Risk Of Self-harm Research Articles

Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers

Cancer is a life-altering event causing considerable psychological distress. However, information on the total burden of psychiatric disorders across all common adult cancers and therapy exposures has remained scarce. Here, we estimated the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer and the risk of unnatural deaths after self-harm in 459,542 individuals. Depression was the most common psychiatric disorder in patients with cancer. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders, whereas those treated with kinase inhibitors had the lowest burden. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (hazard ratio (HR), 6.8; 95% confidence interval (CI), 4.3–10.7). The risk of unnatural death after 12 months was markedly lower (HR, 2.0; 95% CI, 1.5–2.7). We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritizing patients who are most at risk.

26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021

IntroductionThe use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients.MethodsData was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1st, 1990 and September 19th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant.ResultsWe identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm.Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm.ConclusionsThe risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

Resting-state functional connectivity indicators of risk and resilience for self-harm in adolescent bipolar disorder.

Suicide is the second leading cause of death in all youth and among adults with bipolar disorder (BD). The risk of suicide in BD is among the highest of all psychiatric conditions. Self-harm, including suicide attempts and non-suicidal self-injury, is a leading risk factor for suicide. Neuroimaging studies suggest reward circuits are implicated in both BD and self-harm; however, studies have yet to examine self-harm related resting-state functional connectivity (rsFC) phenotypes within adolescent BD. Resting-state fMRI data were analyzed for 141 adolescents, ages 13-20 years, including 38 with BD and lifetime self-harm (BDSH+), 33 with BD and no self-harm (BDSH-), and 70 healthy controls (HC). The dorsolateral prefrontal cortex (dlPFC), orbitofrontal cortex (OFC) and amygdala were examined as regions of interest in seed-to-voxel analyses. A general linear model was used to explore the bivariate correlations for each seed. BDSH- had increased positive rsFC between the left amygdala and left lateral occipital cortex, and between the right dlPFC and right frontal pole, and increased negative rsFC between the left amygdala and left superior frontal gyrus compared to BDSH+ and HC. BDSH+ had increased positive rsFC of the right OFC with the precuneus and left paracingulate gyrus compared to BDSH- and HC. This study provides preliminary evidence of altered reward-related rsFC in relation to self-harm in adolescents with BD. Between-group differences conveyed a combination of putative risk and resilience connectivity patterns. Future studies are warranted to evaluate changes in rsFC in response to treatment and related changes in self-harm.

Association between mirtazapine use and serious self-harm in people with depression: an active comparator cohort study using UK electronic health records

BackgroundStudies report an increased risk of self-harm or suicide in people prescribed mirtazapine compared with other antidepressants.ObjectivesTo compare the risk of serious self-harm in people prescribed mirtazapine versus other antidepressants...

Self-harm risk in pregnancy: recurrent-event survival analysis using UK primary care data.

Perinatal self-harm is of concern but poorly understood. To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome. This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome. The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination. Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.

An Analysis of Risk-Assessment Driven Security Restraint Use during the Transport of Forensic Patients.

Transporting forensic psychiatric patients outside of forensic hospitals has significant risks that pose competing safety and patients' rights interests. Psychiatrists and hospital administrators have a duty to keep their staff and the community safe, but this must be carefully balanced with their obligation to uphold the civil rights and liberty interests of their patients. A critical decision in this balancing is whether to utilize security restraints during patient transportation. Addressing these competing interests while striving to safely transport forensic hospital patients to the community can be challenging as hospital staff and patient advocates may voice strong, and sometimes opposing, opinions about this debate. Very little research has been conducted about these high risk and often contentious actions. Here, we describe the process for assessing risk for violence, self-harm, and elopement prior to transportation at one state forensic hospital using a pretransport risk-assessment tool created specifically for that purpose. We then present the results of research identifying which clinical and legal factors identified by our risk-assessment tool correlate with patients being transported with restraints. We also evaluated the potential for racial/ethnic and gender biases in this transportation risk-assessment process.

Risk of self-harm or suicide associated with specific drug use disorders, 2004-2016: a population-based cohort study.

