Hewage, C.

Marecek, Jeanne

Senadheera, C.

Wijayasiri, W. A.A.

English

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Swarthmore College Works Psychology Faculty Works Psychology 6-18-2010 A Hospital-Based Study On Trends In Deliberate Self-Harm In Children And Adolescents C. Senadheera Jeanne Marecek Swarthmore College, jmarece1@swarthmore.edu C. Hewage W. A.A. Wijayasiri This work is licensed under a Creative Commons Attribution 4.0 License. This work is brought to you for free and open access by . It has been accepted for inclusion in Psychology Faculty Works by an authorized administrator of Works. For more information, please contact myworks@swarthmore.edu. Follow this and additional works at: https://works.swarthmore.edu/fac-psychology  Part of the Psychology Commons Let us know how access to these works benefits you  Recommended Citation C. Senadheera, Jeanne Marecek, C. Hewage, and W. A.A. Wijayasiri. (2010). "A Hospital-Based Study On Trends In Deliberate Self-Harm In Children And Adolescents". Ceylon Medical Journal. Volume 55, Issue 2. 67-68. DOI: 10.4038/cmj.v55i2.1991 https://works.swarthmore.edu/fac-psychology/409 67Vol. 55, No. 2, June 2010Research lettersDeliberate self-harm (DSH) refers to self-inflictedinjuries that may or may not cause death. DSH is commonamong adolescents, especially females [1]. It may be a riskfactor for future suicide [2]. Using data from medicalrecords, this study focuses on children and adolescentswho were admitted to Teaching Hospital, Karapitiyafollowing deliberate self-harm. Approval for the study wasgranted by the Ethical Review Committee of Faculty ofMedicine, University of Ruhuna. We examined the BHTsof all adolescents (those under 19 years of age) admittedto the Teaching Hospital, Karapitiya with DSH during 2001,2003, 2006 and 2007 (these years were selected based onavailability and completeness of the records). Informationabout fatal DSH was obtained from the hospital policepost.  In a few cases, it could not be determined if theself-harm was deliberate; such cases were excluded.827 admissions met the study criteria.  The patients’age ranged from 9 to 18 years, with females (73%)outnumbering males (27%). Only 28 (3.4%) fatalities wererecorded. Admissions of adolescents for DSH increased by91% from 2001 to 2007. Girls accounted for most of thisincrease; admissions of boys increased only slightly. Thisgender difference was significant (p=0.003). Admissionsfor DSH increased consistently with age. Only 38 childrenA hospital-based study on trends in deliberate self-harm in childrenand adolescentsTo the Editors:(Index words: deliberate self-harm, adolescence, gender difference, paracetamol)under the age of 14 years were hospitalised for DSH,compared to 257 patients who were 18 years old. Casefatality rate dropped from 8% to 2.3% from 2001 to 2007.Almost 99% of the admissions involved either ingestionof a poison or an overdose of medicine. Overdosesaccounted for 55% of the admissions. Ingestion of poisons(eg. washing powder, kerosene oil, agrochemicals, andpoisonous plants) accounted for 43% of the admissions.The remaining cases involved burning, hanging andjumping from the roof.Admissions after overdose of medicine increaseddramatically from 2001 to 2007 (Figure 1). In 2006 and2007, 63% of the cases involved overdoses. There was asharp gender difference in the substances ingested. About64% of the boys used poisons and 64% of the girls hadoverdoses (p<0.001). Admissions for paracetamoloverdose increased fivefold from 2001 to 2007. In2006-2007, 45% of adolescents used paracetamol. BHTsrecorded patients’ self-reports of the quantity of tabletsthey had ingested. In patients whom paracetamol was theonly substance ingested, the modal overdose was in therange of 20-25 tablets. The largest overdose reported was108 tablets. None of the patients with paracetamolpoisoning died.Figure 1. Substances used by adolescents for deliberate self harm.Substances used in adolescents’ DSH episodesNumber of admissionsYear68 Ceylon Medical JournalResearch lettersReferences1. Hawton K. Suicide and attempted suicide among childrenand adolescents. Beverly