Risk Of Self-harm Research Articles

Women with Premenstrual Dysphoric Disorder experiences of suicidal thoughts and behaviours: a mixed methods study

BackgroundWomen with Premenstrual Dysphoric Disorder (PMDD) experience debilitating psychological symptoms during each luteal phase of their menstrual cycle. Although women’s increased risk of suicidal thoughts and attempts to end their lives has been highlighted, little is as yet known about women’s own narratives. Therefore, this study aimed to explore the prevalence and the experiences of self-harm, suicidal thoughts and attempts in women with PMDD.MethodIn this mixed methods study, women’s experiences of living with PMDD were captured via an online survey exploring risk and via semi-structured interviews with questions informed by survey results. Data were analysed using descriptive statistics and reflexive thematic analysis.ResultsOver 3,600 women completed the survey between January and March 2020 and 14 women were subsequently interviewed in 2022. The survey revealed that just under half of women had deliberately harmed themselves during a PMDD crisis, 82% had suicidal thoughts on one or more occasions during their luteal phase, and 26% of women had attempted to end their own life. Three main themes, which related to suicidal ideation in the context of PMDD, were generated from the interview data: 1) personal relationships and social connections affected by PMDD, 2) the increase in suicidal experiences caused by diagnosis delays and 3) self-worth damaged by PMDD.ConclusionWomen living with PMDD are at high risk of self-harm, suicidal thoughts and attempts to end their lives each month, narratives highlighted the damaging impacts PMDD had on relationships. Risk was increased by delays in appropriate medical support and women reported internalising their experiences as their problem.

Risk of Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study

Risk of Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study

Artificial intelligence in suicide prevention: Utilizing deep learning approach for early detection

ABSTRACT Background: Suicide among students is increasing in India and is a matter of grave concern. Early identification of students contemplating suicide would facilitate emergency intervention and may save precious lives. Aim: Our primary objective was to construct an artificial intelligence (AI) model employing an artificial neural network (ANN) architecture to predict students at risk of suicidal tendencies. This initiative was prompted by the necessity to implement a proactive and technologically driven strategy for identifying competitive exam-bound students facing heightened vulnerability. The aim was to facilitate timely interventions aimed at reducing the risk of self-harm. Materials and Methods: An AI model utilizing ANNs is devised for suicide risk prediction among exam-stressed students. A 33-feature input layer is curated based on literature and expert insights, with binary features assigned weighted values. A rigorous hyperparameter optimization approach using the Optuna library to select the most effective neural network model. Ridge regression was used to determine bias or variance in the dataset. Training and testing of the model are conducted using fictional and simulated profiles, respectively, and model performance is assessed through statistical metrics and the Cohen’s Kappa coefficient, benchmarked against expert evaluations. Result: The AI model demonstrates exceptional predictive capabilities for suicide risk assessment among competitive exam students. Quantitative Metrics: The model’s accuracy of 98% aligns predictions with outcomes, distinguishing risk categories. Precision at 100% identifies cases within predicted risks, minimizing false positives. A recall of 97% identifies true risk cases, highlighting sensitivity. F1 Score: The model’s F1 score of 98% balances precision and recall, indicating overall performance. Cohen’s Kappa: With a coefficient of 1.00, the model’s substantial agreement with experts underscores its consistent classifications. Conclusion: The study introduces an AI model utilizing ANNs for suicide risk prediction among stressed students. High precision, recall, and accuracy align with expert evaluations, highlighting its promise for timely risk identification. The model’s efficiency in evaluating large populations swiftly indicates its clinical potential. Refinement and real-world validation remain future considerations.

Risk and Protective Factors of Self-Harm and Suicide in Adolescents in The Era of Society 5.0: A Systematic Review

Risk and Protective Factors of Self-Harm and Suicide in Adolescents in The Era of Society 5.0: A Systematic Review

Importance of variables from different time frames for predicting self-harm using health system data.

Self-harm risk prediction models developed using health system data (electronic health records and insurance claims information) often use patient information from up to several years prior to the index visit when the prediction is made. Measurements from some time periods may not be available for all patients. Using the framework of algorithm-agnostic variable importance, we study the predictive potential of variables corresponding to different time horizons prior to the index visit and demonstrate the application of variable importance techniques in the biomedical informatics setting. We use variable importance to quantify the potential of recent (up to three months before the index visit) and distant (more than one year before the index visit) patient mental health information for predicting self-harm risk using data from seven health systems. We quantify importance as the decrease in predictiveness when the variable set of interest is excluded from the prediction task. We define predictiveness using discriminative metrics: area under the receiver operating characteristic curve (AUC), sensitivity, and positive predictive value. Mental health predictors corresponding to the three months prior to the index visit show strong signal of importance; in one setting, excluding these variables decreased AUC from 0.85 to 0.77. Predictors corresponding to more distant information were less important. Predictors from the months immediately preceding the index visit are highly important. Implementation of self-harm prediction models may be challenging in settings where recent data are not completely available (e.g., due to lags in insurance claims processing) at the time a prediction is made. Clinically derived variables from different time frames exhibit varying levels of importance for predicting self-harm. Variable importance analyses can inform whether and how to implement risk prediction models into clinical practice given real-world data limitations. These analyses be applied more broadly in biomedical informatics research to provide insight into general clinical risk prediction tasks.

Trends in incidence of self-harm, neurodevelopmental and mental health conditions among university students compared to the general population: a nationwide electronic data linkage study in Wales.

Objective and ApproachThey are growing concerns that self-harm and mental health conditions are increasing in university students. This may reflect widening access to higher education, existing population trends or stressors associated with this setting. We linked real-world data from the Higher Education Statistics Agency between 2012-2018 with primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. We used regression approach to examine characteristics of students and non-students and their risks of self-harm and mental health conditions before and during university. ResultsThis e-cohort study included 96,760 students and 151,795 non-students. Being male, self-harm and mental-health conditions recorded before university entry, and higher deprivation levels resulted in lower odds of entering university and higher odds of dropout. Risks of self-harm, Autistic Spectrum Disorder (ASD), depression, anxiety, drug misuse, and schizophrenia were lower for students. Risks of self-harm, ASD, ADHD, depression, alcohol misuse and schizophrenia were increasing more in students over time. Older students experienced higher risk of self-harm and mental-health conditions. Younger students were more at risk of alcohol misuse than non-students. ConclusionsMental health conditions in students are common, diverse and they influence their academic outcomes. University students have mental health needs and trajectories that differ from those of the general population. ImplicationsThe diversity and complexity of students’ needs require integrated person-centred stepped care approach within universities including triage, access to well-being support, counselling, and referral pathways to mental health services.

Association Between Impulsivity, Self-Harm, Suicidal Ideation, and Suicide Attempts in Patients with Traumatic Brain Injury.

Traumatic brain injury (TBI) affects over 48 million people worldwide each year. Suicide is common in TBI, and there are several known contributing factors, including severe TBI, depression, alcohol use, and male sex. Impulsivity, or the tendency to act quickly with little thought, may be an early predictor of suicidality following TBI. The purpose of this study was to evaluate the risk of suicidality in patients with a prior history of impulsivity following a traumatic brain injury (TBI). Using de-identified electronic health records from the TriNetX United States Collaborative Network with Natural Language Processing, three cohorts were generated: the impulsivity TBI cohort (I+TBI+) included subjects with a diagnosis of impulsivity before a diagnosis of TBI; the no impulsivity TBI cohort (I-TBI+) included patients with TBI but no impulsivity; the impulsivity no TBI cohort (I+TBI-) included patients with impulsivity but TBI. Two analyses were conducted, including analysis 1 (impulsivity TBI vs. no impulsivity TBI) and analysis 2 (impulsivity TBI vs. impulsivity no TBI). Patients were 1:1 propensity score matched by age, sex, race, ethnicity, psychiatric diagnoses, and antidepressant use. Outcomes included a diagnosis of self-harm, suicidal ideation, or a suicide attempt within one year after the index event. The all-time incidence of each outcome was assessed across different age categories. The chi-square test (categorical variables) and t-test (numerical variables) were used to assess for differences between groups. A total of 1,292,776 TBI patients were identified in the study. After 1:1 propensity score-matching, there were 20,694 patients (mean [SD] age, 48.1 [21.8]; 8,424 females [40.7%]) with impulsivity and TBI (I+TBI+), 1,272,082 patients (mean [SD] age, 46.0 [23.1]; 562,705 females [44.2%]) with TBI alone (I-TBI+), and 90,669 patients (mean [SD] age, 43.7 [22.6]; 45,188 females [49.8%]) with impulsivity alone (I+TBI-). Within the first year after a TBI, patients with impulsivity were more likely to exhibit self-harm (P < 0.001), suicidal ideation (P < 0.001) or a suicide attempt (P < 0.001). Compared to TBI patients without impulsivity, those with impulsivity had a four-fold increase in the incidence of self-harm (2.81% vs. 0.63%), an eight-fold increase in suicidal ideation (52.42% vs. 6.41%), and a twenty-one-fold increase in suicide attempts (32.02% vs. 1.50%). This study suggests that impulsivity diagnosed before a TBI may increase the risk of post-traumatic suicidality, with a four-fold increased risk of self-harm, an eight-fold increased risk of suicidal ideation and a twenty-one-fold increased risk of suicide attempts. This characterizes a group of at-risk individuals who may benefit from early psychiatric support and targeted interventions following a TBI.

