Self-harm Ideation Research Articles

Implementation challenges to TADS cognitive-behavioral therapy

This article discusses treatment obstacles that were frequently encountered by CBT therapists in the Treatment for Adolescents With Depression Study (TADS) trial. The most common or challenging treatment obstacles and their respective solutions were distilled from the minutes of national conference calls attended by TADS CBT supervisors and therapists. Obstacles were categorized into the following 6 themes: (1) comorbid disorders (i.e., anxiety, conduct, attention problems, and learning disorders); (2) severe depressive symptoms (i.e., anhedonia and hopelessness); (3) self-harm and suicidal ideation; (4) school refusal; (5) interpersonal factors, and; (6) treatment noncompliance. Case illustrations are provided throughout to illustrate these treatment obstacles and how they were addressed within the treatment manual.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR CHILDREN AND ADOLESCENTS WITH MAJOR DEPRESSION: CURRENT CONTROVERSIES AND RECOMMENDATIONS

Recent warnings about potential serious adverse effects with the selective serotonin reuptake inhibitors in children and adolescents with depression raises questions about the risk-benefit ratio of these drugs in this population. Published safety and efficacy trials of SSRIs for the treatment of youth with depression are critically reviewed. These data were augmented by information from regulatory hearings in 2003–2004 and selected open-label reports. Based on this review, recommendations for medication treatment and monitoring of children and adolescents with major depression on SSRIs are provided. Emerging data from several clinical trials show that the SSRIs provide moderate benefits for youth with depression. In addition, SSRI treatment may be associated with increased risk of behavioral activation, self-harm, and suicidal ideation. Appropriate use of the SSRIs in children and adolescents requires careful diagnostic assessment, evaluation of comorbidity, and close monitoring, especially early in treatment.

Depressive symptoms and suicidal behaviour: changes with time in an adolescent clinic cohort

Objective: There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment. Method: Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12–17 years, born in a 21-year period (1966–1986). Results: After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966–1971, to 13.1 years in those born in 1981–1986. Conclusions: Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the sample.

Depressive symptoms and suicidal behaviour: changes with time in an adolescent clinic cohort.

There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment. Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12-17 years, born in a 21-year period (1966-1986). After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966-1971, to 13.1 years in those born in 1981-1986. Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the sample.

Adolescents with suicidal behaviour: attendance at A&E and six month follow-up.

To review the clinical presentation, and Accident and Emergency Department clinical response to 14-20 year olds in suicidal crisis in inner city Dublin and to carry out a six month follow up of these young people. A retrospective review of the case notes of all 14-20 year olds who had attended the Mater Hospital A&E department between June 2001 and May 2002 with suicidal behaviour or ideation was carried out in order to establish socio-demographic information, type of suicidal or self-harming behaviour, intervention in the A&E department, and discharge plan. Active outreach attempts were made to trace, contact and interview these young peoples at least six months after the initial presentation. Quantitative measures of psychological functioning at follow-up included the General Health Questionnaire, The Beck Depression Inventory and The Scale for Suicidal Ideation. A qualitative interview covered their recall of the reasons for their deliberate self harm, their view of their current psychological functioning and personal relationships, reported repetition of deliberate self harm, and their views of what type of services would be useful for young people with suicidal ideation or behaviour. A total of 89 young people aged 14-20 years (male: female ratio = 2:3) presented to the Mater A&E department between June 2001 and May 2002 with deliberate self-harm, deliberate self-poisoning and/or suicidal ideation, and accounted for 108 presentations. They showed high levels of psychosocial disadvantage. Almost half had a history of previous contact with mental health services, while the same proportion had a history of previous deliberate self-harm. Drug overdose using paracetamol was the most common method used. Psychiatric assessment was documented in 66% of cases, and documented follow up recommendations were made in 60% of cases. Two thirds of the 89 young people who formed the study population were traced. Half of those contacted agreed to be interviewed and half refused. The majority of those interviewed described themselves as functioning better psychologically than at the time of the index attendance at the A&E department The quantitative measures supported this. One third of those interviewed reported repeated deliberate self-harm since their index attendance, for which most did not seek medical intervention. Many of the young people had clear views about the importance of talking to someone when in crisis. They described a service, which was informal, accessible on a 24-hour basis, and staffed by people with experience of mental health, alcohol and drug related disorders. This is a particularly vulnerable group of patients from a socio-demographic and mental health perspective. Their attendance at the A&E department provides a unique opportunity for an in-depth psychosocial assessment, which should be recorded in a systematic way to assist clinical audit, facilitate strategic mental health planning and may confer some therapeutic clinical benefit to at risk young people. An easily accessible, active DSH team specifically tailored for young people in the A&E department could provide assessment and short-term follow-up. This is the approach recommended by young people in suicidal crisis, whose views need to be heard.

