Increase in self-injury as a method of self-harm in Ghent, Belgium : 1987-2013

Background : Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. Methods : We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. Results : Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. Conclusion : This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients

Applying the Cry of Pain model as a predictor of deliberate self-harm in an early-stage adult male prison population

Purpose: Deliberate self-harming behaviour is more prevalent within the prison environment than in community samples, with those in the first weeks of imprisonment at greatest risk. Research in this area has been largely atheoretical and a unifying model may improve the predictability of assessment and the development of intervention approaches. This study applied William and Pollock’s (2001) Cry of Pain model as the theoretical process of deliberate self-harm in the early stages of imprisonment. Method: A prospective study of new arrivals at an adult male prison. Participants (n =181) completed questionnaires and it was hypothesised that the factors derived from the model (perceived stress, defeat, entrapment and absence of rescue factors) would be predictive of future deliberate self-harm. Prisoners with active psychosis and non-English speakers were excluded. All participants were followed up for four months for instances of self-harm. Eighteen participants engaged in self-harm during this period. Results: The Cry of Pain Model was supported in the analysis. Hierarchical binary logistic regression confirmed that all features of the model were supported as predictive of future self-harm in prison, even after controlling for previous self-harm, depression and hopelessness. Conclusion: The Cry of Pain model is supported as a predictive model for deliberate self-harm in prison. Suggestions are offered as to the impact on assessment and intervention directions in prison

Predictive validity of the short-term assessment of risk and treatability (START) for aggression and self-harm in a secure mental health service:gender differences

The START predicts aggressive outcomes and to some extent self-harm. However, it is not known whether gender moderates its performance. This study used routinely collected data to investigate the predictive ability of the START for aggression and self-harm in secure psychiatric patients. Utility of the START was examined separately for men and women. The START was a stronger predictor of aggression and self-harm in women than men. The specific risk estimates produced large effect sizes for the prediction of aggression and self-harm in women; none of the AUC values reached the threshold for a large effect size in the male sample

Negative intrusive thoughts and dissociation as risk factors for self-harm.

Relationships between self-harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation and childhood trauma, had lower self-worth, and reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly to the self-harmers on the dissociation and self-worth scales, and engaged in potentially maladaptive behaviors that are not defined as indicating clinical self-harm, but experienced fewer negative intrusive thoughts. This group may be at risk of future self-harm if they begin to experience negative intrusive thoughts. If negative intrusive thoughts are playing a causal role, then therapeutic approaches tackling them may help those who are currently self-harming

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

Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes:the effect of diagnosis

The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically diverse samples is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The sample was divided into diagnostic groups; predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger sample sizes of those with multiple diagnoses is required.</p

Non-Suicidal Self-Injury and Suicidal Behaviour in Children and Adolescents Accessing Residential or Intensive Home-Based Mental Health Services

Objective: There is a dearth of Canadian research with clinical samples of youth who self-harm, and no studies could be located on self-harm in children and youth accessing residential or intensive home-based treatment. The purposes of this report were to explore the proportion and characteristics of children and youth identified as self-harming at admission by clinicians compared to youth not identified as self-harming, compare self-harming children to adolescents, and to compare caregiver ratings of self-harm at intake to clinician ratings at admission. Method: This report was developed from a larger longitudinal, observational study involving 210 children and youth accessing residential and home-based treatment and their caregivers in partnership with five mental health treatment centres in southwestern Ontario. Agency data were gleaned from files, and caregivers reported on symptom severity at 12 to 18 months and 36 to 40 months post-discharge. Results: Fifty-seven (34%) children and youth were identified as self-harming at admission. The mean age was 11.57 (SD 2.75). There were statistically significant differences on symptom severity at intake between those identified as self-harming and those not so identified; most of these differences were no longer present at follow up. Children were reported to have higher severity of conduct disorder symptoms than adolescents at intake, and there was some consistency between caregiver-rated and clinician-rated self-harm. Children were reported to engage in a wide range of self-harming behaviours. Conclusion: These findings suggest that youth who were identified as self-harming at admission have elevated scores of symptom severity, self-harm can occur in young children and while many improve, there remains a concern for several children and youth who did not improve by the end of service. Children engage in some of the same types of self-harm behaviours as adolescents, and they also engage in behaviours unique to children