GLP-1 Receptor Agonist Use and Risk of Suicide Death

Concerns have been raised regarding a link between use of glucagon-like peptide-1 (GLP-1) receptor agonists and increased risk of suicidality and self-harm. To assess the association between use of GLP-1 receptor agonists and the risk of suicide death in routine clinical practice. This active-comparator new-user cohort study used nationwide register data from Sweden and Denmark from 2013 to 2021. Adults 18 to 84 years old who initiated treatment with GLP-1 receptor agonists or the comparator sodium-glucose cotransporter-2 (SGLT2) inhibitors were included. Data were analyzed from March to June 2024. Initiation of treatment with a GLP-1 receptor agonist or SGLT2 inhibitor. The primary outcome was suicide death recorded in the cause of death registers. Secondary outcomes were the composite of suicide death and nonfatal self-harm and the composite of incident depression and anxiety-related disorders. Using propensity score weighting, hazard ratios (HRs) with 95% CIs were calculated separately in the 2 countries and pooled in a meta-analysis. In total, 124 517 adults initiated a GLP-1 receptor agonist and 174 036 initiated an SGLT2 inhibitor; among GLP-1 receptor agonist users, the mean (SD) age was 60 (13) years, and 45% were women. During a mean (SD) follow-up of 2.5 (1.7) years, 77 suicide deaths occurred among users of GLP-1 receptor agonists and 71 suicide deaths occurred among users of SGLT2 inhibitors: weighted incidences were 0.23 vs 0.18 events per 1000 person-years (HR, 1.25; 95% CI, 0.83-1.88), with an absolute difference of 0.05 (95% CI, -0.03 to 0.16) events per 1000 person-years. The HR was 0.83 (95% CI, 0.70-0.97) for suicide death and nonfatal self-harm, and the HR was 1.01 (95% CI, 0.97-1.06) for incident depression and anxiety-related disorders. This cohort study, including mostly patients with type 2 diabetes, does not show an association between use of GLP-1 receptor agonists and an increased risk of suicide death, self-harm, or incident depression and anxiety-related disorders. Suicide death among GLP-1 receptor agonist users was rare, and the upper limit of the confidence interval was compatible with an absolute risk increase of no more than 0.16 events per 1000 person-years.

Cross-sectional analysis of healthcare worker mental health and utilisation of a digital mental health platform from 2020 to 2023

BackgroundHealthcare worker (HCW) anxiety and depression worsened during the pandemic, prompting the expansion of digital mental health platforms as potential solutions offering online assessments, access to resources and counselling. The...

