Self-harm Attempts Research Articles

Evaluation of a youth-focused suicide prevention HOPE aftercare service: protocol for a non-randomized hybrid effectiveness-implementation type I design

BackgroundSuicide is the fourth leading cause of death among young people aged 15–29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide-related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time, suicide prevention aftercare services are recommended. Despite their increased popularity, evidence demonstrating the effectiveness of these models is very limited.MethodsUsing a hybrid effectiveness-implementation type I design, this evaluation will assess the effectiveness and implementation of a suicide prevention aftercare (Hospital Outreach Post-suicidal Engagement; HOPE) service designed to reduce risk of self-harm and suicide in young people aged 12–25 who are referred to the service following an ED presentation for self-harm or suicide attempt. Two complementing theoretical frameworks will guide this evaluation, specifically the design, data collection, analysis, and interpretation of results. The RE-AIM evaluation framework will be used to assess Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance of the HOPE aftercare service. The PRISM implementation framework will be used to assess multi-level contextual factors hypothesized to affect the RE-AIM outcomes. Several data sources will be used to assess the changes in primary and secondary outcomes from baseline to post–intervention, and at follow-up, including user and provider self-report surveys, semi-structured interviews, and routinely collected hospital data. An historical control study will also be conducted using data from the Self-Harm Monitoring System for Victoria to examine the impact of the service on rates of self-harm and suicide-related presentations to ED, and compare trends prior to and following commencement of the HOPE aftercare service. In addition, dynamic systems modelling will be used to assess the future scalability of the service.DiscussionFindings from this evaluation will determine the effectiveness, including cost-effectiveness, of the HOPE aftercare service and describe the implementation context. They will inform the future development and sustainability of this and other similar services across Australia and internationally.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 19th December 2023 (Registration number ACTRN12623001332617). We do not foresee any amendments to this protocol however, if any unforeseen modifications are required, they will be submitted to ANZCTR.Trial sponsorOrygen, 35 Poplar Road, Parkville, VIC, 3052, Australia.

Baclofen-related deaths in Australia 2000–2022

In Australia, the therapeutic indication of baclofen (oral tablets) is for the treatment of muscle spasm. Deaths related to baclofen have been reported, as well as misuse, dependence and self-poisoning. This national retrospective study aimed to investigate the number, characteristics, circumstances, and toxicology of baclofen-related deaths in Australia, 2000–2022. We identified 102 baclofen-related deaths, with a mean age of 45.6 years and 51 % being male. Circumstances of death were: intentional toxicity (54.9 %), unintentional toxicity (30.4 %), unintentional toxicity/disease (9.8 %), and accidental injury (4.9 %). Multiple sclerosis or spinal injury was documented in 15.7 % of cases, substance use problems in 43.1 % and specifically alcohol use problems in 38.2 %. Mental health problems were documented in 73.5 %, a previous self-harm or suicide attempt in 30.4 %, and chronic pain in 37.3 %. The median baclofen blood concentration for all cases was 3.10 mg/L (25th 0.70, 75th 8.10, range 0.04–110.00), unintentional toxicity 1.95 mg/L (25th 0.70, 75th 4.35, range 0.04–24.0), intentional toxicity 6.00 mg/L (25th 1.10, 75th 13.0, range 0.05–110.0). Concomitant substance use was seen in 93.8 %, with antidepressants (69.8 %) and benzodiazepines (64.6 %) most frequently detected. In conclusion, the ‘typical’ case was middle-aged, most dying due to intentional toxicity, and likely to have a history of mental health and substance use problems. We suggest caution is needed in prescribing baclofen given its potential to be used in intentional and non-intentional overdose.

Sports-Related Concussion Among Physically Active Adolescents in the Southeastern United States: Effects on Mental Health During the Pandemic.

