Suicidal Self-harm Research Articles

Correlates of Suicidal Ideation and Self-harm in Early Childhood in a Cohort at Risk for Child Abuse and Neglect

Objectives: This study provides prevalence and persistence rates of suicidal ideation and self-harm, and examines how child maltreatment types, mental health symptoms, and age 4 suicidal ideation and self-harm are associated with each suicidal outcome among 6-year-old children.Methods: Participants were 1,090 caregivers assessed when their children were 4 and 6 years old from the Longitudinal Studies of Child Abuse and Neglect. Data were collected from the Child Behavior Checklist, Parent-Child Conflict Tactics Scales, and Child Protective Services.Results: Persistence rates within each suicidal outcome were high. Failure to provide -a physical neglect subtype- was the only maltreatment type that independently predicted self-harm. Depressive/anxious symptoms and age 4 suicidal ideation were independently associated with age 6 suicidal ideation, whereas attention problems and age 4 self-harm predicted age 6 self-harm.Conclusion: Our findings align with the consensus emerging from adolescent studies that risk factors associate differentially with suicidal ideation and self-harm.

Predicting Domestic Homicide and Serious Violence in Leicestershire with Intelligence Records of Suicidal Ideation or Self-Harm Warnings: a Retrospective Analysis

Research QuestionDoes prior information retained in police intelligence records about an offender’s suicidal tendencies help to predict a future domestic homicide or attempted homicide?DataRecords on 158,379 arrestees in 1997–2015 were examined for suicidal or self-harm warnings by date of entry and compared to 620 offenders identified in cases of domestic homicides or serious violence over the same time period.MethodsThe percentage of offenders in domestic homicide and serious violence cases who were known to have reported suicidal ideation prior to those crimes was compared to the overall percentage of arrested persons who had such reports.FindingsOf the total 620 deadly violence offenders, 125 had a marker for suicide or self-harm, of which 35 (5.6%) were posted prior to the deadly domestic violence. Of the 80 homicide cases (excluding grievous bodily harm), 7 had suicide or self-harm markers prior to the homicidal offence, for a rate of 8.75%. These rates compare to an overall marker rate among the 158,379 arrestees in the time period studied, of whom 7,241 were identified as holding a warning marker at the point of data collection for this study in 2016, which equated to only 5% of the group, of which an estimated 38% would have occurred prior to a crime (2,752 cases), or 1.7% of the 158,379. By that metric, it is three times more likely that offenders charged with an act of deadly domestic violence had prior suicidal warning markers than offenders not charged with such crimes (5.6/1.7 = 3.3), and 5.2 times more likely for homicide offenders to have a prior marker than for all arrestees.ConclusionsPolice intelligence system markers for suicide or self-harm can provide valuable information for building more accurate prediction models for domestic homicide and serious assaults.

Treating Adolescent Nonsuicidal Self-Injury: A Review of Psychosocial Interventions to Guide Clinical Practice

This systematic review aims to inform practitioners about the current research-informed practices that are available to treat adolescents who struggle with Non Suicidal Self-Injury (NSSI). A computer based search of the literature was conducted via five databases and resulted in the retrieval of 595 articles, seven of which met all the inclusion criteria (peer-reviewed, published in English between 2000 and 2016, differentiated NSSI from suicidal self-harm, were randomized control trials of interventions, and targeted adolescents age 12–18 who were not diagnosed with Borderline Personality Disorders). Four psychosocial interventions were identified, Dialectical Behavior Therapy, mentalization based treatment for adolescents, developmental group intervention, and therapeutic assessment and brief intervention. At this time, there is no published randomized control trial that demonstrates a significant reduction in NSSI among adolescents. This further highlights the urgent need to develop and test effective and varied interventions for adolescents presenting with NSSI.

