Variations in the hospital management of self harm in adults in England: observational study

More than 140 000 people present to hospital after an episode of self harm each year in England and Wales. Improving the general hospital management of these people is a key area in preventing suicide. Although professional consensus has been reached on how self harm services should be organised and delivered, wide variations in care delivery have been reported in two regions in England. Using a nationally representative sample, we investigated the variation in services and delivery of care for self harm patients in hospitals in England

Suicide epidemics: The impact of newly emerging methods on overall suicide rates - A time trends study

Background: The impact of newly emerging, popular suicide methods on overall rates of suicide has not previously been investigated systematically. Understanding these effects may have important implications for public health surveillance. We examine the emergence of three novel methods of suicide by gassing in the 20 th and 21 st centuries and determine the impact of emerging methods on overall suicide rates. Methods. We studied the epidemic rises in domestic coal gas (1919-1935, England and Wales), motor vehicle exhaust gas (1975-1992, England and Wales) and barbecue charcoal gas (1999-2006, Taiwan) suicide using Poisson and joinpoint regression models. Joinpoint regression uses contiguous linear segments and join points (points at which trends change) to describe trends in incidence. Results: Epidemic increases in the use of new methods of suicide were generally associated with rises in overall suicide rates of between 23% and 71%. The recent epidemic of barbecue charcoal suicides in Taiwan was associated with the largest rise in overall rates (40-50% annual rise), whereas the smallest rise was seen for car exhaust gassing in England and Wales (7% annual rise). Joinpoint analyses were only feasible for car exhaust and charcoal burning suicides; these suggested an impact of the emergence of car exhaust suicides on overall suicide rates in both sexes in England and Wales. However there was no statistical evidence of a change in the already increasing overall suicide trends when charcoal burning suicides emerged in Taiwan, possibly due to the concurrent economic recession. Conclusions: Rapid rises in the use of new sources of gas for suicide were generally associated with increases in overall suicide rates. Suicide prevention strategies should include strengthening local and national surveillance for early detection of novel suicide methods and implementation of effective media guidelines and other appropriate interventions to limit the spread of new methods. © 2011 Thomas et al; licensee BioMed Central Ltd.published_or_final_versio

Prevalence and associated harm of engagement in self-Asphyxial behaviours ('choking game') in young people:A systematic review

OBJECTIVE: To assess the prevalence of engagement in self-asphyxial (risk-taking) behaviour (SAB) (‘choking game’) and associated morbidity and mortality in children and young people up to age 20. DESIGN: Systematic literature review. SEARCH STRATEGY: Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection, BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were reviewed, and experts were contacted to identify additional relevant papers. ELIGIBILITY CRITERIA: Systematic reviews, cross-sectional, cohort and case–control studies, and case reports examining SAB with regard to individuals aged 0–20 years, without explicitly stated autoerotic, suicidal or self-harm intentions were included. RESULTS: Thirty-six relevant studies were identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from 36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature. CONCLUSIONS: The current evidence on SAB among young people is limited, and stems predominantly from North America and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response

Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study

<b>Background</b>: Taller people and those with better lung function are at reduced risk of coronary heart disease (CHD). Biological mechanisms for these associations are not well understood, but both measures may be markers for early life exposures. Some studies have shown that leg length, an indicator of pre-pubertal nutritional status, is the component of height most strongly associated with CHD risk. Other studies show that height-CHD associations are greatly attenuated when lung function is controlled for. This study examines (1) the association of height and the components of height (leg length and trunk length) with CHD risk factors and (2) the relative strength of the association of height and forced expiratory volume in one second (FEV1) with risk factors for CHD. <b>Subjects and methods</b>: Cross sectional analysis of data collected at detailed cardiovascular screening examinations of 1040 men and 1298 women aged 30–59 whose parents were screened in 1972–76. Subjects come from 1477 families and are members of the Midspan Family Study. <b>Setting</b>: The towns of Renfrew and Paisley in the West of Scotland. <b>Results</b>: Taller subjects and those with better lung function had more favourable cardiovascular risk factor profiles, associations were strongest in relation to FEV1. Higher FEV1 was associated with lower blood pressure, cholesterol, glucose, fibrinogen, white blood cell count, and body mass index. Similar, but generally weaker, associations were seen with height. These associations were not attenuated in models controlling for parental height. Longer leg length, but not trunk length, was associated with lower systolic and diastolic blood pressure. Longer leg length was also associated with more favourable levels of cholesterol and body mass index than trunk length. <b>Conclusions</b>:These findings provide indirect evidence that measures of lung development and pre-pubertal growth act as biomarkers for childhood exposures that may modify an individual's risk of developing CHD. Genetic influences do not seem to underlie height-CHD associations

Double jeopardy: the potential for problems when bats interact with breathable roofing membranes in the United Kingdom

