Suicidal Self-harm Research Articles

Дезадаптивные личностные, нейропсихологические и социально-психологические факторы у подростков с отклоняющимся самоповреждающим поведением

According to theoretical data, the propensity to self-injurious behavior is compared with addictive patterns based on unifying behavioral, mental and psychological factors within the framework of a clinical approach. Emotional regulation, cognitive functioning, features of deviant behavior, and socio-psychological characteristics in adolescents with self-harm, depending on the presence or absence of a suicidal goal, have been studied to a small extent so far. The Columbia Suicide Severity Assessment Scale, a questionnaire for the study of deviant behavior, a brief assessment of cognitive functions, and an emotional regulation questionnaire examined 156 adolescents with non-suicidal self-harm and 148 adolescents with suicidal behavior. The results of the study of the cognitive regulation of emotions convincingly indicate the presence of a pronounced cognitive-affective imbalance with a shift towards a deficit of effective strategies for overcoming emotional situations in adolescents with suicidal behavior. Adolescents with suicidal self-harm have a tendency to various manifestations of deviations. Affective interference, problem-solving behavior, operative memory, and emotion suppression are more impaired in adolescents with suicidal behavior compared to adolescents with non-suicidal self-harm.

Gender Differential in the Choice of Methods of Dying by Suicide in Southwest Nigeria

Abstract Background: The choice of method of dying by suicide can determine the lethality of a suicide attempt, especially among males and females. However, a less attention has been paid to this area of research among Nigerian authors. Objective: The objectives of this study were to investigate the distribution of completed suicide across methods of suicide among decedents and to examine the odds ratio of males using hanging or poisoning methods. Materials and Methods: This retrospective chart-based study was conducted among those who died by suicide and whose cases were reported at the police stations. The data were collected by checking the files at the homicide and suicide departments at the police headquarters in southwest Nigeria. Ethical approval was obtained for the study. Descriptive statistics and logistic regressions were used to analyze the data. Results: The results revealed that 78.3% were male, while females were 21.7%. 53.7% of the sampled population died by hanging and 23.2% died by poisoning. 8.9% of the decedents died by self-harm suicide. Suicide choices traceable to mental illness and jumping/drowning were 6.4% and 6.4%, respectively, while suicide by gunshot (1.5%) was less prominent. Furthermore, the result showed that there was a 3% likelihood that a male would die by hanging. Conclusion: Males are 3% more likely to die by hanging and are less likely to die by poisoning.

Investigating the causal risk factors for self-harm by integrating Mendelian randomisation within twin modelling

Previous genetically informed studies have uncovered likely causal relationships between mental health problems and self-harm but resulting causal estimates may be biased due to unmediated pleiotropy. By fitting Mendelian Randomization - Direction of Causation (MR-DoC) models that explicitly model pleiotropy, we investigated the effect of four quantitatively measured mental health problems - major depressive disorder (MDD), schizophrenia, attention-deficit hyperactivity disorder (ADHD), and insomnia, on non-suicidal self-harm (NSSH) and suicidal self-harm (SSH), separately. We used data of 12,723 twins (56.6% females) in the Twins Early Development Study. Besides substantial pleiotropy, we found effects from child-rated depressive symptoms to both NSSH (β = 0.194, 95% CIs: 0.131, 0.257) and SSH (β = 0.210, 95% CIs: 0.125, 0.295). Similarly, effects flowed from parent-rated depressive symptoms to NSSH (β = 0.092, 95% CIs: 0.004, 0.181) and SSH (β = 0.165, 95% CIs: 0.051, 0.281). We did not find evidence of aetiological difference between NSSH and SSH.