Drug use disorders are associated with increased risk of self-harm. Risk differences associated with specific types of drug use disorders are yet to be comprehensively reported. This study aimed to examine the risk of self-harm or suicide associated with different drug use disorders in Hong Kong. Population-based cohort study. The Clinical Data Analysis and Reporting System (CDARS) managed by the Hong Kong Hospital Authority. Cases were people ages 10years or older who visited a hospital Accident and Emergency department between 1 January, 2004 and 31 December, 2016 with any of 10 specific drug use disorders (comprising opioid; ketamine; methamphetamine; sedative, hypnotic, or anxiolytic; amphetamine or related stimulant; cocaine; cannabis; hallucinogen; unspecified or other drug; and polydrug). Each case was matched with two controls, selected from a subset of people in CDARS sharing the same gender, age and psychiatric profile. A total of 8270 cases and 16 540 matched controls were included. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm or suicide for each specific drug use disorder were estimated. The most prevalent drug use disorder was opioid use disorder (2523; 30.51%) and the least prevalent was hallucinogen use disorder (77; 0.93%). The crude incidence of self-harm or suicide ranged from 26.57 (95% CI, 14.23-44.55) per 1000 person-years for cannabis use disorder to 91.97 (77.32-108.37) for polydrug use disorder. The highest risk of self-harm or suicide was observed in ketamine (aHR, 16.36; 95% CI, 11.03-24.29) and opioid (15.97; 10.73-23.23) use disorders. In Hong Kong, all types of drug use disorders appear to be significantly associated with increased risk of self-harm or suicide, but risk levels vary by type of drug use disorder.

Effect of Offering Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care on Self-harm Among Adult Outpatients With Suicidal Ideation

People at risk of self-harm or suicidal behavior can be accurately identified, but effective prevention will require effective scalable interventions. To compare 2 low-intensity outreach programs with usual care for prevention of suicidal behavior among outpatients who report recent frequent suicidal thoughts. Pragmatic randomized clinical trial including outpatients reporting frequent suicidal thoughts identified using routine Patient Health Questionnaire depression screening at 4 US integrated health systems. A total of 18 882 patients were randomized between March 2015 and September 2018, and ascertainment of outcomes continued through March 2020. Patients were randomized to a care management intervention (n = 6230) that included systematic outreach and care, a skills training intervention (n = 6227) that introduced 4 dialectical behavior therapy skills (mindfulness, mindfulness of current emotion, opposite action, and paced breathing), or usual care (n = 6187). Interventions, lasting up to 12 months, were delivered primarily through electronic health record online messaging and were intended to supplement ongoing mental health care. The primary outcome was time to first nonfatal or fatal self-harm. Nonfatal self-harm was ascertained from health system records, and fatal self-harm was ascertained from state mortality data. Secondary outcomes included more severe self-harm (leading to death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm). A total of 18 644 patients (9009 [48%] aged 45 years or older; 12 543 [67%] female; 9222 [50%] from mental health specialty clinics and the remainder from primary care) contributed at least 1 day of follow-up data and were included in analyses. Thirty-one percent of participants offered care management and 39% offered skills training actively engaged in intervention programs. A total of 540 participants had a self-harm event (including 45 deaths attributed to self-harm and 495 nonfatal self-harm events) over 18 months following randomization: 172 (3.27%) in care management, 206 (3.92%) in skills training, and 162 (3.27%) in usual care. Risk of fatal or nonfatal self-harm over 18 months did not differ significantly between the care management and usual care groups (hazard ratio [HR], 1.07; 97.5% CI, 0.84-1.37) but was significantly higher in the skills training group than in usual care (HR, 1.29; 97.5% CI, 1.02-1.64). For severe self-harm, care management vs usual care had an HR of 1.03 (97.5% CI, 0.71-1.51); skills training vs usual care had an HR of 1.34 (97.5% CI, 0.94-1.91). For the broader self-harm definition, care management vs usual care had an HR of 1.10 (97.5% CI, 0.92-1.33); skills training vs usual care had an HR of 1.17 (97.5% CI, 0.97-1.41). Among adult outpatients with frequent suicidal ideation, offering care management did not significantly reduce risk of self-harm, and offering brief dialectical behavior therapy skills training significantly increased risk of self-harm, compared with usual care. These findings do not support implementation of the programs tested in this study. ClinicalTrials.gov Identifier: NCT02326883.

