Self-harm Attempts Research Articles

An evaluation of clinical practice guidelines for self-harm in adolescents: The role of borderline personality pathology.

Borderline personality disorder (BPD) is associated with high rates of self-harm, suicide attempts, and death by suicide in adults and adolescents. Screening and assessment of BPD in self-harming adolescents could be an important clinical intervention. The aim of this article was to identify whether existing clinical practice guidelines (CPGs) for the care of self-harm in adolescents considered the screening, diagnosis, and/or treatment of BPD. Previous work by Courtney, Duda, Szatmari, Henderson, and Bennett (2018) used Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods to identify 10 CPGs relevant to self-harm in children and adolescents. In this study, the 10 CPGs were reviewed for content about screening, assessment, and/or treatment recommendations for adolescents with BPD. Out of the 10 CPGs, 4 acknowledged the association between BPD and self-harm in adolescents. There was minimal to no guidance provided in the CPGs regarding specific screening, assessment, or treatment strategies for BPD. This may be due to the lack of evidence for efficacy and effectiveness of screening for BPD, thereby limiting the development of guideline recommendations. Studies that examine the impact of screening for BPD in clinical settings are needed. In the interim, CPGs should cite the prevalence of BPD in adolescents who self-harm and reference research showing the benefit of treatment with dialectical behavioral therapy for self-harm and suicide attempts in youth with BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Associations between Chinese adolescents subjected to traditional and cyber bullying and suicidal ideation, self-harm and suicide attempts

BackgroundThe incidence of bullying is high among adolescents. Adolescents who were victims of bullying have a higher risk of self-harm and suicidal behavior than adolescents who were non-victims. However, research on suicide and both traditional and cyber bullying was limited in China. Therefore, this study examined the associations between Chinese adolescents who were the victims of traditional and cyber bullying and the prevalence of suicidal ideation, self-harm and suicide attempts.MethodsThis was a population-based study of 2647 students (51.2% girls) with a mean age of 13.6 ± 1.1 years from 10 junior high schools in Shantou, China. Information on bullying victimization, suicidal ideation, self-harm and suicide attempts were collected using a self-administered questionnaire and the psychopathology of the students was assessed using the Strengths and Difficulties Questionnaire (SDQ). The associations were examined with multinomial logistic regression, adjusted for covariates.ResultsTraditional bullying victimization was reported by 16.7% of the adolescents, cyber bullying victimization by 9.0% and both by 3.5%. The prevalence of suicidal ideation was 23.5%, self-harm was 6.2% and suicide attempts was 4.2%. Psychopathology symptoms were risk factors for suicide ideation only, ideation plus self-harm, self-harm only and suicide attempts. Victims of both traditional and cyber bullying had the highest risk of suicidal ideation only, ideation plus self-harm and suicide attempts, compared to those reporting one form of bullying. Victims of cyber bullying only had the second highest risk of suicidal ideation only and suicidal ideation plus self-harm compared to non-victims.ConclusionsAdolescents who were victims of both traditional and cyber bullying had greater risks of adverse outcomes of suicidal ideation only, suicidal ideation plus self-harm and suicide attempts. The results of the current study suggest that those exposed to both forms of bullying should be routinely screened for suicidal risk. In addition, school-based anti-bully interventions should also target cyber bullying.

11 An Interpretable Deep Learning Model for the Prevention of Self-Harm and Suicide

Over 500,000 patients in the United States present to EDs for self-harm or suicide attempts annually, and these patients are at high risk for completed suicide. EDs are therefore a potential venue for the delivery of lifesaving interventions to prevent suicide but identifying patients at imminent risk for serious self-harm is difficult. Our objective was to develop an accurate, interpretable predictive model to identify patients at high risk for self-harm and suicide attempts, and to identify opportunities for early intervention in the ED.

Self-harm as a predisposition for suicide attempts: A study of adolescents' deliberate self-harm, suicidal ideation, and suicide attempts

The aim of this study was to analyze the predictive risk factors for self-harm in adolescents with and without suicidal ideation. 600 adolescents answered a questionnaire about self-harm and suicidal behaviors. A logistic regression analysis was conducted. Over half of the individuals with deliberate self-harm (DSH) presented significant suicide risk. There was a direct association between DSH and suicide attempts, with almost the totality of the adolescents with suicide attempts also reporting DSH. According to the prediction model, suicidal ideation and diversity of DSH behaviors are significant predictors of suicide attempts, with an augmentation in the diversity of DSH behaviors and suicidal ideation predicting suicide attempts. Depression and anxiety appeared also as significant predictors of suicide attempts in adolescent self-harmers. Considering that the majority of the sample was not from a clinical setting, an alarming finding was that one third of the total sample was at suicide risk. These results place DSH as a key variable for early intervention.

Predictors of engagement, understanding and dropout from a community based cognitive skills programme

ABSTRACTAlthough non-completion is common in community based cognitive skills programmes, little is known about the variables associated with engagement, understanding and dropout from these programmes. In this study, it was hypothesised that personality disorder (PD), learning difficulties and elevated criminogenic need profiles would predict ratings of engagement, understanding and dropout. We did this in three stages. At the pre-programme stage, demographic, risk, personality, learning difficulty and criminogenic need data was obtained for 511 offenders under probation supervision in England, referred to a Thinking Skills Programme (TSP). At the 1 year follow up, all participants’ status as either completer, non- completer or non-starter were distinguished through probation records. For programme starters, facilitator ratings of engagement and understanding were obtained. Findings reported that non-completion was most strongly associated with Antisocial Personality Disorder (ASPD) and a history of self-harm or suicide attempts, which both predicted a three times greater likelihood of dropout. Lower engagement and understanding scores were predicted by difficulties with employment and relationships. Offenders with high levels of antisocial traits, a history of self-harm and elevated dynamic risk profiles show higher attrition rates and make limited progress on community based cognitive skills programmes. Implications for programme delivery and evaluation are discussed.

Sexual violence and safety: the narratives of transwomen in online forums

An online forum analysis was conducted to explore experiences of sexual violence and safety among transwomen, with a particular focus on transwomen of colour. Four online forums were chosen for the analysis. Three key themes were identified: dating and violence in intimate relationships; fear of violence and safety strategies; and coping after sexual assault. Forum posters faced heightened gender policing and scrutiny, due to not conforming to normative ideals of femininity. Femininity was also predicated on white, middle-class status, and associated with domesticity and romance. As a result, expressions of femininity from non-white backgrounds could be read as deviant or excessive. The intersection of deviation from gender norms and femininity based on whiteness meant that transwomen of colour faced disproportionate levels of violence, both in public and private spaces. Transwomen of colour also faced disadvantage due to participation in higher-risk forms of sex work, low socioeconomic status and employment, and institutional discrimination. Coping mechanisms to deal with cumulative disadvantage included seeking support from health professionals and transgender community networks. However, it also included more harmful forms of self-medicating such as heavy alcohol and drug use, self-harm and suicide attempts.

Gay, Lesbian, and Transgender Issues in Psychiatry

This review is intended to give an overview of psychiatric considerations for the lesbian, gay, bisexual, and transgender (LGBT) population. The history of LGBT-related diagnoses in the DSM is discussed along with the epidemiology of various mental disorders in the LGBT population, with several diagnoses having a higher incidence including depression, anxiety, substance use disorders, self-harm, and suicidal ideation or attempt. To explain these discrepancies, several theories and models are explored, specifically the minority stress model and adverse childhood events. Additionally, recommendations for clinical psychiatric practice are explored including affirmative therapy and transgender-affirming cognitive behavioral therapy, two interventions specifically studied in the LGBT population as well as overall goals of treatment when treating patients struggling with their gender identity. This review contains 5 tables, and 35 references. Key Words: adverse childhood events, affirmative therapy, bisexual, gay, lesbian, LGBT, minority stress, transgender, transgender-affirming cognitive behavioral therapy