Deliberate self-harm in adolescents screening positive for attention-deficit / hyperactivity disorder: a population-based study

BackgroundAdolescents with attention-deficit / hyperactivity disorder (ADHD) have an increased risk of self-harm. The risk of self-harm among adolescents who display an elevated level of ADHD symptoms, but without a formal diagnosis, is not well-studied and understood.ObjectiveTo investigate the relationship between self-reported symptoms of ADHD and self-harm in a population-based sample of adolescents.MethodsAdolescents in the population-based youth@hordaland study were invited to complete the Adult ADHD Self-Report Scale (ASRS) and the Short Mood and Feelings Questionnaire (SMFQ). They were asked whether they ever deliberately have taken an overdose or tried to harm themselves on purpose, once or multiple times, defined according to the code used in the Child and Adolescent Self-harm in Europe (CASE) Study. Adolescents reporting severe problems on ≥ four of six selected items on the ASRS-v 1.1 screener were defined as ADHD-screen positive (ADHD-SC+), and the remaining sample as ADHD-screen negative (ADHD-SC-). SMFQ score ≥ 12 was used to define a high level of depressive symptoms.ResultsA total of 9692 adolescents (mean age 17.4 years, 53.1% females) participated in the study, of which 2390 (24.7%) screened positive on the ASRS. ADHD-SC+ adolescents engaged in self-harm more often than the ADHD-SC- group (14.6% vs. 5.4%, OR = 3.02, 95%CI [2.57–3.24]). This remained significant after adjustment for demographic variables, SMFQ score ≥ 12, symptoms of conduct disorder and familial history of self-harm and suicide attempts (OR = 1.58, 95%CI [1.31–1.89]). They were also more likely to report an overdose as their method of self-harm (OR = 1.52, 95%CI [1.05–2.23]). Within the ADHD-SC+ group female sex, high levels of inattention and hyperactivity/impulsivity symptoms, SMFQ score ≥ 12, symptoms indicating conduct disorder and familial history of self-harm and suicide attempts increased the likelihood of engaging in deliberate self-harm.ConclusionAdolescents who screened positive for ADHD had increased risk of engaging in self-harm. Clinicians should consider the increased risk of such engagement in adolescents who present with high level of ADHD symptoms, even in the absence of a clinical ADHD diagnosis.

Child Maltreatment, Mental Health Disorders, and Health Risk Behaviors in People With Diverse Gender Identities.

This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders-major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors-smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.

Kriminogén rizikófaktorok az önmérgező serdülők szuicid szándékának alakulásában – Hipotézisek felvetése pszichiátriai konzíliumi munka alapján

Aim: Adolescents frequently encounter normative crises that are neither deviant nor pathologically rooted, yet professionals and daily caregivers may sometimes perceive them as such. Deliberate self-poisoning, a prevalent form of suicidal behaviour in adolescents, often coexists with indicators of deviant developmental patterns and family backgrounds suggestive of potential future criminal lifestyles. This study aims to scrutinise the validity of this assumption. Methodology: Employing document analysis, they examined handwritten consultation records and subjected the extracted data to statistical chi-square tests. Findings: The study encompassed 109 cases (88 girls, 21 boys). While criminogenic risk factors were identified in the adolescents’ lives, the majority showed no direct association with suicidal intent or ideation. Exceptions included school drop-out, domestic violence, and bullying, associating with suicidal intent, and bullying alone linked to suicidal ideation. Both intent and ideation were more prevalent among girls. Value: They findings indicate that deliberate self-harm and criminogenic risk factors are largely disconnected. Thus, they emphasise that attributing deviant family backgrounds and future career prospects to adolescents’ self-poisoning is misleading. Professionals within a child’s environment must refrain from such labelling in their daily communication.

Videoconferencing CBT: a mixed-methods analysis of outcomes amongst young people depending on current self-harm risk status

PurposeA notable number of young people self-harm, with only a minority receiving professional support. Evidence suggests that therapy can help recovery from self-harm, but little is known about the experiences of those who self-harm and participate in therapy delivered via videoconferencing.Design/methodology/approachRisk assessments were examined for evidence of self-harm and used to identify two groups for analysis: young people who had self-harmed in the past six months and those who had not. A mixed methods analysis was then conducted to examine process and outcome data for these two groups. Data included a number of sessions attended, late-cancelled and missed without notice; and patient-reported outcome measure scores (Young Person-Clinical Outcomes in Routine Evaluation and Revised Children’s Anxiety and Depression Scale). End-of-treatment reports were subsequently analysed using thematic analysis.FindingsThose with current self-harm risk appeared to start therapy with lower well-being. No notable differences in progress were found between groups on quantitative outcomes. There was greater reporting of poorer clinical outcomes in the reports of those with current self-harm risk, including two unique types of barriers to effective therapy: “general difficulties” (e.g. poor well-being limiting engagement, specific components of therapy being challenging) and “CBT was not preferred”.Originality/valueLower baseline well-being could explain the greater ongoing care needs and lower well-being post-therapy among those with current self-harm risk, despite both groups appearing to make similar levels of therapeutic progress quantitatively. Recent self-harm does not appear to reduce the utility of videoconferencing cognitive behavioural therapy; however, clients’ individual needs should be carefully considered.