Sports-related concussions (SRC) pose risks to young people's physical and mental health. During the COVID-19 pandemic, we studied linkages between youths' SRC experiences and internalizing problems (depression, self-harm, and suicidality) among a representative sample in Southeastern state (n = 4,668 total, n = 547 reported SRC experience). Logistic regressions indicated significant associations between youths' SRC experiences and depression (AOR = 1.32, p < .05), suicidality (e.g., attempted suicide AOR = 2.68, p < .001), and self-harm (AOR = 1.97, p < .001) while controlling for being bullied or teased, gender, age, race, and COVID-19's mental health impact. Contrary to prior findings: (1) SRC associations with self-harm and suicide attempts were consistent across genders; and (2) African American students with SRC were significantly more likely to experience depression, self-harm, suicide planning, and attempts than peers without SRC. Results indicated mental health resilience post-concussion for Latinx youth. Implications advocate population-specific health promotion measures that address vulnerabilities and protective factors while emphasizing SRC education for parents, coaches, and young athletes for timely psychological evaluation and support.

Association Between Rapid Opioid Reduction or Discontinuation and Self-Harm, Suicide Attempt, and Suicide Death Among High-Dose Long-Term Opioid Therapy Patients in North Carolina, 2006-2018.

We examined the association between rapid opioid reduction or discontinuation and self-harm, suicide attempt, and suicide death among high-dose long-term opioid therapy (HD-LTOT) patient and examined effect measure modification by individual and neighborhood-level characteristics. Using private insurance data from North Carolina, this retrospective cohort study covered January 2006 to September 2018, with up to four years of follow-up. Participants included patients aged 18-64 years who were prescribed HD-LTOT. Time-varying exposure was ever exposed to rapid opioid reduction or discontinuation vs never exposed. The outcomes were self-harm or suicide attempt, suicide death, and the combined outcome. We estimated cumulative incidence and used Fine-Gray models to estimate sub-distribution hazard ratios (HRs). There were 21,450 HD-LTOT patients. In year 1, rapid opioid reduction or discontinuation was not associated with the combined outcome, HR: 1.09 (95% CI: 0.61-1.96). However, in years 2-4, rapid opioid reduction or discontinuation was associated with higher hazard of the combined outcome, HR: 2.77 (95% CI: 1.45-5.27). This association was stronger among patients with mental health conditions and those residing in underserved neighborhoods. These findings underscore the importance of provider training in adhering to guideline-concordant gradual tapering, offering mental health support, and ensuring patient safety throughout the tapering process.

Program Pendidikan Kecakapan Hidup Bagi Anak Usia Fase A

Imam Al-Ghazali defined that education is the perfection of life in this world and the hereafter. Thus, humans who want to achieve perfection in life in this world and the afterlife must have religious knowledge. Religious knowledge is so important for provision in life, without religious knowledge humans can be said to be far from perfection. Apart from religious knowledge, life skills education is also very important for provisions in life. However, it is very unfortunate that many children who are teenagers or are about to enter puberty do not yet have mature life skills in terms of personal skills and social skills. From KPAI (Indonesian Child Protection Commission) data during January - November 2023, 37 children ended their lives. Self-harm behavior and attempts to end life are major global mental health problems due to their increasing frequency. This case occurred at a vulnerable age (grade 5-6 of elementary school), grade 1 or 2 of junior high school, grade 1.2 of high school. Another case related to juvenile delinquency is the incident involving the death of a student in Bogor which sadistically adds to the number of delinquencies among students. It also leaves a red report card for the world of education, because the sadistic incident was carried out by students. From this background, it is necessary to have a program that will strengthen children's life skills education from pre-adulthood, especially phase A, so that class children can be ready to live life in the next phases. This research uses the Research and Development (R&amp;D) method with the ADDIE model, namely Analyze, Design, Development, Implementation, Evaluation. The program needs analysis was carried out by creating a Google form with a closed questionnaire which was distributed randomly to ten respondents. After the needs analysis, the researcher analyzed previous programs. There were two programs that the researcher used as a reference, namely the entrepreneurship program and the self-help program in an effort to increase independence. then the next step is to design the program, the programs prepared by the researchers are as follows: cookies (cooking with kids), market day, BTS (Bed Time Sirah), PKS (Student Independence Habits), PMO (Habits of Helping Parents) and CLMH (Love of the Environment and Living Creatures). After the program was prepared, it was validated by several experts including Islamic religious education experts, language experts and also child psychology experts. After going through expert validation, the program is implemented to users. After implementation, the final stage is to test the feasibility through evaluation. The feasibility test is carried out by experts by providing an assessment of the program being prepared. From the results of this feasibility test, it was found that this program was good and suitable to be applied to pre-age children, especially in phase A in the life skills education process.

