Self-harm Prevention Research Articles

Financial Stress Amongst People Who Self-Harm in Sri Lanka

Objective Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka. Methods Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected. Results The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors. Conclusion The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

Comparing times of self-harm presentations to hospital emergency departments in children, adolescents, young adults and adults: a national registry study 2007–2019

PurposeThe few studies that have explored self-harm presentation times at hospital emergency departments (EDs) – an important factor that can determine if a patient receives a mental health assessment – primarily focus on adult samples. This study examined the times of self-harm presentations to EDs, self-harm methods used, mental health assessments, and admission data across different age-groups.MethodsUsing data from the National Self-Harm Registry Ireland over a 13-year timeframe (2007–2019), this study compared times, days, seasons, methods of self-harm, and admission data for children (8–12 years), adolescents (13–17 years), young adults (18–25 years) and adults (> 25 years).ResultsThe majority of the 152,474 self-harm presentations (78.6%) for all ages occurred out-of-hours (outside the standard working hours or in-hours times of 09:00–17:00, Monday-Friday). The four hours before midnight had the highest proportions of self-harm presentations for adolescents (27.9%) and adults (23.1%), whereas the four hours after midnight had the highest proportion of self-harm presentations for young adults (22.9%). The 16:00-midnight timeframe had highest proportion of self-harm presentations in children (52.3%). Higher proportions of patients received a mental health assessment in-hours compared to out-of-hours among young adults (78.2% vs. 73.3%) and adults (76.1% vs. 72.0%). Self-harm presentations were lowest during summer months in children and adolescents.DiscussionHospitals should ensure that adequate resources are available for individuals presenting with self-harm, especially in the case of overcrowded EDs, and protocols need to be designed for those presenting with self-harm due to intoxication. In line with national policy, protocols for patients presenting during out-of-hours should be designed that can incorporate services from allied health multidisciplinary teams, social work, addiction services and counselling organisations. Given the lower rates of self-harm during school holidays for children and adolescents, the school environment must be considered in the context of mental health and self-harm public health prevention interventions.

Clinical effectiveness and safety of adding a self-harm prevention app (BlueIce) to specialist mental health care for adolescents who repeatedly self-harm: A single blind randomised controlled trial (the BASH study)

No randomised controlled trials have evaluated whether the addition of a smartphone app to usual child and adolescent mental health care (CAMHS) can reduce self-harm in adolescents (<18 years) with repeated self-harm. We enrolled 170 participants aged 12–17, receiving CAMHS treatment who had self-harmed ≥2 in the past 12 months. Participants were randomised via an independent web-based system (1:1, minimised for gender, age, self-harm frequency, and depression severity) to treatment as usual (TAU) or treatment as usual plus BlueIce (TAU+BI). BlueIce is a self-harm prevention app that includes techniques from CBT and DBT that was co-designed with adolescents who self-harm. The primary outcome was change from baseline to 12-weeks on the self-harm scale of the Risk Taking and Self-Harm Inventory for Adolescents (RTSHIA), analysed by intention to treat (ITT). Emergency department attendances or admissions for self-harm were assessed over 6-months via a review of clinical records. Both groups improved but there were no statistically significant between group differences at 12 weeks or 6 months on the self-harm scale of the RTSHIA. There were fewer emergency department attendances and admissions in those who received the app, a finding that approached statistical significance. BlueIce can be helpful in some important aspects by contributing to fewer emergency department admissions and attendances. Trial registrationTrial registration number ISRCTN10541045.

Self-harm presentations to hospital trauma centre emergency departments during the first year of the COVID-19 pandemic

The COVID-19 pandemic raised concerns regarding increased suicide-related behaviours. We compared characteristics and counts of Emergency Department (ED) presentations for self-harm, an important suicide-related outcome, during versus prior to the pandemic's first year. We included patients presenting with self-harm to the ED of two trauma centres in Toronto, Canada. Time series models compared intra-pandemic (March 2020-February 2021) presentation counts to predictions from pre-pandemic data. The self-harm proportion of ED presentations was compared between the intra-pandemic period and preceding three years. A retrospective chart review of eligible patients seen from March 2019-February 2021 compared pre- vs. intra-pandemic patient and injury characteristics. While monthly intra-pandemic self-harm counts were largely within expected ranges, the self-harm proportion of total presentations increased. Being widowed (OR=9.46; 95 %CI=1.10–81.08), employment/financial stressors (OR=1.65, 95 %CI=1.06–2.58), job loss (OR=3.83; 95 %CI=1.36–10.76), and chest-stabbing self-harm (OR=2.50; 95 %CI=1.16–5.39) were associated with intra-pandemic presentations. Intra-pandemic self-harm was also associated with Intensive Care Unit (ICU) admission (OR=2.18, 95 %CI=1.41–3.38). In summary, while the number of self-harm presentations to these trauma centres did not increase during the early pandemic, their proportion was increased. The association of intra-pandemic self-harm with variables indicating medically severe injury, economic stressors, and being widowed may inform future suicide and self-harm prevention strategies.