Unintentional Intoxication or Injury and Risk for Self-Harm in Adolescents and Young Adults

This cohort study explores the risk of nonfatal self-harm in French adolescents and young adults hospitalized for unintentional intoxication or injury.

Symptoms of the suicide crisis syndrome and therapist emotional responses: associations to self-harm and death by suicide within 18-months post-discharge among patients at an acute psychiatric department

Background and aims This study explored the associations between symptoms of the Suicide Crisis Syndrome (SCS) at admission and self-harm and death by suicide post-discharge. The association between clinicians’ emotional responses toward inpatients at admission and post-discharge self-harm and suicide death was also explored. Methods Within the first 24-h of admission, patients completed a self-report measure of symptoms of SCS, and clinicians reported their emotional responses toward the patients. Follow-up data were obtained from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. Results Within 18 months post-discharge, 44 (12.7%) out of 347 patients had self-harmed, and five patients (1.4%) had died by suicide. At admission, patients who later self-harmed reported higher symptoms of SCS compared to the other patients. Clinicians reported more negative emotional responses toward the self-harm group. In a regression analysis, previous suicidal behavior and a diagnosis of “emotionally unstable personality disorder” (EUPD; F60.3) were associated with increased risk of self-harm post-discharge. Conclusion The results indicated that patients with post-discharge episodes of self-harm are significantly different from patients who do not self-harm in terms of more intense symptoms of SCS during admission. Clinicians’ negative emotional responses may be relevant in the assessment of the risk of post-discharge self-harm.

A Systematic Review on Ketamine and Esketamine for Treatment-Resistant Depression and Suicidality in Adolescents: A New Hope?

Treating depression in adolescents is a significant challenge, and major depressive disorder (MDD) with suicidal ideation and treatment-resistant depression (TRD) are common and potentially devastating to optimal psychological and physical development in this age group. Suicide is among the leading causes of youth mortality, and TRD occurs in up to 40% of adolescents with MDD. TRD involves severe, persistent symptoms that are hard to treat, significantly reducing functioning and quality of life. We conducted a literature search focusing on key terms related to ketamine and esketamine for MDD with suicidal ideation and TRD in adolescents, aiming to review the potential utility of these molecules in adolescents for these conditions. Ketamine has shown efficacy in reducing depressive symptoms in adolescents with TRD. Esketamine has shown efficacy in reducing depressive symptoms and treating suicidal ideation in adolescents. Both ketamine and esketamine have demonstrated favorable safety and tolerability profiles. Using these drugs for serious conditions like adolescent MDD with suicidal thoughts and TRD can effectively treat symptoms, reduce self-harm and suicide risks, and provide a window for longer-term therapeutic interventions. The prompt and effective treatment of TRD could improve adolescents' quality of life. However, more research is needed to optimize treatment protocols and evaluate long-term effects.

Suicide and Intentional Self-harm Among Older Men Treated With 5-Alpha Reductase Inhibitor or Alpha-blockers for Benign Prostatic Hyperplasia