Hills: Sage, 1986.2. Brent D, Perper J, Moritz G, et al. Psychiatric risk factorsfor adolescent suicide: A case control study. Journal of theAmerican Academy of Child and Adolescent Psychiatry1993; 32: 521-9.3. Sri Lanka Police Service. Crime trends. Mode of suicide foryears 2005, 2006, 2007. Available at http://www.police.lk.4. Senaratne SMDKG, Sri Ranganathan S, Dawson AH,Buckley N, et al. Management of acute paracetamol poisoningin a tertiary care hospital. Ceylon Medical Journal 2008; 53:89-92.This study provides evidence of a recent increase inhospital admissions after DSH among children andadolescents, especially girls. This is in contrast to thedecline in suicide rates reported nationally [3]. The dataalso suggest an increase in paracetamol overdose amongadolescents, especially girls. This mirrors a broadernational trend, as suggested by a recent study from theNational Hospital of Sri Lanka [4]. Though there were nodeaths, medical management of paracetamol overdose iscostly. Furthermore it is difficult to restrict children's accessto paracetamol, which is found in many households andcan easily be purchased. This study has some limitations.Information on BHTs may not be accurate. Moreover, anyhospital-based study of DSH underestimates its trueincidence because many episodes of DSH are not admittedto a hospital.C Senadheera1, J Marecek2, C Hewage1 and W A A Wijayasiri31Department of Psychiatry, Faculty of Medicine, University of Ruhuna, Sri Lanka.2Department of Psychology, Swarthmore College, USA.3Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka.Correspondence:  CS, e-mail <chandaniesenadheera@yahoo.co.uk>. Received 19 June and revised version accepted1 October 2009. Competing interests: none declared.Prevalence of Helicobacter pylori infection determined by histologyin patients with different upper gastrointestinal diseasesTo the Editors:Helicobacter pylori infection is prevalent indeveloping countries. India, Pakistan and Bangladeshreport around 80% prevalence both in patients withupper gastrointestinal diseases and asymptomaticindividuals [1-2]. Among Sri Lankans, the reportedH.pylori prevalence is inconsistent and shows a widevariation [3-5]. Many Sri Lankan studies have either usedsmall number of patients or used limited number ofdiagnostic techniques and these may have partlycontributed to the variation in the prevalence reported.This study examined the prevalence of H. pylori infectionin a group of patients with upper gastrointestinal diseasesat a tertiary care centre in southern Sri Lanka.We selected 251 consecutive patients who underwentroutine upper gastrointestinal endoscopy for clinicalindications in Teaching Hospital, Karapitiya, Galle fromJanuary 2006 to June 2007. Patients who had taken specificH. pylori eradication therapy during the previous six monthsand patients who consumed antibiotics active againstH. pylori during four weeks preceding the endoscopywere excluded. Informed written consent was obtainedfrom all the patients. Approval for the study was grantedby the Ethics Committee, Faculty of Medicine, Galle.Minimum of five gastric biopsies; three antral andtwo corporal, were collected from each patient into 10%formalin. Haematoxylin and Eosin (H&E) and modifiedGiemsa staining techniques were used to detect H. pyloriinfection. Presence of H. pylori was confirmed by anexperienced histopathologist when either H&E or modifiedGiemsa showed the characteristic morphological evidenceof H. pylori.The overall prevalence of H. pylori was 49.4%(124/251). Of the oesophageal diseases, oesophagealvarices had H. pylori prevalence of 63.2% (12/19). H. pyloriprevalence among patients with erosive oesophagitis andhiatus hernia was 53.3% (24/45) and 48.6% (18/37),respectively. Number of patients with oesophageal ulcersand growths were too small to obtain a true prevalencevalue.

A Hospital-Based Study On Trends In Deliberate Self-Harm In Children And Adolescents

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A Hospital-Based Study On Trends In Deliberate Self-Harm In Children And Adolescents

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