Correlates of deliberate self-harm among youth with bipolar disorder

ObjectiveYouth with bipolar disorder (BD) are at high risk for deliberate self-harm (DSH) and suicide. However, research regarding factors associated with DSH, a key suicide risk factor, among youth with BD is limited. In a population-based sample of youth with BD, we therefore investigated associations between demographic, clinical, and service utilization factors and DSH incidence and compared suicide, unintentional injury, and all-cause mortality to the general population. MethodWe analyzed a retrospective cohort of youth aged 5 to 19 years with a new BD episode between 2010 and 2017 (n = 25,244) using Ohio Medicaid claims and death certificate data. Cox proportional hazards models examined associations between different factors and DSH. Mortality rates were compared to the general population using standardized mortality ratios. ResultsDuring follow-up, 1,517 (6.0%) youth had at least one DSH event. Older index age, female sex, comorbid psychiatric/medical conditions, prior DSH/suicidal ideation, and prior ER mental healthcare were associated with increased DSH risk. Prior DSH was most strongly associated with increased DSH risk for 3 months after a new BD episode. Being non-Hispanic Black (vs. White, non-Hispanic) and prior psychiatric hospitalization were associated with decreased DSH hazard. DSH risk was highest for 3 months after a new BD episode. Suicide, unintentional injury, and all-cause mortality rates were elevated in youth with BD. LimitationsMay not generalize to other states or non-Medicaid populations; claims data cannot distinguish suicidal intent of self-harm ConclusionEarly intervention following a new BD episode, particularly among high-risk groups, is key to prevent DSH.

P652 The burden of mental illness, including deliberate self-harm, before and after a diagnosis of IBD, a UK population study

Abstract Background The burden of mental illness among IBD patients is recognised to be greater than among their healthy peers. Due to the bi-directional influence of the gut-brain axis,mental health may be linked to IBD outcomes and vice versa. The aim of this study was to use population level data to describe the incidence of anxiety, depression, insomnia, severe mental illness and deliberate self-harm in patients with IBD. Methods A retrospective cohort study was conducted using The Health improvement Network (THIN) database to estimate the incidence rates of anxiety, depression, insomnia, severe mental illness and deliberate self harm in patients with IBD between 1995 to 2021 and matched controls with no pre-existing mental health illness.The prevalence of pre-existing depression, anxiety and insomnia prior to IBD diagnosis was assessed for IBD patients and matched controls.The association between deliberate self harm and incident mental health diagnoses following IBD diagnosis were estimated using Cox regression analysis. Results We identified 59,613 incident cases of IBD,34,615 (58.1%) had UC and 25,000 (41.9%) had Crohn’s disease. The median age was;41.5 (IQR 29.6–57.5) years,with an equal proportion of males and females with IBD (49.2% vs 50.8%). Patients with a diagnosis of IBD had an increased prevalence of anxiety 10 years (3.0% vs 2.5%,p&amp;lt;0.001) and 2 years prior to diagnosis (6.2% and 5.3%,p&amp;lt;0.001). A similar pattern was seen for insomnia at 10 years (1.0% vs 0.9%, p=0.028) and 2 years (3.4% vs 3.0%, p&amp;lt;0.001) and for depression at 10 years (3.7% vs 4.5%, p&amp;lt;0.001) and 2 years (8.1% vs 9.6%, p&amp;lt;0.001). The incidence of mental illness was higher in IBD patients than controls for; anxiety [6.1 vs 5.3 per 1000 patient years,HR 1.14(1.09–1.20),p&amp;lt;0.001], depression [11.3 vs 7.5 per 1000 patient years,HR 1.34 (1.28–1.39),p&amp;lt;0.001], insomnia [9.6 vs 6.0 per 1000 patient years,HR 1.54(1.5–1.6),p&amp;lt;0.001] and DSH [1.6 vs 1.2 per 1000 patient years,HR 1.20(1.07–1.35),p&amp;lt;0.001]. Associations of deliberate self harm in this patient groups included: IBD (HR 1.20(1.07–1.35),p=0.002),female gender (HR 1.06(1.35–1.60),p&amp;lt;0.001),age quintile &amp;lt;27.4 years (HR 4.48(3.95–5.93),p&amp;lt;0.001) compared to &amp;gt;61.3 years,anxiety (HR 1.57(1.35–1.82),p&amp;lt;0.001),depression (HR 5.97(5.33–6.69),p&amp;lt;0.001),insomnia (HR 2.32(2.02–2.66),p&amp;lt;0.001), and severe mental illness (HR 5.74(4.56–7.22),p&amp;lt;0.001). Conclusion There is an additional burden of mental illness in patients who are later diagnosed with IBD. Following diagnosis,the incidence of depression, anxiety, insomnia and deliberate self harm is higher in individuals with IBD than controls.Patients who develop mental illness in the setting of IBD are at particularly high risk of deliberate self-harm.

