Factors associated with deliberate self-harm method among patients in a tertiary hospital in South Africa

Background: Hospital-based research provides important insight into the burden of suicide behaviour and methods used in deliberate self-harm (DSH). The information on methods used in DSH may be useful to plan suicide-related intervention and prevention programmes. We aimed to investigate the socio-demographic and clinical factors associated with the methods used in DSH at a tertiary hospital in Cape Town, South Africa. Methods: Socio-demographic, clinical and treatment data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Univariate analyses and a logistic regression model were used to explore the associations between these variables and violent and non-violent method of DSH. Results: Self-poisoning was the most common method of self-harm (80.3%, n=191). Prescription medication was the most common form of self-poison (57.6%, n=137) while a large number of patients used the non-prescription medication paracetamol (40.9%, n=54). In the bivariate regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. Conclusion: This study contributes to emerging literature on methods used in DSH in South Africa. There is an urgent need to improve monitoring of prescription medication commonly used in DSH. More research on the source of prescription medication and its relationship to DSH is needed. Limiting the quantity and reviewing the packaging of paracetamol available in supermarkets may be effective strategies of means restriction that could be adopted in South Africa. This study underscores the need for increased collaboration between the Department of Social Development and the Department of Health in providing substance use interventions to high-risk population groups

Methods of deliberate self-harm in a tertiary hospital in South Africa

CITATION: Pieterse, D. et al. 2020. Methods of deliberate self-harm in a tertiary hospital in South Africa. South African Journal of Psychiatry, 26:a1399, doi:10.4102/sajpsychiatry.v26i0.1399.The original publication is available at https://sajp.org.zaBackground: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. Aim: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. Setting: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. Method: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. Results: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. Conclusion: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.South African Medical Research Councilhttps://sajp.org.za/index.php/sajp/article/view/1399Publisher's versio

Factors associated with readmission in South African adolescents discharged from two inpatient psychosocial rehabilitation units

Objective: This study aimed to describe the socio-demographic and clinical factors associated with readmission in an adolescent population discharged from two  inpatient psychosocial rehabilitation (PSR) units in Cape Town, South Africa.Method: Data were obtained from 97 consecutive patients discharged from two adolescent psychiatric PSR units over a period of one year. Patients were followed up for readmission to hospitals offering specialised psychiatric care in the Western Cape Province over a period of 18 months.Results: 35 patients (36%) were readmitted during the study period. Multivariable analysis showed that previous admission increased readmission rate (Incidence Rate Ratio (IRR): 8.01, p < 0.001). Adolescents who were still schooling (IRR: 0.29, p < 0.001) or had a higher level of education (IRR: 0.45, p = 0.001) were less likely to be readmitted. No association was seen with type of diagnosis and readmission, although 51 adolescents (53%) were diagnosed on the schizophrenia spectrum of disorders.Conclusion: Study findings highlight the need for increased collaboration between the Departments of Health and Education. Furthermore, the study illustrates the need for specific post-discharge community follow-up for adolescents. Prospective  research in this particular population group is needed to contribute to the literature on factors associated with readmission in South African adolescent patients

International differences in employee silence motives: Scale validation, prevalence, and relationships with culture characteristics across 33 countries

Employee silence, the withholding of work‐related ideas, questions, or concerns from someone who could effect change, has been proposed to hamper individual and collective learning as well as the detection of errors and unethical behaviors in many areas of the world. To facilitate cross‐cultural research, we validated an instrument measuring four employee silence motives (i.e., silence based on fear, resignation, prosocial, and selfish motives) in 21 languages. Across 33 countries (N = 8,222) representing diverse cultural clusters, the instrument shows good psychometric properties (i.e., internal reliabilities, factor structure, and measurement invariance). Results further revealed similarities and differences in the prevalence of silence motives between countries, but did not necessarily support cultural stereotypes. To explore the role of culture for silence, we examined relationships of silence motives with the societal practices cultural dimensions from the GLOBE Program. We found relationships between silence motives and power distance, institutional collectivism, and uncertainty avoidance. Overall, the findings suggest that relationships between silence and cultural dimensions are more complex than commonly assumed. We discuss the explanatory power of nations as (cultural) units of analysis, our social scientific approach, the predictive value of cultural dimensions, and opportunities to extend silence research geographically, methodologically, and conceptually

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes