Method Of Self-harm Research Articles

Developing interventions for prevention of self-harm for British South Asian women: A qualitative study

IntroductionIt has been estimated that the global burden of suicide is a million deaths per year (WHO, 2014). Rates of self-harm in British South Asian (BSA) women are higher compared to their white counterparts. Limited evidence is available on effective preventative strategies and culturally sensitive interventions for these patients.ObjectiveTo understand common perceptions about self-harm, identify any barriers to accessing services and service improvement recommendations including appropriate interventions for BSA women.AimTo examine the views of health professionals on the culturally adapted problem solving therapy (C-MAP) in BSA women.MethodsThe design was a qualitative study using focus group discussion. This is part of a larger exploratory trial, to test a culturally adapted problem solving therapy (C-MAP) in British South Asian women who have a history of self-harm (Husain et al., 2011). Three focus groups were held with Asian lay members of the community, health professionals and service users. The data was analysed using a manual content analysis and indexing technique.ResultsResults showed lack of identification of self-harm by health professionals. Common self-harm methods reported were serious overdoses, use of household chemicals, burning and cutting. Lack of trust in GP s was one common reason for non-disclosure of self-harm behaviour. Need for increased awareness, working along with local Imams, better cultural sensitivity among health professionals and non-judgmental support were some solutions offered to address these barriers.ConclusionThe results of this study have provided insight into developing strategies to prevent and manage self-harm in British South Asian women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: A population-level record linkage study in Western Australia.

The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old). We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.

Plant poisoning—an observational study in a tristate region emergency department

Background: Poisoning is of the common methods of self-harm. Exposure to plants and its consequences account for considerable number of deaths in rural regions. Objective: Describe the most common poisonous plant exposures causing either local or systemic toxic manifestations. Materials and Methods: A retrospective observational study was conducted by the Emergency Department (ED) over a period of 2 years. All cases presented to the ED with a history of exposure to plants were included. Data were analyzed and tabulated. Literature review was done to check for the poisonous principles, clinical features and management of exposure to poisonous plant. Results: A total number of 62 cases were included. Male to female distribution was almost equal. Fifty cases were suicidal and 12 cases were accidental. In 56 cases, poisoning was by ingestion and in 6 cases by dermal exposure. Suicidal exposure was mostly in adults, while children were accidentally exposed. Twenty-six patients with oral ingestion died despite treatment, common cause being delayed presentation. Forty-six cases needed ICU admission for more than 3 days; indication for ICU admission was hemodynamic and electrolyte abnormalities. Common poisons causing mortality were Cleistanthus, oleander, and strychnine. Conclusion: As plant poisoning not being uncommon, all emergency physicians should have complete knowledge of plant exposures. Management mostly being symptomatic, early treatment prevents mortality. Public should be educated about the high fatality rates in plant poisoning.

Trends in Self-Harm in Kuala Lumpur, 2005–2011

Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007–2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6–8 or 8–13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.

Suicide attempts and completions in Veterans Affairs nursing home care units and long-term care facilities: a review of root-cause analysis reports.

Suicide was the 10th leading cause of death for Americans in 2010. The suicide rate is highest among men who are aged 75 and older. The prevalence of suicidal behavior in nursing homes and long-term care (LTC) facilities was estimated to be 1%. This study describes the systemic vulnerabilities found after suicidal behavior in LTC facilities as well as steps to decrease or mitigate the risk. This is a retrospective review of root-cause analysis (RCA) reports of suicide attempts and completions between 1 January 2000 and 31 December 2013 in the Veterans Health Administration LTC and nursing home care units. The RCA reports of suicide attempts and completions were coded for patient demographics, method of attempt or completion, root causes, and actions developed to address the root cause. Thirty-five RCA reports were identified. The average age was 65 years, 11 had a previous suicide attempt, and the primary mental health diagnoses were depression, posttraumatic stress disorder, and schizophrenia. The primary methods of self-harm were cutting with a sharp object, overdose, and strangulation. It is recommended that all staff members are aware of the signs and risk factors for depression and suicide in this population and should systematically assess and treat mental disorders. In addition, LTC facilities should have a standard protocol for evaluating the environment for suicide hazards and use interdisciplinary teams to promote good communication about risk factors identified among patients. Finally, staff should go beyond staff education and policy to make clinical changes at the bedside. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Suicide risk after nonfatal self-harm: a national cohort study, 2000-2008.