Role of alcohol use in suicidal behavior in public places

IntroductionSuicide in public places is a relatively common emergency in which alcohol use could be a factor involved.MethodsA total of 169 patients were attended for SB in Madrid public places by SAMUR (Municipal assistance service for emergency and rescue) and transferred to FJD emergency room where all of them were assessed by the psychiatrist on duty. For all (but 47 of them), blood alcohol level was measured and other variables were collected: age, sex, history of suicide attempt and characteristic of the attempt. A descriptive analysis was made and then differences between those using alcohol and those not was made.ResultsOur sample comprises 169 patients, 40.2% woman and 59.8% man (median age = 39.36 years). Alcohol was measured in 122 patients, being positive in 52.4% (median alcohol level = 95.09 mg/dL). We found that 64.6% of man had consumed alcohol against the 30.2% of women (P = 0.000). 64.8% of alcohol users were discharged, against the 35.2% that not users. We admitted 28.1% of the alcohol users and 56.8% of the non-users (P = 0.007). We did not found statistically significance differences when compared patients that consumed against patients who did not regarding previous attempts, behavior (ideation, intent, non suicidal self-harm) and method.ConclusionsWhen assessed SB, we found that most of the patients were man under the alcohol influence and most of them were discharged after being evaluated. The data does not reflect the seriousness of the SB, which opens the possibility of correlating the levels of alcohol with suicidal risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Life, lifestyle and location: examining the complexities of psychological distress in young adult Indigenous and non-Indigenous Australians.

Mental health is fundamental to an individual's health and well-being. Mental health disorders affect a substantial portion of the Australian population, with the most vulnerable time in adolescence and young adulthood. Indigenous Australians fare worse than other Australians on almost every measure of physical and mental health. Cross-sectional data from young adults (21-27 years) participating in the Life Course Program, Northern Territory, Australia, is presented. Rates of psychological distress were high in remote and urban residing Indigenous and urban non-Indigenous young adults. This rate was more pronounced in young women, particularly in Indigenous remote and urban residing women. Young adults with high psychological distress also had lower levels of positive well-being, higher perceived stress levels, experienced a higher number of major life events and were at an increased risk of suicidal ideation and/or self-harm. This study supports the need for a continued focus on early screening and treatment at this vulnerable age. The significant association seen between psychological distress and other markers of emotional well-being, particularly risk of suicidal ideation and/or self-harm, highlights the need for a holistic approach to mental health assessment and treatment. A concerted focus on improving the environs of young adults by lowering levels of stress, improving access to adequate housing, educational and employment opportunity, will assist in improving the emotional health of young adults.

Mental Health, Suicidal Thoughts and Self-Harm Inside Immigration Detention

Evidence from the Oxford studies inside UK Immigration Removal Centres (IRCs) has shown that detainees inside the centres experience worrying levels of depression, deliberate self-harm and suicidal thoughts (Bosworth & Kellezi, 2012; 2015; Bosworth, Kellezi & Slade, 2012; Gerlach & Bosworth, 2016). This research also shows that the majority of those reporting suicidal thoughts are not currently part of ACDT plans within IRCs. An analysis of 377 surveys distributed across 6 IRCS between 2010-2014, showed that there are a number of risk factors associated with depression, self-harm and suicidal thoughts. Detainees who had spent less time in the UK prior to detention were more likely to report suicidal thoughts, and those who had applied for asylum reported higher scores of depression. Detainees who were concerned with safety inside detention reported higher suicidal thoughts and self-harm. This same analysis shows that over 70% of those who had thought about killing themselves, and over 78% of those who had self-harmed whilst in that IRC were not part of ACDT plans (Kellezi, Bosworth, & Slade, 2016).The present study investigated a number of topics related to mental health, self-harm and suicide in detention. The study took place in Yarl’s Wood IRC in June 2016, and it involved 25 semi-structured interviews with women detainees and 6 members of staff. A number of results emerged from the analysis of the interviews relating to detainee mental health in general and those on ACDT plans in particular. The issues identified apply specifically to women detainees. Further research is required to explore whether they would apply to male detainees.

