Self-harm Behaviors Research Articles

Are hospitals with both medical/surgical and psychiatric services associated with decreased difficulty in ambulance transfer for patients with self-harm behaviour? A nationwide retrospective observational study using ambulance transfer data in Japan

ObjectivesAmbulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with difficulty in hospital acceptance and longer prehospital transfer...

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Mental health impacts of interpersonal violence in sports

Mental health impacts of interpersonal violence in sports

Modeling structural relationships of social cognition with self-harming behaviors adolescent: mediating role of distress tolerance

Modeling structural relationships of social cognition with self-harming behaviors adolescent: mediating role of distress tolerance

The barriers and facilitators to the reporting and recording of self-harm in young people aged 18 and under: a systematic review

Background and aimsThis systematic review sought to identify, explain and interpret the prominent or recurring themes relating to the barriers and facilitators of reporting and recording of self-harm in young people across different settings, such as the healthcare setting, schools and the criminal justice setting.MethodsA search strategy was developed to ensure all relevant literature around the reporting and recording of self-harm in young people was obtained. Literature searches were conducted in six databases and a grey literature search of policy documents and relevant material was also conducted. Due to the range of available literature, both quantitative and qualitative methodologies were considered for inclusion.ResultsFollowing the completion of the literature searches and sifting, nineteen papers were eligible for inclusion.Facilitators to reporting self-harm across the different settings were found to be recognising self-harm behaviours, using passive screening, training and experience, positive communication, and safe, private information sharing. Barriers to reporting self-harm included confidentiality concerns, negative perceptions of young people, communication difficulties, stigma, staff lacking knowledge around self-harm, and a lack of time, money and resources.Facilitators to recording self-harm across the different settings included being open to discussing what is recorded, services working together and co-ordinated help. Barriers to recording self-harm were mainly around stigma, the information being recorded and the ability of staff being able to do so, and their length of professional experience.ConclusionFollowing the review of the current evidence, it was apparent that there was still progress to be made to improve the reporting and recording of self-harm in young people, across the different settings. Future work should concentrate on better understanding the facilitators, whilst aiming to ameliorate the barriers.

Recognising & responding to defendants with intellectual disability in court settings

BackgroundTo date, there is little evidence on the characteristics of defendants with intellectual disability when presenting to the criminal court system. This study was developed to recognise and examine the characteristics related to gender, ethnicity, mental health and index offences of defendants with intellectual disability and compare these to defendants without intellectual disability within Court Liaison & Diversion Services in London, England. MethodsThis is a retrospective data analysis of routine administrative data collected by the Liaison and Diversion services across five Magistrates courts in London, England. Data were analysed on defendants identified through screening to have an intellectual disability and compared to defendants without an intellectual disability. Results9088 defendants were identified, of these 4%, (349) were screened as having an intellectual disability. The study found an overrepresentation of defendants of black ethnicity along with high rates of comorbid mental illness and personality disorder amongst both non-intellectual disability and intellectual disability defendants. Defendants with intellectual disability self-reported self-harm and suicidal behaviour at higher rates. For neurodevelopmental disorders (NDD), those with intellectual disability were over 4 times more likely to have comorbid ADHD and over 14 times more likely to have ASD. Index offences were mostly similar although defendants with intellectual disability had elevated rates of being charged with sexual offences and breach of the peace. ConclusionThe findings confirm the presence of a small but significant number of defendants with intellectual disability presenting to the Court Liaison & Diversion services who have significant needs in terms of comorbidity and risk for suicide and self-harm behaviour. Further research is needed to understand the experiences of defendants with intellectual disability presenting to the Court including how best to deliver service models to improve recognition and respond to their high rates of health needs.

Peer support mental health teams in correctional settings in Uganda

Globally, the mental health and wellbeing of people who are incarcerated is a major public health and human rights issue.1 Approximately 70% of the world prison population is in low-income and middle-income countries (LMICs), and the pooled 1-year prevalence of living with a mental illness diagnosis in this population is high.1 People who are incarcerated and have untreated mental health conditions have a high likelihood of self-harming behaviours, violence to others, being physically or sexually victimised, increased rates of recidivism on release, and substance misuse.

The Pronoun Conundrum: He or She or They or Per or Ve: To Renounce or Denounce?

