Self-harm Attempts Research Articles

Comparison of Outcomes of Dialectical Behavior Therapy (DBT) Alone versus DBT Combined with Second-Generation Antipsychotic in the Treatment of Borderline Personality Disorder

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, self-harming behaviors, and difficulties in interpersonal relationships. While Dialectical Behavior Therapy (DBT) is widely recognized as the most effective treatment for BPD, some individuals continue to struggle with severe mood disturbances and impulsive behaviors, necessitating additional therapeutic interventions. This study aimed to compare the outcomes of DBT alone versus DBT combined with second-generation antipsychotic medication (olanzapine) in the treatment of BPD. Methodology: A randomized controlled trial was conducted at Gulab Devi Hospital, Lahore, where 102 participants diagnosed with BPD, as per DSM-5 criteria, were recruited and assigned to one of two treatment groups. Group A received DBT alone, while Group B received DBT along with olanzapine (5-20 mg/day). Treatment effectiveness was assessed using standardized clinical scales, including the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HARS), and Barratt Impulsiveness Scale (BIS-11). Additionally, self-harm attempts and emergency unit visits were recorded over a 12-week period. Result: The results indicated that both groups showed significant symptom reduction; however, the DBT + Olanzapine group demonstrated greater improvements across all measured outcomes. Participants in the combination therapy group exhibited significantly lower post-treatment scores for depression, anxiety, and impulsivity compared to the DBT-alone group (p < 0.05). Moreover, there was a notable reduction in self-harm attempts and emergency visits in the DBT + Olanzapine group, suggesting enhanced emotional stabilization and crisis prevention. Conclusion: These findings support the potential benefits of combining DBT with pharmacological intervention in the management of BPD, particularly for individuals with severe emotional dysregulation and high-risk behaviors. However, given the side effect profile of olanzapine, individualized treatment plans should be considered. Further research with long-term follow-up is needed to assess the sustainability of treatment effects and medication adherence.

A qualitative exploration of the lived experiences and views of users of mental health services after self-harm

ABSTRACT Background: Individuals at risk of suicide have low engagement with mental health services (MHS). Reasons for this include stigma about suicide, inadequate public awareness, and the difficulty in approaching MHS. Lived experiences of users of MHS might yield insights into this low engagement and improve the access to mental health interventions for users. Aim: To explore the lived experiences and views of individuals with self-harm who were users of specialist MHS in a tertiary general hospital setting. Methods: We used a qualitative study design with in-depth interviews. We included participants who had used inpatient or outpatient MHS for a self-harm attempt. We used a realist approach to thematic analysis and ATLAS ti qualitative software for coding. Results: We recruited 25 participants (16 women and nine men) between 18 and 43 years. All participants had completed a randomized controlled trial on the efficacy of telephone outreach in suicide prevention. The themes generated were the participants’ inherent attitudes toward self-harm and suicide, their experiences of MHS, their perspectives on treatments that helped with suicidal ideation, and the impact of their experiences with MHS on future help-seeking. Conclusions: The user perspectives of MHS appear to be influenced by their inherent pre-existing beliefs about suicide. Users find specific interventions for suicidal ideation beneficial and healthcare infrastructural problems as challenges. Individuals with persistent difficulties after self-harm were more likely to engage with healthcare services. The study limitation was the absence of perspectives from those individuals who dropped out from MHS and other settings.

Multitrait GWAS of non-suicidal self-injury and the polygenetic effects on child psychopathology and brain structures.

Multitrait GWAS of non-suicidal self-injury and the polygenetic effects on child psychopathology and brain structures.