National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000–2020

Background and objectives Anti-epileptic drugs (AEDs) are increasingly used to treat psychiatric conditions, exposing many children to potentially harmful medications. This includes adolescents, who are at higher risk for self-harm. The purpose of this study was to describe the epidemiology of pediatric AED poisonings and assess which AEDs are associated with more severe clinical outcomes. Methods This retrospective cross-sectional analysis examined single-substance AED exposure cases in pre-teens (10–14 years) and adolescents (15–19 years) reported to the National Poison Database System (NPDS) between 2000 and 2020 (cases through 2019 were included for trend analysis due to incomplete population data). We described characteristics of ingestions by age group, including AEDs implicated. Results There were 74,818 AED exposure cases reported to the NPDS, including 25,928 (34.7%) in pre-teens and 48,890 (65.3%) in adolescents. Among adolescents, 35,570 (72.8%) exposure cases were intentional, with 27,655 (56.6%) specifically related to a suspected suicide attempt. The most common AEDs implicated in poisonings were clonazepam (19.8%), valproic acid (15.3%), and lamotrigine (13.8%). The odds of hospitalization (adjusted odds ratio [aOR] 2.0 [95% confidence interval [CI], 2.0–2.1]), intubation (aOR 2.1 [95% CI, 1.8–2.4]), seizure (aOR 1.6 [95% CI, 1.4–1.9]), and serious outcome (aOR 1.8 [95% CI, 1.7–1.9]) were higher in the adolescent group compared to the pre-teen group. Intentional ingestions increased by a yearly rate of 2.8% (95% CI, 2.3–3.2). Intentional tiagabine exposure was associated with the greatest increased odds of serious outcome (aOR 4.7 [95% CI, 3.6–6.3]). Discussion In this cross-sectional analysis of pediatric AED exposure cases reported to the NPDS, AED poisonings among pre-teens and adolescents increased significantly between 2000 and 2019. Of particular concern is the large increase in intentional exposure cases related to AEDs. With the population-adjusted rate of epilepsy diagnoses remaining relatively unchanged, these results may indicate that the rise in AED exposure cases may be related to increased prescribing of AEDs for psychiatric indications as opposed to epilepsy. Conclusions Pediatric AED poisonings reported to the NPDS are increasing, especially among adolescents engaging in intentional ingestions. These findings provide additional information for consideration in risk-benefit assessments when selecting medications for the treatment of psychiatric conditions in children.

Comparison of Self-harm or Overdose Among Adolescents and Young Adults Before vs During the COVID-19 Pandemic in Ontario