In order to reduce environmental impacts and achieve sustainability, it is important to balance the interactions between the built and natural environment. The construction industry is becoming more aware of ecological concerns and the importance that biodiversity and maintenance ecosystem services has for sustainability. Bats constitute an important component of urban biodiversity and several species in the UK are highly dependent on buildings, making them particularly vulnerable to anthropogenic and environmental changes. Many buildings suitable for use as bat roosts often require re-roofing as they age and traditional bituminous roofing felts are frequently being replaced with breathable roofing membranes (BRMs). In the UK new building regulations and modern materials may substantially reduce the viability of existing roosts, yet at thesame time building regulations require that materials be fit for purpose. Reports suggest that both bats and BRMs may experience problems when the two interact. Such information makes it important to understand how house dwelling bats and BRMs may be affected. This paper considers the possible ways in which bats and BRMs may interact, how this could affect existing bat roosts within buildings and the implications for BRM service life predictions and warranties. Keywords –Breathable Roofing Membranes, Bats in Buildings, Material Deterioration, Sustainability, Conservation, Biodiversi

Adolescent over-general memory, life events and mental health outcomes: Findings from a UK cohort study

Previous research suggesting that over-general memory (OGM) may moderate the effect of life events on depressive symptoms and suicidality has sampled older adolescents or adults, or younger adolescents in high-risk populations, and has been conducted over relatively short follow-up periods. The authors examined the relationship between OGM at age 13 and life events and mental health outcomes (depression, self-harm, suicidal ideation and planning) at age 16 years within a sample of 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), approximately 3800 of whom had also provided data on depression and self-harm. There was no clear evidence of either direct or interactive effects of OGM at age 13 on levels of depression at age 16. Similarly there was no clear evidence of either direct or interactive effects of OGM on suicidal ideation and self-harm. Although there was some evidence that over-general autobiographical memory was associated with reduced risk of suicidal planning and increased risk of self-harm, these associations were absent when confounding variables were taken into account. The findings imply that although OGM is a marker of vulnerability to depression and related psychopathology in high-risk groups, this cannot be assumed to generalise to whole populations

Suicide and self-harm in Britain: researching risk and resilience using UK surveys

Aim The main aim of this study was to raise awareness of surveys that could be used to inform self-harm and suicide prevention work. We asked: What UK survey datasets are available for research? What aspects of people’s lives are associated with self-harm and attempted suicide? How do statistical findings resonate with people’s lived experience? What implications do they see? Findings Survey analyses revealed that risk factors for self-harm are wide ranging and include: Mental health Physical health and health behaviours Social relationships Stressful events Employment and financial circumstances Identity and demographics Many different factors are independently associated with self-harm. There is a dose relationship, with more exposure to a factor linked with increased risk. Risks are cumulative that is, exposure to multiple factors is associated with greater risk. Through facilitated consultation, men with lived experience, bereaved family members, and practitioners identified recommendations for responding to suicidal distress in men. These related to the following three main areas: 1. Recognising need: who is ‘ill enough’? Permission - men said that they often did not know they were entitled to help Ask - people who outwardly appear to be functioning may not be Persistence - ask and offer help more than once. 2. Facilitating access: right words, time and place What is available - support is needed with ongoing stress as well as for crises Find the words - men wanted examples of how to ask for help Allow time - employers expect recovery to be swift, some men felt rushed to come off medications or were discharged from services they still needed. 3. Adjusting delivery: equal engagement Power - some were uncomfortable with service dynamics, preferring peer support Every service contact counts - negative contacts had particular impact Safe spaces - may be different for men and women. Methods There were three strands of work: Secondary analysis of nine survey series, spanning more than twenty years Linkage of 144,000 survey participants to information on whether they were alive in 2013 and whether they had taken their own life Facilitated consultation, through depth interviews with people with lived experience

Adiposity, its related biologic risk factors, and suicide: a cohort study of 542,088 Taiwanese adults

Recent studies in Western nations have shown inverse associations between body mass index (BMI, measured as weight (kg)/height (m)(2)) and suicide. However, it is uncertain whether the association is similar in non-Western settings, and the biologic pathways underlying the association are unclear. The authors investigated these issues in a cohort of 542,088 Taiwanese people 20 years of age or older who participated in a health check-up program (1994-2008); there were 573 suicides over a mean 8.1 years of follow up. There was a J-shaped association between BMI and suicide risk (P for the quadratic term = 0.033) but limited evidence of a linear association (adjusted hazard ratio per 1-standard-deviation increase = 0.95 (95% confidence interval: 0.85, 1.06)); compared with individuals whose BMI was 18.5-22.9, adjusted hazard ratios for those with a BMI /=35 were 1.56 (95% confidence interval: 1.07, 2.28) and 3.62 (95% confidence interval: 1.59, 8.22), respectively. A high waist-to-hip ratio was associated with an increased risk of suicide. There was some evidence for a reverse J-shaped association of systolic blood pressure and high density lipoprotein cholesterol with suicide and an association of higher triglyceride level with increased suicide risk; these associations did not appear to mediate the associations of BMI and waist-to-hip ratio with suicide.postprin