Gender dysphoria (GD) is when a person has a strong desire to act differently than their assigned gender, which causes significant distress and dysfunction. Western countries, especially those that legalise the third gender, employ affirmative therapy for people with GD. However, Islam and Malaysian law only recognise gender expression based on natal sex. This further put those with gender dysphoria in Malaysia at risk of developing anxiety, depression, self-harm behavior, and suicide. Apart from that, they are more likely to engage in risky behaviours such as unsafe sex, sex with same-sex, chemsex, substance misuse, drinking alcohol and smoking. This sexual behaviour, especially man sex with man (MSM), contributes to HIV/AIDS, sexual transmitted diseases, and anal cancer. Consequently, it increases the health burden. Thus, this presentation will discuss approaches to dealing with people with this gender dysphoria. There are also ethical dilemmas or conflicts among psychiatrists in giving the diagnosis of gender dysphoria, especially in children and adolescents. Once giving the diagnosis of gender dysphoria, what is the best approach that a Muslim psychiatrist needs to consider? Are we going to practise affirmative therapy or conversion therapy or what? Do Muslim healthcare providers have the right to enforce patients against their will? Still, this would make it harder for people to get help and make them less likely to go to healthcare providers, especially Muslims. In contrast, this will encourage people with GD to go to healthcare providers that can support or affirm their desire, which is against Islamic and Malaysian law. Muslim healthcare providers should take the opportunity to help people with GD manage their conflicts according to the Islamic way. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S5

Patients with borderline personality disorder and the effects of compulsory admissions on self-harm behaviour: a questionnaire study

Background Previous research on patients with borderline personality disorder (BPD) has indicated negative effects, including increased suicidality, from long hospital admissions and paternalism. Still, long-term compulsory admissions have been reported to occur regularly. Less is known about how healthcare personnel perceives these admissions and to what extent they think the use of compulsory care can be diminished. This study addresses those questions to make care more beneficial. Methods A questionnaire study, the respondents being nurses and psychiatric aides employed at psychiatric hospital wards in Sweden. The questionnaire contained questions with fixed answers and room for comments. 422 questionnaires were distributed to 21 wards across Sweden, and the response rate was 66%. The data were analysed with descriptive statistics and qualitative descriptive content analysis. Results Most respondents experienced that more than a week’s compulsory admission either increased (68%) or had no effect (26%) on self-harm behaviour. A majority (69%) considered the compulsory admissions to be too long at their wards, with detrimental effects on the patients. They also recognized several reasons for compulsory admissions without medical indication, like doctors’ fear of complaints and patients’ lack of housing. Also, patients sometimes demand compulsory care. Respondents recommended goal-oriented care planning, around three-day-long voluntary admissions, and better outpatient care to reduce compulsory hospital admissions. Discussion These findings imply that many BPD patients are regularly forced to receive psychiatric care that inadvertently can make them self-harm more. The respondents’ comments can be used as a source when formulating clinical guidelines.

Association of Non-Suicidal Self-Harm with Anxiety, Depression and Aggressive Behavior in Young Men of Military Age

Background: suicidal behavior, intentional self-harm and non-suicidal self-harm are important precursors of suicide in children and adolescents. The objective: to determine the prevalence and structure of non-suicidal self-harm, as well as the relationship of non-suicidal self-harming behavior with aggression, anxiety and depression in a non-clinical group of young men of military age. Participants and methods: the object of the study was 507 young men (from 18 to 27 years old). The average age of the examined was 19.32 years (± 2.35). Assessment of non-suicidal self-harm was carried out using a clinical interview and the scale of self-harming behavior (Polskaya N.A., 2014). The analysis of patterns of aggressive behavior was carried out with the Buss-Perry Aggression Questionnaire (BPAQ) to identify the propensity to aggression, the assessment of anxiety and depression level was assessed on Beck Anxiety and Depression Scales (BAI; BDI). Results: the study showed a high prevalence of non-suicidal selfharm in the non-clinical population of young people (33.9%). Instrumental self-harm was committed at least once in a lifetime by 14.7% of the surveyed, somatic — 19.2%. The most common acts of instrumental self-harm are blows with a fist, foot, head or body body on hard surfaces and cuts with cutting objects. From somatic — biting nails and lips, biting cheeks and tongue, combing the skin and creating obstacles to wound healing were the most frequent. As a result of the correlation analysis of the links of acts of self-harm with the domains of the scale of propensity to aggression from instrumental self-harm, a significant positive correlation was found in relation to self-burns. Punching your body and pulling out your hair turned out to be associated with all domains of the aggression scale. Self-harming was accompanied by depressive symptoms. Symptoms of anxiety correlate with somatic self-harm — punching your body, scratching your skin and biting your cheeks or tongue. Conclusion: non-suicidal self-harm showed positive correlations with manifestations of aggression, anxiety and depression. Effective and evidence-based prevention programs can be implemented at the population, subpopulation and individual levels to timely identify self-harming behavior. At the stage of psychiatric examination of young people, it is advisable to include in the complex of psychodiagnostic methods scales aimed at identifying self-harm, anxiety, depression and aggressive behavior.

