Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England - ADDENDUM

The relative toxicity of anxiolytic and hypnotic drugs commonly used for self-poisoning was assessed using data on suicides, prescriptions and non-fatal self-poisonings in England, 2005–2012. Data on suicide by self-poisoning were obtained from the Office for National Statistics, information on intentional non-fatal self-poisoning was derived from the Multicentre Study of Self-harm in England and data on prescriptions in general practice from the Clinical Practice Research Datalink. We used two indices of relative toxicity: fatal toxicity (the number of fatal self-poisonings relative to the number of individuals prescribed each drug) and case fatality (the number of fatal relative to non-fatal self-poisonings). Diazepam was the reference drug in all analyses. Temazepam was 10 times (95% confidence interval 5.48–18.99) and zopiclone/zolpidem nine times (95% confidence interval 5.01–16.65) more toxic in overdose than diazepam (fatal-toxicity index). Temazepam and zopiclone/zolpidem were 13 (95% confidence interval 6.97–24.41) and 12 (95% confidence interval 6.62–22.17) times more toxic than diazepam, respectively (case-fatality index). Differences in alcohol involvement between the drugs were unlikely to account for the findings. Overdoses of temazepam and zopiclone/zolpidem are considerably more likely to result in death than overdoses of diazepam. Practitioners need to exercise caution when prescribing these drugs, especially for individuals who may be at risk of self-harm, and also consider non-pharmacological options.

Download Full-text

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.

Download Full-text

Trends in mental health, non‐suicidal self‐harm and suicide attempts in 16–24-year old students and non-students in England, 2000–2014

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01797-5 ◽

2019 ◽

Vol 55 (1) ◽

pp. 125-128 ◽

Cited By ~ 2

Author(s):

S. McManus ◽

D. Gunnell

Keyword(s):

Mental Health ◽

Young People ◽

Mental Disorder ◽

Suicide Attempts ◽

Common Mental Disorder ◽

Psychiatric Morbidity ◽

Female Students ◽

Self Harm ◽

Using Data ◽

Over Time

Abstract There are concerns about high levels of mental ill-health amongst university students, but little is known about the mental health of students compared to non-students over time. Using data on young people (16–24) from three UK National Psychiatric Morbidity Surveys (2000, 2007, and 2014), we found no evidence that the overall prevalence of common mental disorder (CMD), suicide attempts, or non-suicidal self-harm (NSSH) differed between students and non-students, although there was an indication that CMDs rose markedly in female students between 2007 and 2014. A rise in NSSH is apparent in both students and non-students.

Download Full-text

Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England

European Child & Adolescent Psychiatry ◽

10.1007/s00787-012-0269-6 ◽

2012 ◽

Vol 21 (7) ◽

pp. 369-377 ◽

Cited By ~ 55

Author(s):

Keith Hawton ◽

Helen Bergen ◽

Keith Waters ◽

Jennifer Ness ◽

Jayne Cooper ◽

...

Keyword(s):

Multicentre Study ◽

Children And Adolescents ◽

Self Harm

Download Full-text

Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: findings from the Multicentre Study of Self-harm in England

BMJ Open ◽

10.1136/bmjopen-2015-010538 ◽

2016 ◽

Vol 6 (4) ◽

pp. e010538 ◽

Cited By ~ 65

Author(s):

Galit Geulayov ◽

Navneet Kapur ◽

Pauline Turnbull ◽

Caroline Clements ◽

Keith Waters ◽

...

Keyword(s):

Multicentre Study ◽

Self Harm

Download Full-text

Self-harm and life problems: findings from the Multicentre Study of Self-harm in England

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-015-1136-9 ◽

2015 ◽

Vol 51 (2) ◽

pp. 183-192 ◽

Cited By ~ 16

Author(s):

Ellen Townsend ◽

Jennifer Ness ◽

Keith Waters ◽

Navneet Kapur ◽

Pauline Turnbull ◽

...

Keyword(s):

Multicentre Study ◽

Life Problems ◽

Self Harm

Download Full-text

Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors

Psychological Medicine ◽

10.1017/s0033291711001747 ◽

2011 ◽

Vol 42 (4) ◽

pp. 727-741 ◽

Cited By ~ 28

Author(s):

H. Bergen ◽

K. Hawton ◽

N. Kapur ◽

J. Cooper ◽

S. Steeg ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Multicentre Study ◽

Mental Health Problems ◽

Psychiatric Treatment ◽

Accident Risk ◽

Cox Models ◽

Self Harm ◽

Drug Problems ◽

Risk Factors For Suicide

BackgroundMortality, including suicide and accidents, is elevated in self-harm populations. Although risk factors for suicide following self-harm are often investigated, rarely have those for accidents been studied. Our aim was to compare risk factors for suicide and accidents.MethodA prospective cohort (n=30 202) from the Multicentre Study of Self-harm in England, 2000–2007, was followed up to 2010 using national death registers. Risk factors for suicide (intentional self-harm and undetermined intent) and accidents (narcotic poisoning, non-narcotic poisoning, and non-poisoning) following the last hospital presentation for self-harm were estimated using Cox models.ResultsDuring follow-up, 1833 individuals died, 378 (20.6%) by suicide and 242 (13.2%) by accidents. Independent predictors of both suicide and accidents were: male gender, age ⩾35 years (except accidental narcotic poisoning) and psychiatric treatment (except accidental narcotic poisoning). Factors differentiating suicide from accident risk were previous self-harm, last method of self-harm (twofold increased risks for cutting and violent self-injury versus self-poisoning) and mental health problems. A risk factor specific to accidental narcotic poisoning was recreational/illicit drug problems, and a risk factor specific to accidental non-narcotic poisoning and non-poisoning accidents was alcohol involvement with self-harm.ConclusionsThe similarity of risk factors for suicide and accidents indicates common experiences of socio-economic disadvantage, life problems and psychopathology resulting in a variety of self-destructive behaviour. Of factors associated with the accidental death groups, those for non-narcotic poisoning and other accidents were most similar to suicide; differences seemed to be related to criteria coroners use in reaching verdicts. Our findings support the idea of a continuum of premature death.

Download Full-text