Self-harm and deaths among adolescents and young adults are notably related to drug poisonings and suicide. With the emergence of the COVID-19 pandemic, there are projections about a greater likelihood of such events arising among adolescents and young adults. To evaluate the risk of self-harm, overdose, and all-cause mortality among adolescents and young adults during the COVID-19 pandemic. This population-based cohort study took place in Ontario, Canada, where a universal health care system captures all emergency department (ED) visits, hospitalizations, and deaths. The participants included all adolescents and young adults born in Ontario between 1990 and 2006, who were aged 14 to 24 years between March 1, 2018, and June 30, 2021. The COVID-19 pandemic era (April 1, 2020 to June 30, 2021), relative to the 2 years preceding the pandemic (March 1, 2018 to February 28, 2020). ED encounters or hospitalizations for self-harm or overdose. A secondary outcome was self-harm, overdose, or all-cause mortality. Cause-specific hazard models to estimate hazard ratios (HR) and 95% CIs were used for the primary outcome. Follow-up started at March 1, 2018, or the individual's 14th birthday, whichever was later, and age was used as the time scale. In this study, 1 690 733 adolescents and young adults (823 904 [51.3%] female participants) were included with a median (IQR) age of 17.7 (14.1-21.4) years at start of follow-up. After 4 110 903 person-years of follow-up, 6224 adolescents and young adults experienced the primary outcome of self-harm or overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an HR of 0.78 (95% CI, 0.75-0.80). The risk of self-harm, overdose, or death was also lower during than before the pandemic (HR, 0.78; 95% CI, 0.76-0.81), but not all-cause mortality (HR, 0.95; 95% CI, 0.86-1.05). Among adolescents and young adults, the initial 15-month period of the COVID-19 pandemic was associated with a relative decline in hospital care for self-harm or overdose.

Validity and reliability of resiliency measures trialled for the evaluation of a preventative Resilience-promoting social-emotional curriculum for remote Aboriginal school students.

PurposeWe aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm.MethodsConfirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales.ResultsCFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10).ConclusionsThe CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.

An Audit of Mental Health Care Plans in Community Mental Health Services for Older Persons in Rural Communities in a State in Australia.

Mental health care planning is an important part of holistic, patient-centred care provision. Rural older adults represent a vulnerable population with unique and complex care needs requiring robust care planning approaches. This study's aim was to audit care plan documentation for rural older Australians against quality standards. A retrospective review of the care plans from electronic case records was performed for all patients who were 65years or older and managed by rural community mental health teams over a 12-month period. 72.1% of patients had a care plan available. Multiple assessment areas were sparsely documented, such as cognition (32%), self-harm risk assessments (29.8%), visual impairment (5.5%), hearing issues (5%) and Advance Care Directives (35.4%). This study highlighted the need for the development and implementation of a care plan template specific to rural older patients. Further research into care planning processes and barriers to implementation is also required for this population.

Anna Nilsson, Compulsory Mental Health Interventions and the CRPD: Minding Equality (Hart Publishing, 2021, xi + 186pp, £67.50) ISBN 97815099315 76 (hb)

The Convention on the Rights of Persons with Disabilities (‘CRPD’) is the first international human rights treaty to recognize rights specifically for disabled people. It has been heralded as revolutionary in creating a ‘paradigm shift’ in how disability is understood within law. The CRPD moves away from a medical model of disability (which focuses on the individual’s limitations) to a social model of disability (which focuses on social barriers and how they can be alleviated to better promote the rights of disabled people.) Nilsson rightly points out that much of the originality of the CRPD’s approach rests with its focus on equal treatment and non-discrimination (pp 12–14). One of the areas in which disabled people are still discriminated against is in the context of compulsory mental health treatment. The presence of a psychosocial disability is still used in the majority of domestic mental health laws to justify compulsion. This includes where an individual is refusing treatment a professional believes they require and the person either lacks decision making ability, or there is a risk of self harm, harm to others, serious deterioration in health or a combination of these factors (pp 45–49). Therefore, one of the questions dominating CRPD implementation is if and when compulsory treatment is justified under the CRPD.

Treatment for opioid dependence and suicide prevention

A new study has shed light on the need for better treatment for opioid dependency in people who are at increased risk of suicide and self-harm

Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis.

Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. There is some evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm, but the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm is unknown. A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over 2years. Data on risk of subsequent self-harm and hospital costs of treating self-harm were drawn from the Multicentre Study of Self-Harm in England, while estimates of effectiveness of psychosocial assessment on risk of self-harm, quality of life, and other costs were drawn from literature. Incremental cost-effectiveness ratios (ICERs) for cost per Quality Adjusted Life Year (QALY) gained were estimated. Parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses. Cost per QALY gained from psychosocial assessment was £10,962 (95% uncertainty interval [UI] £15,538-£9,219) from the National Health Service (NHS) perspective and £9,980 (95% UI £14,538-£6,938) from the societal perspective. Results were generally robust to changes in model assumptions. The probability of the ICER being below £20,000 per QALY gained was 78%, rising to 91% with a £30,000 threshold. Psychosocial assessment as implemented in the English NHS is likely to be cost-effective. This evidence could support adherence to NICE guidelines. However, further evidence is needed about the precise impacts of psychosocial assessment on self-harm repetition and costs to individuals and their families beyond immediate hospital stay.