P009: Medical assistance in dying – a survey of Canadian emergency physicians

Introduction: There have been 3714 medically assisted deaths recorded in Canada so far, with more than half of those deaths occurring outside the hospital – whether this has had any impact on emergency medicine has not yet been documented. This survey sought to find out Canadian emergency physicians’ (EPs) attitudes and experiences with medical assistance in dying (MAID). Methods: An electronic survey was distributed to CAEP members using a modified Dillman technique. The primary outcome was defined as the proportion of EPs in favour of MAID. Secondary outcomes included experience with suicide in the setting of terminal illness, their experience and opinion on referring patients for MAID from the ED, their experience with complications of MAID, and their response to hypothetical cases of complications from MAID. Nominal variables were analyzed and reported as percentages for each relevant answer. Answers submitted as free-form text were coded into themes by the author and reported based on these themes. Results: There were 303 completed surveys. EPs were largely in support of MAID (80.5%), and would be willing to refer patients for assessment from the ED (83.2%), however fewer (58.3%) knew how to do so. 37.1% of EPs had been asked for a referral for MAID assessment, but only 12.5% had made a referral. While only 1% of EPs reported having seen patients present with complications from MAID (failed IVs in the community), 5.0% had seen patients present with suicide or self-harm attempts after being told they were ineligible for MAID by another provider. Conclusion: This is the first study to examine the impact of MAID on emergency medicine in Canada, and it demonstrates that patients are both requesting referrals through the ED and, in rare cases, requiring medical attention for complications. This has implications for both increasing awareness of MAID referral processes for EPs, as well as for the prevention and treatment of complications of MAID in the community.

SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging

BackgroundHospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia.Methods/designOur study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge.DiscussionThis study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense.Trial registration and ethics approvalThis trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370. Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170).

Survivors of deliberate self-harm attempt in the military milieu: An exploratory study of psychiatric morbidity and psychosocial correlates

BackgroundDeliberate self-harm (DSH) is common in modern society. A million people worldwide die from suicide each year, leading to a large toll on human resources and economy. Research has revealed DSH as an important indicator of eventual suicide worldwide. The present study focused on DSH attempters among Armed Forces personnel and family members with the aim of identifying modifiable factors to provide recommendations for primary prevention in the military milieu. MethodsHundred cases of survivors of DSH were evaluated in a case–control study using psychiatry assessment instruments (the Mini-International Neuropsychiatric Interview, Pierce Suicide Intent Scale, Hamilton's Depression and Anxiety Scales and presumptive life event scale) to assess psychiatric morbidity and psychosocial correlates. The findings were compared with those of 100 healthy matched controls. The data were analysed using SPSS software. ResultThe majority of DSH survivors (98%) had concurrent psychiatric morbidity, major depressive disorder (23%) being the commonest diagnosis followed by psychotic disorder and alcohol use disorder. Presence of relationship problems (69%) and financial difficulties (19%) were significant triggering factors in our study. Many DSH attempters had voiced suicidal ideation (66%) before their act and had history of aggression or violence (76%) in the past. ConclusionOur findings are discussed in relation with findings in the literature. Recommendations regarding awareness campaign, specific skill development programs and the need for early intervention in individuals with psychiatric morbidity have been proposed to prevent such behaviours.

Patients with deliberate self-harm attended in emergency setting at a tertiary care hospital: A 13-month analysis of clinical-psychiatric profile.

Objectives To describe the pattern and clinical-psychiatric profile of patients presenting with deliberate self-harm attempt to an emergency setting. Methods The study involves the analysis of the case records of 109 consecutive patients with deliberate self-harm evaluated by the psychiatric emergency team at a premier, tertiary care hospital in India over a period of 13 months (January 2015–January 2016). Results Deliberate self-harm had a clinical prevalence of 16.4% (109/666) among total mental and behavioral emergencies attended in the same period. A large majority of attempters were in the age range of 18–39 years (84.4%), and females (58.7%) outnumbered males in total sample. Married females and unmarried males had significantly higher chances of attempting deliberate self-harm (χ2 = 6.57, p = 0.01). More than half (52.3%) of patients were found to have a diagnosable psychiatric illness at the time of presentation, most common being depressive disorder in 19.3% of overall sample. Past history of a psychiatric illness was evident in only 12.5% of patients. Common methods of deliberate self-harm were prescription drug/psychotropic overdose, poisoning with ingestion of phenyl cleaner or rat-killer poison. Significant gender differences were observed in the nature of precipitating events for deliberate self-harm, with interpersonal relationship problems being significantly more common in women (p = 0.03). Conclusion This study adds relevant and useful information on cross-cutting as well as gender-specific characteristics of patients presenting with deliberate self-harm attempt, from a developing country context. The study findings bear implications for designing interventions for primary and secondary prevention of such behavioral emergencies at a community level.

