The prevalence of self-reported deliberate self harm in Irish adolescents

Background: Deliberate self harm is major public health problem, in particular among young people. Although several studies have addressed the prevalence of deliberate self harm among young people in the community, little is known about the extent to which deliberate self harm comes to the attention of medical services, the self harm methods used and the underlying motives. The aim of this study was to determine the prevalence of deliberate self harm in adolescents and the methods, motives and help seeking behaviour associated with this behaviour. Methods: A cross-sectional survey using an anonymous self-report questionnaire was administered in 39 schools in the Southern area of the Health Service Executive, Ireland. Of the 4,583 adolescents aged 15–17 years who were invited to participate in the survey, 3,881 adolescents took part (response: 85%). Results: A lifetime history of DSH was reported by 9.1% (n = 333) of the adolescents. DSH was more common among females (13.9%) than males (4.3%). Self cutting (66.0%) and overdose (35.2%) were the most common DSH methods. A minority of participants accessed medical services after engaging in DSH (15.3%). Conclusion: DSH is a significant problem in Irish adolescents and the vast majority do not come to the attention of health services. Innovative solutions for prevention and intervention are required to tackle DSH in adolescents

Payout Policy in the 21st Century

We survey 384 CFOs and Treasurers, and conduct in-depth interviews with an additional two dozen, to determine the key factors that drive dividend and share repurchase policies. We find that managers are very reluctant to cut dividends, that dividends are smoothed through time, and that dividend increases are tied to long-run sustainable earnings but much less so than in the past. Rather than increasing dividends, many firms now use repurchases as an alternative. Paying out with repurchases is viewed by managers as being more flexible than using dividends, permitting a better opportunity to optimize investment. Managers like to repurchase shares when they feel their stock is undervalued and in an effort to affect EPS. Dividend increases and the level of share repurchases are generally paid out of residual cash flow, after investment and liquidity needs are met. Financial executives believe that retail investors have a strong preference for dividends, in spite of the tax disadvantage relative to repurchases. In contrast, executives believe that institutional investors as a class have no strong preference between dividends and repurchases. In general, management views provide at most moderate support for agency, signaling, and clientele hypotheses of payout policy. Tax considerations play only a secondary role. By highlighting where the theory and practice of corporate payout policy are consistent and where they are not, we attempt to shed new light on important unresolved issues related to payout policy in the 21st century.

Suicide and deliberate self harm in older Irish adults

Background: Hospital-treated deliberate self harm and suicide among older adults have rarely been examined at a national level. Methods: The Irish Central Statistics Office provided suicide and undetermined death data for 1980-2006. The National Registry of Deliberate Self Harm collected data relating to deliberate self harm presentations made in 2006-2008 to all 40 Irish hospital emergency departments. Results: Rates of female suicide among older adults (over 55 years) were relatively stable in Ireland during 1980-2006 whereas male rates increased in the 1980s and decreased in more recent decades. Respectively, the annual male and female suicide and undetermined death rate was 22.1 and 7.6 per 100,000 in 1997-2006. Male and female deliberate self harm was 3.0 and 11.0 times higher at 67.4 and 83.4 per 100,000, respectively. Deliberate self harm and suicide decreased in incidence with increasing age. Deliberate self harm generally involved drug overdose (male: 72%; female 85%) or self-cutting (male: 15%; female 9%). The most common methods of suicide were hanging (41%) and drowning (29%) for men and drowning (39%) and drug overdose (24%) for women. City and urban district populations had the highest rates of hospital-treated self harm. The highest suicide rates were in urban districts. Conclusions: Older Irish adults have high rates of hospital-treated deliberate self harm but below average rates of suicide. Drowning was relatively common as a method of suicide. Restricting availability of specific medications may reduce both forms of suicidal behavior

Psychotropic medication involved in intentional drug overdose: implications for treatment.

Aims: Limited information is available on the source of medications taken in intentional drug overdoses (IDOs). The present study aimed to investigate the proportion of patients who engaged in IDOs with current prescriptions and the proportion of those that used their medicines in overdose acts, as well as the factors associated with patients who do so. Methods: The registration systems of three hospital emergency departments participating in the Irish National Registry of Deliberate Self Harm were screened over a continuous 6-month period and a consecutive series of 299 IDO presentations were identified. Results: Most of the IDO presentations involved female patients (59.9%) and half (50.4%) had a previous history of self-harm. The prescription of psychotropic drugs was associated with the use of these drugs in IDOs, particularly minor tranquilizers. Having a prescription of a minor tranquilizer increased the risk of using prescribed psychotropic drugs in IDOs even when controlling for other factors. Conclusion: These findings highlight the importance of considering the risk of IDO among patients who are prescribed minor tranquilizers

A study of untimely sudden deaths and people who took their lives while in the care of the Donegal Mental Health Service.

Unexpected, tragic events with adverse outcomes present a huge challenge to individuals, health services, families and communities who are striving to do their best in stressful circumstances. In order to progress towards better mental wellbeing for all, we must question how we can help vulnerable people. This research has examined in depth and in detail those tragic circumstances that no one personally or professionally ever wishes to face. To do this objectively, openly and with a fierce intent to use the findings to improve the identification of people at risk to sudden unexpected deaths in mental health services, examining the factors that contribute to risk and the consequences for families in the aftermath were key objectives of the research team. The findings revealed that no single factor dominated the cases examined. Each case had a complexity which underlined that any recommendations made needed a multifaceted, collaborative approach. It is hoped that the research tools described, the recommendations made and the contributions of all the families who gave their time so unreservedly will help all mental health services in Ireland. This data set of consecutive untimely sudden deaths will contribute to suicide research internationally, but most importantly it helps cast light onto what must be done to provide effective suicide prevention in Ireland. When a series of unexpected deaths occurred in Donegal, local mental health services began to search for answers. P.8 The clinical files of all 34 cases were examined with regard to cause of death. Overdose of medication or drugs accounted for the largest loss of life (n=15, 44%) followed by hanging (n=14, 41%) and drowning (n=5, 14.7%). Almost half of the cases being examined were known to abuse both drugs and alcohol prior to death (n=16, 47%), six had abusive or dependent issues with a single substance while more than one third were reported to abuse neither drugs nor alcohol

Involving young people in cyberbullying research: the implementation and evaluation of a rights-based approach.

Background: Cyberbullying is an international Public Health concern. Efforts to understand and address it can be enhanced by involving young people. This paper describes a rights‐based collaboration with young people in a qualitative exploration of cyberbullying. It describes the establishment, implementation and evaluation of a Young Person's Advisory Group as well as identifying the impact on the research process and the young people involved. Methods: Sixteen post primary school students met with researchers on five occasions in a youth centre. Sessions focused on building the young people's capacity to engage with the research, designing the qualitative study, interpreting study findings and evaluating the collaboration process. Results: The Advisory Group highlighted a lack of understanding and appropriate action with regard to cyberbullying but believed that their involvement would ultimately help adults to understand their perspective. Evaluation findings indicate that members were supported to form as well as express their views on the design, conduct and interpretation of the research and that these views were acted upon by adult researchers. Their involvement helped to ensure that the research was relevant and reflective of the experiences, interests, values and norms of young people. Conclusion: Young people can contribute a unique perspective to the research process that is otherwise not accessible to adult researchers. The approach described in this study is a feasible and effective way of operationalizing young people's involvement in health research and could be adapted to explore other topics of relevance to young people