Siam (Suicide Intervention Assisted by Messages): the Development of a Post-acute Crisis Text Messaging Outreach for Suicide Prevention

Introduction Suicidal behaviour and deliberate self-harm are common among adults. Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services can reduce reattempt risk. Feasibility trials demonstrated that intervention through text message was also acceptable to suicide attempters. Objective The aim of the current study is to investigate the effect of text message intervention versus traditional treatment on reducing the risk of suicide attempt repetition among adults after self-harm. Method The study will be a 2-year multicentric randomized controlled trial conducted by the Brest University Hospital, France. Participants will be adults discharged after self–harm, from emergency services or after a short hospitalization. The intervention is comprised of an SMS that will be sent at h48, D7, D15 and monthly during 6 month. The text message enquires about the patients’ well-being and includes information regarding individual sources of help and evidence-based self help strategies. As primary endpoint, we will assess the number of patients who reattempt suicide in each group at 6 months. As secondary endpoints, we will assess the number of patients who reattempt suicide at 13 month, suicidal behaviour at month 6 and 13 and Medical costs at month 13. Results Results will be accepted regarding the preliminary results of the study. Discussion This paper describes the design and deployment of a trial SIAM; an easily reproducible intervention that aims to reduce suicide risk in adults after self-harm. It utilizes several characteristics of interventions that have shown a significant reduction in the number of suicide reattempts.

Differences in risk factors for self-harm with and without suicidal intent: Findings from the ALSPAC cohort

BackgroundThere is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. MethodParticipants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. ResultsMany risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. Limitationsi) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. ConclusionSelf-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm.

Prevalence rates and risk factors for mental health difficulties in adolescents aged 16 and 17 years living in rural Ireland.

This study sought to ascertain the prevalence rates and risk factors for a range of mental health difficulties, including suicidal ideation/self-harm among 16 and 17-year-old rural Irish adolescents, a vulnerable group in transition from childhood to adulthood. Adolescents (n=237) took part in this cross-sectional study. Participants completed a questionnaire compendium consisting of generic questions on demographic information, use of mental health services and four normed questionnaires: The Youth Self-Report, the Children's Depression Inventory, the Coping Inventory for Stressful Situations-Adolescent and The Family Assessment Device. We found that 16.9% of adolescents reported clinically significant mental health difficulties. Significant gender differences were found on internalising and externalising difficulties. There were no gender differences in suicidal ideation or self-harm. Only 3.4% of adolescents were receiving professional help for mental health difficulties. Multiple regression analyses revealed that family dysfunction, emotion-focussed coping and poor academic competence were significant predictors of poorer mental health difficulties in both genders. Family dysfunction was the strongest predictor of mental health difficulties in males. Among females, emotion-focussed coping was the strongest predictor of internalising difficulties and depression. Social diversion (social support) was predictive of less internalising difficulties and depression for females. The study shows that a significant number of Irish 16 and 17 year olds have mental health difficulties, yet very few are receiving treatment. Emotion-focussed coping, family dysfunction, poor academic competence and less social support were important predictors of mental health difficulties. A new finding is the stronger association that family dysfunction has with poorer mental health in males than females, when controlling for academic competence and coping skills. The findings may have implications for psychological interventions.

Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study.

BackgroundStudies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact.MethodsData on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14–17 years who participated in a school survey in Oslo, Norway.ResultsAdolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non–suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood.ConclusionsIn this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.

IQ and adolescent self-harm behaviours in the ALSPAC birth cohort

BackgroundLow IQ is associated with an increased risk of suicide and suicide attempt in adults, but less is known about the relationship between IQ and aspects of suicidal/self-harm behaviours in adolescence. MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective UK cohort. Binomial and multinomial logistic regression models were used to examine the association of IQ measured at age 8 with suicide-related outcomes amongst 4810 adolescents aged 16–17 years. ResultsThere was some evidence that associations differed in boys and girls (p values for interaction ranged between 0.06 and 0.25). In boys higher IQ was associated with increased risk of suicidal thoughts (adjusted odds ratio per 10 point increase in IQ score=1.14, 95% Confidence Interval [CI] 1.01–1.28) and suicidal plans (1.15, 95% CI 0.93–1.43), although statistical evidence for the latter association was limited. There was also evidence for an association with non-suicidal self-harm (1.24, 95% CI 1.08–1.45) but not suicidal self-harm (1.04, 95% CI 0.86–1.25). In girls higher IQ was associated with increased risk of non-suicidal self-harm (1.11, 95% CI 1.02–1.22) but not suicidal thoughts, suicidal plans or suicidal self-harm. LimitationsLoss to follow up and questionnaire non-response may have led to selection bias. ConclusionIn contrast to previous studies of IQ–suicide associations in adults, we found that higher IQ was associated with an increased risk of non-suicidal self-harm in male and female adolescents and suicidal thoughts in males. Associations of IQ with self-harm differed for self-harm with and without suicidal intent, suggesting that the aetiology of these behaviours may differ.