Acceptability, use and safety of the BlueIce self-harm prevention app: qualitative findings from the Beating Adolescent Self-Harm (BASH) randomised controlled trial

BackgroundLittle is known about the social validity of self-harm prevention apps for young adolescents with severe mental health problems who repeatedly self-harm.ObjectiveWe assessed the acceptability, use and safety of BlueIce,...

Emotion dysregulation, bullying, and suicide behaviors in adolescents

Background: Among adolescents, rates for suicide attempts and non-suicidal self-injury (NSSI) remain high. Adolescents also often experience bullying, which has been found to associate with increased risk of suicide attempts and NSSI. Emotion regulation difficulties are associated with both bullying victimization and self-harm behaviors in adolescents. Aims: The current study examined the relationship between emotion dysregulation and suicide attempts and NSSI with bullying as a moderating factor. Method: High school students (n = 804) completed self-report measures on emotion regulation difficulties, suicide attempts, nonsuicidal self-injury, and past-year bullying experiences. Results: Moderation analyses found that the relationships between multiple emotion dysregulation dimensions and suicide attempts were significant regardless of bullying experience, but the relationship was stronger when bullying was present. For NSSI, bullying only moderated the relationships between nonacceptance of emotions, limited emotion regulation strategies and NSSI, with stronger associations when bullying was present. Limitations: Different types of bullying were not assessed, all measures were self-report, and the community sample had relatively low clinical severity. Conclusion: Results indicate that poor emotion regulation and bullying victimization associate with greater frequencies of suicidal and nonsuicidal behaviors. These findings point to the need for self-harm prevention programs to address both bullying and emotion regulation skills.

정신건강의학과 환자안전사고 분석(2017-2021)

The study was undertaken to investigate the occurrence and risk levels of patient safety incidents in the mental health department of domestic medical institutions, aiming to provide essential data for formulating strategies to prevent such incidents in the future.&#x0D; The data for this study were collected nationwide from medical institutions accredited by the Korean Institute for Healthcare Accreditation, with a focus on patient safety statistics. A total of 521 cases from comprehensive and tertiary hospitals with more than 200 beds, classified under the department of mental health and psychiatry, were analyzed. Data analysis was performed using SPSS/WIN 27.0 software, encompassing descriptive statistics, cross-tabulation analysis, and binary logistic regression.&#x0D; The results showed that the number of patient safety incidents increased slightly in 2020 and 2021 compared to 2017. However, the level of harm caused by these incidents indicated a trend of increasing near misses and decreasing adverse events from 2017 to 2021. Comprehensive hospitals had a significantly higher proportion of adverse events in patient safety incidents compared to tertiary hospitals. The results of binary logistic regression analysis revealed that comprehensive hospitals had a 2.459 times higher risk of adverse events compared to tertiary hospitals. When comparing incident types, the risk of adverse events for falls was 10.677 times higher, and for suicide and self-harm events, it was 66.103 times higher compared to medication errors. Regarding age groups, the risk of adverse events for the 20-39 age group was 3.335 times higher compared to the 0-19 age group. For the 40-59 age group, the risk was 4.911 times higher for the 60-79 age group, it was 5.340 times higher, and for the 80 years and above age group, it was 4.027 times higher . The goodness of fit test for the final model indicated a good fit, and the model's explanatory power was 30.2%.&#x0D; Based on the study results, there is a need for a systematic analysis of nursing staff levels in comprehensive hospitals and their relationship with patient safety incidents and it is crucial to prioritize comprehensive hospitals when devising patient safety incident prevention measures in mental health. Suicide and self-harm prevention, and fall prevention strategies, should be considered as indispensable components. Furthermore, it is recommended to give priority to implementing patient safety incident prevention strategies for individuals aged 60-79 years of age.

Antecedents, clinical and psychological characteristics of a large sample of individuals who have self-harmed recruited from primary care and hospital settings in Pakistan.

Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries. To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan. This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed. Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals. Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.

Emotion regulation weakens the associations between parental antipathy and neglect and self-harm

Using a representative sample of 7918 Portuguese adolescents (Mage = 15.5, SD = 1.7, 53.3% female gender) and three self-report measures of parental antipathy and neglect, self-harm and its functions, and emotion regulation, this cross-sectional study examined the moderating role of emotion regulation in the links between these negative childhood experiences and self-harm in adolescence. Maternal and paternal antipathy and neglect had the largest effects on self-harm for youth with low levels of emotion regulation. These results emphasize the relevance of promoting emotion regulation across multiple contexts (e.g., school, family, legal system) for the prevention of adolescent self-harm, even in situations with a history of childhood emotional abuse and/or neglect.

