Fluctuation of suicide intent and other matters in psychosocial assessment post self-harm

Background: Contemporary literature focuses on various socio-demographic, clinical profile and psychiatric comorbitidies in patients with first attempt suicide. Aim: 1. To study the socio-demographic factors and the clinical profile of subjects with the first attempt suicide. 2. To assess the severity of depression and severity of stress due to various stressful events in patients with first attempt suicide. 3. To assess the severity of the suicide intent in patients with first attempt suicide. 4. To study the association between socio demographic profile of the patients with severity of depression, severity of suicide intent and severity of stress. Materials and Methods: Hundred fifteen patients were assessed using Hamilton rating scale for depression, becks suicide intent scale, Holmes-Rahe life stress inventory, MINI international neuropsychiatric interview. The data was analysed using the statistical software SPSS version 20. Results: The sample of 115 patients showed mean age to be 29 years, majority of them being males (58%). With most common mode of attempting suicide to be drug overdose and most of the patients had adjustment issues due to various domestic household issues and financial stressors. The severity of depression was mild and suicide intent were low (67%). In our study chi square finding association between various socio demographic variables and severity of depression found to be highly significant. It was strongest among gender at p value 0.009, occupation in which depression was found mostly among employed patients and housewives at p value 0.001. Results also found depression more common among participants with urban background at p value 0.03 and family type being nuclear at p value 0.05. Conclusion: Promoting healthy coping mechanism and reduction in stress is required to reduce self-harm. As is evident from the study, modifying the interpersonal relationship problems in the family might help in preventing many of suicide attempts/intentional self-harm and therefore important to address their various life events that might be stressful for them forcing them to take this step. In a country like India, where formal mental health resources are limited and are attached to a stigma, it is important to provide adequate information also among people hailing from lower economic status.

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Impact of perceived social support and parental bonding in predicting suicidal intent among self-harm patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1299 ◽

2021 ◽

pp. 1-11

Author(s):

Naila Yaqoob ◽

Sadaf Ahsan

Keyword(s):

Mental Health ◽

Social Support ◽

Perceived Social Support ◽

Demographic Variable ◽

Parental Bonding ◽

Cross Sectional ◽

Suicidal Intent ◽

Suicide Intent ◽

Self Harm ◽

The Impact

Objective: The present study investigated the impact of perceived social-support and parental-bonding in predicting suicidal intent among self-harm patients.Methods: Cross-sectional research design was used in current study. Study was conducted at Foundation University, Rawalpindi from February, 2019 to September, 2019. A purposive sample of 50 self-harm patients was collected from different mental health departments of hospitals of Rawalpindi, Jhelum and Peshawar. Participants were administered Multidimensional Scale of Perceived Social Support (MSPSS), Parental-Bonding Instrument (PBI) and Beck Suicide Intention Scale (BSIS). Data was analyzed through SPSS using correlation, t test and regression. Differences on the basis of demographic variable were also studied.Results: The main results of the study specified that social support and parental bonding’ factor ‘care’ had significant negative correlation with suicide intent. Moreover, it negatively predicted suicide intent. Whereas, parental boding’ factor ‘overprotectiveness’ had significant positive correlation with suicide intent and significantly positively predicted suicide intent. Conclusion: The outcomes of present study emphasized that social-support and parental bonding both can play substantial roles in saving lives. Researchers and mental health experts will be able to start examine about the factors that distinguish deliberate self-harm from attempted suicide as well as the characteristics common to both conducts. Continuous...

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Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

The Psychiatrist ◽

10.1192/pb.bp.108.023929 ◽

2010 ◽

Vol 34 (6) ◽

pp. 226-230 ◽

Cited By ~ 1

Author(s):

Nicholas Holdsworth ◽

Hugh Griffiths ◽

David Crawford

Keyword(s):

Alcohol Use ◽

General Hospital ◽

Screening Tool ◽

District General Hospital ◽

Alcohol Screening ◽

Screening Tools ◽

Psychosocial Assessment ◽

Different Types ◽

Self Harm ◽

Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). 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.ResultsThe proportion 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.Clinical implicationsThe 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.

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Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment

Crisis ◽

10.1027/0227-5910.25.4.183 ◽

2004 ◽

Vol 25 (4) ◽

pp. 183-186 ◽

Cited By ~ 6

Author(s):

Rachel Crowder ◽

Rohan Van Der Putt ◽

Ceri-Anne Ashby ◽

Andrew Blewett

Keyword(s):

General Hospital ◽

Care Pathway ◽

Alcohol Intoxication ◽

Psychosocial Assessment ◽

Hospital Environment ◽

Control Group ◽

Deliberate Self Harm ◽

Increased Risk ◽

Self Harm ◽

Integrated Care Pathway

Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

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Concordance of clinical estimation of suicidal intent

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700007126 ◽

2002 ◽

Vol 19 (3) ◽

pp. 84-85 ◽

Cited By ~ 2

Author(s):

Helen S Keeley ◽

Carmel McAuliffe ◽

Paul Corcoran ◽

Ivan J Perry

Keyword(s):