Suicidality among clients in a network of coordinated specialty care (CSC) programs for first-episode psychosis: Rates, changes in rates, and their predictors

BackgroundPeople experiencing their first episode of psychosis have high risk of suicide, and programs specializing in early psychosis have not always achieved reduced risk. The present study analyzes patterns of suicide ideation, self-harm, and suicide attempts within the Connection Learning Healthcare System of 23 early psychosis programs in Pennsylvania and Maryland that follow the Coordinated Specialty Care treatment model. MethodPeople with first episode psychosis (n = 1101) were assessed at admission and every six months using a standardized battery that included self-reported past-month ideation and clinician-reported past-six-month ideation, self-harm, and suicide attempts. ResultsAt admission, there were 28 % rates of self-reported past-month suicide ideation and 52 % rates clinician-reported past-six-month suicide ideation, 23 % rate of clinician-reported self-harm, and 15 % rate of attempts. After the first six months of treatment there were significantly lower rates of clinician-reported suicidality (with reductions of at least 77 %), and after the first year of treatment there was significantly lower self-reported ideation (with approximately 54 % reporting lower past-month ideation). Changes were not accounted for by differential early discharge. A range of psychosocial variables predicted within- and between-subject variability in suicidality. Social and role functioning, depressive symptom severity, and a sense of recovery were significant within-subject predictors of all four measures of suicidality. ConclusionsCompared to admission, we observed substantially lower rates of suicidality within the first year of treatment for clients with first episode psychosis in Coordinated Specialty Care. Reductions were predicted by some of the variables targeted by the treatment model.

Risk of suicide after hospitalizations due to acute physical health conditions—a cohort study of the Norwegian population

BackgroundIt is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions.MethodsA Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide.ResultsA total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable.ConclusionsThe heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

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.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

How do young adults deal with suicidal ideation? A qualitative study of the experiences of stakeholders.

Persistent suicidal ideation, self-harm behaviors, and suicide attempts constitute suicidality and are consistent predictors for future suicides. Research on what protects individuals from harming themselves is equivocal. While factors like impulsivity could increase risk of suicide, research is needed on what stops people from acting out on self-harm thoughts/suicidal ideation. To explore the help-seeking behaviors and other protective factors during periods of suicidality in individuals at risk of suicide. This study aimed to explore help-seeking behavior and other protective factors that prevent or delay self-harm and suicide attempts during suicidality in individuals at risk. We used a qualitative study design and interviewed 15 participants comprising at-risk individuals, caregivers, and mental health professionals (MHPs). We used thematic analysis for deriving themes. Themes in 'at-risk individuals' include mental state during suicidality, handling of oneself during suicidality, and seeking help from support systems. Themes from caregivers included handling of crises and the role of informal and formal support systems. Themes from MHPs included phenomenology of suicidality, handling of suicidality, help-seeking, and support systems. At-risk individuals handle suicidality by either managing themselves on their own or seeking help from informal sources and formal health systems. Caregivers appear to be crucial stakeholders in help-seeking during self-harm. The involvement of caregivers - in discussion with the at-risk individual - should be a necessary component of suicide risk management. Suicide prevention policies at institutional, regional, and national levels should include strategies to prevent burnout and other occupational health issues in MHPs.

