Social Science and Medicine, 65(5), September 2007, pp.855-867.
Publisher:
Elsevier
Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH
Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH to a general hospital Emergency Department in Oxford, UK. Autoregression analysis of all episodes from 1976 to 2003 (controlling for day of the week, month and year) revealed significant reductions in the occurrence of DSH compared with expected numbers on each day from December 19th to 26th (except the 23rd), though no significant increase was found on any of the subsequent 11 days. When analysed separately, young people aged under 25 years showed decreases in the occurrence of DSH on several days throughout Christmas and New Year. Patients with partner relationship problems showed a decrease 3 days before Christmas Day and an increase on New Year's Day. Patients with family relationship problems showed decreases before Christmas and after New Year. Patients with social isolation problems, or a previous history of DSH showed decreases before Christmas only. Patients who used alcohol at the time of DSH or in the 6 h beforehand, but did not chronically misuse alcohol, showed an increase on New Year's Day. There was no significant variation in the occurrence of DSH for patient groups with either low/medium or high suicide intent. The findings elucidate how social and individual factors may interact in contributing to DSH. They are of theoretical interest, and have important clinical implications regarding identification of patient groups especially susceptible to DSH at New Year.
British Journal of Psychiatry, 194(3), March 2009, pp.266-272.
Publisher:
Cambridge University Press
Little is known about self-harm in the armed forces. This study aimed to investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed. Armed forces personnel presenting to hospital between 1989 and 2003 following self-harm were included in the study and the case–control comparison was with people in the general population who had self-harmed. One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide. It is concluded that self-harm by armed forces personnel may
Little is known about self-harm in the armed forces. This study aimed to investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed. Armed forces personnel presenting to hospital between 1989 and 2003 following self-harm were included in the study and the case–control comparison was with people in the general population who had self-harmed. One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide. It is concluded that self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.
It is estimated that up to five per cent of those attending an emergency department have a primary diagnosis of mental ill health, of which substance misuse and deliberate self-harm (DSH) are the largest groups. A further 20-30 per cent of attendees have coexisting physical and psychological problems, with much of the latter remaining undetected. It is estimated that 35 per cent of emergency departments attendances are related to alcohol including violent assaults, road traffic accidents, mental health emergencies and deliberate self-harm.
It is estimated that up to five per cent of those attending an emergency department have a primary diagnosis of mental ill health, of which substance misuse and deliberate self-harm (DSH) are the largest groups. A further 20-30 per cent of attendees have coexisting physical and psychological problems, with much of the latter remaining undetected. It is estimated that 35 per cent of emergency departments attendances are related to alcohol including violent assaults, road traffic accidents, mental health emergencies and deliberate self-harm.
Subject terms:
mental health problems, self-harm, violence, alcohol misuse, emergency health services;
HOLDSWORTH Nicholas, GRIFFITHS Hugh, CRAWFORD David
Journal article citation:
Psychiatrist (The), 34(6), June 2010, pp.226-230.
Publisher:
Royal College of Psychiatrists
... a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm. Results showed that the number of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool. The paper suggests that the routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.
Alcohol use commonly associated with self harm, but there is nothing in the literature that bases the association on validated screening tools. This paper sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT), a 10 item screening instrument designed to identify people at risk from alcohol misuse. Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm. Results showed that the number of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool. The paper suggests that the routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.
Journal of Adolescence, 32(5), October 2009, pp.1125-1136.
Publisher:
Academic Press
This study examined whether depressed adolescent outpatients with deliberate self-harm behaviour (DSH) differed from non-suicidal depressed adolescent outpatients in depressive and anxiety symptoms, alcohol use, perceived social support and number of negative life-events. Depressed adolescent outpatients (n = 155) aged 13–19 years were interviewed using K-SADS-PL for DSM-IV Axis I diagnoses
This study examined whether depressed adolescent outpatients with deliberate self-harm behaviour (DSH) differed from non-suicidal depressed adolescent outpatients in depressive and anxiety symptoms, alcohol use, perceived social support and number of negative life-events. Depressed adolescent outpatients (n = 155) aged 13–19 years were interviewed using K-SADS-PL for DSM-IV Axis I diagnoses and completed self-report questionnaires. Suicidal behaviour was assessed by K-SADS-PL suicidality items. Depressed adolescents with DSH were younger, perceived less support from the family, had more severe depressive symptoms and used more alcohol than non-suicidal depressed adolescents. Adolescents with DSH and suicidal ideation or suicide attempts had more depressive and anxiety symptoms than adolescents with DSH only. Adolescents with severe internalizing distress symptoms are at risk not only for DSH, but also additional suicidal behaviour. Family interventions may be needed in the treatment of depressed adolescents with DSH.
