcium and cardiac glycoside concentrations were measured at presentation for all 192 patients. Serial estimation of cardiac glycoside concentration was done in 43 patients who presented within 24 hours of consuming at least five seeds.Results: At presentation, 46 patients had serious arrhythmias and on follow-up, 11 developed new-onset serious arrhythmia. Sinus bradycardia (27%) was the most common arrhythmia followed by second-degree AV block (17%); multiple arrhythmias were observed in 18%. Digoxin effect in ECG correlated significantly with hyperkalemia. Mortality rate was 5%. Serum sodium, total calcium and magnesium levels did not correlate with cardiotoxicity. Cardiac glycoside concentration was of relatively modest clinical utility to discriminate patients with serious dysrhythmias (AUC: 0.719, 95% CI: 0.63–0.81). Prolonged PR interval and digoxin effect in ECG were significantly associated with an increased likelihood of serious dysrhythmias. Increase in 0.4 number of seed intake increased the odds of mortality by 1.5 times when all other independent variables were kept constant.Conclusion: Cardiac glycoside concentration at the time of presentation predicted the development of new-onset serious arrhythmias. Although serum potassium correlated significantly with cardiac glycoside concentration at admission and overall serious dysrhythmias, it did not predict the development of new-onset serious arrhythmia. On the whole, serious dysrhythmias were significantly associated with higher number of seeds ingested, hypotension at admission, PR interval prolongation, presence of digoxin effect in ECG, hyperkalemia and higher cardiac glycoside concentration. The independent determinants of mortality were larger number of seeds ingested and hypotension at admission. Cardiac glycoside concentration and hyperkalemia failed to be independent markers of serious dysrhythmias as well as mortality.

Prevalence of Deliberate Self-harm Among Chinese Patients With Heroin Dependence: A Meta-Analysis.

Background: There is paucity of data regarding the prevalence and methods of deliberate self-harm (DSH) in patients with heroin dependence in international literature. In China, there have been a few studies investigating the prevalence of DSH in heroin-dependent patients (HDPs), but their rates varied widely. We thus conducted a meta-analysis of studies assessing the prevalence of DSH among Chinese HDPs.Methods: Relevant studies were retrieved from major Chinese databases (China National Knowledge Infrastructure, Wanfang data, and SinoMed) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently identified eligible studies and extracted data. Studies that included a representative sample of Chinese HDPs and ascertained DSH caseness in a reliable way were considered as high quality. Statistical analysis was performed using R software.Results: In total, 15 eligible studies with a total of 37,243 Chinese HDPs were included. All included studies were conducted in heroin detoxification settings. Only two studies were rated as high quality. The pooled prevalence of DSH in Chinese HDPs was 4.4% (95%CI: 2.9, 6.2%), but the heterogeneity of prevalence rates across studies was significant (I2 = 98%, P < 0.001). Studies rated as high quality had significantly higher prevalence of DSH than those rated as low quality (13.2 vs. 3.4%, P < 0.001). Swallowing foreign objects was the most common method of DSH, with a combined prevalence of 2.7% (95%CI: 1.6, 4.4%). Extreme DSH methods such as cutting off fingers and jumping from height were also not uncommon in this patient population.Conclusion: Due to methodological problems in available studies, we find a relatively low prevalence of DSH among Chinese HDPs receiving detoxification treatment. Nevertheless, the self-harmers of Chinese HDPs are more likely to harm themselves in a dangerous or life-threatening way. Restricting the availability of DSH methods may be an effective way to prevent or reduce DSH in China's detoxification treatment settings.

Self-harm by Sharp Foreign Body Ingestion.

Ingestion of sharp foreign bodies is a less frequently encountered method of selfharm. This study aims to follow up patients presenting with foreign body (FB) ingestion requiring urgent endoscopic intervention under general anaesthetic in theatre, characterise each patient and establish whether admission or removal of the FB promotes further self-harm. Eleven adult patients, totalling 38 presentations over a 28-month period were identified. Each was followed up from an initial presentation requiring endoscopy. 9/11 (81.9%) where transferred either from prison or psychiatric care with an extensive history of multimodal and usually violent self-harm. Of these 8/9 (88.9%) had a formal psychiatric diagnosis linked to their previous self-harm. Objects retrieved included pens, razor blades, cutlery, wiring, batteries, a metal screw and a TV aerial. The median time between presentations with self-harm was 11 days. Those discharged from the emergency department re-presented after a median of 7.5 days. This was longer, at 14 days, if admitted to hospital; with those having endoscopic procedures re-presenting after a median of 11 days. Inpatient endoscopic removal of the FB was not associated with an earlier presentation with further self-harm when compared with discharge straight form A+E, but was frequently repeated, often in a characterised manner.

Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016.

Rates of hospital-treated self-harm are highest among young people. The current study examined trends in rates of self-harm among young people in Ireland over a 10-year period, as well as trends in self-harm methods. Data from the National Self-Harm Registry Ireland on presentations to hospital emergency departments (EDs) following self-harm by those aged 10-24years during the period 2007-2016 were included. We calculated annual self-harm rates per 100,000 by age, gender and method of self-harm. Poisson regression models were used to examine trends in rates of self-harm. The average person-based rate of self-harm among 10-24-year-olds was 318 per 100,000. Peak rates were observed among 15-19-year-old females (564 per 100,000) and 20-24-year-old males (448 per 100,000). Between 2007 and 2016, rates of self-harm increased by 22%, with increases most pronounced for females and those aged 10-14years. There were marked increases in specific methods of self-harm, including those associated with high lethality. The findings indicate that the age of onset of self-harm is decreasing. Increasing rates of self-harm, along with increases in highly lethal methods, indicate that targeted interventions in key transition stages for young people are warranted.

Foreign Body Ingestion in a Patient with Psychiatric Illness

Background: There are many challenges in treating patients who engage in deliberate foreign-body ingestion as a method of self-harm. Whereas other forms of mutilation may be dangerous to patients and distressing to their treaters, foreign-body ingestion carries a sense of insidiousness in the lack of outward evidence that harm has been done and in the latent risk of further injury even after a diagnosis has been made. Case Report: Here we report a case of foreign body ingestion in a patient with psychiatric illness and discuss what is known about deliberate foreign-body ingestion and some of the clinical problems they pose, with a focus on medical literature regarding the diagnosis and treatment of such cases. Conclusion: Timely counseling and psychiatric support is essential for foreign body ingestions.

Suicide After Deliberate Self-Harm in Adolescents and Young Adults.

Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety.