Self-harm Research Articles

The association between aggressive behaviour and non-suicidal self-injury and shared risk factors in adults with mild intellectual disability.

Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them. We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements. There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB. Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.

Gender-specific factors of suicidal ideation among high school students in Yunnan province, China: A machine learning approach.

Suicidal ideation (SI) assumes a pivotal role in predicting suicidal behaviors. The incidence of SI among high (junior and senior) school students is significantly higher than that of other age groups. The aim of this study is to explore the gender differences in SI among high school students in Yunnan Province. A total of 6180 students in grades 7-12 in Yunnan province, China from May 2021 to May 2022 participated in this survey. Univariate analysis was employed to describe the influencing factors of male and female students' SI. Subsequently, data were stratified by gender. Adopting machine learning technique, including Least Absolute Shrinkage and Selection Operator (Lasso) and Boruta algorithm, and logistic regression model to estimate the direction and effect magnitude of the influencing factors. The prevalence of SI was significantly higher for females (31.34%) than males (16.73%). The logistic regression model was established using the variables screened by Boruta algorithm, indicated that anxiety, depression, suffering emotion abuse or emotion neglect in childhood, non-suicidal self-injury, evening chronotype are common risk factors for SI in male and female students. Notably, female students who exhibited aggressive behavior, have experienced bullying, and were in the junior high school learning stage were more likely to report SI than their male counterparts. Females showed more vulnerability to SI than males especially among females in junior high school, reporting aggressive behavior and bullying experiences. Tailored prevention strategies, informed by these gender-related distinctions, should be developed and implemented.

How to prevent suicidal behavior and non-suicidal self-injury? An analysis of adolescent typologies

Non-suicidal self-injury (NSSI) and suicidal behavior in adolescence are global mental health concerns. These behaviors are often interconnected, but can also manifest independently. This study aimed to assess the predictive abilities of neuroticism, emotional competencies, and the school social climate on four typologies based on the presence of NSSI and levels of suicidal behavior. The study included 713 participants aged 11–16 years who completed questionnaires assessing suicidal behavior, NSSI, neuroticism, emotional competencies, and the school social climate. The data were analyzed using logistic regression techniques. The findings revealed that adolescents with high levels of neuroticism and emotion perception, low levels of emotion expression and regulation and an inadequate school social climate were more likely to belong to typologies characterized by NSSI and/or high suicidal behavior. This study underscores the importance of enhancing the school social climate as a crucial step toward reducing the likelihood of NSSI and suicidal behavior.

A systematic review and meta-ethnography exploring personal perspectives of recovery among those with lived experience of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is a significant public health concern. Research and treatment interventions largely focus on stopping self-injury. People who self-injure do not necessarily equate recovery to cessation. Qualitative accounts allow greater understanding of personal recovery narratives. This study aimed to synthesise personal conceptualisations of NSSI recovery. Participants had lived experience of NSSI and discussed their recovery. Papers not written in English or had a quantitative design were excluded. Four databases (PsycInfo, CINAHL, Medline and Web of Science) were systematically searched. The quality of each paper was assessed using the CASP quality assessment tool. Data were synthesised using a meta-ethnographic approach. Thirteen studies comprising 159 participants were included. Three overarching themes were developed. While ceasing NSSI was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non-linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis. This was the first qualitative synthesis of personal conceptualisations of NSSI recovery. The findings highlighted the personal and multifaceted nature of NSSI recovery and supported person-centred models of self-injury recovery. Clinical implications include the importance of expanding self-injury recovery beyond cessation within research and clinical practice, and for collaborative and person-centred approaches to be embraced when supporting those who self-injure.

Self-harming behaviours and social support among a sample of young men in Belfast, Northern Ireland

Abstract Background Psychiatric morbidity is substantially higher in Northern Ireland (NI) than in peer nations and men are disproportionately represented in suicide mortality data, particularly at early adulthood and middle age. To better scale interventions to reduce morbidity and mortality among young men, a mixed-methods study was conducted combining interviews and validated quantitative tools. Methods A non-random community sample of 30 working-class young men in Belfast aged 16-19 was recruited via organisations focused on job training, restorative justice, and youth work. Participants completed the Self-Harm Inventory and a semi-structured interview. Analyses were completed in NVivo and RStudio. Results The prevalence of self-harm was more than 8 times higher than for the general population of adolescents in NI, with 83.3% reporting ever engaging in self-harm. Only 2 of the 28 participants reported making a suicide attempt and most injuries were minor, suggesting nonsuicidal self-injury (NSSI) represented almost all injuries. Although the sample had a higher risk profile than the general population-with high levels of trauma, substance use, and socioeconomic deprivation-participants also endorsed strong social connections to friends, family, and community. While many expressed concerns about sharing their own emotional distress, almost all reported that disclosures are important to avert poor mental health and shared times when they or friends sought support. Conclusions Although there was a high prevalence of NSSI in the sample, the low prevalence of suicide attempts may be associated with the high levels of protective social connections reported by participants. Gender-based concerns regarding emotional support were common, but there was also strong endorsement for the importance of seeking support from trusted relationships. This suggests that there may be an appetite for male role models to provide education around the “bravery” of help-seeking. Key messages • Prevalence of nonsuicidal self-injury may be substantially more elevated in some populations of adolescent males. • Gender-based concerns continue to act as a barrier to young men sharing their emotional distress with trusted individuals.

Gambaran Kecenderungan Perilaku Self Injury pada Siswa SMP

This research is motivated by the phenomenon of junior high school students who have difficulty channeling negative emotions when facing problems. Self-injury behavior will have a negative impact on students, therefore students are expected to be able to carry out positive activities to vent their negative emotions. The objectives of this study are (1) to describe the tendency of students' self-injury behavior, (2) to describe the tendency of students' self-injury behavior from the environmental dimension, (3) to describe the tendency of students' self-injury behavior from the biological dimension, (4) to describe the tendency of students' self-injury behavior from the cognitive dimension, (5) to describe the tendency of students' self-injury behavior from the affective dimension and (6) to describe the tendency of students' self-injury behavior from the behavioral dimension. The method used is quantitative descriptive, with a sample of 49 students and the instrument used is a self-injury behavior tendency instrument with a Likert scale. The results of the study showed that: (1) the tendency of self-injury behavior in students as a whole is in the moderate category (56.44%), (2) the tendency of self-injury behavior in students from the environmental dimension is in the moderate category (55.10%), (3) the tendency of self-injury behavior in students from the biological dimension is in the moderate category (61.22%), (4) the tendency of self-injury behavior in students from the cognitive dimension is in the low category (48.98%), (5) the tendency of self-injury behavior in students from the affective dimension is in the moderate category (42.86%) and (6) the tendency of self-injury behavior in students from the behavioral dimension is in the moderate category (46.94%). Based on the results of this study, it is recommended that guidance and counseling teachers provide services to reduce the tendency of self-injury behavior in students in the form of information services, individual counseling services, group counseling services and group guidance services.

Risky decision-making and nonsuicidal self-injury among university students: Examining the role of criticism feedback.

Risky decision-making putatively contributes to nonsuicidal self-injury (NSSI) yet empirical support for this association is inconsistent. Studies have not simulated socioemotional contexts most closely linked to NSSI, which may partially explain mixed findings. Accordingly, we examined the association between NSSI and risky decision-making following the receipt of criticism from a close other, a key interpersonal context. The study included 286 university students (Mage = 21.11) oversampled for a lifetime history of NSSI. Participants completed a modified Iowa Gambling Task, in which they chose to play or pass on "good" and "bad" decks associated with monetary gains and losses. Participants also completed the Criticism Gambling Task, which was identical to the Iowa Gambling Task except critical audio comments preceded each block of trials. Based on results of multilevel growth curve analyses, decreases in risky decision-making were steeper on the Iowa Gambling Task compared to the Criticism Gambling Task, suggesting poorer learning in the context of criticism. Further, how past-month NSSI was related to changes in risky decision-making across blocks differed between the two tasks, b = -0.004, t(3140.00) = 2.48, p = .013. On the Iowa Gambling Task, all participants decreased their risky decision-making, whereas on the Criticism Gambling Task, higher past-month NSSI frequencies were associated with riskier decision-making. Our findings support associations between risky decision-making and NSSI in negative socioemotional contexts, consistent with functional models of NSSI.

Different influence paths of peer victimization and cybervictimization on non-suicidal self-injury: a longitudinal moderated mediation model

Different influence paths of peer victimization and cybervictimization on non-suicidal self-injury: a longitudinal moderated mediation model

Symptom profile in suicide attempters during the COVID-19 pandemic: Relationships with suicide outcomes.

Suicidal behavior constitutes a multi-cause phenomenon that may also be present in people without a mental disorder. This study aims to analyze suicidal behavior outcomes in a sample of attempters, from a symptom-based approach. The sample comprised 673 patients (72% female; M=40.9years) who attended a hospital emergency department due to a suicide attempt. A wide range of clinical factors (e.g., psychopathology symptoms, psychiatric diagnoses, impulsivity, acquired capability), was administered within 15days after the index attempt. Nine psychopathology domains were explored to identify the profile of symptoms, using latent profile analysis. The relationship between the profile membership and suicide outcome (i.e., intensity of suicidal ideation, number of suicide behaviors, and medical injury derived from index attempt) was also studied, using linear and logistic regression. Three psychopathology profiles were identified: high-symptom profile (45.02% of participants), moderate-symptom profile (42.50%), and low-symptom profile (12.48%). High-symptom profile members were more likely to show higher risk of non-suicidal self-injury, acquired capability for suicide, and more severe suicide behavior and ideation. On the other hand, a more severe physical injury was associated with low-symptom profile membership in comparison to membership from the other profiles (OR<0.45, p<.05). A symptom-based approach may be useful to monitor patients and determine the risk of attempt repetition in the future and potential medical injury, and to optimize prevention and intervention strategies.

Does patient-ventilator asynchrony really matter?

Past observational studies have reported the association between patient-ventilator asynchronies and poor clinical outcomes, namely longer duration of mechanical ventilation and higher mortality. But causality has remained undetermined. During the era of lung and diaphragm protective ventilation, should we revolutionize our clinical practice to detect and treat dyssynchrony? Clinicians' ability to recognize asynchronies is typically low. Automatized softwares based on artificial intelligence have been trained to largely outperform human eyesight and are close to be implemented at the bedside. There is growing evidence that in susceptible patients, dyssynchrony may lead to ventilation-induced lung injury (or patient self-inflicted lung injury) and that clusters of such dyssynchronous events have the highest association with poor outcomes. Dyssynchrony may also be associated with harm indirectly when it reflects over-assistance or over-sedation. However, the occurrence of reverse triggering by means of low inspiratory efforts during passive ventilation may prevent diaphragm dysfunction and atrophy and be beneficial. Most recent evidence on the topic suggests that synchrony between the patient and the mechanical ventilator is a critical element for protecting lung and diaphragm during the time of invasive mechanical ventilation or may reflect inadequate settings or sedation. Therefore, it is a complex situation, and clinical trials are still needed to test the effectiveness of keeping patient-ventilator interaction synchronous on clinical outcomes.

PANDAS, a series of difficult decisions: a case report

BackgroundPediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) is a controversial diagnosis with limited evidence-based treatment guidelines available, particularly for severe and treatment-resistant cases.Case presentation: This report describes a 9-year-old male presenting with sudden onset, severe obsessive-compulsive disorder (OCD) symptoms one month following a streptococcus infection. His symptoms included suicidality and recurrent self-injurious behaviors, which led to multiple inpatient hospitalizations. He was diagnosed with PANDAS and was treated with psychotropic medications, antibiotics, immunotherapy, and a tonsillectomy. Over the two years since initial admission, the patient’s condition improved, with a decrease in symptom severity and an increase in adaptive functioning, though symptom remission was slow to occur.ConclusionsThis paper explores the controversies surrounding the PANDAS diagnosis, reviews potential treatments, and discusses the dilemmas of medical decision-making in the setting of severe treatment-resistant symptoms and limited evidence-based guidelines. We hope that this case report will be valuable to healthcare providers facing similar presentations and inspire further investigation into this complex condition.

Exploring the effect of family function on non-suicidal self-injury among Chinese adolescents in different family socioeconomic status.