주의력 결핍/과잉행동 장애 초등학생의 학교 내 공격행동에 대한 다중체계치료 사례연구

This study is a case study of the use of multi-systemic therapy to improve the severe aggressive behavior exhibited by elementary school students diagnosed with attention deficit/hyperactivity disorder. The purpose of this study is to confirm that multi-systemic therapy is a promising approach to severe aggressive behavior in elementary school students with attention deficit/hyperactivity disorder. To achieve this goal, the pre- and post-treatment changes were assessed using the standardised assessment tools, the K-CBCL for parents and the K-TRF for teachers, and the frequency of problem behaviour was measured daily throughout the baseline and intervention periods. The core goals of the treatment were set as 1) reducing aggressive behavior, 2) reducing self-harm and suicide attempts, 3) increasing compliance behavior, 4) reducing classroom escape behavior, and 5) increasing prosocial behavior. In the implementation phase, a multi-systemic strategy was implemented for each system surrounding the child. Individual intervention included anger management skills training and medication management, while behavioral parental training and school-home notes were implemented in the family. Teacher systems implementation included alternative behavior differential reinforcement (praise) teacher training, school-home notes, and time-outs, while classroom systems intervention included on-site monitoring and immediate crisis intervention, and social skills training for the entire class. Finally, at the community level, the police were dispatched to assist in crisis situation. The research results showed that the incidence of problem behavior during the intervention period decreased by 71.26% compared to the baseline. No problem behaviors were observed two weeks before the end of the intervention period. The PEM calculated by Ma (2006) showed a very high intervention effect of 98%. In the parent rating of the child's problem behavior, the scales that were previously at the clinical and subclinical levels all returned to normal levels after the intervention.

Mental health and self-harm/suicide risk screening at prison entry over 12 months in a total population sample in New South Wales, Australia.

International research has found high rates of mental illness and self-harm/suicide among people in prison. However, existing studies are often limited by their sample selection methodology, and many do not examine mental health at prison entry specifically. In addition, with smaller samples, previous studies have lacked statistical power to robustly examine and compare subgroups. This study examines a total population sample of 9568 individuals entering public prisons in New South Wales, Australia over a 1-year period, and describes the prevalence of a range of mental health and self-harm/suicide risk indicators collected during routine health screening upon prison entry. In total, 62% of prison entrants reported a lifetime mental health condition and 23% reported a serious mental illness. Lifetime self-harm (14%) and suicide attempts (12%) were also high. Women and First Nations people entering prison had higher prevalence of most mental health diagnoses and of previous self-harm and suicidal ideation/behaviour than men and non-First Nations people. These results establish the scale of mental health need and self-harm/suicide risk among people entering prison, particularly among women and First Nations people. There is a clear need for investment to adequately resource prison-based mental health services to meet the needs of prison entrants, but also in interventions to prevent those with significant mental health needs from entering prison in the first place. These strategies may include targeted and preventive approaches via mental health diversion and community-based mental health services.

Prevalence of personality disorder and psychiatric co-morbidity in an Irish inpatient setting.

Personality disorders, characterised by pervasive emotional and interpersonal dysfunction, are integral to psychiatric practice. This service review estimated the prevalence of personality disorders in a psychiatric inpatient setting and looked at various clinical and demographic factors of interest. Data were retrospectively collected from 526 patients discharged from St Patrick's University Hospital in 2019-2020 under the care of two consultant-led teams. Demographic and clinical data such as age of first mental health contact, number of previous admissions, and risk history were recorded as well as the use of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). 37% of the sample had at least one personality disorder, with borderline (24.9%), avoidant (13.3%) and obsessive-compulsive (7.6%) being the most common subtypes. Notably, in 72.1% of cases the diagnosis was new. High comorbidity was observed, particularly with affective (47.7%) and anxiety disorders (28.4%). Patients with personality disorders exhibited high rates of self-harm (45%) and suicide attempts (40%). The review highlighted potential delays in diagnosis, with an average of 15 years of mental health service contact prior to diagnosis. The findings underscore the need for specialised services and further research to better understand and manage personality disorders in the Irish psychiatric setting. Limitations include the specific sample from a private mental health facility and the high use of structured interviews, which may affect the generalisability of the results to other settings. This review contributes valuable data to the limited research on personality disorder prevalence in Irish psychiatric services.