Relationship between alcohol use disorders and suicidality in a psychiatric population: in-patient prevalence study.

Alcohol misuse is a risk factor in suicide and parasuicide. To measure the prevalence of alcohol use disorders in a cohort of psychiatric admissions using the Alcohol Use Disorders Identification Test (AUDIT), and the relationship between the AUDIT score and suicidality. Consecutive psychiatric admissions were interviewed with a lifestyle survey that included the AUDIT, and admission case notes were reviewed. Out of 200 subjects, 48.5% scored 8 or more (indicating hazardous or harmful alcohol use) and 22.5% scored 16 or more (indicating significant alcohol dependence) on the AUDIT. There were no significant gender differences. Alcohol misuse was strongly associated with suicidality. The AUDIT questionnaire should be incorporated into psychiatric assessments when risk of self-harm is being evaluated. Further research is warranted to examine the impact of interventions for alcohol use disorders in psychiatric settings on self-harm and suicidal ideation.

Predictors of Outcome Following Brief Psychodynamic-Interpersonal Therapy for Deliberate Self-Poisoning

We found that brief psychodynamic-interpersonal therapy was more helpful than usual care in deliberate self-poisoning patients, and resulted in reduced suicidal ideation and repetition of self-harm in the 6 months post-treatment. Here, we explore which baseline factors predicted outcome following treatment. Patients presenting to an emergency department with deliberate self-poisoning were randomly assigned to brief psychodynamic-interpersonal therapy (PIT) or usual care. Severity of suicidal ideation 6 months post-treatment was used as the main outcome measure. Sociodemographic features and baseline psychological measures were used as predictor variables. Univariate and regression analyses were used to identify predictors of outcome for the whole group and for those who received psychotherapy. Principal predictors for the psychotherapy group were baseline severity of depression and a prior history of self-harm. For the group as a whole predictors were severity of suicidal ideation, anxiety and prior history of self-harm. Four session PIT for deliberate self-poisoning is effective in reducing suicidal ideation in patients with less severe depression, no prior history of self-harm, and who have not consumed alcohol with the overdose. Extended therapy may be indicated for those with more severe depression.

Self-harm And Dementia: A Case Report

The association between dementia and self-harm behavior remains controversial.Some authors report that the diagnosis of dementia is rarely found in those who commit suicide, yet others have reported Alzheimer pathology to be overrepresented in this same group. We report the case of a man with a dementia superimposed on a longstanding mood disorder who recently started to express self-harm ideation.This case highlights several aspects of management including the importance of differentiating self-harm ideation and behavior as a symptom of psychosis in dementia vs a symptom of affective illness.

Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood

Childhood sexual abuse (CSA) as a predictor of depression and self-destructive behaviors in adulthood was examined relative to other traumatic stressors in childhood and adulthood with special attention to sex differences. In a college sample of 173 men and 265 women, 16% of male (n = 28) and 24% of female respondents (n = 63) reported having been sexually abused as children. CSA, ranging from unwanted kissing and fondling to unwanted sexual intercourse, predicted depression, chronic self-destructiveness, self-harm ideation, acts of self-harm, suicide ideation, and suicide attempts, for both men and women. The more frequent and severe the sexual abuse and the longer its duration, the more depression and self-destructiveness reported in adulthood. Other stressors predicted these effects less consistently but their occurrence in combination with CSA contributed to the negativity of long-term outcomes. Study results affirm previous findings of a relationship between CSA and depression and self-destructiveness in adult females and extend them to males.