Protective factors for suicidal behaviour in adults self-reported as LGBTQ+: a study based on modulating variables

This study aims to identify factors that modulate resilience in LGBTQ + adults with a history of suicide attempts and reattempts, by hypothesising that positive mental health and various internal and external protective factors will predict suicide resilience in this population. 112 LGBTQ + Spanish individuals (60.7% self-identified as female, 34.8% as male and 4.5% did not identify their gender) aged 18–41 years with a history of self-harm or suicide attempts completed several questionnaires measuring variables such as self-efficacy, emotion regulation, social support, entrapment, anxiety, depression, positive mental health and resilience. In terms of the protective variables most predictive of resilience, social support, positive mental health and emotion regulation were found to be crucial and, to a lesser extent, self-efficacy expectations for coping with stressful or adverse situations. In addition, path analyses revealed distinct profiles of modulated categorical variables in LGTBQ + individuals who had attempted suicide once or who had attempted suicide two or more times. These findings highlight the importance of addressing protective factors, such as social support and positive mental health, in promoting resilience and reducing suicide risk among LGBTQ + individuals.

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.

Characterization of Suicide, Suicidal Ideation, and Self-harm Attempts: A Pre-hospital Descriptive Study

Characterization of Suicide, Suicidal Ideation, and Self-harm Attempts: A Pre-hospital Descriptive Study

Prevalence, distribution, and inequitable co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people in Australia: epidemiological findings from a population-based cohort study

PurposeTo estimate the prevalence, distribution, and co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people relative to their cisgender and heterosexual peers in Australia using population-level, nationally representative data.MethodsWe utilised Wave 8 (2018) data from the Longitudinal Study of Australian Children (N = 3037, Mage = 18.4) collected via an assessment protocol comprising interviews, direct observations, and assessments (on average 60 min per survey occasion). Weighted prevalence ratios and logistic regression models adjusted for demographic confounders were used to estimate the prevalence and distribution of mental ill-health (psychological distress, past 12-month self-harm thoughts and behaviours, past 12-month suicidal ideation, planning, attempt/s) and substance use outcomes (past 12-month cigarette, alcohol, and marijuana use) across gender identity (trans vs. cisgender), sexuality (gay/lesbian, bisexual, queer [those identifying with an ‘other’ sexuality identity that is not ‘gay’, ‘lesbian’, ‘bisexual’, or ‘heterosexual’] vs. heterosexual) and sexuality diversity status (sexuality diverse vs heterosexual) subgroups. Sex-stratified prevalence rates and accompanying adjusted logistic regression models were also used to assess mental ill-health and substance use disparities by sexuality diversity status. Adjusted multinominal logistic regression models were used to test disparities in co-occurring outcomes by sexuality identity) sexuality status sub-groups, and Fisher’s Exact Test of Independence for co-occurring disparities by gender identity (due to small sample size). All analyses used Wave 8 sample weights and adjusted for postcode-level clustering.ResultsAmong gender and sexuality diverse participants, 59 − 64% reported high or very high levels of psychological distress, 28 − 46% reported past 12-month self-harm ideation or attempts, and 26 − 46% reported past 12-month suicidal ideation, planning, or behaviour. We found significant disparities in high/very high levels of psychological distress, self-harm behaviours and suicidal behaviours among trans participants (adjusted odds ratios (aORs) ranged from 3.5 to 5.5) and sexuality diverse participants (aORs ranged from 3.5 to 3.9), compared with cisgender and heterosexual participants, respectively. Highest disparities in any past 12-month self-harm and suicidal behaviours appeared most pronounced among trans participants and queer participants compared with their cisgender, heterosexual counterparts. Minor differences by sex among sexuality diverse participants were observed for select mental ill-health outcomes. Sexuality diverse participants, and particularly sexuality diverse females, were significantly more likely to report past 12-month cigarette use and past 12-month marijuana use (adjusted odds ratio (aORs) ranging 1.4–1.6). Trans young people were at significantly elevated risk of mental ill-health in co-occurrence with cigarette and marijuana use compared with their cisgender peers (Fisher’s Exact Test of Independence p < 0.05 for all), whereas sexuality diverse young people were at greater risk of co-occurring mental ill-health and cigarette co-use and marijuana co-use, compared with their non-sexuality diverse peers (adjusted multinomial odds ratios (aMORs) ranging 2.2-6.0).ConclusionMental ill-health, substance use, and their co-occurrence disproportionately affects gender and sexuality diverse young people in Australia. Further research should study the longitudinal development of these disparities through adolescence, with close attention to the social, embodied contexts of substance use among LGBTQ + young people with the view to building LGBTQ + affirming models of harm reduction.