Multi-site medical record review for validation of intentional self-harm coding in emergency departments

BackgroundCodes in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), are used for injury surveillance, including surveillance of intentional self-harm, as they appear in administrative billing records. This study estimated the positive predictive value of ICD-10-CM codes for intentional self-harm in emergency department (ED) billing records for patients aged 10 years and older who did not die and were not admitted to an inpatient medical service.MethodsThe study team in Maryland, Colorado, and Massachusetts selected all or a random sample of ED billing records with an ICD-10-CM code for intentional self-harm (specific codes that began with X71-X83, T36-T65, T71, T14.91). Positive predictive value (PPV) was determined by the number and percentage of records with a physician diagnosis of intentional self-harm, based on a retrospective review of the original medical record.ResultsThe estimated PPV for the codes’ capture of intentional self-harm based on physician diagnosis in the original medical record was 89.8% (95% CI 85.0–93.4) for Maryland records, 91.9% (95% CI 87.7–95.0) for Colorado records, and 97.3% (95% CI 95.1–98.7) for Massachusetts records.ConclusionGiven the high PPV of the codes, epidemiologists can use the codes for public health surveillance of intentional self-harm treated in the ED using ICD-10-CM coded administrative billing records. However, these codes and related variables in the billing database cannot definitively distinguish between suicidal and non-suicidal intentional self-harm.

Self-harm and Suicidality Experiences of Middle-Age and Older Adults With vs. Without High Autistic Traits

Suicide has been identified as a leading cause of premature death in autistic populations. Elevated autistic traits have also been associated with higher rates of self-harm, suicidal ideation, and suicidal self-harm in the general population, but this has yet to be examined in older age. Using baseline cross-sectional data from the PROTECT study, middle-age and older adults with high autistic traits (n = 276) had significantly higher rates of suicidal ideation, deliberate self-harm, and suicidal self-harm than an age/sex-matched comparison group (n = 10,495). These differences represented a 5- to 6-fold increase in likelihood for self-harming and suicidality. These findings, which remained when controlling for depression symptoms, suggest that middle-age and older adults with high autistic traits may be particularly at risk of self-harm and suicidal behaviours.

Non-suicidal and Suicidal Self-harm at a Psychiatric Centre: A review of cases

Background
 Previous self-harm has been reported as an important risk factor for future attempts and death by suicide, therefore understanding the psychosocial characteristics of people with a history of self-harm may help in developing models for reduction of suicide. The objective of this study was to present the psychosocial characteristics of patients who presented with self-harm and recorded them in our suicidality register.
 Method
 This is a review of the suicidality register of patients who presented with deliberate self-harm and were referred and reviewed by the psychiatric unit at the Ekiti State University Teaching Hospital (EKUSTH). Data were retrieved from the register and enter in SPSS version 25. Descriptive statistics such as mean with standard deviation and frequency were done to describe the characteristics of interest.
 Results
 Of the 33 cases reviewed, the majority were females 51.6%, aged 29years and below, single (67.7%), unemployed 17 (51.5%), and had depression as the primary psychiatry diagnosis (54.5%). Although multiple reasons were given for self-harm, the desire to die was the commonest (54.5%) while ingestion of poisons was the commonest (75.8%) method adopted.
 Conclusion
 Previous self-harm is an important risk factor for future attempts and death by suicide, understanding the psychosocial characteristics of people with a history of self-harm may help in developing frameworks for a surveillance system for self-harm and attempted suicides.

Non-suicidal and Suicidal Self-harm at a Psychiatric Centre: A review of cases

Background
 Previous self-harm has been reported as an important risk factor for future attempts and death by suicide, therefore understanding the psychosocial characteristics of people with a history of self-harm may help in developing models for reduction of suicide. The objective of this study was to present the psychosocial characteristics of patients who presented with self-harm and recorded them in our suicidality register.
 Method
 This is a review of the suicidality register of patients who presented with deliberate self-harm and were referred and reviewed by the psychiatric unit at the Ekiti State University Teaching Hospital (EKUSTH). Data were retrieved from the register and enter in SPSS version 25. Descriptive statistics such as mean with standard deviation and frequency were done to describe the characteristics of interest.
 Results
 Of the 33 cases reviewed, the majority were females 51.6%, aged 29years and below, single (67.7%), unemployed 17 (51.5%), and had depression as the primary psychiatry diagnosis (54.5%). Although multiple reasons were given for self-harm, the desire to die was the commonest (54.5%) while ingestion of poisons was the commonest (75.8%) method adopted.
 Conclusion
 Previous self-harm is an important risk factor for future attempts and death by suicide, understanding the psychosocial characteristics of people with a history of self-harm may help in developing frameworks for a surveillance system for self-harm and attempted suicides.

The Buffering Effect of Perceived Parental Social Support in the Longitudinal Relationship Between Homophobic Cyberbullying and LGBTQIA Adolescents’ Health Outcomes

This 1-year longitudinal study examined the moderating effect of perceived parental social support in the associations between homophobic cyberbullying involvement (victimization and bystanding) and suicidal ideation, non-suicidal self-harm, and subjective health complaints among 467 adolescents ( Mage = 13.81 years; 59% female) who identified as LGBTQIA. Results showed that homophobic cyberbullying involvement were both related positively to suicidal ideation, non-suicidal self-harm, and subjective health complaints 1 year later. Parental support did not moderate the relationship between homophobic cyberbullying involvement and subjective health complaints. However, parental support moderated the relationship between homophobic cyberbullying involvement (both victimization and bystanding) and suicidal ideation and non-suicidal self-harm. Hence, the present study highlights the need for more research on homophobic cyberbullying, the crucial role parents can play in mitigating negative outcomes of involvement in homophobic cyberbullying, and the development of inclusive anti-cyberbullying prevention programs that acknowledge the needs of LGBTQIA adolescents.

Suicide and deliberate self-harm among women in Nepal: a scoping review

BackgroundSuicide is a growing public health problem globally. Suicide accounts for 70% of violent deaths among women in low and middle income countries. In Nepal suicide is the single leading cause of death among women of reproductive age. The aim of this scoping review is to explore and understand the various contexts related to vulnerability of Nepalese woman towards suicide and deliberate self-harm.MethodsA scoping review based on Arksey and O’Malley’s methodological framework including a combination of peer-reviewed publications and grey literature was conducted. The National Library of Medicine’s PubMed and Google Scholar search engines were used during July 2019 applying a Boolean search strategy.ResultsSuicide incidence was found to be higher among younger age group and married women, with poisoning as the most common means of suicide. Psychosocial and economic factors such as abuse, interpersonal conflicts, marital disputes, relationship problems, adjustment problems, unpaid loans and financial losses; and mental health conditions such as mood disorder, adjustment disorder and substance abuse disorder were found to be contributing factors for suicide and deliberate self-harm among women in Nepal.ConclusionSocio-cultural and economic factors shape family and marital relationships which impacts psycho-social and mental wellbeing of women in Nepal inciting suicidal attempts and deliberate self-harm. However, very few studies were found that explore the context of poverty, social exclusion, gender inequality, education, traditional/cultural and patriarchal system in which suicide among women in Nepal occurs.

The antecedents and outcomes of persistent and remitting adolescent depressive symptom trajectories: a longitudinal, population-based English study

Depression often first emerges in adolescence and, for many, is a lifelong disorder. The long-term clinical course of depression is highly variable. We aimed to examine the adult outcomes of adolescent-onset trajectories of clinically significant depressive symptoms and to identify factors differentiating trajectories that persist and desist in adulthood. We included participants from the English population-based Avon Longitudinal Study of Parents and Children with data on depressive symptoms. Self-reported depression symptoms were assessed on ten occasions when participants were age 10·5-25 years using the short Mood and Feelings Questionnaire, and major depressive disorder episodes were assessed at age 13·0 years, 15·0 years, 17·5 years, and 25·0 years. We characterised trajectories of depression symptoms using latent class growth analysis, for which we required depression data at least once from each of three key phases: ages 10·5-13·5 years; 16·5-18·5 years; and 21-25 years. We examined adult outcomes by assessing lifetime suicidal self-harm and functional impairment at age 24·0 years, and employment, education, and the self-reported Strengths and Difficulties Questionnaire at age 25·0 years. We studied 4234 participants: 2651 (63%) female, 1582 (37%) male, and one individual with missing sex data. The mean age was 10·6 years (SD 0·2) at baseline and 25·8 years (SD 0·5) at the final timepoint. Data on ethnicity were not available in our data set. We identified four depression trajectory classes: adolescent-persistent depression with onset early in adolescence (7%, n≈279), adolescent-limited depression with onset later in adolescence and remittance by adult life (14%, n≈592), adult-increasing depression (25%, n≈1056), and stable-low levels of depression (54%, n≈2307). The adolescent-persistent class was associated with poor adult outcomes for functional impairment (62%), suicidal self-harm (27%), mental health difficulties (25%), and not being in education, employment, or training (16%). Adolescent-limited depression was associated with transient adolescent stress, but by early adulthood functional impairment and mental health difficulties were similar to the stable-low group. Major depressive disorder polygenic score (odds ratio [OR] 1·36, 95% CI 1·04-1·79), adolescent educational attainment (OR 0·47, 0·30-0·74), and any early childhood adversity (OR 2·60, 1·42-4·78), that persisted into adulthood (OR 1·60, 1·38-1·87) distinguished the adolescent-persistent and adolescent-limited groups. The future course of adolescent depression can be differentiated by age at onset during adolescence, adolescent academic attainment, early and persistent adversity, and genetic loading. A detailed social and educational history could be helpful in making clinical decisions about the intensity of interventions for young people with clinically elevated depressive symptoms who seek help. Medical Research Council, Wolfson Centre for Young People's Mental Health, Wolfson Foundation.

When should we intervene in adolescent depression and with whom?

When should we intervene in adolescent depression and with whom?

Investigating the genetic and environmental aetiologies of non-suicidal and suicidal self-harm: a twin study.

Self-harm is a major health concern, not only as a signal of distress but also as a strong predictor of later suicide. Self-harm can be further refined into suicidal self-harm (SSH, i.e. suicide attempt) and non-suicidal self-harm (NSSH). Understanding the aetiologies of NSSH and SSH can help inform suicide prevention strategies. Using a twin design, we investigated the phenotypic and aetiological relationships between NSSH and SSH, and their aetiological overlap with mental health problems. We analysed data from the Twins Early Development Study using structural equation modelling. At age 21 years, 9063 twins (62.4% female) answered questions related to self-harm. At age 16 years, 19 self- or parent-reported mental health measures were administered, including measures of internalising and externalising problems, psychotic-like experiences and substance abuse. Prevalences for NSSH and SSH were 21.9% and 10.5%, respectively. Additive genetic factors explained half of the variance in NSSH (55%) and SSH (50%), with the rest explained by non-shared environmental factors. Phenotypically, NSSH and SSH were strongly correlated (r = 0.87) with their correlation explained by genetic (57%) and non-shared environmental (43%) factors. We found no evidence that NSSH and SSH differed in their phenotypic and aetiological relationships with mental health measures. Our findings suggest no aetiological difference between NSSH and SSH. NSSH and SSH should be regarded as two different ends of a continuum, rather than as two distinct categories.

Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: the feasibility of a randomised controlled trial of a guided online intervention

BackgroundThe evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual.MethodsTurkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis.ResultsEighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups.ConclusionAlthough intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not.Trial registrationNetherlands Trial Register, NTR5028. Registered on 1 March 2015

91 Mental Health Burden of Adolescents with Dysautonomia

Abstract Background Dysautonomia of Adolescence (DAOA) results from a dysregulation of the autonomic nervous system during puberty and affects multiple organ systems in the body. Symptoms have a significant impact on quality of life (QoL) with many adolescents reporting a poorer QoL compared to other pediatric chronic illness populations. Furthermore, there is a paucity of research looking at underlying mental health conditions in patients with DAOA that might be contributing to poor QoL. Objectives The aim of this review was to characterize the underlying mental health status of patients with DAOA followed in a tertiary care DAOA Clinic. Design/Methods Single-centre retrospective chart review (January 2017-November 2019) of all current patients followed in a tertiary care DAOA Clinic. Mental health challenges were classified as significant symptoms reported and/or formal diagnosis of anxiety, depression, attention deficit hyperactivity disorder, obsessive compulsive disorder, eating disorders, somatization, mood disorders, suicidal ideation, and self-harm. Frequency tables were generated for all categorical variables. Results Seventy-three patients are currently being followed in the DAOA clinic. Fifty-five of 73 (75%) had some form of mental health challenge including 11 (15%) which had a history of suicidal ideation and/or self-harm, 12 (17%) had no mental health concerns, and 6 (8%) are unknown. Of the 55 patients with a mental health challenge, 27 (49%) were diagnosed with a mental health condition prior to formal DAOA diagnosis and 10 (18%) were diagnosed after DAOA diagnosis. Eighteen (14%) reported symptoms of a mental health challenge but no confirmed mental health diagnosis. A breakdown of mental health symptoms and diagnoses are shown in Table 1. Of the 73 current patients, 41 (56%) accessed psychology services either through the DAOA Clinic or in the community, 9 (12%) have been referred to other health care services, and 8 (11%) did not access services. Psychiatric services were required by 15 patients (21%). Conclusion Three-quarters of DAOA patients report some mental health challenges. This emphasizes the need for psychology to support patients with DAOA. It is unclear as to whether a mental health challenge exacerbates symptoms of DAOA or DAOA symptoms negatively impact their mental health.

The Association Between App-Administered Depression Assessments and Suicidal Ideation in User Comments: Retrospective Observational Study.

BackgroundMany people use apps to help understand and manage their depression symptoms. App-administered questionnaires for the symptoms of depression, such as the Patient Health Questionnaire-9, are easy to score and implement in an app, but may not be accompanied by essential resources and access needed to provide proper support and avoid potential harm.ObjectiveOur primary goal was to evaluate the differences in risks and helpfulness associated with using an app to self-diagnose depression, comparing assessment-only apps with multifeatured apps. We also investigated whether, what, and how additional app features may mitigate potential risks.MethodsIn this retrospective observational study, we identified apps in the Google Play store that provided a depression assessment as a feature and had at least five user comments. We separated apps into two categories based on those having only a depression assessment versus those that offered additional supportive features. We conducted theoretical thematic analyses over the user reviews, with thematic coding indicating the helpfulness of the app, the presence of suicidal ideation, and how and why the apps were used. We compared the results across the two categories of apps and analyzed the differences using chi-square statistical tests.ResultsWe evaluated 6 apps; 3 provided only a depression assessment (assessment only), and 3 provided features in addition to self-assessment (multifeatured). User comments for assessment-only apps indicated significantly more suicidal ideation or self-harm (n=31, 9.4%) compared to comments for multifeatured apps (n=48, 2.3%; X21=43.88, P<.001). Users of multifeatured apps were over three times more likely than assessment-only app users to comment in favor of the app’s helpfulness, likely due to features like mood tracking, journaling, and informational resources (n=56, 17% vs n=1223, 59% respectively; X21=200.36, P<.001). The number of users under the age of 18 years was significantly higher among assessment-only app users (n=40, 12%) than multifeatured app users (n=9, 0.04%; X21=189.09, P<.001).ConclusionsApps that diagnose depression by self-assessment without context or other supportive features are more likely to be used by those under 18 years of age and more likely to be associated with increased user distress and potential harm. Depression self-assessments in apps should be implemented with caution and accompanied by evidence-based capabilities that establish proper context, increase self-empowerment, and encourage users to seek clinical diagnostics and outside help.