Resilience mediates the association between impulsivity and self-harm in Chinese adolescents

ObjectiveExisting literature is supportive for the positive connection between impulsivity and self-harm (SH), nevertheless, less is known regarding to the role of resilience in this association. This research primarily explored potential mediation of resilience in the association between impulsivity and SH in a large sample of Chinese adolescents. MethodA population-based cross-sectional survey of 4552 adolescents was conducted in southwest China. A self-administered questionnaire was adopted for data collection from all subjects. The Barratt Impulsiveness Scale (BIS), the Modified version of Adolescents Self-Harm Scale (MASHS) and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure impulsivity, SH, and resilience, respectively. The associations between impulsivity, resilience, and SH were estimated by using stepwise multivariate Logistic regression models. Mediation of resilience in impulsivity and SH association was evaluated by using path model. ResultsThe prevalence of SH was 39.1% (95% CI: 34.0%-45.0%) for surveyed adolescents. Impulsivity and resilience were significantly associated with the prevalence of SH. Prominent dose-response association between impulsivity and SH prevalence was further confirmed. Resilience was a salient mediator which accounted for 42.90% of the total impulsivity-SH association. Among all the five dimensions of resilience, goal concentration (23.98%) and emotion regulation (21.94%) showed the strongest mediation. ConclusionsThe findings suggest that resilience building intervention strategies, particularly those focusing on improving goal concentration, emotion regulation, and positive perception, could be effective in reducing impulsivity related SH risk among Chinses adolescents.

Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals.

Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 - 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 - 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 - 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 - 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 - 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.

Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: a cohort study

The first 4 weeks after initiation and cessation of opioid agonist treatment for opioid dependence are associated with an increased risk of all-cause mortality and overdose. We aimed to investigate whether the rate of self-harm and suicide among people who were prescribed opioid agonist treatment differs during initiation, cessation, and the remainder of time on and off treatment. We did a retrospective cohort study and used health-care records from UK Clinical Practice Research Datalink, linked to mortality and hospital admission data, for adults (age 18-75 years at cohort entry) who were prescribed opioid agonist treatment at least once in primary care in England between Jan 2, 1998, and Nov 30, 2018. We estimated rates and adjusted risk ratios (aRRs) of hospital admissions for self-harm and death by suicide, comparing time during and after treatment, as well as comparing stable periods of time on treatment with treatment initiation, cessation, and the remaining time off treatment. Between Jan 2, 1998, and Nov 30, 2018, 8070 patients (5594 [69·3%] men and 2476 [30·7%] women) received 17 004 episodes of opioid agonist treatment over 40 599 person-years. Patients were mostly of White ethnicity (7006 [86·8%] patients). 807 episodes of self-harm (1·99 per 100 person-years) and 46 suicides (0·11 per 100 person-years) occurred during the study period. The overall age-standardised and sex-standardised mortality ratio for suicide was 7·5 times (95% CI 5·5-10·0) higher in the study cohort than in the general population. Opioid agonist treatment was associated with a reduced risk of self-harm (aRR in periods off treatment 1·50 [95% CI 1·21-1·88]), but was not significantly associated with suicide risk (aRR in periods off treatment 1·21 [0·64-2·28]). Risk of self-harm (aRR 2·60 [95% CI 1·83-3·70]) and suicide (4·68 [1·63-13·42]) were both elevated in the first 4 weeks after stopping opioid agonist treatment compared with stable periods on treatment. Stable periods of opioid agonist treatment are associated with reduced risk of self-harm, emphasising the importance of improving retention of patients in treatment. The first month following cessation of opioid agonist treatment is a period of increased risk of suicide and self-harm, during which additional psychosocial support is required. Medical Research Council.