Non-suicidal self-injury (NSSI) among adolescents represents an alarming public health concern worldwide. Both family function and family socioeconomic status (SES) were found to play important roles in adolescent NSSI engagement. However, the effects of family function on NSSI among adolescents in different family SES are not well evidenced. This study aimed to explore how family functions (adaptation, partnership, growth, affection, and resolve) affect NSSI among adolescents in different family SES levels. Data used in this study was derived from the Students' Mental Health Network Project (SMHN), a survey conducted among 8,872 pairs of adolescent-caregivers in a city in central China. Socio-demographic characteristics, family function, NSSI, adverse life events, and depressive symptoms were measured among adolescents. Family SES were generated from caregivers self-reported information using principal component analysis. Chi-square test and multivariate binary logistic regression analyses were adopted to analyze the effects of family function on NSSI. It revealed that 10.2% of adolescents reported engaging in NSSI in the past 12 months. Poor family function and high family SES were positively associated with NSSI. Partnership, both adaptation and affection, resolve were NSSI-protective factors for adolescents in low, middle, high family SES, respectively. Efforts to address NSSI should acknowledge the association between family function and NSSI among adolescents in different family SES levels.

Alterations of regional brain activity and corresponding brain circuits in drug-naïve adolescents with nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) is one of the major public health problems endangering adolescents. However, the neural mechanisms of NSSI is still unclear. The purpose of this study was to explore regional brain activity and corresponding brain circuits in drug-naïve adolescents with NSSI using amplitude of low-frequency fluctuations (ALFF) combined with functional connectivity (FC) analysis. Thirty-two drug-naïve adolescents with NSSI (NSSI group) and 29 healthy controls matched for sex, age, and level of education (HC group) were enrolled in this study. ALFF and seed-based FC analyses were used to examine the alterations in regional brain activity and corresponding brain circuits. The correlation between ALFF or FC values of aberrant brain regions and clinical characteristics were detected by Pearson correlation analysis. The NSSI group showed increased ALFF in the left inferior and middle occipital gyri, lingual gyrus, and fusiform gyrus; additionally, decreased ALFF in the right medial cingulate gyrus, left anterior cingulate gyrus, and left medial superior frontal gyrus compared to those in the HC group. With the left inferior occipital gyrus as seed, the NSSI group showed increased FC between the left inferior occipital gyrus and the bilateral superior parietal gyrus, right inferior parietal angular gyrus, right inferior frontal gyrus of the insular region, and left precuneus relative to that the HC group. With the left anterior cingulate gyrus as seed, the NSSI group showed increased FC between the left anterior cingulate gyrus and right dorsolateral superior frontal gyrus. With the left lingual gyrus as seed, the NSSI group showed increased FC between the left lingual gyrus and right middle frontal gyrus, and decreased FC between the left lingual gyrus and the left superior temporal gyrus, right supplementary motor area, and left rolandic operculum. With the left fusiform gyrus as seed, the NSSI group showed increased FC between the left fusiform gyrus and left middle and inferior temporal gyrus, and decreased FC between the left fusiform gyrus and the bilateral postcentral gyrus, right precentral gyrus, right lingual gyrus, and left inferior parietal angular gyrus. Moreover, the FC value between the left fusiform gyrus and left inferior temporal gyrus was positively correlated with suicidal ideations score. This study highlights alterations in regional brain activity and corresponding brain circuits in brain regions related to visual and emotional regulation functions in drug-naïve adolescents with NSSI. These findings may facilitate better understand the underlying neural mechanisms of NSSI in adolescents.

Psycho-Socio-Demographic Risk Factors of Self-injurious Behaviors in Iranian Females Inmates: A Case-Control Study