To study the short-term risk of suicide after nonfatal deliberate self-harm and its association with coexisting mental disorders and with the method of self-harm used. We used linked Swedish national registers to design a cohort study with 34,219 individuals (59% females) who were admitted to hospital in 2000-2005 after deliberate self-harm (ICD-10-defined). They were followed for 3-9 years. The studied outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Temporal patterns were plotted with Kaplan-Meier survival curves, calculated separately for each mental disorder and for the method used at the previous self-harm event. 1,182 subjects committed suicide during follow-up (670 males and 512 females). Coexisting bipolar disorder (in males, adjusted HR = 6.3; 95% confidence interval [CI], 3.8-10.3; in females, adjusted HR = 5.8; 95% CI, 3.4-9.7) and nonorganic psychotic disorder (in males, adjusted HR = 5.1; 95% CI, 3.5-7.4; in females, adjusted HR = 4.6; 95% CI, 2.8-7.7) implied the highest risk of suicide after previous self-harm. Hanging as index self-harm method was a strong predictor of later suicide in both males (adjusted HR = 5.3; 95% CI, 4.0-7.0) and females (adjusted HR = 4.5; 95% CI, 2.5-8.1). Of those with bipolar disorder who used a method other than poisoning at the index event, 20.4% had already committed suicide after 3-9 years. Individuals with severe mental disorders (affective and psychotic disorders) have a poor prognosis in the first years after hospital admission due to self-harm. The risk of subsequent suicide is higher after attempts by hanging and other self-injury methods (vs self-poisoning). Aftercare for those with a self-harm episode should focus on treatment of the mental disorder present at the time of the episode.

Information-Seeking on the Internet.

The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. We aimed to identify and analyze websites potentially accessed by these young people. Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

Suicidal Intent and Method of Self-Harm: A Large-scale Study of Self-Harm Patients Presenting to a General Hospital.

Data from the Oxford Monitoring System for Attempted Suicide (2004-2011) were used to study hospital presentations for self-harm in which Suicidal Intent Scale (SIS) scores were obtained (N=4,840). Regression of medians was used to control for the confounding effect of age and gender. Higher estimated median SIS scores were associated with increasing age, male gender, self-poisoning versus self-injury, multiple methods of self-harm versus self-injury alone, use of gas (mainly carbon monoxide), dangerous methods of self-injury (including hanging, gunshot), and use of alcohol as part of the act. For self-poisoning patients, there was a correlation between the number of tablets taken and the total SIS score. Compared with self-poisoning with paracetamol and paracetamol-containing compounds, self-poisoning with antipsychotics was associated with a lower median SIS score while antidepressants had the same estimated median as paracetamol. Use of alcohol within 6hours of self-harm was associated with lower SIS scores. In conclusion, certain methods of self-harm, particularly dangerous methods of self-injury and self-poisoning with gas, were associated with high intent and should alert clinicians to potential higher risk of suicide. However, apart from use of gas, suicidal intent cannot be inferred from type of drugs used for self-poisoning.

Switching methods of self-harm at repeat episodes: Findings from a multicentre cohort study

BackgroundSelf-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. MethodsThe pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. ResultsOver an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching. LimitationsSelf-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. ConclusionsMethod of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm.

Suicide and the ‘Poison Complex’: Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic

Suicide prevention efforts in Asia have increasingly turned to ‘quick win’ means restriction, while more complicated cognitive restriction and psychosocial programs are limited. This article argues the development of cognitive restriction programs requires greater consideration of suicide methods as social practices, and of how suicide cognitive schemata form. To illustrate this, the article contributes an ethnographically grounded study of how self-poisoning becomes cognitively available in Sri Lanka. I argue the overwhelming preference for poison as a method of self-harm in the country is not simply reflective of its widespread availability, but rather how cognitive schemata of poison—a ‘poison complex’—develops from early childhood and is a precondition for suicide schemata. Limiting cognitive availability thus requires an entirely novel approach to suicide prevention that draws back from its immediate object (methods and causes of self-harm) to engage the wider poison complex of which suicide is just one aspect.

Suicide following self-harm: Findings from the Multicentre Study of self-harm in England, 2000–2012

BackgroundSelf-harm is a key risk factor for suicide and it is important to have contemporary information on the extent of risk. MethodsMortality follow-up to 2012 of 40,346 self-harm patients identified in the three centres of the Multicentre Study of Self-harm in England between 2000 and 2010. ResultsNineteen per cent of deaths during the study period (N=2704) were by suicide, which occurred in 1.6% of patients (2.6% of males and 0.9% of females), during which time the risk was 49 times greater than the general population risk. Overall, 0.5% of individuals died by suicide in the first year, including 0.82% of males and 0.27% of females. While the absolute risk of suicide was greater in males, the risk relative to that in the general population was higher in females. Risk of suicide increased with age. While self-poisoning had been the most frequent method of self-harm, hanging was the most common method of subsequent suicide, particularly in males. The number of suicides was probably a considerable underestimate as there were also a large number of deaths recorded as accidents, the majority of which were poisonings, these often involving psychotropic drugs. LimitationsThe study was focussed entirely on hospital-presenting self-harm. ConclusionsThe findings underline the importance of prevention initiatives focused on the self-harm population, especially during the initial months following an episode of self-harm. Estimates using suicide and open verdicts may underestimate the true risk of suicide following self-harm; inclusion of accidental poisonings may be warranted in future risk estimates.