A Study on Deliberately Self-Poisoned In-Hospital Patients in a Tertiary Health Care Center in Northeast India: ACross-Sectional Review.

The nature and profile of different modes of poisoning vary significantly in different parts of India. The assessment of the magnitude of suicidal poisoning is an area of paramount importance not only for appropriate management but also for raising social awareness and framing government policies for the prevention of same. We aimed to determine the pattern of poisoning, the sociodemographic profile of patients who poison themselves, and the in-hospital outcome of self-poisoned patients over a 1-year period. This was a cross-sectional observational study conducted between May 2015 and April 2016 that included 492 patients >12years of age who were admitted to our hospital after consuming poison with the intention of deliberate self-harm. Relevant history with respect to the nature and amount of poison ingested were taken and recorded, and the patients' sociodemographic profiles and outcome (as either discharge or death) were noted. Most of the patients were 13-28years of age (69%). Males (n=293 [59.55%]) predominated over females and the majority were farmers (n=193 [39.23%]). Rural cases (n=373 [75.81%]) outnumbered urban cases. The major causes of deliberate self-harm attempts were impulsive actions (n=442 [89.84%]). Pesticides (n=393 [79.88%]) were the most commonly consumed poison. The overall mortality rate was 12%, with paraquat (94.74%) topping the list of fatal substances. Young adults and males constitute majority of the population in this study. Agricultural poisons made up the bulk of the cases, mostly taken by rural population. Paraquat, an herbicide banned in several countries, had the highest mortality rate in this study.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury.

Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. An urban Midwestern city's hospital-based Children's Advocacy Center. Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka.

IntroductionRepetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka.MethodsDetails of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433).ResultsThere were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5–2.3%), 5.7% (95% CI 5.0–6.4) and 7.9% (95% CI 7.1–8.8) respectively. The median interval between two attempts were 92 (IQR 10–238) and 191 (IQR 29–419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4–0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7–12.2%).ConclusionsThe comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.

IMPROVEMENT IN BORDERLINE PERSONALITY DISORDER SYMPTOMS WITH DORSOMEDIAL PREFRONTAL CORTEX rTMS: TWO CASES

Borderline Personality Disorder (BPD) is a mental illness characterized with impulsiveness, both interpersonal relationships and emotional disturbance. Symptoms are related to hypofunction of frontal areas like Dorsomedial Prefrontal Cortex (DMPFC). Psychotherapy is the base treatment in this disease, but economic costs and long-time therapy have difficulted the attachment. Repetitive Transcranial Magnetic Stimulation(rTMS), authorized by Food&Drug Administration (FDA) on Major Depressive Disorder (MDD) treatment has proven good results in previous works in BPD clinical characteristics on both dorsolateral prefrontal cortex (DLPFC) and enhancement in depressive symptoms stimulating DMPFC. We present two clinical cases with BPD symptomatology improvement.Case I: A, 20-year-old woman, diagnosed with BPD five years ago, history of impulsiveness, self-harm and suicidal attempts. Referred depressive and binge episodes, low self-esteem and anger trouble management. Substance use history, suspended a year ago. Not psychotic symptoms presented.Case II: J, 20-year-old man, recent BPD diagnosis, history of high depressive and anxiety episodes, low self-esteem and unstable interpersonal relationships. No history of substance abuse or psychotic symptoms. Both patients got diagnosis confirmed and baseline clinical evaluations. No abnormal brain electrical activity was presented. They underwent through 5 Hz rTMS 30 sessions, one per weekday, 30 trains, 50 pulses each, with 10s inter-train interval; first half was an active modality, second half in a placebo mode. Both patients got symptoms severity evaluation, showing improvement from Baseline to Final (BvsF) scores in BPD clinical areas (Global Clinical Impression, CGI-BPD: A(39 vs 14), J(20 vs 15); Borderline-Symptoms-List, BSL:A(48 vs 12), J(10 vs 9)), depression and anxiety symptoms through Hamilton Depression (HDRS; A(23 vs 8), J(14 vs 5)) and Anxiety Rating-Scale (HARS; A(24 vs 3), J(9 vs 3)), respectively. CONCLUSIONS: Although rTMS proved enhancement on BPD symptoms, evidence is limited on the efficacy of this technique in this pathology.

