Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury

Objective: Self-injury (SI), self-injurious behaviour (SIB), including suicidal or non-suicidal self-injury (SSI, NSSI) represent an increasing problem among teenagers amounting to a 6–17% prevalence rate in adolescence, yet little data exists on detailed characteristics and associated factors of SI reaching clinical severity. There is also a scarcity of data distinguishing between suicidal and non-suicidal subsamples of self-injuring patients, i.e. showing which predictors contribute to develop self-injurious behaviour with a previous suicidal history (SSI). Method: Clinical diagnoses and characteristics of risk behaviour were examined in a crosssectional design in suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injurious behaviour. From the total pool of 708 new patients consecutively referred with various psychiatric problems in five regional child psychiatric centres in Western-Hungary over an 18-month period, 105 adolescent outpatients suffering from self-injurious behaviour participated in the study (28 males and 77 females aged from 14 to 18 years, mean age 15.97, SD 1.05). The Ottawa/Queen’s self-injury questionnaire (OSI) was used to measure the characteristics of risk behaviour, while the comorbid clinical diagnoses were confirmed by the M.I.N.I. Plus International Neuropsychiatric Interview. Descriptive statistics presented the frequencies of the characteristics of SI, bilateral comparisons were used to reveal relevant items to differentiate between sex, duration of practice and SSI versus NSSI and logistic regression was performed to identify significant predictors of suicidal subtype of self-injuring practice. Results: A total of 60% of the clinical SI population experienced a present or past episode of major depression. The motivation of patients to resist impulses and to discontinue malpractice was low. Cutting and scratching was the most common self-injuring methods. Two-thirds of the sample practised the impulsive type of SI, while 30% practised premeditated SI having an incubation time from 30 min to days and weeks before carrying out SI. Although duration of SI did not distinguish the sample in important aspects, girls and boys differed in several aspects of SI practice. SSI adolescents differed from their NSSI peers in a number of important characteristics including the frequency of actions, injured areas, methods, specific stresses and motivations. SSI adolescents were more likely to favour cutting of the lower leg and drug overdose as modes of SI. SSI adolescents were more likely to report addictive features than their peers with no suicidal motivation. From the aspect of self-injurious practice, logistic regression analysis found only two significant predictors for the combined pathology

Önsértő serdülő betegek diagnózisai, és magatartásuk részletes jellemzése = Diagnoses and detailed behavioural characteristics of self-injurious adolescent outpatients

A szerzők a “Pannónia” multicentrikus serdülőpszichiátriai felmérés keretében négy dunántúli gyermekpszichiátriai gondozóban egy év alatt jelentkezett összes új beteg közül az Ottawai Önsértő Kérdőív alapján önsértő magatartásúnak bizonyult 72, 14-18 éves fiatal anyagából áttekintették 48 lány (életkori átlag 16.1 év) M.I.N.I. Plusz diagnosztikai interjúval megerősített klinikai diagnózisait. A gondozókban jelentkezőknél 10,2%-ban, a kezelésben részesülő serdülőkorú fiatalok között már több mint egynegyedüknél (25,6%) találtak önsértő magatartást, ami a vártnál gyakoribb előfordulási arány. Megállapítják, hogy a serdülők többsége major depresszióban, vagy valamilyen szorongásos zavarban szenved, gyakori továbbá a szuicid magatartás is. Ezek a betegségek mind monodiagnózis, mind pedig komorbid társbetegség formájában egyaránt előfordulnak, ugyanis az állomány több mint kétharmada a többes diagnózis tüneti feltételeit is kielégítette. Az önsértő serdülők magatartástüneteit (a rizikómagatartás gyakorisága, lefolyása, okai, fajtái, a kísérő érzelmek, az akció “hozama” az önsértő serdülő számára, következmények) a tanulmány részletesen jellemzi, és sor kerül néhány epidemiológiai megállapításra is. | Authors present a descriptive statistics on data of 48 female outpatients from the total pool of 72 adolescents aged 14 through to-18 years (Mean age 16.1 years) showing symptoms of self-injurious behaviour according to Ottawa Self Injury Inventory (OSI). All patients were recruited from the one-year clinical, representative sample of “Pannonia” multicentre adolescent psychiatry survey. 10.2% of consecutively referred and 25.6% of treated adolescent patients had symptoms of self-injurious behaviour in one-year pool of Transdanubian Child Psychiatric Centres, which is more frequent, than expected rate. Referring the clinical diagnoses of adolescents confirmed by M.I.N.I. Plus Diagnostic Interview, authors estimate, that the majority of youth suffered from episode(s) of present or past major depression, from at least one form of anxiety disorder and/or from suicidal behaviour. These illnesses occur either in monodiagnoses or in comorbid variations, as more than two third of the patient population fulfilled criteria of two or three diagnoses. The study presents risk behaviour including motivations, frequency of acts, ideas, afflicted body regions, emotional correlates, benefits to obtain, escalation of problem behaviour and consequences in detail. Some epidemiological results are also discussed

A STUDY OF HUNGARIAN ADOLESCENT OUTPATIENTS SUFFERING FROM SELF-INJURIOUS BEHAVIOUR

In this pilot study (Study A), the authors administered the Hungarian standard version of Beck Depression Inventory (BDI) and the translated version of the Ottawa Self Injury Inventory (OSI) to students of 3 educational facilities in a county town. Fourteen to eighteen year old pupils were tested in order to measure the key symptoms of depression and the frequency and characteristics of self-injurious behaviour among this sample of the high school population. Twentysix youngsters were found to have had any form of self-injurious actions in their life-time. The paper presents descriptive data on the basis of statistics of symptom occurence. Although the depressive symptoms have an expected correlation with the selfinjurious ideas,depression seems not to have the same relationships with actual selfharm action. In study B, the authors present descriptive statistics on the data of 48 female outpatients from the total pool of 72 adolescents aged 14 through to-18 years (average age 16.1 years) showing symptoms of self-injurious behavior according to the Ottawa Self Injury Inventory (OSI). All patients were recruited from a one-year clinical,representative sample of the „Pannonia” multicentre adolescent psychiatry survey. Ten point two percent of consecutively referred and 25.6% of treated adolescent patients had symptoms of self-injurious behavior over a one-year period in 4 Transdanubian Child Psychiatric Centers, which is more frequent than the expected rate. Referring to the clinical diagnoses of adolescents confirmed by M.I.N.I. Plus Diagnostic Interview, the authors estimate, that the majority of these young people suffered from episode(s) of present or past major depression, from whatever form of anxiety disorder and/or from suicidal behaviour. The study presents details of risk behavior including motivations, frequency of acts, ideas, afflicted body regions, emotional correlates, secondary obtained benefits, escalation of problem behavior and consequences in detail