ObjectiveTo compare the risk of intentional self-harm (ISH) and suicide in older men using 5-α reductase inhibitors (5-ARIs) and alpha-blockers for benign prostatic hyperplasia (BPH). Observational research of older men with BPH suggested an increase in ISH with 5-ARI use compared with nonuse; we aimed to address potential confounding by indication with an active comparator reference group. MethodsUsing Medicare data linked to the National Death Index (NDI) from 2007-2016, we implemented a retrospective cohort design in males aged ≥65 years who initiated 5-ARI or alpha-blocker use for BPH. ISH was identified using ICD-9-CM and ICD-10-CM diagnosis codes. Suicides were identified through cause-of-death information from the NDI. We used inverse probability of treatment weighted Cox proportional hazards regression to compare time-to-event between treatment groups, with robust variance estimation. ResultsThe event rates for ISH and suicide, respectively, were 0.314 and 0.308 per 1000 person-years (PY) among 5-ARI users (n=181,675), and 0.364 and 0.382 per 1000PY among alpha-blocker users (n=850,476). For 5-ARI use relative to alpha-blocker use, hazard ratios (HRs) for ISH and suicide, respectively, were 0.88 (95% CI:0.62–1.25) and 0.82 (95% CI:0.54–1.24); for the composite outcome (non-fatal ISH or suicide), the HR was 0.88 (95% CI:0.66–1.16). Subgroup and sensitivity analyses supported these results. Conclusion5-ARI use was not associated with an increased risk for ISH or suicide compared to alpha-blocker use in older men with BPH. Study limitations included low event rates and potentially low sensitivity for ISH events.

Cyberbullying Perpetration and Victimization as Risk Factors for Self-Harm: Results From a Longitudinal Cohort Study of 13–14-Year-Olds in England

PurposeCyberbullying is a crucial issue that affects adolescent mental health, with evidence to suggest that adolescents who are victims of cyberbullying are at higher risk for self-harm. However, longitudinal evidence is lacking, meaning the direction of effects cannot be established. This study investigated longitudinal associations between levels of cyberbullying involvement (bully, victim, or both), frequency, and self-harm a year later in an adolescent sample. MethodsData were collected from Year 9 students (13–14-year-olds; N = 1,195) enrolled in 19 schools in Southwest England using an online questionnaire with a 1-year follow-up period (October 2019–October 2020). Multivariable logistic regression analysis was conducted to test for associations between different levels of cyberbullying involvement at baseline and the likelihood of self-harm a year later, adjusting for key covariates. A secondary regression analysis also explored the associations between the frequency of cyberbullying involvement at baseline and subsequent self-harm. ResultsCompared to those with no cyberbullying involvement, individuals who were both victims and perpetrators (adjusted odds ratio = 2.94, 95% confidence interval: 1.99–4.34) as well as victims only (adjusted odds ratio = 2.81, 95% confidence interval: 1.95–4.04) showed an increased risk of subsequent self-harm. In terms of frequency, associations were found between frequent and occasional cyberbullying and self-harm for both victims and perpetrators; however, associations for the perpetrator group attenuated to the null following adjustment for covariates. DiscussionOur findings highlight cyberbullying in early adolescence as a risk factor for subsequent self-harm. Cyberbullying prevention should be a priority for school mental health interventions, with consideration that most perpetrators of cyberbullying may also be victims.

The Torture of Isolation: The Negative Effects of Solitary Confinement

Solitary confinement is a popular form of punishment for misbehaving inmates in United States’ prison systems. However, the question surrounding solitary confinement is the psychological effect on solitary confinement inmates. Two studies were analyzed to determine not only what the effects of isolation were, but how the findings from these studies could be applied to the field of psychology and everyday life. Even with the drastic difference in sample size and data collection methods between the two studies, the results from both studies were that solitary confinement has lasting negative psychological effects. It causes incarcerated individuals to be at increased risk for mild psychosis, self harm, anxiety, and depression. This mental decline can be explained with social and developmental psychology, namely ostracism and Erikson’s developmental stages, which both demonstrate why social relationships are necessary for personal well being. The information from this research also exemplifies why people are averse to social isolation, for instance, the mandated quarantine and social distancing during the COVID-19 pandemic. The concern is how these lasting psychological effects impact the ability of these individuals to be rehabilitated and reintegrated into general society.

Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm

BackgroundPresentation to the emergency department (ED) with self-harm provides an important opportunity for intervention.AimsTo investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health–related aftercare.MethodData on consecutive self-harm presentations to EDs for the years 2013–2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated.ResultsHalf of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health–related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51–0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017–2019 vs. 2013–2016), but was more likely for those brought by ambulance, presenting outside 9 am–5 pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14–10.62).ConclusionsThe findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.