Vulnerabilities and life stressors of people presented to emergency departments with deliberate self-harm; consolidating the experiences to develop a continuum of care using a mixed-method framework.

Suicide is a crucial public health concern. However, the interactions between bio psychosocial vulnerabilities and stressors leading to deliberate self-harm behavior remain unexplored, especially in the Indian context. This study examined the experiences leading to self-harm behavior among people who presented to emergency departments with suicidal attempts. In this mixed-methods study, we enrolled 44 patients who presented with self-harm behavior at three tertiary health care facilities between October and December 2019. To collect quantitative data, we employed standardized tools: General Health Questionnaire (GHQ-28), General Help-Seeking Questionnaire, Mini International Neuropsychiatric Interview, and the Brief Resilience Scale. Further, we conducted semi-structured interviews to qualitatively explore participants' life experiences and other risk factors. Qualitative analyses were performed using thematic analysis and quantitative descriptive and inferential statistics were performed using STATA software. The mean age of subjects were 29.8 years. The mean suicidality score for the patients was 26 (±8.7). In univariate analysis, depression and anxiety were positively associated with suicidality. While help-seeking behavior and resilience were negatively associated with suicidality. Qualitative results were centered on three major themes; life stressors, family related stressors, and social support-related vulnerabilities. The subjects' lived experiences were introduced in the backdrop of the interplay of vulnerabilities and stressors. The biopsychosocial vulnerabilities remain dormant until it is activated by life stressors resulting in severe self-harm behaviors. Mental health team-driven assertive engagement, positive coping, and social support interventions would help prevent reattempts in people with self-harm behaviors.

Review: Interventions to prevent or manage self-harm among students in educational settings - a systematic review.

At least half of all young people who die by suicide have previously self-harmed and most of those who self-harm will not seek help from health services for self-harming behaviours. By default, schools, colleges and universities necessarily play a key role in identifying those who self-harm and supporting them to access help. We conducted a systematic review (PROSPERO ID: CRD42021243692) of five databases (Medline, PsycINFO, ASSIA, ERIC and BEI) for quantitative studies evaluating interventions to reduce self-harm among students in schools, colleges and universities. We identified six eligible studies that reported interventions. Two interventions used mindfulness-based approaches and the remaining four interventions focused on in-classroom education. Three interventions reported a significant reduction in self-harm, all three used in-classroom education. Of the six studies, one study was rated methodologically moderate, while the remaining five were weak. In summary, the evidence base is limited in size and quality. Most current interventions to address self-harm in schools focus on training staff in awareness, with a significant gap in direct support for students.

Influence of academic stress and school bullying on self-harm behaviors among Chinese middle school students: The mediation effect of depression and anxiety.

The purpose of this study was to explore the relationship between academic stress, school bullying and self-harm behaviors among Chinese middle school students and to further explore the impact of anxiety and depression on this relationship. The students (aged 12-16 years) in a middle school in Changsha city were invited to respond to a questionnaire through an online platform. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess the severity of anxiety and depressive symptoms, respectively. The experience of being bullied, academic stress, and self-harm behaviors were assessed using several questions on the basis of previous studies. A total of 1,313 middle school students completed the study, and 3.40% and 4.10% of them reported suicide attempts (SAs) and non-suicidal self-injury (NSSI), respectively. Univariate logistic regression analysis revealed that anxiety symptoms (OR = 1.23, 95% CI: 1.18-1.28; OR = 1.25, 95% CI: 1.19-1.31), depressive symptoms (OR = 1.20, 95% CI: 1.16-1.25; OR = 1.26, 95% CI: 1.20-1.31), school bullying (OR = 3.8, 95% CI: 2.11-6.89; OR = 2.76, 95% CI: 1.39-5.47), and academic stress (OR = 2.20, 95% CI: 1.27-3.80; OR = 3.80, 95% CI: 1.20-7.25) were common factors of NSSI and SAs. In addition, depressive symptoms showed a mediating effect on the association of school bullying and academic stress with SAs or NSSI, and anxiety symptoms showed a mediating effect on the association of school bullying and academic stress with NSSI only. Appropriate strategies are needed to reduce academic pressure and prevent school bullying. Meanwhile, negative emotions such as depression and anxiety should be evaluated and intervened in to prevent self-harm behaviors among middle school students.