Lifestyle risk indices in adolescence and their relationships to adolescent disease burden: findings from an Australian national survey

BackgroundThe current study investigates the extent to which an adolescent-specific lifestyle risk factor index predicts indicators of the leading causes of adolescent morbidity and mortality.MethodsData came from 13 to 17 year-old respondents from the 2013–2014 nationally representative Australian Child and Adolescent Survey of Mental Health and Wellbeing (n = 2314). Indicators of adolescent disease burden included Major Depressive Disorder, psychological distress, self-harm and suicide attempt. Risk factors included risky alcohol use, drug use, unprotected sex, smoking, BMI and sleep duration. The extent to which these risk factors co-occurred were investigated using tetrachoric correlations. Several risk indices were then constructed based on these risk factors. Receiver Operating Characteristic curves determined the precision with which these indices predicted the leading causes of adolescent disease burden.ResultsRisky alcohol use, drug use, smoking, unprotected sex, and sleep were all highly clustered lifestyle risk factors, whereas BMI was not. A risk index comprising risky alcohol use, drug use, unprotected sex and sleep duration predicted the disease burden outcomes with the greatest precision. 31.9% of the sample reported one or more of these behaviours.ConclusionsThis lifestyle risk factor index represents a useful summary metric in the context of adolescent health promotion and non-communicable disease prevention. Lifestyle risk factors were found to cluster in adolescence, supporting the implementation of multiple health behaviour change interventions.

Self-poisoning as a Target Group for Prevention of Suicide

Purpose: The Korean government has tried to decrease the suicide death rate over the last decade. Suicide attempts, particularly non-fatal attempts, are the most powerful known risk factor for a completed suicide. An analysis of suicide attempt methods will help establish the effective preventive action of suicide. Fit prevention according to the method of suicide attempt may decrease the incidence of suicide death. Self-poisoning is suggested as a major method of both suicide attempts and suicide death. The aim of this study was to determine if a self-poisoning patient is a suitable target for the prevention of the suicide. Methods: This was retrospective analysis of a prospective cohort, which included patients who presented to the emergency department (ED) after a self-harm or suicide attempt from Jan 2013 to Dec 2017. The proportion of methods in suicide attempts, psychological consultation, and fatality according to the suicide attempt method were analyzed. The types of poison were also analyzed. Results: Poisoning was the most common method of suicide attempts (52.1%). The rate of psychological consultations were 18.8% for all patients and 29.1% for poison patients (p&lt;0.001). The rate of mortality in poisoning was 0.6%. Psychological consultation was performed more frequently in admission cases than discharged cases. The most common materials of poisons was psychological medicines and sedatives that had been prescribed at clinics or hospital. Conclusion: Self-poisoning is a major method of suicide attempt with a high rate of psychiatric consultation, low mortality rate, versus others methods. The prevention of suicide death for suicide attempts may focus on self-poisoning, which is the major method of suicide attempts. A suitable aftercare program for self-poisoning may be an effective method for preventing suicide if an early diagnosis and management of psychiatric disorders through psychiatric consultation can be made, and early connection to social prevention program for non-fatal patients are possible.