Social Media Use and Mood, Suicidal Ideation and Self-Harm in Adolescents

Objective: The aim of our observational study was to evaluate depressive symptoms in adolescent population, focusing on suicidal ideation and intentionality, and to establish the relationship between depressive symptoms/self-harm and the average time spent in social media. Methods: Our study was an observational cross-sectional study that involved three Middle Schools and three High Schools in the Campania region of Italy. One thousand three hundred sixty-five students 11-19 years of age were recruited (mean age=15 years; female=51%, male=49%). Percentage of adhesion was 95%. All the subjects were administered three self-report questionnaires, filled out anonymously and in the presence of the teachers after illustrating their validity and purpose. Results: In 23% females and 18% males, depressive symptoms were above the norm, with a slight increase in the prevalence of depressive symptoms in high school students compared to middle school ones. Suicidal intentionality was expressed in 4% of the total sample, with no differences between males and females. Suicidal ideation was present in 14% of the total sample, with a higher prevalence in females than in males (17% vs 10%). We found a significant positive relationship between the depressive symptoms and the hours spent on Social Media, in both males and females. A significant relationship was also found between hours on Social Media and suicidal ideation/intentionality. Conclusions: Our study showed a high prevalence of depressive symptoms in adolescents, in keeping with previous studies. Our study also showed a significant association between the use of social networks and the development of depressive symptoms, as well as suicidal ideation and intentionality. Further studies are needed to investigate the nature of this relationship.

Detection and Prevention of Twitter Users with Suicidal Self-Harm Behavior

Recently, with the development of communication means such as 4G and the rapid growth of the use of mobile devices (smartphones and tablets) the number of twitter users has increased exponentially. By the end of 2018 Twitter had 321 million active users with over 600 million tweets every day. However, all this information will have no use if we cannot access the meaning it carries. The authors' idea is to identify Twitter users with suicidal or self-harm behaviors by analyzing their tweets using an algorithm inspired from the social life of Asian elephants. The objective is to prevent the situations of depressions, threats of suicide or any other form of self-destructive behavior that exists on Twitter.

The Independent and Cumulative Effects of Sibling and Peer Bullying in Childhood on Depression, Anxiety, Suicidal Ideation, and Self-Harm in Adulthood.

Sibling and peer bullying are reported as the most frequent forms of violence experienced across childhood. There is now ample evidence indicating an association between sibling and peer bullying, with those reporting sibling bullying at an increased risk of peer bullying. While there is convincing evidence of a causative association between peer bullying and a range of mental health outcomes, sibling bullying continues to receive far less attention. The aim of this study was to explore whether sibling bullying roles (non-involved, victim, bully-victim, bully) in middle childhood were independently associated with clinical diagnoses of depression and anxiety and reports of suicidal ideation and self-harm in early adulthood. We further tested whether there was a cumulative relationship between involvement in sibling and peer bullying victimization. This study was based on up to 3,881 youth from the Avon Longitudinal Study of Parents and Children, a prospective birth-cohort based in the United Kingdom. Sibling and peer bullying was assessed via self-report when youth were 12 years of age, while depression, anxiety, suicidal ideation, and self-harm were assessed via self-administered computerized interviews at 24 years of age. Involvement as a sibling bully-victim was associated with clinical diagnosis of depression (OR = 1.91, 95% CI: 1.33–2.72), while sibling victims were at increased odds of both suicidal ideation (OR = 1.52; 95% CI, 1.16–1.98) as well as suicidal self-harm (OR = 2.20, 95% CI, 1.36–3.58) in early adulthood, even after accounting for concurrent peer bullying and a range of other pre-existing childhood confounders. Sibling and peer bullying were further associated in a homotypic manner. A dose–response relationship of bullying in the home and school across mental health outcomes was found. Youth victimized by both their siblings and peers displayed the highest odds of developing clinical depression, suicidal ideation, and self-harm. Children bullied at home and at school had no safe place to escape the bullying and torment. Our findings highlight the need for intervention studies tailored toward reducing sibling bullying, as these may hold large promise for alleviating a range of adverse outcomes, including the prevention of peer bullying, which may be contingent on early bullying experiences in the home environment.

Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population

SummaryBackgroundThe number of people presenting to hospital emergency departments after self-harming has increased in England. However, most people who self-harm do not present to hospitals, so whether this rise reflects an increase in the prevalence of self-harm in the community is unknown. Also unknown is whether the prevalence of non-suicidal self-harm (NSSH) or suicidal self-harm, or both, has increased. We aimed to establish temporal trends in the prevalence of NSSH in England.MethodsWe analysed data from participants in the 2000 (n=7243), 2007 (n=6444), and 2014 (n=6477) Adult Psychiatric Morbidity Surveys of the general population, selecting those aged 16–74 years and living in England. We used weighted data and controlled for complex survey design. We generated temporal trends in lifetime prevalence and methods of, and motivations for, NSSH, and consequent service contact. We used multiple variable logistic regression analyses to investigate factors associated with service contact.FindingsThe prevalence of self-reported lifetime NSSH increased from 2·4% (95% CI 2·0–2·8) in 2000, to 6·4% (5·8–7·2) in 2014. Increases in prevalence were noted in both sexes and across age groups—most notably in women and girls aged 16–24 years, in whom prevalence increased from 6·5% (4·2–10·0) in 2000, to 19·7% (15·7–24·5) in 2014. The proportion of the population reporting NSSH to relieve unpleasant feelings of anger, tension, anxiety, or depression increased from 1·4% (95% CI 1·0–2·0) to 4·0% (3·2–5·0) in men and boys, and from 2·1% (1·6–2·7) to 6·8% (6·0–7·8) in women and girls, between 2000 and 2014. In 2014, 59·4% (95% CI 54·7–63·9) of participants who had engaged in NSSH reported no consequent medical or psychological service contact, compared with 51·2% (42·2–60·0) in 2000 and 51·8% (47·3–56·4) in 2007. Male participants and those aged 16–34 years were less likely to have contact with health services than were female participants and older people.InterpretationThe prevalence of NSSH has increased in England, but resultant service contact remains low. In 2014, about one in five female 16–24-year-olds reported NSSH. There are potential lifelong implications of NSSH, such as an increased frequency of suicide, especially if the behaviours are adopted as a long-term coping strategy. Self-harm needs to be discussed with young people without normalising it. Young people should be offered help by primary care, educational, and other services to find safer ways to deal with emotional stress.FundingNHS Digital, English Department of Health and Social Care, and the National Institute for Health Research.

Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data.

Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. We used the 2000 Adult Psychiatry Morbidity Survey and an 18-month follow-up data to test hypotheses relating to the role of impulsivity, CSA and MI in the inception and persistence of self-harm. We assessed associations of impulsivity with (1) suicidal self-harm (SSH) and (2) non-SSH (NSSH) at baseline and follow-up, controlling for confounders including MI. Finally, we tested whether impulsivity mediated the relationship between CSA and self-harm. A total of 8,580 respondents were assessed at baseline and 2,406 at follow-up as planned. Impulsivity significantly predicted emergence of new NSSH at 18-month follow-up even after adjustment for MI and other confounders. Impulsivity did not significantly predict repetition of NSSH, or repetition or new inception of SSH, even before inclusion of MI in the model. However, the absolute numbers involved were small. Cross-sectionally, impulsivity was a stronger mediator of the link between CSA and SSH (13.1%) than that between CSA and NSSH (4.8%). Impulsivity may increase the risk of future development of NSSH independently of MI, which is clinically important for risk assessment. The involvement of impulsivity in the repetition of self-harm generally appears less certain. However, impulsivity may have a role in SSH in the context of previous CSA.