Background: Self-injurious behavior or self-harm among inmates is a common phenomenon. However, no study has yet been conducted in Iran regarding self-harm in female inmates. Objectives: The present study aimed to investigate the psycho-socio-demographic risk factors associated with non-suicidal self-harm in Iranian female inmates. Patients and Methods: Participants in this case-control study were 306 female inmates in Tehran, who were randomly selected and divided into two groups: (1) 88 individuals who scored 5 or higher on the Sansone Self-harm Inventory (SHI), and (2) 88 individuals randomly selected from the 218 inmates who did not self-harm as the comparison group. The participants completed a researcher-designed questionnaire, SHI, and the Difficulties in Emotion Regulation Scale. The data were analyzed using logistic regression analysis in SPSS version 16. Results: Logistic regression analysis revealed that marital status (B = 1.438, P = 0.002), arrest history (B = 1.295, P = 0.005), substance abuse (B = 1.198, P = 0.011), psychiatric diagnoses (B = 1.126, P = 0.018), parental divorce (B = 1.280, P = 0.005), and difficulties in emotion regulation (B = 0.027, P = 0.022) were significant predictors of self-harm in inmates. Although there was a difference in the addiction rates of parents between those with self-harm and those without, this variable did not predict self-harm in female inmates (B = 0.488, P = 0.307). Conclusions: The results of this study underscore the importance of family-based preventive interventions to prevent self-harm behaviors among female inmates.

Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States.

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than one to 100%, with a mean of 29.6 +/- 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that pre-admission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at-risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the U.S..

Mobile phone addiction and self-injury in adolescents with MDD: mediation by self-esteem and depression, and the failure of usage restrictions

BackgroundPrevious studies have suggested a significant association between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) in general adolescents. However, limited research has analyzed this relationship in clinical populations, such as those with major depressive disorder (MDD), and the potential mediation mechanisms remain unclear.MethodsThis cross-sectional observational study analyzed data from 2343 adolescents with MDD (77.9% females; mean age = 14.99 years, SD = 1.65). Using mediation models, we explored the roles of self-esteem and depression severity (measured by Patient Health Questionnaire-9) in the relationship between MPA and NSSI. Additionally, we evaluated the associations between existing school-implemented mobile phone usage policies and levels of MPA, self-esteem, depression symptoms, and NSSI.ResultsMPA was significantly associated with NSSI, with low self-esteem and increased depression severity almost entirely mediating this effect (log-odds = 0.016, 95%CI = 0.02–0.013). Subdomains of MPA, including inability to control craving, feelings of anxiety, and productivity loss, followed similar mediation models, while the subdomain of withdrawal/escape had a partial effect mediated by depression severity. Additionally, enforced restrictions on mobile phone usage in schools did not show positive effects on related variables and even exacerbated MPA by increasing cravings and reducing productivity.ConclusionOur study suggests that MPA in adolescents with MDD may be an important risk factor for NSSI occurrence, and that reducing the negative impact of mobile phone usage on self-esteem and depressive symptoms, rather than simply restricting usage, may be crucial for effective intervention.

Mediating effects of child schema mode in the relationship between negative parent-child relationships in childhood and non-suicidal self-injurious behavior in college students

This study was aimed to investigate the psychological mechanisms underlying non-suicidal self-injurious behavior. For this purpose, we hypothesized that dysfunctional child modes act as a psychological mechanism to influence the relationship between negative parent-child relationships in childhood and current cognitions (catastrophizing), emotions (emotional dysregulation and depression), and behaviors (non-suicidal self-injurious behaviors). A sample of 430 college students (male 97, female 333) with experience of non-suicidal self-injurious behavior was selected to test the multi-mediation effects of child schema mode (angry, impulsive), catastrophizing, emotional dysregulation, and depression on the relationship between negative parent-child relationships in childhood and non-suicidal self-injury. As a result of structural equation modeling analysis, it was found that negative parent-child relationships in childhood directly influenced child schema mode, catastrophizing, depression, and non-suicidal self-injurious behaviors. In addition, it was found that negative parent-child relationships in childhood were dually mediated by child schema mode and depression and child schema mode and emotional dysregulation. The present study highlights the mediating role of child schema modes as a psychological mechanism underlying the relationship between negative parent-child relationships in childhood and non-suicidal self-injurious behavior. Based on these findings, the usefulness and direction of schema therapy interventions in the field of non-suicidal self-injury counseling are discussed.

Epidemiology and characteristics of unintentional self-inflicted penetrating ocular injuries in children less than 6 years-old

IntroductionPediatric ocular injuries, notably unintentional self-inflicted penetrating ocular injuries in children under 6, pose a substantial public health concern, leading to visual impairment and psychological distress. With global prevalence indicating severe visual impairment or blindness in 2–14% of affected children, these injuries necessitate multiple surgeries and extended monitoring. Our study aims to analyze the epidemiology and characteristics of such injuries, emphasizing preventive measures, parental supervision, and timely medical intervention to mitigate their impact on young lives.MethodConducted at Khalili Hospital in Shiraz, Iran, our retrospective study included 141 cases admitted between April 2018 and April 2023. Ethical principles guided data collection from medical records, encompassing demographic details, causative objects, ocular laceration specifics, surgical procedures, complications, and visual acuity assessments.ResultsThe mean age of the participants in this study was 47.18 ± 16.48 months (ranging from 10 to 71 months), and the male to female ratio was 1.76:1 (90 vs. 51). Objects of injury mostly included knives (34.8%), wood (12.1%), and glass (10.6%), and the most common initial manifestation of injury was iris prolapse (56.7%), followed by traumatic cataract (46.8%) and limbus laceration (34.0%). Fifteen (10.6%) patients had a visual acuity better than LogMAR 0.5, 24 (17.1%) had finger count vision, 37 (26.2%) had hand motion, 7 (0.5%) had light perception, and 58 (41.1%) were uncooperative. Type of laceration and season of injury were associated with retinal detachment, and a longer time-to-visit was correlated with a higher risk of developing retinal detachment or endophthalmitis.ConclusionOur study highlights the significant burden of unintentional self-inflicted penetrating ocular injuries in children under 6. Emphasizing preventive measures, parental supervision, and timely medical intervention, our findings underscore the potential psychological and visual consequences. This research advocates for parental education and safety measures to reduce the occurrence and severity of such injuries in this vulnerable population, promoting a healthier and safer environment for children.

Risk of Suicide and Suicidality in Patients with Moderate to Severe Psoriasis: results from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR).

Psoriasis is associated with poor mental health and reduced quality of life. Although the high risk for depression in patients with psoriasis is well-established, their suicidality risk is uncertain. Previous studies provide contrasting results and have not included patients with clinically-confirmed severe disease. Our aim was to determine risk of suicide among patients with moderate to severe psoriasis compared with the general population, and investigate if psychiatric comorbidity or history of suicidality increases future suicidality risk in psoriasis. We further estimated the incidence of suicidal and self-injurious behaviours in patients. Analysis was performed using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). As controls, general population mortality and suicide data were used. There were 9 suicides in BADBIR. The incidence rate of suicide was 12.5 per 100,000 person-years (95% CI 6.53, 24.11) in BADBIR versus 11.0 per 100,000 person-years (95% CI 10.7, 11.3) in the general population in England and Wales. Among patients, psychiatric comorbidity or past suicidality was associated with higher risk for suicidal ideation, suicide attempts and self-injurious behaviours. Suicide rates among patients with moderate to severe psoriasis were not significantly higher compared with the general population. Suicide is a rare event and our results are limited by the uncertainty in the estimate reliability. However, considering the high depression prevalence in psoriasis, our findings support the need for prompt assessment of patients for psychiatric comorbidities and suicidality history. Further research is required on suicidal behaviours and the role of psoriasis severity.

Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs.

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.g., overdose, suicide attempts, non-suicidal self-injury, falls and fall-related injuries, fire-setting, hoarding, apartment takeovers, violence, property damage, drug selling) in their programs. In-depth interviews were completed with a purposive sample of 32 service providers. Data were analyzed using an integrative approach that incorporated techniques from qualitative description and thematic analysis. Four thematic factors, which were comprised of various barriers and facilitators, that affected management of high-risk issues in supportive housing and Housing First programs were identified: [1] flexibility in addressing risk issues; [2] early identification of risk issues; [3] built environment and housing location; and [4] resource availability. Overall, the findings underscore how service providers aim to identify high-risk issues promptly, beginning as early as referral, and that their capacity to effectively do this and intervene accordingly is dynamically shaped by various aspects of the program model, environment, and availability of internal and external resources. Yet, the findings also highlight how risk management approaches may conflict with other programmatic goals and values, and the importance of considering these collectively. Systems-level changes to strengthen programs' capacity to prevent risk and implications for future research are discussed.