27 An evaluation of suicidality of those over 65 years referred to liaison psychiatry in the acute hospital setting

Abstract Background The Mental Health Service for Older People (MHSOP) Liaison Service in North Dublin noted an exponential increase in suicide attempts in those over 65 over a period of 3 years (2020–2022). Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged &amp;gt;60). Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men. Methods Analysis of referrals to the service from an established clinical database was performed to include those referred post suicide attempt or those referred for suicidal ideation or expressing a Passive Death Wish (PDW). Data was anonymized and recorded using Microsoft excel. Results There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n = 1) and 2022 (n = 13), with z = +3.21 p &amp;lt; 0.001. Referrals post suicide attempt in 2021 consisted of 2% (n = 6) of all referrals to the service, and 6% (n = 20) in 2022. In 2021 the mean age of those referred was 75.16, and in 2022 was slightly lower at 72.65, with 60% of those in the 65–72 year age range. Alcohol was involved in 45% of all suicide attempts in 2022. The overall referrals to the service for suicidality (post suicide attempt and PDW) increased from 5% to 16% from 2021 to 2022 of all those referred. Conclusion A Suicide prevention working group was established to include members of: MHSOP, Older Persons Services, Public Health and the National Office for Suicide Prevention (NOSP) to explore evidence based suicide and self-harm prevention strategies and guidelines in order to address the multiple precipitative factors for suicidality in older persons by developing improved care pathways and integration of services.

Psychosocial interventions for the prevention of self-harm repetition: protocol for a systematic review and network meta-analysis

IntroductionSuicide is an important public health problem. Providing evidence-based psychosocial interventions to individuals presenting with self-harm is recognised as an important suicide prevention strategy. Therefore, it is crucial to understand...

A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial

BackgroundSelf-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm.MethodsThis was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016).ResultsWe screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (− 3.6 (− 4.9, − 2.4)), depression (− 7.1 (− 8.7, − 5.4)), hopelessness (− 2.6 (− 3.4, − 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention.ConclusionsSuicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.

Substance Use, Internet Risk Behavior, and Depressive Symptoms as Predictors of Self-harm Thoughts in Adolescents: Insights from the 2019 ESPAD Survey in Croatia.

Self-harm has become a nonspecific symptom of mental distress that is most prevalent in the adolescent population. Since it is often a hidden problem, it is important to focus on preventing it. This study used the data from the Croatian leg of the European School Survey Project on Alcohol and Other Drugs to assess certain risk factors and possible protective factors for self-harm thoughts among 16-year-olds in Croatia. Using binary logistic regression, we identified that being female, having less family support and less parental knowledge of adolescents' activities, more frequent cannabis use, more compulsive Internet use and more frequent depressive symptoms significantly increased the likelihood of self-harm thoughts in this sample. Identifying factors that lead to thoughts of self-harm may open a potential space for self-harm prevention before those thoughts progress into behavior.

The role of alcohol use in pesticide suicide and self-harm: a scoping review

PurposeSuicide and self-harm by pesticide self-poisoning is common in low- and middle-income countries (LMICs). Alcohol is an important risk factor for self-harm; however, little is known about its role in pesticide self-poisoning. This scoping review explores the role that alcohol plays in pesticide self-harm and suicide.MethodsThe review followed the Joanna Briggs Institute scoping review guidance. Searches were undertaken in 14 databases, Google Scholar, and relevant websites. Articles were included if they focussed on pesticide self-harm and/or suicide and involvement of alcohol.ResultsFollowing screening of 1281 articles, 52 were included. Almost half were case reports (n = 24) and 16 focussed on Sri Lanka. Just over half described the acute impact of alcohol (n = 286), followed by acute and chronic alcohol use (n = 9), chronic use, (n = 4,) and only two articles addressed harm to others. One systematic review/meta-analysis showed increased risk of intubation and death in patients with co-ingested alcohol and pesticides. Most individuals who consumed alcohol before self-harming with pesticides were men, but alcohol use among this group also led to pesticide self-harm among family members. Individual interventions were recognised as reducing or moderating alcohol use, but no study discussed population-level alcohol interventions as a strategy for pesticide suicide and self-harm prevention.ConclusionResearch on alcohol’s role in pesticide self-harm and suicide is limited. Future studies are needed to: further assess the toxicological effects of combined alcohol and pesticide ingestion, explore harm to others from alcohol including pesticide self-harm, and to integrate efforts to prevent harmful alcohol use and self-harm.

A qualitative study on lived experience of self-harm in South Asians in the UK: From reasons to recovery.

