Retrospective Identification of Episodes of Deliberate Self-Harm from Emergency Room Registers in General Hospitals: An Example from Shanghai

Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives.

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Thirteen-year follow-up of deliberate self-harm, using linked data

The British Journal of Psychiatry ◽

10.1192/bjp.172.3.239 ◽

1998 ◽

Vol 172 (3) ◽

pp. 239-242 ◽

Cited By ~ 55

Author(s):

David J. Hall ◽

Fiona O'Brien ◽

Cameron Stark ◽

Antony Pelosi ◽

Helen Smith

Keyword(s):

Linked Data ◽

Attempted Suicide ◽

Alcohol Misuse ◽

Median Number ◽

Contributory Factor ◽

Data Set ◽

General Hospitals ◽

Deliberate Self Harm ◽

Self Harm

BackgroundWe describe a national cohort of individuals surviving an episode of deliberate self-harm (DSH). Subsequent admissions for DSH and mortality over the following 13 years were studied.MethodIn 1981, 8304 individuals were discharged from Scottish general hospitals with a diagnosis of attempted suicide (E950–959). They were followed-up to the end of 1994 using the Scottish Linked Data Set. Mortality was compared to the Scottish population using person-years analysis.Results2624 people (31.6%) were readmitted with further episodes of DSH. The median number of readmissions was I, range 1–137. The observed: expected ratio for all-cause mortality was 2.26 (95% CI 2.13–2.26). One hundred and sixty-eight people (2%) died from suicide, and 46 (0.6%) from undetermined causes. The observed: expected ratio for suicide plus undetermined deaths was 12.17 (95% CI 10.64-13.91). Accidental deaths in men and homicide deaths in men and women were elevated. The pattern of deaths from other causes suggested that alcohol misuse was a contributory factor.ConclusionsPeople admitted to general hospitals in Scotland after attempted suicide are at high risk of readmission for further episodes of DSH. Long-term follow-up of such large cohorts is impractical, but services should review the scope for intervention in alcohol misuse following DSH.

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The Epidemiology of Deliberate Self-harm

The British Journal of Psychiatry ◽

10.1192/bjp.149.6.734 ◽

1986 ◽

Vol 149 (6) ◽

pp. 734-737 ◽

Cited By ~ 21

Author(s):

A. O. Odejide ◽

A. O. Williams ◽

J. U. Ohaeri ◽

B. A. Ikuesan

Keyword(s):

Prospective Study ◽

Interpersonal Relationships ◽

Psychotropic Drugs ◽

General Hospitals ◽

Female Ratio ◽

Deliberate Self Harm ◽

Self Harm ◽

Male To Female ◽

Ibadan Nigeria

In a 6-month prospective study of the three main general hospitals in Ibadan, Nigeria, 39 cases of deliberate self-harm were reported out of a total 23, 859 subjects attending the sections of hospital studied. Thirty (76.9%) were under 30 years of age and 36 (86.3%) were under 34 years of age. The male to female ratio was 1.4.1: more than half of the population (51.3%) were students and 25.6%, manual workers. The methods used were mainly ingestion of chemicals (24 patients) and psychotropic drugs (11 patients). Disturbed Interpersonal relationships, especially with parents, were mainly found to have motivated the acts. The implications of these findings are discussed.

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Coping Style as a Mediator of the Relationship Between Depressive Symptoms and Deliberate Self-Harm

Crisis ◽

10.1027/0227-5910/a000083 ◽

2011 ◽

Vol 32 (5) ◽

pp. 272-279 ◽

Cited By ~ 9

Author(s):

Allison S. Christian ◽

Kristen M. McCabe

Keyword(s):

Depressive Symptoms ◽

Undergraduate Students ◽

Cross Sectional Study ◽

Self Report ◽

Hierarchical Regression ◽

Cross Sectional ◽

Deliberate Self Harm ◽

Self Blame ◽

Self Harm ◽

The Relationship

Background: Deliberate self-harm (DSH) occurs with high frequency among clinical and nonclinical youth populations. Although depression has been consistently linked with the behavior, not all depressed individuals engage in DSH. Aims: The current study examined maladaptive coping strategies (i.e., self-blame, distancing, and self-isolation) as mediators between depression and DSH among undergraduate students. Methods: 202 students from undergraduate psychology courses at a private university in Southern California (77.7% women) completed anonymous self-report measures. Results: A hierarchical regression model found no differences in DSH history across demographic variables. Among coping variables, self-isolation alone was significantly related to DSH. A full meditational model was supported: Depressive symptoms were significantly related to DSH, but adding self-isolation to the model rendered the relationship nonsignificant. Limitations: The cross-sectional study design prevents determination of whether a casual relation exists between self-isolation and DSH, and obscures the direction of that relationship. Conclusions: Results suggest targeting self-isolation as a means of DSH prevention and intervention among nonclinical, youth populations.

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Negative Life Events Associated With Deliberate Self-Harm in an African Population in Uganda

Crisis ◽

10.1027/0227-5910.26.1.4 ◽

2005 ◽

Vol 26 (1) ◽

pp. 4-11 ◽

Cited By ~ 24

Author(s):

E. Kinyanda ◽

H. Hjelmeland ◽

S. Musisi

Keyword(s):

Life Events ◽

Negative Life Events ◽

Life Time ◽

Later Life ◽

Dose Effect ◽

Deliberate Self Harm ◽

Time Period ◽

Significant Difference ◽

Self Harm ◽

Suicide Interventions

Abstract. Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.

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Non-Fatal Deliberate Self-Harm in Three Remote Indigenous Communities in Far North Queensland, Australia

Crisis ◽

10.1027/0227-5910/a000589 ◽

2019 ◽

Vol 40 (6) ◽

pp. 422-428 ◽

Cited By ~ 1

Author(s):

Chris Rouen ◽

Alan R. Clough ◽

Caryn West

Keyword(s):

Health Care ◽

Primary Health Care ◽

Care Center ◽

Indigenous Communities ◽

Indigenous Australians ◽

Deliberate Self Harm ◽

Health Care Center ◽

Far North ◽

Primary Health ◽

Self Harm

Abstract. Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential. Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia. Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011. Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers. Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

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