Medication used in intentional drug overdose in Flanders 2008-2013

Background : Intentional drug overdose is the most common method of self-harm. As psychiatric disorders are very common in self-harm patients, the medication used to treat these disorders can become the means for the self-harm act. The present study aimed at investigating an association between the use of prescribed medication (analgesics and antipyretics, anti-epileptics, antipsychotics, antidepressants and psychostimulants) as a method of self-harm and prescription rates of this medication in Flanders. We investigated the possible effect of gender, alcohol use during the self-harm act and a history of self-harm. Methods : Data from the multicenter study of self-harm in Flanders between 2008 and 2013 were used. The significance of differences in percentages was calculated by GEE and the strength by odds ratios (OR). Results : There was an increase in the odds of using antidepressants (0.8%) and antipsychotics (2%) among females when the rate of prescription increases. Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were the most commonly prescribed drugs among females. Antidepressants (63.9/1,000) and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among males. Antidepressants and analgesics and antipyretics were the most frequently used medications for self-harm. Analgesics and antipyretics during the self-harm act were more common among first-timers, while repeaters more commonly overdosed using antipsychotics and antidepressants. Conclusion : These findings suggest that the availability of medication via prescriptions plays an important role in the choice of the medication ingested during the self-harm act. Precautions are necessary when prescribing medication, including restrictions on the number of prescriptions and the return of unused medication to pharmacies after cessation of treatment. These issues should be a focus of attention in the education and training of physicians and pharmacists

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

Purpose: Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods: We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945–1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results: There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21–1.35, p &lt; 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50–1.91, p &lt; 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions: The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated

LGBTQIAP+ University Students and Likelihood of Self-Harm

Self-harm is defined as the direct, deliberate destruction or alteration of body tissue (Bakken and Gunter 2012). This research is important because previous research has found that university students are likely to engage in self-harm and that it is an often-overlooked problem among both young people and university students (Gollust et al. 2008; Whitlock et al. 2011; Bakken and Gunter 2012). Additionally, the more we know about self-harm and self-harm trends the more we can do to reduce it in our communities. In crafting my research question I examined previous research of self-harm on college campuses. One of the studies I examined focused on establishing an estimate of the amount of non-suicidal self-injury (NSSI) among university students by using an internet-based survey to examine self-harm as well as risk factors such as depression, anxiety, and eating disorders (Gollust et al. 2008). The authors found that seven percent of survey respondents reported selfinjury in the past four weeks (Gollust et al. 2008). Other research I looked at focused on NSSI characteristics and sex differences, similarly using a web-based survey of university students (Whitlock et al. 2011). The authors of this study found that females were more likely to selfinjure than males and that individuals with a sexual orientation other than heterosexual were at a higher level of risk for NSSI (Whitlock et al. 2011). Another study I looked at focused on comparing mental health and self-harm between lesbian, bisexual, and heterosexual women on college campuses. This study found that both lesbian bisexual women were the more likely to self-harm than heterosexual women and that bisexual women were the most likely to self-harm (Kerr et al. 2013). The fourth study I looked at also examined risk factors for self-harm among college students and likelihood of self-harm. The study found that seventeen percent of university students self-harmed, and of that seventeen percent, seventy-five percent did it more than once. The researchers also found that many of the self-harm behaviors occurred among individuals who had never been in therapy and rarely disclosed that they had self-harm tendencies. The researchers concluded that it is critical that medical and mental health providers find effective strategies for detecting and addressing self-harm behaviors among university students (Whitlock et al. 2006). The previous research studies have multiple limitations that limit their generalizability. One limitation is the small sample sizes of the previous research, which limit the ability to generalize to a larger population. Another limitation is a focus on primarily LGBTQIAP+ women and men, which again leads to lack of generalizability as it can ignore the transgender and non-binary or nonconforming communities. Another limitation is that while much of the previous research explores which groups are more likely to self-harm than others and what variables increase or decrease the likelihood of self-harm, there is no discussion on the amount of self-harm between groups. While research has stated that LGBTQIAP+ people are generally more likely to self-harm than non-LGBTQIAP+ people, the research has not examined if they are likely to do so more frequently