"I Feel Permanently Traumatized By It": Physical and Emotional Impacts Reported by Men Forced to Penetrate Women in the United Kingdom.

This article reports findings from the first empirical study in the United Kingdom on forced-to-penetrate cases, where a man is forced to penetrate a woman either orally, vaginally, or anally with his penis and without his consent. Using an online survey, data were collected in relation to the physical and emotional impacts experienced by 154 men following their most recent forced-to-penetrate experience. Quantitative and qualitative data were collected through the use of closed and open-ended survey questions, where participants were asked about the context and circumstances of their most recent experience and whether they had suffered any physical injuries. A unipolar scale was used to measure the emotional impact on participants, with an open-ended follow-up question gathering qualitative data. The majority of participants did not report suffering physical injuries, but those that did suffered injuries to their genitalia and upper bodies. Participants most frequently indicated that their most recent forced-to-penetrate experience had had a severe negative emotional impact on them. Negative emotional impacts disclosed by participants were complex, ranging from anxiety and depression, to self-harm and suicidal thoughts and attempts. Quantitative analysis highlighted that when certain variables were present, participants more frequently reported physical injuries, as well as higher average levels of emotional harm. The findings from the study challenge existing understandings of masculinity and rigid sex and gender roles, which assume that men will always consent to sexual activity with a woman and that they cannot or do not experience emotional or physical harms at the hands of a woman. The findings are also considered in relation their implications for law and legal discourse, where evidence of harm is used as a justification for the criminalisation of certain behaviors and the severity of the legal response through sentencing.

Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study.

ObjectiveVictimized adolescents have an increased risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death in adolescents. This study tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ increased risk of self-injurious thoughts and behaviors.MethodParticipants were 2,232 British children followed from birth to 18 years of age as part of the Environmental Risk Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the 18-year assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at 18 years.ResultsVictimized adolescents had an increased risk of suicidal ideation (odds ratio [OR] 2.40, 95% CI 2.11–2.74), self-harm (OR 2.38, 95% CI 2.10–2.69), and suicide attempt (OR 3.14, 95% CI 2.54–3.88). Co-twin control and propensity score matching analyses showed that these associations were largely accounted for by pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest increase in risk for suicidal ideation (OR 1.45, 95%CI 1.10–1.91) and self-harm (OR 1.50, 95% CI 1.18–1.91) but not for suicide attempt (OR 1.28, 95% CI 0.83–1.98).ConclusionRisk for self-injurious thoughts and behaviors in victimized adolescents is explained only in part by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents.

The association between psychotic experiences (PEs) and non-accidental self-injury (NASI; including self-harm and suicide attempts) is well established, although variables influencing this relationship have not been comprehensively examined. This study aimed to investigate (1) the cross-sectional PE-NASI association before and after adjustment for confounders, and (2) the individual contribution of each confounding and potentially mediating variable to the association. A random sample of Australian adolescents aged 14-17years (n = 1998) completed self-report questions regarding any self-harm, suicidality or PEs experienced in the past 12months in 2013-2014 as part of the Young Minds Matter Survey, a national household survey. We conducted logistic regression analyses to investigate the association between NASI and PEs, after controlling for confounders (sociodemographics, substance use, and parental mental illness) as well as the influence of potential mediators (major depression, bullying, psychological distress, sleep, self-esteem, disordered eating behaviour, social isolation, and intervention factors). Except for special messages, all PE subtypes (auditory and visual hallucinatory experiences [HEs], and two of the three delusional experiences [DEs]) were associated with NASI after adjustment for confounders (OR range: 2.60-5.21). Depression and psychological distress significantly influenced all PE-NASI associations, where depression appeared to fully explain the DE-NASI association, and partially attenuate the HE-NASI association. Variables such as parental mental illness, disordered eating behaviour, and social isolation had negligible effects in nearly all self-harm and attempted suicide models. Adolescents reporting any PE in the past 12 months reported increased likelihood of NASI in the same time period and, auditory HEs in particular, were strongly and independently associated with self-harm and suicide attempts. These results highlight the importance of PEs as indicators of risk of self-injurious behaviour among Australian youth.