Association between alcohol consumption and severity of self-harm behaviors based on suicidal intent in patients admitted to the emergency department for self-harm

This study aimed to investigate the association between alcohol consumption and the severity of self-harm behaviors based on the suicidal intents of patients admitted to the emergency department (ED) for self-harm. This was a retrospective study on patients admitted to the ED between March 2017 and December 2020 owing to self-harm behaviors and were grouped into a suicide attempt (SA) and non-suicidal self-harm (NSSH) group. A total of 642 (73.5%) and 232 (26.5%) patients were classified into SA and NSSH groups, respectively. In the SA group, 270 (42.1%) patients reported consuming alcohol, which was independently associated with ≥12 years of formal education and no history of psychiatric hospitalization. In the NSSH group, 87 (37.5%) patients reported consuming alcohol, which was associated with male sex, being married or unmarried but living together, ≥12 years of formal education, and no history of depression. Alcohol consumption could predict ED disposition in the SA group but not in the NSSH group. The impact of alcohol consumption varied according to suicidal intents among patients admitted to the ED for self-harm behavior. Regardless of suicidal intent, patients with a higher education level tended to drink alcohol when engaging in self-harm behaviors.

User profiles of electronic ecological momentary assessment in outpatient child and adolescent mental health services

IntroductionElectronic ecological momentary assessment (EMA) can provide precise information regarding day-to-day functioning of patients overcoming some of the limitations of usual clinical evaluation; however adherence to this methodology might be a major threat. Research and application of EMA concerning clinical settings remains scant. Our goal was to study the user profiles of EMA in a clinical sample of adolescents. Material and methods209 adolescents following an outpatient mental health treatment accepted to use EMA. They were evaluated in different sociodemographic and clinical variables as well as the use that they made of EMA. Results39.7% of patients were considered users and 60.3% non-active users. Certain self-harm behaviours were more common in the group of active users, while hyperkinetic disorders were more common in the group of non-active users. A regression analysis revealed that non-suicidal self-injury (OR=2.99) and hyperkinetic disorders (OR=0.51) were related to the use of EMA. ConclusionThis preliminary study adds novel and promising information about EMA use in clinical practice. Adolescents with self-harm behaviours EMA seem more prone to use this tool. Our study provides support for actively monitoring self-harm behaviours with EMA. Future studies might consider a comprehensive analysis of adherence and EMA data collection.

Self-harming Behaviors and suicide probability in delinquent adolescent girls: The role of emotion dysregulation and modeling the self-harming of peers

Background: Adolescents may be exposed to several mental health related difficulties due to lack of complete cognitive maturity. Objective: This study investigated the mediation of emotion dysregulation and modeling of peers in relation between self-harming behaviors and suicide probability in adolescent. Material& Methods: In a descriptive study, we investigated juvenile delinquents of Correction and Rehabilitation Center of Mashhad during 2021. A total of 148 individuals were selected and evaluated using the self-harm motivation scale, Ottawa self-harming inventory, regulation problems scale and peer self-harm modeling scale. Data were analyzed using structural equation modeling in SmartPLS-3 software. Results: The mean age of participants was 16.21 (standard deviation=2.42). There was significant direct effect of self-harming behaviors on suicide probability (β=0.86 , P= 0.001 ). The significant indirect effect of self-harming behaviors on suicide probability through emotional dysregulation (β= 0.36, P= 0.001 ) was stronger than indirect effect mediated by peers modeling (β=0.17 , P= 0.04 ). The model account for 87 % of total variance of suicide probability. Conclusion: Based on the findings of the study, it can be concluded that emotion dysregulation and peers modeling play a role in increasing suicide probability and should be considered in preventing harmful behaviors in adolescents.

Etiopathogenesis in the Development of Borderline Personality Characteristics in Children and Adolescents.