Subject terms:
self-harm, social networks, young people, alcohol misuse, depression, family relations;
Depressive disorders can produce dramatic and frightening changes in young peoples’ behaviour, but while parents may suspect something is wrong, they are often at a loss to know what. This book shows parents how to tell the difference between the ordinary ups and downs and true depression, helping them better understand clinical warning signs and the various approaches to treatment. Dealing sensitively with how depression sometimes manifests itself—self-harm, alcohol and drug abuse, and suicide attempts—the book offers parents practical guidance on how they can reach out to their children and find professional assistance.
Depressive disorders can produce dramatic and frightening changes in young peoples’ behaviour, but while parents may suspect something is wrong, they are often at a loss to know what. This book shows parents how to tell the difference between the ordinary ups and downs and true depression, helping them better understand clinical warning signs and the various approaches to treatment. Dealing sensitively with how depression sometimes manifests itself—self-harm, alcohol and drug abuse, and suicide attempts—the book offers parents practical guidance on how they can reach out to their children and find professional assistance.
Subject terms:
parents, self-harm, alcohol misuse, attempted suicide, children, depression, drug misuse;
International Journal of Integrated Care, 6(3), 2005, Online only
Publisher:
International Foundation for Integrated Care
To examine assessed need and wider health and social care service contact for a total Deliberate Self Harm (DSH) population in the UK. The study first recorded assessed needs and referrals for this population, then used a new method of identifying and describing all other agency contacts for this population by combining the total anonymised DSH population data with total mental health, health and social care agency populations for one geographical area. For a DSH unit population of 427, half (53%) were assessed with mental health and 18% with drug or alcohol problems; two thirds were referred to appropriate services. Wider service contact for a total DSH population (n=2,205 over three years) confirmed that 53% had contacted mental health (compared to 2.9% of the geographical area population (n=646,239) and 7.4% of the total hospital Emergency population (n=91,911). The DSH population was three times more likely to contact social care agencies (21.1%: 7.2%) and ten times more likely to attend drug (7.3%: 0.7%) and alcohol agencies (8.8%: 0.8%). This new method described the wider service use of one vulnerable shared care population, it is suggested that the method could be used to inform the development of integrated care initiatives in different areas.
To examine assessed need and wider health and social care service contact for a total Deliberate Self Harm (DSH) population in the UK. The study first recorded assessed needs and referrals for this population, then used a new method of identifying and describing all other agency contacts for this population by combining the total anonymised DSH population data with total mental health, health and social care agency populations for one geographical area. For a DSH unit population of 427, half (53%) were assessed with mental health and 18% with drug or alcohol problems; two thirds were referred to appropriate services. Wider service contact for a total DSH population (n=2,205 over three years) confirmed that 53% had contacted mental health (compared to 2.9% of the geographical area population (n=646,239) and 7.4% of the total hospital Emergency population (n=91,911). The DSH population was three times more likely to contact social care agencies (21.1%: 7.2%) and ten times more likely to attend drug (7.3%: 0.7%) and alcohol agencies (8.8%: 0.8%). This new method described the wider service use of one vulnerable shared care population, it is suggested that the method could be used to inform the development of integrated care initiatives in different areas.
Subject terms:
mental health services, needs, referral, self-harm, service uptake, alcohol misuse, drug misuse;
British Journal of Psychiatry, 169, October 1996, pp.451-458.
Publisher:
Cambridge University Press
Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct subgroup, sometimes termed "multi-impulsive bulimia". Results of this research found Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only 6% bulimia nervosa cases had two or more of these behaviours concurrently. Concludes that sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably
Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct subgroup, sometimes termed "multi-impulsive bulimia". Results of this research found Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only 6% bulimia nervosa cases had two or more of these behaviours concurrently. Concludes that sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.