Pattern of poisoning cases in Bir Hospital

Background: Poisoning is one of the major causes of hospitalization through emergency and is a major public health problem in the country. For starting preventive measures, information on nature and extent of poisoning is required. For some years, there has been no study on poisoning at Bir hospital. Objectives: To find out the patient profile, the common poisons and outcome of poisoning cases. Materials and Methods: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Bir Hospital from January 2005 to June 2005 was done to study the pattern of acute poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the poisonous substance, actual use, chemical type, hospitalization days, severity and outcome were collected and analyzed. Results: The age of the patients varied from 16 to 65 years. The male female ratio was 1:1.3. More than three-fourth (76.8%) of the female patients were from 16 to 25 years age group. Similarly, 46.5% of the male patients were from 16 to 25 years age group. In more than 25 years of age, there was malepredominance in all the age group. The common insecticides used for poisoning were organophosphorus compounds mainly Methyl Parathion (Metacid) and Dichlorovos (Nuvan). Paracetamol alone or combination preparations with antihistamines were the most common analgesic used. Benzodiazepines were the most commonly used anxiolytics. Ninety-seven percent of caseswere intentional poisoning for suicidal attempt. Most of the cases (61.6%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay of the admitted patients with poisoningranged from one to sixteen days. The mean hospital stay was 5.9 days. During the hospital stay, six (6.0%) cases were managed in Intensive Care Unit (ICU) service. In this study, only 3% cases had mortality. There were 5 cases of Aluminium Phosphide poisoning but surprisingly, none of them died from this highly toxic poison. Conclusion: Suicide among adolescents and young adults is a common public health problem. Patients with intentional poisoning must undergo psychiatric consultation during their stay in the hospital for the treatment poisoning. This will minimize the risk of next attempt of self harm. In addition, strict rules must be followed regarding sale of psychotropic medicines and pesticides. Effective clinical management of poisoning can minimize the mortality.

Impairment of Visual Fixation and Preparatory Saccade Control in Borderline Personality Disorder With and Without Comorbid Attention-Deficit/Hyperactivity Disorder

BackgroundBorderline personality disorder (BPD) is associated with heightened impulsivity, evidenced by increased substance abuse, self-harm, and suicide attempts. Addressing impulsivity in individuals with BPD is a therapeutic objective, but its underlying neural basis in this clinical population remains unclear, partly due to its frequent comorbidity with attention-deficit/hyperactivity disorder (ADHD). MethodsWe used a response inhibition paradigm—the interleaved pro-/antisaccade task—among adolescents diagnosed with BPD with and without comorbid ADHD (n = 25 and n = 24, respectively) during concomitant video-based eye tracking. We quantified various eye movement response parameters reflective of impulsive action during the task, including delay to fixation acquisition, fixation breaks, anticipatory saccades, and direction errors with express saccade (saccade reaction time: 90–140 ms) and regular saccade latencies (saccade reaction time > 140 ms). ResultsIndividuals with BPD exhibited deficient response preparation, as evidenced by reduced visual fixation on task cues and greater variability of saccade responses (i.e., saccade reaction time and peak velocity). The ADHD/BPD group shared these traits and made more anticipatory responses and direction errors with express saccade latencies and reduced error correction. ConclusionsSaccadic deficits in BPD and ADHD/BPD stemmed not from an inability to execute antisaccades but rather from inadequate preparation for the upcoming task set. These distinctions may arise due to abnormal signaling in cortical areas like the frontal eye fields, posterior parietal cortex, and anterior cingulate cortex. Understanding these mechanisms could provide insights into targeted interventions focusing on task set preparation to manage response inhibition deficits in BPD and ADHD/BPD.

Population-adjusted numbers, demographics and mental health among children and adolescents referred to the Norwegian National Center for Gender Incongruence over two decades.

