Co-ingested alcohol and the timing of deliberate self-poisonings

Objective: Investigating diurnal variation in the timing of suicidal behaviours offers opportunity to better understand its various proximal risk factors. Acute use of alcohol is a potent proximal risk factor for suicidal behaviour, though the nature of this risk is poorly understood. The aim of this study was to compare the diurnal variation in time of poison ingestion between deliberate self-poisonings that involve alcohol versus those that do not. Methods: A retrospective analysis of consecutive presentations to a toxicology service following deliberate self-poisoning, 1996–2016. An independent samples Kolmogorov–Smirnov test was performed to test the null hypothesis that the diurnal distribution of poison ingestion time was equal across self-poisonings that did and did not involve alcohol co-ingestion. Presence of circadian rhythmicity was established using cosinor analysis. Results: A total of 11,088 deliberate self-poisoning records, for 7467 patients (60.8% females), were included in the analysis. In all, 31.3% of the total records involved alcohol co-ingestion. Distribution of exposure time was significantly different between deliberate self-poisonings that did and did not involve alcohol ( p < 0.001). The alcohol co-ingestion group showed a significantly greater prominent peak with poisoning occurring later in the evening (~20:00 hours) compared to poisonings that did not involve alcohol (~18:00 hours). Conclusion: This study exposed the differential diurnal patterns in deliberate self-poisoning according to the presence of alcohol co-ingestion. This analysis adds to the accumulating evidence that suicidal behaviour that involves alcohol co-ingestion represents a distinct subtype, which may be driven by alcohol consumption patterns in society. This also means that this large proportion of deliberate self-poisonings may not otherwise have occurred if it were not for alcohol consumption, underscoring the importance of drug and alcohol services for alcohol-related self-harm.

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Postcard intervention for repeat self-harm: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.075754 ◽

2010 ◽

Vol 197 (1) ◽

pp. 55-60 ◽

Cited By ~ 69

Author(s):

Annette L. Beautrais ◽

Sheree J. Gibb ◽

Alan Faulkner ◽

David M. Fergusson ◽

Roger T. Mulder

Keyword(s):

Emergency Department ◽

New Zealand ◽

Randomised Controlled Trial ◽

Outcome Measures ◽

Suicidal Behaviour ◽

Controlled Trial ◽

Elevated Risk ◽

Emergency Department Presentation ◽

Self Harm ◽

Randomised Controlled

BackgroundSelf-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.AimsTo examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.MethodRandomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.ResultsAfter adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.ConclusionsThe postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.

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Antidepressant dose and the risk of deliberate self-harm

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000456 ◽

2014 ◽

Vol 23 (4) ◽

pp. 329-331 ◽

Cited By ~ 4

Author(s):

C. Barbui ◽

S.B. Patten

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Propensity Score ◽

Adverse Effects ◽

Suicidal Behaviour ◽

Research Question ◽

Observational Cohort Study ◽

Panic Attacks ◽

Observational Cohort ◽

Self Harm

Although the mechanism by which antidepressants (ADs) may increase the risk of suicide-related outcomes is unknown, it has been hypothesised that some adverse effects, including akathisia, insomnia and panic attacks, as well as an early energising effect that might allow patients with depression to act on suicidal impulses, may have a key role. Considering that these adverse effects are dose-related, it might be hypothesised that the risk of suicidal behaviour is similarly related to the AD dose. This research question has recently been addressed by a propensity score-matched observational cohort study that involved 162 625 patients aged 10–64 years with a depression diagnosis who initiated therapy with citalopram, sertraline or fluoxetine. In this commentary, we discuss the main findings of this study in view of its methodological strengths and limitations, and we suggest possible implications for day-to-day clinical practice.

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Sociocultural Context of Suicidal Behaviour in the Sundarban Region of India

Psychiatry Journal ◽

10.1155/2013/486081 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

A. N. Chowdhury ◽

S. Banerjee ◽

A. Brahma ◽

A. Hazra ◽

M. G. Weiss

Keyword(s):

Psychiatric Diagnosis ◽

Suicidal Behaviour ◽

Adjustment Disorder ◽

Community Action ◽

Easy Access ◽

Social Stressors ◽

Young Females ◽

Detailed Assessment ◽

Self Harm

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their “intention to die, and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

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Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection

Acta Psychiatrica Scandinavica ◽

10.1111/j.1600-0447.1992.tb03229.x ◽

1992 ◽

Vol 86 (1) ◽

pp. 70-75 ◽

Cited By ~ 30

Author(s):

C. Gala ◽

A. Pergami ◽

J. Catalan ◽

M. Riccio ◽

F. Durbano ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Virus Infection ◽

Human Immunodeficiency Virus Infection ◽

Suicidal Behaviour ◽

Deliberate Self Harm ◽

Factors Associated ◽

Immunodeficiency Virus ◽

Self Harm ◽

Asymptomatic Individuals

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Depression, Self-Harm and Suicidal Behaviour in Young Offenders

Forensic Child and Adolescent Mental Health ◽

10.1017/9780511777127.013 ◽

2017 ◽

pp. 135-151

Author(s):

Gemma Trainor ◽

Justine Rothwell ◽

Heidi Hales

Keyword(s):

Suicidal Behaviour ◽

Young Offenders ◽

Self Harm

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Self-harm and suicidal behaviour in Ghana: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-053144 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053144

Author(s):

Emmanuel Nii-Boye Quarshie ◽

Kwaku Oppong Asante ◽

Johnny Andoh-Arthur

Keyword(s):

Mental Health ◽

Systematic Review ◽

Global Health ◽

Protective Factors ◽

Suicide Prevention ◽

Suicidal Behaviour ◽

Observational Studies ◽

Risk And Protective Factors ◽

Prevalence Estimates ◽

Self Harm

IntroductionSelf-harm and suicidal behaviour represent major global health problems, which account for significant proportions of the disease burden in low-income and middle-income countries, including Ghana. This review aims to synthesise the available and accessible evidence on prevalence estimates, correlates, risk and protective factors, the commonly reported methods and reasons for self-harm and suicidal behaviour in Ghana.Methods and analysisWe will conduct a systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (2009) recommendations. Regional and global electronic databases (African Journals OnLine, African Index Medicus, APA PsycINFO, Global Health, MEDLINE and PubMed) will be searched systematically up to December 2021 for observational studies and qualitative studies that have reported prevalence estimates, correlates, risk and protective factors, methods and reasons for self-harm and suicidal behaviour in Ghana. The electronic database searches will be supplemented with reference harvesting and grey literature searching in Google Scholar and ProQuest Dissertations & Theses Global for postgraduate dissertations. Only records in English will be included. The Mixed Methods Appraisal Tool (2018) will be used to assess the methodological quality of included studies. Meta-analysis or narrative synthesis or both will be used, contingent on the extent of heterogeneity across eligible observational studies.Ethics and disseminationConsidering that this is a systematic review of accessible and available literature, we will not seek ethical approval. On completion, this review will be submitted to a peer-reviewed journal, be disseminated publicly at (mental) health conferences with focus on self-harm and suicide prevention. The important findings would also be shared with key national stakeholder groups in Ghana: Ghana Association for Suicide Prevention, Ghana Mental Health Authority, Ghana Psychological Association, Centre for Suicide and Violence Research, Accra and the Parliamentary Select Committee on Health.Prospero registration numberCRD42021234622.

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The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial

Psychological Medicine ◽

10.1017/s0033291709991899 ◽

2010 ◽

Vol 40 (11) ◽

pp. 1821-1828 ◽

Cited By ~ 19

Author(s):

M. J. Crawford ◽

E. Csipke ◽

A. Brown ◽

S. Reid ◽

K. Nilsen ◽

...

Keyword(s):

Alcohol Consumption ◽

Health Information ◽

Brief Intervention ◽

Primary Outcome ◽

Alcohol Misuse ◽

Controlled Trial ◽

Information Leaflet ◽

Deliberate Self Harm ◽

Self Harm ◽

Secondary Outcomes

BackgroundReferral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm (DSH) has not been examined.MethodConsecutive patients who presented to an Emergency Department (ED) following an episode of DSH were screened for alcohol misuse. Those found to be misusing alcohol were randomly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone. The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months. Secondary outcomes were alcohol consumption, mental health and satisfaction with care measured 3 and 6 months after randomization.ResultsOne hundred and three people took part in the study. Follow-up data on our primary outcome were obtained for all subjects and on 63% for secondary outcomes. Half those referred for brief intervention received it. Repetition of DSH was strongly associated with baseline alcohol consumption, but not influenced by treatment allocation. There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those randomized to brief intervention.ConclusionsReferral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm. Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse.

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