Multicentre Study ◽

Suicidal Intent ◽

Deliberate Self Harm ◽

Statistical Comparison ◽

Accident And Emergency ◽

Psychometric Instruments ◽

Suicide Intent ◽

Self Harm ◽

Clinical Records ◽

Level Of Agreement

AbstractObjective: The aim of this paper is to assess the level of agreement between clinical estimates of suicidal intent based entirely on information recorded in the Accident and Emergency acute assessment and Beck's Suicide Intent Scale (SIS) scores.Method: As part of the WHO/EURO Multicentre Study of Parasuicide, cases of deliberate self-harm (DSH) in Cork city hospitals were monitored. Over the period 1995-1997, the information recorded in the Accident and Emergency acute assessment was examined by a psychiatrist and, if possible on the available evidence, clinical estimates were made at three levels of suicidal intent: minimal, moderate and definite. Seventy-nine of these cases had fully completed Beck's SIS. Statistical comparison was made between the results of the SIS and the clinical estimate of suicide intent.Results: The agreement (Kappa = 0.146, p = 0.046) and concordance (Lin's concordance coefficient = 0.330, p = 0.001) between the two ratings are statistically significant but both are low. The overlap between those identified as high or low intent is low.Conclusions: These findings indicate low agreement between a clinician's rating of suicide intent based on clinical records and Beck's SIS. This is especially relevant given the increasing reliance on psychometric instruments in assessment in psychiatry. However, further investigation is necessary to clarify which is the more valid method.

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Assessing young people who deliberately harm themselves

The British Journal of Psychiatry ◽

10.1192/bjp.176.2.126 ◽

2000 ◽

Vol 176 (2) ◽

pp. 126-131 ◽

Cited By ~ 30

Author(s):

Jane Hurry ◽

Pamela Storey

Keyword(s):

At Risk ◽

Young People ◽

Service Management ◽

Postal Questionnaire ◽

Psychosocial Assessment ◽

Old Patients ◽

Admission Rates ◽

Accident And Emergency ◽

Patients At Risk ◽

Self Harm

BackgroundMany young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.AimsTo describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.MethodA postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.ResultsPsychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.ConclusionsYoung DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.

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Compliance with NICE guidelines in the management of self-harm

The Psychiatrist ◽

10.1192/pb.bp.109.027961 ◽

2010 ◽

Vol 34 (9) ◽

pp. 385-389 ◽

Cited By ~ 4

Author(s):

Diane Mullins ◽

Siobhan MacHale ◽

David Cotter

Keyword(s):

Clinical Excellence ◽

Psychosocial Assessment ◽

Standards Of Care ◽

Liaison Psychiatry ◽

Single Male ◽

Nice Guidelines ◽

Accident And Emergency ◽

Self Harm ◽

Male Patients ◽

Accident And Emergency Department

Aims and methodTo identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.ResultsA total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.Clinical implicationsSingle men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

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Motives and Suicide Intent Underlying Hospital Treated Deliberate Self-Harm and Their Association with Repetition

Suicide and Life-Threatening Behavior ◽

10.1521/suli.2007.37.4.397 ◽

2007 ◽

Vol 37 (4) ◽

pp. 397-408 ◽

Cited By ~ 19

Author(s):

Carmel McAuliffe ◽

Ella Arensman ◽

Helen S. Keeley ◽

Paul Corcoran ◽

Anthony P. Fitzgerald

Keyword(s):

Deliberate Self Harm ◽

Suicide Intent ◽

Self Harm

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Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

Emergency Medicine Journal ◽

10.1136/emermed-2019-208967 ◽

2020 ◽

pp. emermed-2019-208967

Author(s):

Mohammed Gaber Zayed ◽

Victoria Williams ◽

Alexander Charles Glendenning ◽

Jenna Katherine Bulger ◽

Tom Hewes ◽

...

Keyword(s):

Mental Health ◽

Hospital Admissions ◽

Psychosocial Assessment ◽

Mental Health Crisis ◽

Health Crisis ◽

Alternative Pathways ◽

Mental Health Patients ◽

Emergency Ambulance ◽

Self Harm ◽

The Uk

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

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Developing best practice guidelines for the psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420924082 ◽

2020 ◽

Vol 54 (9) ◽

pp. 874-882 ◽

Cited By ~ 1

Author(s):

Bernard Leckning ◽

Tanja Hirvonen ◽

Gregory Armstrong ◽

Timothy A Carey ◽

Mark Westby ◽

...

Keyword(s):

Culturally Responsive ◽

Best Practice ◽

Torres Strait Islander ◽

Expert Panel ◽

Assessment Tools ◽

Psychosocial Assessment ◽

Torres Strait Islander People ◽

Suicidal Thoughts ◽

Self Harm ◽

Torres Strait

Objective: To develop guidelines for the culturally responsive psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. Method: The Delphi method was used to establish expert consensus. A systematic search and review of relevant research literature, existing guidelines and grey literature was undertaken to develop a 286-item questionnaire. The questionnaire contained best practice statements to guide clinicians undertaking psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. An expert panel comprising 28 individuals with clinical, community-based and lived experience in Aboriginal and Torres Strait Islander mental health and/or suicide prevention were recruited and independently rated the items over three rounds. Statements endorsed as essential or important by 90% or more of the expert panel were then synthesised into recommendations for the best practice guideline document. Results: A total of 226 statements across all relevant areas of clinical practice were endorsed. No statements covering the use of structured assessment tools were endorsed. The endorsed statements informed the development of a set of underlying principles of culturally competent practice and recommendations for processes of effective and appropriate engagement; risks, needs and strengths to be assessed; formulation of psychosocial assessment; and recommendations specific to children and young people. Conclusion: The guidelines are based on recommendations endorsed across a range of expertise to address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings. Further work is needed to develop an implementation strategy and evaluate the recommendations in practice.

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