The validity and clinical significance of the characteristics of borderline personality disorder (BPD) in adolescents are increasingly being recognized. The persistence of BPD characteristics in adolescence is high and is associated with negative interpersonal, academic, professional, and financial outcomes. In the literature, BPD characteristics observed in children and adolescents are explained with psychodynamic theories, developmental models, and evolutionary approaches. Emotional dysregulation, interpersonal dysfunction, impulsivity, and self-harming behavior, negative life events, temperament characteristics, neuropsychological dysfunctions, neuroanatomical, genetic, hormonal, and immunological factors may play a role in BPD etiopathogenesis. This review aims to address different approaches and relevant factors for the development of BPD. The articles published between 1968-2021 in the PubMed database were reviewed, and prominent studies were selected for evaluation. The importance of invalidating environment, epistemic freezing and hypermentalization, complex or attachment trauma is emphasized in psychodynamic and developmental literature. In the evolutionary approach, on the other hand, romantic relationships and the onset of reproduction are emphasized as the reason for the emergence of symptoms during adolescence, and it is argued that BPD is related to the rapid life history strategy. It is stated that a decrease in volume in the orbitofrontal cortex and anterior cingulate cortex, which are involved in top-down emotional processing, and an increase in the activity of thalamus and hippocampus regions, which are involved in bottom-up emotional processing are observed in adolescents with BPD characteristics when compared to healthy controls. It is thought that the increase in activation in the superior temporal gyrus and precuneus observed in adolescents with BPD features is a neural indicator of hypermentalization, and the increase in activation in the insula is a neural indicator of social pain. It has been reported that the decrease in resting heart rate and the increase in heart rate variability observed in adolescents with BPD symptoms are associated with the activation of the parasympathetic system. BPD in adolescents is a disorder that challenges clinicians in terms of diagnosis, differential diagnosis, and treatment. It is crucial to evaluate the factors related to etiopathogenesis in BPD in a multifaceted and detailed manner. Keywords: Borderline Personality Disorder, Difficulty in Emotion Regulation, Mentalization, Trauma, Self-harming Behavior, Temperamental Characteristics.

Suicidal and Homicidal Thoughts as Psychotic Symptoms in an Adolescent: A Case Report.

The first episode of psychotic disorders often occurs in adolescence. Depressive symptoms are the most common symptoms in the prodromal period and the symptoms in this period are not specific to psychosis. Adolescence is a risky period in terms of suicidal behaviors. The risk of self-harm is further increased in the prodromal period and in the psychotic episode. Homicides in psychosis constitute a small part of all homicidal cases and homicidal thoughts have been associated with command hallucinations and delusions. In this article, an adolescent girl with psychosis who had intense homicidal and suicidal thoughts and self-harming behaviors will be presented, and homicidal thoughts in psychosis will be discussed. The symptoms of the case decreased with risperidone, and she started to socialize with the support of her teacher, who visited her house for lectures. The medical, legal, and social aspects of suicides and homicides in psychosis are discussed. Keywords: Adolescent, psychosis, homicidal, suicidal.

Main Risk Factors Associated With Self-Harm Behaviors in Child and Adolescent Population: A Systematic Review Before and After the Pandemic

Main Risk Factors Associated With Self-Harm Behaviors in Child and Adolescent Population: A Systematic Review Before and After the Pandemic

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study.

Intoxication with pesticides is a well-known public health problem. We aimed to describe the demographic and toxico-clinical characteristics and outcomes of patients with pesticide poisoning. This retrospective cross-sectional study was performed in Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. All patients with pesticide poisoning (insecticides, herbicides, fungicides, rodenticides, and acaricides) were evaluated. The patients' demographic, toxicological, clinical, and laboratory findings from March 2016 until March 2021 were collected and analyzed. During the study period, 25,659 patients with acute poisoning were admitted, of which, 1567 (6.1% of the total poisoning) with pesticide poisoning were included. The mean ± SD age of the patients was 31.34 ± 13.7 years and 55.3% were men (male/female ratio = 1.23). In approximately 75% of the patients, poisoning occurred by suicidal attempts, while in 14.3% (n = 224), it was accidental. Insecticides caused about 51.30% of the poisonings. However, rodenticides were most commonly used in completed suicide attempts (79.9%). The frequency of previously attempted suicide, and self-harming was different among the patients with respect to the type of pesticide poisoning (p < 0.05). Previous suicidal attempts (35.3%) and self-harming (17.3%) were reported more in patients poisoned with the combination of pesticides. Half of the patients were employed. Nausea and vomiting (56.7%, n = 889) were the most common clinical manifestations; 8.3% (n = 130) of the patients died, 64 of whom had rodenticide poisoning. The prevalence of pesticide poisoning was relatively low; most were insecticide poisoning. Poisoning occurred most through attempted suicide. Rodenticides and herbicides had higher mortality rates than other pesticides. Patients with previously attempted suicide and self-harming behavior may use a combination of pesticides.