2047 – Suicidal behaviour in stress disorder

Aims To examine the predictors of suicidal ideation and self-harm in patients diagnosed with a depressive episode or an adjustment disorder, and to examine any difference in these predictors between the two diagnostic categories. Methods Patients referred to the liaison psychiatry services at two Dublin hospitals and diagnosed with either a depressive episode or an adjustment disorder were recruited to this study. They were interviewed at time of diagnosis, and again after six months, with a number of validated instruments to examine levels of suicidality or self-harm and their relationship to depressive symptoms, life events, social functioning and personality factors. Results 300 patients were recruited to the study, 154 of whom had a diagnosis of an adjustment disorder and the remainder diagnosed with a depressive episode. On univariate analysis there was no significant difference in the rates of suicidal ideation between the diagnoses of depressive episode and adjustment disorder. On logistic regression there were no significant predictors of suicidal ideation in adjustment disorder. A single marital status and low levels of social support were more predictive of suicidality in the subgroup with a diagnosis of depression. Conclusions There has been little prior research into the predictors of suicidal behaviour in patients with diagnoses of depression and adjustment disorders. Our finding that social support and marital status are protective against suicidality in this population is in keeping with the literature. The absence of any significant contribution of the severity of depressive symptoms to suicidality was unexpected.

Pushing the Boundaries: Understanding Self-Harm in a Non-Clinical Population

This study investigates 122 people's descriptions of their self-harm experiences using thematic analysis. Analysis revealed four themes: What counts as self-harm, What leads to self-harm, Intentions and Managing stigma. Our participants challenged commonly accepted understandings in terms of method, outcome and intentions. Several difficulties associated with discriminating between suicidal and non-suicidal self-harm were highlighted, which may be important in clinical practice. Few participants mentioned diagnosed psychiatric disorders; they best understood self-harm through their social experiences. Focusing on social understandings of self-harm may help reduce associated stigma and barriers to help-seeking.

Mental Health Service Contacts Among Sexual Minority and Heterosexual Girls in Boston Public High Schools

Although sexual minority (SM) adolescent girls are at high risk for suicidal behavior, little is known about their use of mental health services (MHS). Therefore, we examined survey data from a sample of Boston high school students to compare the prevalence of MHS use among SM and heterosexual girls.We used chi-square tests to assess the statistical significance of group differences. To test whether SM status moderated the association between MHS use and mental health need (i.e., whether the student reported self-harm, suicidal ideation, or a suicide attempt in the past year), we entered mental health need, SM status, and the interaction term of the two into a regression model that predicted past 12-month MHS use.SM girls (n = 89) were significantly more likely than heterosexual girls (n = 800) to report suicidal ideation, suicide attempts, and self-harm. SM girls were also more likely to have reported a past 12-month MHS contact (54% vs. 26%, p < 0.0001); this finding held for those with and without a high level of mental health need. The interaction term was not statistically significant, indicating that SM status does not moderate the effect of mental health need on MHS use. These results indicate that SM girls, particularly those experiencing suicidality, are likely to report a MHS contact. Future research is needed to elucidate when/how SM girls come to use MHS and what types of services they are receiving.

Adolescents with suicidal and nonsuicidal self-harm: Clinical characteristics and response to therapeutic assessment.

Self-harm is one of the best predictors of death by suicide, but few studies directly compare adolescents with suicidal versus nonsuicidal self-harm. Seventy adolescents presenting with self-harm (71% young women, ages 12-18 years) who participated in a randomized controlled trial were divided into suicidal and nonsuicidal self-harm categories using the Columbia Classification Algorithm of Suicide Assessment. Adolescents with suicidal self-harm were more likely than those with nonsuicidal self-harm to be young women, 22/23 (96%) versus 34/47 (72%), odds ratio (OR) = 8.33, 95% confidence interval (CI) [1.03, 50.0]; had a later age of onset of self-harm, 15.4 years vs. 13.8 years, mean difference = 1.6, 95% CI [.8, 2.43]; and used self-poisoning more often, 18/23 (78%) versus 11/47 (23%), OR = 3.43, 95% CI [2.00, 5.89]. Only those with nonsuicidal self-harm had an improvement on Children's Global Assessment Scale score following a brief therapeutic intervention, mean difference = 8.20, 95% CI [.97, 15.42]. However, there was no interaction between treatment and suicidality. There are important differences between adolescents presenting with suicidal and nonsuicidal self-harm. Suicidal self-harm in adolescence may be associated with a less favorable response to therapeutic assessment.

