Risk of suicide, deliberate self-harm and psychiatric illness after the loss of a close relative: A nationwide cohort study

With increasing numbers of people in western society engaging in deliberate self-harm behaviours, psychiatric practitioners should reconsider some of the implications. 1. Psychiatry as a branch of medicine has a medical bias in assessing people who have engaged in deliberate self-harm behaviours and tends to view these behaviours as symptoms of psychiatric illness rather than sociological disorder. 2. The increasing number of these distressed people is causing an increasing psychiatric workload to the disadvantage of other patients, research activity and teaching. 3. The psychiatric profession should focus its attention on patients with formal psychiatric illness and encourage the involvement and participation of professionals from other agencies and services who are now trained and willing to become involved. Psychiatry cannot replace the enfeebled phenomena of collective sentiment or the regulatory function of a simpler, more cohesive society (as described by Durkheim) but many of the established self-help groups can help and links could be established with these agencies. To do this will require changes to established professional role boundaries and the loosening of medico-legal constraints which currently prevent relinquishing of responsibility when there is an obvious absence of psychiatric illness.

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Patients with deliberate self-harm attended in emergency setting at a tertiary care hospital: A 13-month analysis of clinical-psychiatric profile

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217419837052 ◽

2019 ◽

Vol 54 (6) ◽

pp. 363-376

Author(s):

Swarndeep Singh ◽

Saurabh Kumar ◽

Raman Deep

Keyword(s):

Psychiatric Illness ◽

Tertiary Care Hospital ◽

Past History ◽

Tertiary Care ◽

Emergency Setting ◽

Care Hospital ◽

Deliberate Self Harm ◽

Emergency Team ◽

Self Harm ◽

Behavioral Emergencies

Objectives To describe the pattern and clinical-psychiatric profile of patients presenting with deliberate self-harm attempt to an emergency setting. Methods The study involves the analysis of the case records of 109 consecutive patients with deliberate self-harm evaluated by the psychiatric emergency team at a premier, tertiary care hospital in India over a period of 13 months (January 2015–January 2016). Results Deliberate self-harm had a clinical prevalence of 16.4% (109/666) among total mental and behavioral emergencies attended in the same period. A large majority of attempters were in the age range of 18–39 years (84.4%), and females (58.7%) outnumbered males in total sample. Married females and unmarried males had significantly higher chances of attempting deliberate self-harm (χ2 = 6.57, p = 0.01). More than half (52.3%) of patients were found to have a diagnosable psychiatric illness at the time of presentation, most common being depressive disorder in 19.3% of overall sample. Past history of a psychiatric illness was evident in only 12.5% of patients. Common methods of deliberate self-harm were prescription drug/psychotropic overdose, poisoning with ingestion of phenyl cleaner or rat-killer poison. Significant gender differences were observed in the nature of precipitating events for deliberate self-harm, with interpersonal relationship problems being significantly more common in women (p = 0.03). Conclusion This study adds relevant and useful information on cross-cutting as well as gender-specific characteristics of patients presenting with deliberate self-harm attempt, from a developing country context. The study findings bear implications for designing interventions for primary and secondary prevention of such behavioral emergencies at a community level.

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