‘Man up and get on with it’: a qualitative exploration of UK ex-serving personnel’s experiences of seeking help for self-harm and suicidal behaviours

ABSTRACT Background: A substantial proportion of UK military personnel experiencing mental health problems do not seek professional support. Although the promotion of help-seeking is a key suicide prevention strategy, little is known about help-seeking for self-harm and suicidal behaviours among the UK Armed Forces. Objective: This study aimed to explore UK ex-serving personnel’s experiences of seeking help for self-harm, suicidal ideation, and suicide attempts. Method: Participants were recruited via an existing longitudinal cohort study exploring the health and well-being of the UK Armed Forces. A subgroup of ex-serving personnel reporting lifetime self-harm and/or suicidal behaviours was invited to participate in semi-structured interviews and 15 individuals participated, representing help-seekers/non-help-seekers and formal/informal support. Interviews were analysed using reflexive thematic analysis. Results: Five distinct but related and interacting themes were developed: (1) military mindset; (2) stigma; (3) fear of consequences; (4) access to and awareness of support; and (5) facilitators to help-seeking. Conclusions: Help-seeking decisions and experiences were influenced by several barriers and facilitators. Providing an environment where military populations feel willing and able to access support for self-harm and suicidal behaviours could lessen the impact on their health and well-being and ultimately save lives.

Polygenic risk scores in relation to suicidality among youth with or at risk for bipolar disorder.

Polygenic risk scores in relation to suicidality among youth with or at risk for bipolar disorder.

Suicidal thoughts and behavior of adolescents with depression in Reunion Island – evolution before and after the initial Covid-19 lockdown

Suicidal thoughts and behavior of adolescents with depression in Reunion Island – evolution before and after the initial Covid-19 lockdown

Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study.

Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study.

Adolescent self-harm and suicide attempts: An analysis of emergency department presentations in Singapore.

The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore's future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour. A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore's KK Women's and Children's Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted. A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts. Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore's National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.

Unraveling Gender Differences in Obsessive-Compulsive Disorder: A Focus on Key Micronutrients.

Introduction Obsessive-compulsive disorder (OCD) is a persistent psychiatric condition that causes significant clinical and functional impairments. Recent research suggests a link between deficiencies in micronutrients, particularly vitamin B12, folic acid, and elevated homocysteine, and the development of OCD. This study investigates the blood levels of these micronutrients and their relationship to OCD severity, with an emphasis on potential gender differences. Methods This cross-sectional study included300 drug-free OCD patients. Serum levels of vitamin B12, folic acid, and homocysteine were measured using established biochemical methods. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess clinical severity. Data were examined to determine relationships between micronutrient levels and OCD severity and differences between male and female patients. Results This study found that women had higher levels of vitamin B12 (405.3 ± 15.1 vs. 360.4 ± 14.3) and folic acid (7.18 ± 0.27 vs. 5.76 ± 0.25) but lower levels of homocysteine (9.35 ± 0.64 vs. 14.4 ± 0.60) compared to men. Higher folic acid levels were linked to study participants having higher levels of education (at a college or university, where subjects are studied at an advanced level) compared to those withprimary-level education. Lower vitamin B12 levels were linked to family mental health history and noncommunicable diseases. Women exhibited lower levels of substance use but higher rates of self-harm and suicide attempts. Elevated homocysteine levels were linked to longer illness duration and more severe OCD symptoms. Conclusion These findings suggest that imbalances in micronutrients, particularly vitamin B12, folic acid, and homocysteine, may contribute to OCD severity and treatment resistance. Gender-specific variations in micronutrient levels could provide valuable insights into personalized OCD therapy choices. Further longitudinal studies are needed to understand theserelationships and their potential as therapeutic targets.

Paracetamol Overdoses Among Danish Adolescents: A COVID-19 Perspective.

This study examines trends in paracetamol overdoses among Danish adolescents during and following the COVID-19 pandemic. A retrospective observational study was conducted using data from the national databases, covering all paediatric departments in Denmark from January 2016 to December 2023. Patients between 10 and 19 years of age diagnosed with paracetamol overdose were stratified by sex, age and number of hospital admissions. As the dataset covers the entire population, observed values reflect true parameters. A one-sample t-test compared post-COVID-19 values to the pre-COVID-19 mean. A total of 4.448 patients accounted for 5.794 hospital admissions due to paracetamol overdoses, with a majority being girls. During the second year of the pandemic (2021), a rise in overdose cases (26.5%) and hospital admissions (30.3%) was observed, especially among girls. The average number of admissions per patient increased, indicating repeated self-harm attempts. Cases of severe overdoses leading to acute liver failure increased at Rigshospitalet. These trends reversed post-pandemic. The findings suggest an association between pandemic-related isolation and an increase in adolescent paracetamol overdoses. While rates began to normalise after restrictions were lifted, further research is needed to assess the long-term mental health impact of such restrictions.

Mortality in adolescents after therapeutic intervention for self-harm: A systematic review and meta-analysis.

Self-harm in adolescents is an international concern. Evidence highlights that therapeutic intervention (TI), such as cognitive behaviour therapy informed treatments, after self-harm leads to reduced self-harm repetition. However, there is no prior literature about the effects of TI on future mortality in adolescents. We examined the effect of TI on mortality rates in adolescents across RCTs. This review was reported in accordance with PRISMA guidance. MEDLINE, EMBASE, PsycINFO, and Cochrane Library were searched to 19 June 2024. Two authors independently screened titles, abstracts, and full texts against predefined criteria. RCTs were included if they compared a TI versus a comparator in adolescents up to 18 years with at least one prior self-harm episode. There was no lower age limit. For the pooled effect size of mortality, the DerSimonian-Laird method was used, and a random effects model for self-harm and suicide attempts. The primary outcome was intra or post-trial mortality in adolescent post TI, and the effect of TIs on self-harm including attempted suicide episodes were secondary outcomes. Analyses were done in Stata. Twenty-four trials of TIs consisting of 3470 randomised adolescents were included. The pooled risk difference for mortality of participants in the TI group was 0.002 (95% CI -0.003 to 0.008, p = 0.42). There were 6 deaths in the TI group compared to 15 deaths in the comparator group. The pooled risk difference for TI on repeat self-harm was -0.07 (95% CI -0.132 to -0.007, p = 0.028), and -0.05 (95% CI -0.086 to -0.007, p = 0.022) for suicide attempts compared to comparator. This review found no significant impact of TIs on future mortality in adolescents. We also demonstrated that TIs can reduce suicide attempts which can lead to substantial benefits for adolescents, families, and clinical services.

The effect of the COVID-19 pandemic and school closures on self-harming and suicidal behaviors in adolescents: A comprehensive meta-analysis.

The COVID-19 pandemic has significantly affected adolescents' mental health, raising concerns about the potential increase in self-harming and suicidal behaviors (SIB). This study aimed to evaluate the pandemic's impact on SIB among adolescents and explore the effects of school closures and psychiatric vulnerabilities to inform future interventions. A systematic review and meta-analysis were conducted using PubMed, resulting in 420 studies, of which 36 studies (comprising 53 samples) met the inclusion criteria, encompassing 1,754,106 adolescents. Effect sizes were calculated using proportion effect size. Heterogeneity across studies was assessed using Q-statistics and I², while Egger's test was applied to evaluate publication bias. Differences between clinical and community samples, as well as the influence of psychiatric symptoms or disorders, were examined. Clinical samples demonstrated higher rates of SIB compared to community samples, with adolescents having psychiatric symptoms or disorders being more vulnerable. Overall, the pandemic was associated with a decline in SIB rates compared to pre-pandemic levels. Suicidal ideation decreased by 4.14% in combined samples and by 7.13% in community samples. Self-harm rates fell by 5.38% and 6.62% in combined and community samples, respectively. In contrast, clinical samples showed a distinct trend, with suicidal ideation decreasing by 29.39%, while self-harm rates increased by 32.51% and suicide attempts rose by 22.41%. The COVID-19 pandemic's impact on adolescents' SIB varied significantly across population types and levels of psychiatric vulnerability. While general declines were observed, the pronounced increases in self-harm and suicide attempts among clinical samples highlight the need for tailored mental health interventions. Addressing these disparities is essential for future mental health strategies and crisis preparedness.

The Etiopathogenic Mosaic of Suicidal Behaviour.