Distinguishing Suicidal from Non-Suicidal Deliberate Self-Harm Events in Women with Borderline Personality Disorder

Deliberate self-harm (DSH) is common in Borderline Personality Disorder, may be due to a variety of reasons, and is associated with different degrees of suicidal intent. Understanding the reasons for episodes of DSH in this population may be helpful in developing interventions to reduce the rate of DSH or to assist in the clinical judgement of suicidal intention after DSH has occurred. The Parasuicide History Interview, version 2 (PHI-2) was used to determine the reasons for DSH events in 70 Australian women diagnosed with Borderline Personality Disorder. Factor analysis of the responses identified four empirically derived component factors. Multivariate models were developed to identify the independent predictors of suicidal deliberate self-harm (S-DSH) versus non-suicidal deliberate self-harm (NS-DSH) events. Participants and raters showed strong agreement in classifying S-DSH and NS-DSH events. Methods used that involved self-poisoning, jumping or stabbing showed increased risk for S-DSH, adjusted odds ratio 12.07 (95% CI 2.17, 67.29), compared to the referent group, external damage to skin with no rescue contact being sought. Although no grouping of reasons were independently significant, the lower the effectiveness of the DSH event to resolve the reasons for the event, the higher the risk of it having been a S-DSH event. In clinical situations, any Borderline Personality Disorder patient seeking help or medical attention, using any method other than superficial external injury to skin, or reporting a failure to effectively resolve the reasons for the DSH event, should be considered as likely to have had a S-DSH event (greater suicidal intention). However, specific reasons for the DSH event, or individual subject characteristics, did not meaningfully distinguish S-DSH from NS-DSH events.

Efficacy of dialectical behaviour therapy for adolescents

The current review provides a qualitative assessment of the efficacy of dialectical behaviour therapy (DBT) as adapted for adolescents. The aim was to assess the efficacy of DBT compared to usual methods in the treatment of adolescent mental health symptoms, inclusive of suicidal ideation and self-harm. Computerised databases including Medline and PsycINFO were accessed and knowledgeable informants in the area of DBT were contacted. Inclusion criteria required the studies to be clinical trials on DBT provided to adolescents. Due to the requirements on research design only three studies were appropriate for review. The review focused on quality assessment of the current data, including investigation into the effects of selection bias, confounding variables, outcome measures and measurement errors. The data suggest that there is some evidence for DBT being effective in reducing symptoms of mental health, especially those consistent with borderline personality disorder. The resultant data, however, are of very poor quality, and as such the review addresses ways to improve the quality of research and offers suggestions for future research.

Antidepressiva bei Kindern und Jugendlichen - welchen Stellenwert hat Johanniskraut?

ANTIDEPRESSANTS FOR JUVENILES: WHAT ABOUT ST. JOHN'S WORT?Analyses of juvenile depression studies with long-established antidepressants (tricyclic ADs, TCA) have revealed discouragingly little benefit, while side effects have been profound. Modern ADs like selective serotonin reuptake inhibitors (SSRIs) seemed to solve part of this problem until they were found to be associated with an increased risk of suicidal attempts, hostile behaviour and self-harm, while meta-analyses have revealed only marginal therapeutic effects for the majority. Indeed, no drug is unequivocally accepted as the gold-standard for young depressive patients. Today, St. John's Wort is by far the most frequently prescribed medication for child and adolescent depression in Germany. Some pilot and observational studies from Germany, Canada and the US have delivered promising results. However, randomised controlled trials for this age group have yet to be carried out and are long overdue.

Brief psychodynamic interpersonal therapy after deliberate self-poisoning reduced suicidal ideation and deliberate self-harm

Brief psychodynamic interpersonal therapy after deliberate self-poisoning reduced suicidal ideation and deliberate self-harm