Subject terms:
self-harm, alcohol misuse, bulimia nervosa, drug misuse, eating disorders, comorbidity;
Objective: This study aimed to provide a synthesis and evaluation of psychosocial interventions to prevent suicide and reduce self-harm, as well as alcohol intake, for patients with alcohol problems. Methods: The systematic review was carried out according to the PRISMA guidelines and considered articles published in English from all countries. Terms relating to suicidality and alcohol problems
(Edited publisher abstract)
Objective: This study aimed to provide a synthesis and evaluation of psychosocial interventions to prevent suicide and reduce self-harm, as well as alcohol intake, for patients with alcohol problems. Methods: The systematic review was carried out according to the PRISMA guidelines and considered articles published in English from all countries. Terms relating to suicidality and alcohol problems were used to search Medline, EMBASE and PsycINFO databases. Randomized controlled trials of psychosocial interventions targeted for outpatient settings were included. Results: Six studies with a total of 400 participants were included. Two investigated dialectic behavioural therapy (DBT), one internet-delivered DBT, one dynamic deconstructivist psychotherapy (DDP) and two integrated cognitive behavioural therapy (CBT). Face to face and online DBT was significantly associated with abstinence and reductions in consumption with only a trend for a reduction in suicide attempts in one study relative to treatment at usual (TAU). DDP yielded significant reductions in alcohol consumption and suicide attempts versus community care. CBT was significantly effective relative to TAU in reducing alcohol use and suicide attempts in one trial with adolescents but not in another trial in an adult population. Conclusion: Integrated CBT has promise for adolescents, DBT may be helpful for alcohol patients with borderline personality disorder and iDBT may be useful for the wider community with heavy alcohol use. However, given the paucity of studies and the exploratory nature of these trials, there is currently no strong evidence for an effective psychosocial intervention to reduce alcohol consumption and suicidal behaviour in adults with problematic alcohol use.
(Edited publisher abstract)
Sets out findings of a survey to understand the experiences of people with pre-existing mental health problems during the coronavirus (Covid-19) pandemic, the challenges that they are facing, the coping strategies that they are using, and the support they would like to receive. The report highlights how pre-existing inequalities have been worsened by the pandemic with some groups being more likely to report that their mental health has declined, including women, people with disabilities, those living in social housing, people with eating disorders, obsessive compulsive disorder, or personality disorders, and frontline workers. Whilst the research did not find a significant difference in the overall rate of decline in mental health for people from BAME communities in comparison to White people, they did report that their mental health got worse. Key learnings set out in this report include: more than half of adults and over two thirds of young people said that their mental health has gotten worse during the period of lockdown restrictions, from early April to mid-May; restrictions on seeing people, being able to go outside and worries about the health of family and friends are the key factors driving poor mental health; feelings of loneliness have made nearly two thirds of people’s mental health worse during the past month; many people do not feel entitled to seek help, and have difficulty accessing it when they do; a quarter of adults and young people who tried to access support were unable to do so - not feeling comfortable using phone/video call technology has been one of the main barriers to accessing support.
(Edited publisher abstract)
Sets out findings of a survey to understand the experiences of people with pre-existing mental health problems during the coronavirus (Covid-19) pandemic, the challenges that they are facing, the coping strategies that they are using, and the support they would like to receive. The report highlights how pre-existing inequalities have been worsened by the pandemic with some groups being more likely to report that their mental health has declined, including women, people with disabilities, those living in social housing, people with eating disorders, obsessive compulsive disorder, or personality disorders, and frontline workers. Whilst the research did not find a significant difference in the overall rate of decline in mental health for people from BAME communities in comparison to White people, they did report that their mental health got worse. Key learnings set out in this report include: more than half of adults and over two thirds of young people said that their mental health has gotten worse during the period of lockdown restrictions, from early April to mid-May; restrictions on seeing people, being able to go outside and worries about the health of family and friends are the key factors driving poor mental health; feelings of loneliness have made nearly two thirds of people’s mental health worse during the past month; many people do not feel entitled to seek help, and have difficulty accessing it when they do; a quarter of adults and young people who tried to access support were unable to do so - not feeling comfortable using phone/video call technology has been one of the main barriers to accessing support.
(Edited publisher abstract)
Subject terms:
mental health problems, mental health services, access to services, mental health, black and minority ethnic people, ethnicity, Covid-19, self-harm, substance misuse, alcohol misuse;