Suicidality is among the most controversial concepts in multi-disciplinary studies worldwide, regardless of the form and approach. The etiopathological variability in suicidal ideation correlates with the heterogeneity of the clinical and behavioural patterns of self-harm attempts, which significantly impact the prognosis and quality of life of patients. The main objective of the present study was to identify and outline the spectrum of factors predisposing to suicide, with the whole suite of consequences and manifestations in ideation and behaviour. In this regard, the research literature of the last decade contains numerous articles dealing with the theoretical premises pertaining to both the statistical and the profoundly psychological and philosophical dimensions of suicide. The micro-environment favouring the clinical evolution of self-harm/self-destructive thoughts and attempts to the terminal, final act integrates individual medical-biological and psychological factors into the overall social reality. Knowledge of the whole etiopathogenic amalgam with clinical-evolutionary implications allows for the development of methods and tools for the early assessment and prevention of suicidal risk. At the same time, the present study aims to qualitatively focus on the subjective motivation declared by patients regarding the internal, individual catalyst of suicidal ideation and attempts on a predominantly psycho-social coordination.

Age-period-cohort analysis of self-harm incidence rates by gender in Iran among individuals aged 10–39 years, 1990–2019

This study investigates trends and patterns in self-harm incidence rates among individuals aged 10–39 years in Iran from 1990 to 2019. Using Age-Period-Cohort (APC) analysis, it aims to identify significant age, period, and cohort effects, and to highlight gender-specific trends for effective prevention strategies. Utilizing data from the Global Burden of Disease (GBD) study, we performed an APC analysis to assess trends in self-harm incidence rates by gender. Data was stratified into six age groups and six five-year periods, and analyzed using the APC Web Tool from the National Cancer Institute. The average incidence rates of self-harm attempts and deaths among individuals aged 10–39 years were 93.87 and 7.55 per 100,000 individuals, respectively. Females had 1.75 times higher attempt rates than males, while males had 1.62 times higher death rates. The APC analysis revealed that males experienced stable self-harm rates over time, while females showed a significant decline. Peak incidence for both genders occurred at age 22.5 years. Self-harm incidence rates show younger females are more vulnerable to self-harm, but there has been a general decline in incidences over time, particularly for more recent cohorts but the stability of rates across ages and the lower rates in more recent cohorts highlighted in male.

Systematic Review and Individual Participant Data Meta-analysis: Reducing Self-harm in Adolescents: Pooled Treatment Effects, Study, Treatment, and Participant Moderators.

Systematic Review and Individual Participant Data Meta-analysis: Reducing Self-harm in Adolescents: Pooled Treatment Effects, Study, Treatment, and Participant Moderators.

Self-Harm as a Contributor to the Opioid Epidemic: Data From the Toxicology Investigators Consortium Registry.

Although considerable focus has been placed on understanding the causes of opioid drug overdoses, the intentions for such overdoses are not well characterized. We investigated the motivations behind nonfatal opioid exposures resulting in serious adverse health outcomes. We analyzed prospectively collected data on nonfatal opioid overdoses in the multicenter Toxicology Investigators Consortium (ToxIC) Core Registry between 2014 and 2021. Included patients were age ≥11 years with serious toxicity after use of pharmaceutical and/or nonpharmaceutical opioids for whom the reasons for opioid exposure were determined. Pharmaceutical opioids were defined as United States Food and Drug Administration-approved medications. All other opioids were classified as nonpharmaceuticals. The 5250 cases meeting the criteria were 56.6% male with a median age of 36 years (IQR, 26-50). There were 2960 (56.4%) opioid misuse cases and 1456 (27.7%) self-harm attempts. Within the self-harm group, 1242 (85.3%) were suicidal, and 1187 (95.6%) of these used pharmaceutical opioids in their suicide attempt. Only 94 (4.2%) patients using nonpharmaceutical opioids did so in a suicide attempt. Pharmaceutical opioid suicide attempts as a percent of all registry cases peaked between 2015 and 2017 and fell dramatically thereafter (P = 0.005). For comparison, benzodiazepine overdoses similarly decreased (P = 0.003), whereas non-opioid analgesic or antidepressant overdoses increased. A majority of serious opioid overdoses were sequelae of opioid misuse, but over a quarter were intentional self-harm attempts, primarily involving pharmaceutical opioids. Decreased prescribing of opioids and benzodiazepines after 2016-2017 may have resulted in decreased pharmaceutical opioid and benzodiazepine misuse and self-harm attempts. Similar trends were not seen for nonpharmaceutical opioids.

Risk of mortality among adolescents and young adults following hospitalization from an intentional overdose

Risk of mortality among adolescents and young adults following hospitalization from an intentional overdose