Over the last decade, there has been a sharp increase in young people seeking medical treatment for gender dysphoria/gender incongruence (GD/GI). The aims of this study were to calculate yearly population-adjusted numbers of children and adolescents referred to the Norwegian National Center for Gender Incongruence (NCGI) at Oslo University Hospital (OUS) from 2000 to 2022; to describe the demographic characteristics and prevalence of psychiatric diagnoses, self-harm and suicide attempts among the referred from 2000 to 2020; and to investigate time trends. The study used data from the Gender Incongruence Registry for Children and Adolescents (GIRCA) in Norway. All persons under 18 years (n = 1258) referred to the NCGI between 2000 and 2020 were included: 68.4% assigned female gender at birth (AFAB) and 31.6% assigned male gender at birth (AMAB). We found a sharp increase in referrals to the NCGI favouring AFAB over AMAB. Nearly two in three (64.5%) had one or more registered psychiatric diagnoses. Self-harm was registered among 35.5%, and 12.7% had attempted suicide. Registered psychiatric diagnoses were significantly (p ≤ 0.001) more prevalent among AFAB (67.8%) than AMAB (57.4%). The number of registered diagnoses per person decreased significantly over time, with an average reduction of 0.02 diagnoses per person per year. Although there was a downward time trend in registered diagnoses per person, the total mental health burden among children and adolescents with GI emphasizes the need for a holistic approach.

Promoting Adolescent Suicide Prevention Programmes in Pakistan: An Insight into Challenges and Opportunities.

Suicide is a global health concern, with profound social, emotional, and economic repercussions for individuals, families, and communities. Suicidal behaviour among adolescents, encompassing ideation, self-harm, and suicide attempts poses a significant global public health challenge. The cultural, social, and economic factors that contribute to suicide in Pakistan are complex and multifaceted, making it imperative to develop tailored interventions, necessitating collaborative efforts involving researchers, educators, clinicians, practitioners, and policymakers. The purpose of this study is to emphasise the risk factors contributing to adolescent suicidal behaviour and to delve into the strategies and interventions that can help prevent suicide in Pakistan, considering the unique challenges and opportunities within the country. This study highlights the relevance of the WHO (2023) Thinking Healthy Programme and stress management measures tailored to the needs of low- and middle-income nations like Pakistan. These resources empower healthcare workers to enhance mental health screening and identification of adolescents within their communities. In conclusion, dispelling the myths, reducing the societal stigma associated with mental health, and enhancing the accessibility of mental health services is an imperative mission that demands concerted efforts from all sectors of the society. Key Words: Suicide, Adolescent, Mental health, WHO (2023) Thinking Healthy Programme.

Suicidal ideation, suicide attempts, suicide methods, and correlates of suicidality among Nigerian LGBT persons: The role of minority stress. A narrative literature review

Introduction This paper reviews the literature on suicidal ideation, suicidal behavior, suicide methods and correlates of suicidality among Nigerian LGBT persons. Understanding the suicidality-related issues facing LGBT Nigerians can inform the designing of evidence-based interventions to reduce suicidality. Results Findings revealed that Nigerian LGBT persons experienced self-harm, suicidal ideation, suicide attempts and the repetition of suicidal behavior using suicide methods such as pesticide self-poisoning, jumping, hanging, and overdose of medicines. LGBT persons who attempted suicide more than once reported experiencing different forms of minority stress. Several LGBT suicide attempters and ideators reported experiencing prior internalized homophobia, anti-LGBT bullying in schools and the larger society, anti-LGBT discrimination from family and conversion therapy. Minority stress was found to be linked with self-harm, suicidal ideation and suicide attempts among Nigerian LGBT persons. Additionally, experiencing anti-LGBT discrimination, conversion therapy and depression were found to be correlates of suicidal ideation and suicide attempts among Nigerian LGBT persons. Discussion This study highlights the importance of addressing the minority stress experienced by Nigerian LGBT persons in order to reduce their vulnerability to suicidality. Finally, this study highlights research gaps and discusses the implications of the study findings for suicide prevention interventions, advocacy and policy making in Nigeria.