Self-harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self-harm. Previous research suggested investigating individuals' experiences with self-harm with qualitative studies in developing self-harm prevention strategies. This research aims to explore self-harm experiences among South Asians in the United Kingdom. Qualitative study. Participants were recruited via third-sector organizations and online platforms. Semi-structured interviews were conducted with 11 South Asian individuals with a history of self-harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach. Results revealed four main themes: (1) reasons for self-harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self-harm included negative life circumstances, social life difficulties, challenges faced during COVID-19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self-care, psychoeducation and personal growth, improving social relationships,and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self-harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self-harm. The findings suggest that socio-cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self-harm among South Asian communities.

Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder

BackgroundAlthough there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown.ObjectiveTo examine whether specific physical injuries are associated with risks...

Incidence of suicide and self-harm among people with opioid use disorder and the impact of opioid agonist treatment: A retrospective data linkage study

BackgroundRates of suicide and self-harm are elevated among people with opioid use disorder (OUD). This study examined incidence of self-harm and suicide among people who have entered OAT and assessed the impact of different OAT exposure periods on these events. MethodWe conducted a retrospective population-based cohort study of all OAT recipients (N = 45,664) in New South Wales, Australia (2002–2017), using linked administrative data. Incidence rates of self-harm hospitalisations and suicide deaths were estimated per 1000 person-years (PY). The first 28 days of an OAT episode, ≥ 29 days on OAT, the first 28 days off OAT, and ≥ 29 days off OAT (maximum four years post-OAT) were exposure periods. Poisson regression models with generalised estimating equations estimated the adjusted incidence rate ratios (ARR) of self-harm and suicide by OAT exposure periods, adjusting for covariates. ResultsThere were 7482 hospitalisations (4148 individuals) for self-harm and 556 suicides, equating to incidence rates of 19.2 (95% confidence intervals [CI]=18.8–19.7) and 1.0 (95%CI=0.9–1.1) per 1000 PY, respectively. Opioid overdose was implicated in 9.6% of suicides and 28% of self-harm hospitalisations. Compared to ≥ 29 days on OAT, the incidence rate of suicide was elevated in the 28 days following OAT cessation (ARR=17.4 [95%CI=11.7–25.9]), and the rate of self-harm hospitalisations was elevated during the first 28 days of OAT (ARR=2.2 [95%CI=1.9–2.6]) and the 28 days after leaving OAT (ARR=2.7 [95%CI=2.3–3.2]). ConclusionsOAT may reduce suicide and self-harm risk among people with OUD; however, OAT initiation and cessation are critical periods for targeting self-harm and suicide prevention interventions.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Journey of young self-harm survivors from being vulnerable to resilient: Participants’ perspective on a culturally-adapted self-harm prevention intervention

IntroductionRepeated self-harm represents the single strongest risk factor for suicide. Worldwide, suicide is the second leading cause of death in young people aged 15-29 year, and the leading cause of death in many Asian countries.ObjectivesThis qualitative study was nested in a multi-center effectiveness trial of a Youth Culturally-adapted Manual Assisted Problem-solving intervention (Y-CMAP) for prevention of self-harm in Pakistan and aimed to explore young people’s perspective on the intervention.MethodsOne-to-one in-depth qualitative interviews were conducted with 20 participants from 5 cities across Pakistan, using a semi-structured topic guide to explore their views about self-harm, Y-CMAP intervention content, perceived effectiveness and challenges. Interviews were conducted in Urdu language, digitally recorded, transcribed verbatim and translated into English. Thematic analysis was conducted by the trained qualitative researchers.ResultsInterpersonal conflicts including relationship difficulties, financial problems, and lack of social support were highlighted as precipitating factors of self-harm. Participants reported that Y-CMAP intervention is structured and easy to understand. They acknowledged the role of distraction techniques, cost-benefit analysis, discussion on thinking pattern, problem-solving and anger management in improving their mental health and wellbeing and reduce self-harm. Participants also shared their initial fears regarding the intervention, such as fear of disclosure of information to media. School and job timings were described as potential challenges for participation in the intervention.ConclusionsExploring the perspectives of young people about culturally-appropriate intervention is imperative in their journey towards preventing suicide, which is a preventable cause of premature death. Findings are particularly relevant for Pakistan, one of the youngest nations in the world with limited resources for suicide prevention.Disclosure of InterestNone Declared

Empowering community control over alcohol availability as a suicide and self-harm prevention measure: Policy opportunity in Aotearoa New Zealand

One of the most pressing issues in public health in Aotearoa New Zealand (NZ) is our rate of suicide and self-harm, particularly among young people.1,2 The 2018 New Zealand Government Inquiry into Mental Health and Addiction recognised the challenge of reducing these rates, and raised the important issue of the role of alcohol and other substance use in increasing suicide risk.1