Intentional Self-harm in Children and Adolescents: A Study from Psychiatry Consultation Liaison Services of a Tertiary Care Hospital.

Objective:The objective of this study was to evaluate the socio-demographic and the clinical profile of children and adolescents presenting with Intentional self-harm.Materials and Methods:Records of all children and adolescents (≤19 years) seen by the consultation liaison (CL) services during the period of 2000-2012 were screened. Patients with a diagnosis of intentional self-harm (at the time of assessment) were taken up for this study. Data was extracted from the records, to study the socio-demographic and clinical profile.Results:During the study period, 101 patients aged ≤19 years and diagnosed with intentional self-harm at the time of admission were evaluated by the psychiatry CL services in various emergency and medical surgical wards. In the study population, females (N = 61; 60.4%) outnumbered males. The age of the patients ranged from 12 to 19 with a median and mean of 17.0 years (standard deviation-1.6 years; interquartile range 16-18 years). Children and adolescent with self harm were more commonly females, from nuclear families, middle socio-economic status and Hindu by religion. The common method of self-harm in adolescents is by ingestion of insecticides (65%) and the self-harm behavior was often precipitated by interpersonal problems in the family context. About one-fifth of the patients have psychiatric morbidity.Conclusion:Findings suggest that the most common method of intentional self-harm in children and adolescents is consumption of insecticides and precipitated by interpersonal problems in the family context.

Suicide after nonfatal self-harm.

Nonfatal self-harm is the strongest predictor of suicide, with some of the risk factors for subsequent suicide after nonfatal self-harm being similar to those for suicide in general. However, we do not have sufficient information regarding the medical care provided to nonfatal self-harm episodes preceding suicide. Our study sought to explore hospital care and predictive characteristics of the risk of suicide after nonfatal self-harm. Individuals with history of nonfatal self-harm who died by suicide were compared with those who had a nonfatal self-harm episode but did not later die by suicide. Cases were identified by cross-linking data collected through a self-harm monitoring project, 2000-2007, and comprehensive local data on suicides for the same period. Dying by suicide after nonfatal self-harm was more common for male subjects than for female subjects (OR = 3.3, 95% CI = 1.7-6.6). Self-injury as the method of nonfatal self-harm was associated with higher risk of subsequent suicide than was self-poisoning (OR = 2.0, 95% CI = 1.04-3.9). More urgent care at the emergency department (OR = 2.7, 95% CI = 1.1-6.3) and admission to hospital (OR = 2.0, 95% CI = 1.0-4.0) at the index episode were related to a heightened risk of suicide. The findings of our study could help services to form assessment and aftercare policies.

Emergency Room Visits for Suicide Attempts: Rates, Trends and Sociodemographic Characteristics of Suicide Attempts in Northeastern Anatolia

OBJECTIVE: In this study, we aimed to assess the epidemiology of suicide attempts, especially focusing on rates and trends in Northeastern Turkey. MATERIALS AND METHODS: This is a cross-sectional study including 893 parasuicide events recorded prospectively in 17 emergency rooms of state hospitals in two neighboring counties over three years. Information on each case was recorded on a standardized monitoring form that covered a series of sociodemographic and psychosocial features. RESULTS: In 2007, parasuicide rates per 100,000 inhabitants were 47.7 for females, 17.7 for males, and 32.5 for both genders. Suicide attempts were more common in women in all age groups except ≥50 years. The most common methods of deliberate self-harm were as follows: medical drug/toxic substance ingestion (93.3%), hanging (1.7%), and cutting or stabbing (3.6%). Housewives (53.8%) formed the largest group among women. Physical domestic violence was a common reason for suicide attempts in women aged 15-34 years. The only cited reason for suicide attempts that was predominant in males was financial difficulties. A previous psychiatric diagnosis was present in 19.5% of parasuicide cases, and the rate of seeing a doctor for psychiatric reasons in the last 6 months prior to the suicide attempt was 15.8%. CONCLUSION: Self-poisoning is the most common method for attempted suicide. The risk groups in our region appeared to be younger and married females. The epidemiology of suicide attempt cases in our region resembles a mixture of both European and Asian communities' parasuicide patterns. KEYWORDS: suicide attempt, parasuicide, sociodemographic findings, epidemiology. Language: en

Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study

BackgroundPrevious research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have...

Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: A cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India

BackgroundRates of self harm are high in south India, but little is known about the relationship between antecedent behaviour, suicidal intent and method. AimsTo identify clinical, social and behavioural antecedents preceding an act of self-harm. Methods200 participants, consecutively presenting with deliberate self harm to a hospital in south India, were interviewed. Socio-demographic and clinical characteristics were recorded, together with behaviours preceding self-harm. The Pierce Suicidal Intent Scale and Mini International Neuropsychiatric Inventory were administered. ResultsPesticide poisoning was the most common method, especially amongst men, in rural areas, and amongst professionals. No particular antecedent behaviour or activity appears to be associated with higher levels of suicidal intent. Absenteeism from work was the most commonly reported change of behaviour in the month preceding an act of self-harm. Unskilled labourers and professionals had significantly greater suicidal intent (adjusted for age, gender and method) than skilled labourers and the unemployed. There were no differences in suicidal intent between different methods. Rural dwellers had significantly greater suicidal intent compared to urban dwellers, irrespective of the method. Major Depressive Disorder was associated with significantly greater suicidal intent compared with other diagnoses and no diagnosis. ConclusionsAmongst people who harm themselves in south India, professionals and unskilled labourers, rural residents, and people with current major depressive disorder have higher levels of suicidal intent. Severity of suicidal intent does not appear to influence choice of method of self-harm. Behaviours predictive of self-harm in the west may not be relevant in south India.

Self‐harm in people with epilepsy: A retrospective cohort study

Little is known about self-harm in people with epilepsy, despite suicide being recognized as a leading cause of mortality in this population. This study aimed to investigate the characteristics of self-harm in people with epilepsy, and associated demographic and psychosocial factors. Patients presenting to hospital following self-harm between 1994 and 2008 were identified from the Oxford Monitoring System for Self-Harm. Epilepsy diagnosis was confirmed through review of medical records. Demographic features, patient, and self-harm characteristics of 132 people with epilepsy and 9,778 self-harm patients without epilepsy were compared using a regression model, adjusting for age, sex, and repetition. Patients presenting between 1998 and 2008 were followed up for all-cause mortality to the end of 2011. The rate of self-harm per individual with epilepsy was 2.04 (95% confidence interval [CI] 1.85-2.25) times that of the comparison group, and time between first and second self-harm events was shorter (hazard ratio 1.86; 1.46-2.38). People with epilepsy were significantly more likely to use antiepileptic medication in overdose, although overall methods of self-harm were similar in the two groups. No significant differences in suicide intent scores or the proportion of patients who died by suicide were found. Previous outpatient psychiatric treatment, longer duration of unemployment, experience of violence, and housing problems were associated with self-harm in people with epilepsy. People with epilepsy who self-harm do so more frequently than other self-harm patients. Clinicians should be aware of this and pay attention to contributory factors as these may enhance risk in this population. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

Factors Associated with Hospitalization after Suicide Spectrum Behaviors: Results from a Multicenter Study in Spain

The objective of this study was to identify factors associated with hospital admission after suicide spectrum behaviors. Patients’ characteristics, the nature of the suicidal behavior, admission rates between centers, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in 3 Spanish cities. The intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors, and psychiatric diagnosis of schizophrenia, mood, or personality disorder were independently associated with being admitted. There was a 3-fold between-center difference in the rate of hospitalization. Widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.

Tongues of Fire: Women's Suicide and Self-Injury by Burns in the Kurdistan Region of Iraq

Self-burning and self-immolation are forms of self-harm found across the Eastern Mediterranean region and South and Central Asia. The majority of those choosing these methods of self-harm are young women. Using data from 100 young female survivors of suicidal attempts in the Kurdistan Region of Iraq, this article analyses the phenomenon in the context of a life-course progression arguing that the period around first marriage is a time of particular trauma to women. We suggest that self-burning should be understood as a communicative act with an indigenous semiology which functions as an expression of subordinated agency within a male-dominated society, in which marriage is a major source of conflict between generations and genders.

Development of item bank to measure deliberate self-harm behaviours: Facilitating tailored scales and computer adaptive testing for specific research and clinical purposes

The purpose of this study was to investigate the application of item banking to questionnaire items intended to measure Deliberate Self-Harm (DSH) behaviours. The Rasch measurement model was used to evaluate behavioural items extracted from seven published DSH scales administered to 568 Australians aged 18–30 years (62% university students, 21% mental health patients, and 17% community members). Ninety four items were calibrated in the item bank (including 12 items with differential item functioning for gender and age). Tailored scale construction was demonstrated by extracting scales covering different combinations of DSH methods but with the same raw score for each person location on the latent DSH construct. A simulated computer adaptive test (starting with common self-harm methods to minimise presentation of extreme behaviours) demonstrated that 11 items (on average) were needed to achieve a standard error of measurement of 0.387 (corresponding to a Cronbach׳s Alpha of 0.85). This study lays the groundwork for advancing DSH measurement to an item bank approach with the flexibility to measure a specific definitional orientation (e.g., non-suicidal self-injury) or a broad continuum of self-harmful acts, as appropriate to a particular research/clinical purpose.