scholarly journals What happens after self-harm? An exploration of self-harm and suicide using the Northern Ireland Registry of Self-Harm

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Aideen Maguire ◽  
Emma Ross ◽  
Foteini Tseliou ◽  
Denise O'Hagan ◽  
Dermot O'Reilly
Keyword(s):  
Northern Ireland ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Health Concern ◽  
Prevention Strategies ◽  
Completed Suicide ◽  
Target Prevention ◽  
Self Harm ◽  
The Uk

Background Suicide is a major public health concern and Northern Ireland (NI) has the highest rate of both self-harm and suicide in the UK and Ireland. In order to target prevention strategies effectively, it is vital to understand who is most at risk. Aim To explore the risk factors for completed suicide following presentation with self-harm. Methods The Northern Ireland Registry of Self-Harm (NIRSH) collects information on all self-harm and suicide ideation presentations to all Emergency Departments in NI. NIRSH data from 2012-2015 was linked to centralised electronic data relating to primary care, prescribed medication and mortality records. Logistic regression was employed to quantify the likelihood of mortality with adjustment for factors associated with mental ill health and suicide risk, and Cox regression was used to explore which characteristics of those who self-harm are most associated with risk of suicide. Results The cohort consisted of all 1,483,435 individuals born or resident in NI from 1st January 1970 until 31st December 2015 (maximum age in 2015, 45 years). During the follow-up period, 12,327 (0.8%) individuals presented with self-harm and 892 (0.1%) died by suicide. Rates of self-harm were equivalent for males and females with highest rates observed in the 18-24 years age group, and more common in deprived than affluent areas (OR=3.42, 95%CI 3,21, 3.65). Most individuals self-harmed via self-poisoning with psychotropic medications (71.5%), followed by self-injury with a sharp object (21.7%). Although only 162 (1.3%) of those who presented with self-harm went on to die by suicide, those who presented with self-harm were 24 times more likely to die by suicide compared to those who did not present with self-harm after adjustment for age and sex (HR=24.3, 95%CI 20.46,28.76). Conclusion This constitutes the first population-wide study of self-harm in the UK and could be utilised to inform suicide prevention strategies.

scholarly journals Suicide following presentation to emergency departments with suicidal ideation: a population-wide study

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Emma Ross ◽  
Aideen Maguire ◽  
Denise O'Hagan ◽  
Dermot O'Reilly
Keyword(s):  
Emergency Departments ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Factors Associated ◽  
Risk Of Death ◽  
Emergency Department Staff ◽  
Completed Suicide ◽  
Target Prevention ◽  
Self Harm ◽  
The Uk

Background Little is known about the association between suicide ideation and completed suicide. As NI has the highest suicide rate in the UK and Ireland it is vital to understand who is most at risk in order to target prevention strategies effectively. Aim To explore the risk factors for completed suicide following presentation with suicide ideation. Methods The Northern Ireland Registry of Self-Harm and Suicide Ideation contains information on all presentations to all Emergency Departments in NI for self-harm and suicide ideation. Data from 2012-2015 were linked to centralised electronic data relating to primary care, prescribed medication and mortality records. Initial analyses were completed to explore the profile of those who present with suicide ideation, and logistic regression was utilised to examine the likelihood of mortality post presentation. Cox regression was utilised to examine the factors associated with completed suicide following presentation with ideation. Results The cohort consisted of 1,483,435 individuals born or resident in NI from 1st January 1970 until 31st December 2015 (maximum age in 2015, 45 years). Between 2012-2015, 4,975 (0.3%) individuals presented with suicide ideation and 583 (0.04%) individuals died by suicide. Ideation is more likely in men compared to women (OR=1.87, 95%CI 1.76,1.98), in those aged 18-24 years, and in more deprived individuals. Of those who presented with ideation, 66 (1.3%) subsequently died by suicide. In fully-adjusted models, those who presented with suicide ideation were 25 times more likely to die by suicide compared to those who did not (HR=25.0, 95%CI 19.3,32.5). Amongst suicide ideators, male gender (HR=2.67, 95% CI 1.39,5.10) and multiple presentations (HR=1.95, 95% CI 1.09,3.50) were associated with the greatest risk of death by suicide. Conclusion These findings could help emergency department staff identify individuals at greatest risk of suicide and could be utilised in the development of targeted intervention strategies.

scholarly journals Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study

2014 ◽  
Vol 29 (4) ◽  
pp. 246-252 ◽  
Author(s):  
L. Mellesdal ◽  
R.A. Kroken ◽  
O. Lutro ◽  
T. Wentzel-Larsen ◽  
E. Kjelby ◽  
...  
Keyword(s):  
Cohort Study ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Psychiatric Patients ◽  
First Year ◽  
Recurrent Depression ◽  
Psychiatric Admission ◽  
Self Harm ◽  
Observation Period

AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

scholarly journals Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: seven-year follow up of the UK Biobank cohort

2019 ◽  
Author(s):  
Richard J. Shaw ◽  
Breda Cullen ◽  
Nicholas Graham ◽  
Donald M. Lyall ◽  
Daniel Mackay ◽  
...  
Keyword(s):  
Emotional Support ◽  
Living Arrangements ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Living Alone ◽  
Uk Biobank ◽  
Self Harm ◽  
The Uk ◽  
The Relationship

AbstractBackgroundThe association between loneliness and suicide is complex, poorly understood, and there are no prior longitudinal studies. We aimed to investigate the relationship between living alone, loneliness and emotional support as predictors of death by suicide and self-harm.MethodsBetween 2006 and 2010 UK Biobank recruited over 0.5m people aged 37-73. This data was linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate the relationship between self-reported measures of loneliness, emotional support and living arrangements and death by suicide and self-harm.ResultsFor women, there was no evidence that living arrangements, loneliness or lack of emotional support were associated with death by suicide. However, for men, both living alone (Hazard Ratio (HR) 2.19 95%CI 1.47-3.27) and with non-partners (HR 2.17 95%CI 1.28-3.69) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide in men (HR 1.45 95%CI 0.99-2.12). Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.90 95%CI 1.58-2.29) and men (HR 1.75 95%CI 1.41-2.18).ConclusionsFor men -but not for women- living alone or with a non-partner increased the risk of suicide, a finding not explained by loneliness. Loneliness may be more important as a risk factor for self-harm than for suicide, and appears to mitigate against any protective effect of cohabitation.

scholarly journals Diet and risk of glioma: combined analysis of 3 large prospective studies in the UK and USA

2019 ◽  
Vol 21 (7) ◽  
pp. 944-952 ◽  
Author(s):  
Ai Seon Kuan ◽  
Jane Green ◽  
Cari M Kitahara ◽  
Amy Berrington De González ◽  
Tim Key ◽  
...  
Keyword(s):  
Dietary Patterns ◽  
Prospective Studies ◽  
Statistical Power ◽  
Cox Regression ◽  
Health Concern ◽  
Food Groups ◽  
Relative Risks ◽  
The Us ◽  
The Uk

Abstract Background Available evidence on diet and glioma risk comes mainly from studies with retrospective collection of dietary data. To minimize possible differential dietary recall between those with and without glioma, we present findings from 3 large prospective studies. Methods Participants included 692 176 from the UK Million Women Study, 470 780 from the US National Institutes of Health–AARP study, and 99 148 from the US Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cox regression yielded study-specific adjusted relative risks for glioma in relation to 15 food groups, 14 nutrients, and 3 dietary patterns, which were combined, weighted by inverse variances of the relative risks. Separate analyses by <5 and ≥5 years follow-up assessed potential biases related to changes of diet before glioma diagnosis. Results The 1 262 104 participants (mean age, 60.6 y [SD 5.5] at baseline) were followed for 15.4 million person-years (mean 12.2 y/participant), during which 2313 incident gliomas occurred, at mean age 68.2 (SD 6.4). Overall, there was weak evidence for increased glioma risks associated with increasing intakes of total fruit, citrus fruit, and fiber and healthy dietary patterns, but these associations were generally null after excluding the first 5 years of follow-up. There was little evidence for heterogeneity of results by study or by sex. Conclusions The largest prospective evidence to date suggests little, if any, association between major food groups, nutrients, or common healthy dietary patterns and glioma incidence. With the statistical power of this study and the comprehensive nature of the investigation here, it seems unlikely we have overlooked major effects of diet on risk of glioma that would be of public health concern.

THE TREATMENT OF DELIBERATE SELF-HARM IN BORDERLINE PERSONALITY DISORDER USING DIALECTICAL BEHAVIOUR THERAPY: A PILOT STUDY IN A HIGH SECURITY HOSPITAL

2001 ◽  
Vol 29 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Gail Low ◽  
David Jones ◽  
Conor Duggan ◽  
Mick Power ◽  
Andrew MacLeod
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Ideation ◽  
Borderline Personality ◽  
Institutional Setting ◽  
Behaviour Therapy ◽  
Deliberate Self Harm ◽  
Dialectical Behaviour Therapy ◽  
Self Harm

Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.

A Study of Psychiatric Emergencies: Part II. Suicide

1970 ◽  
Vol 1 (4) ◽  
pp. 359-366 ◽  
Author(s):  
Charles H. Browning ◽  
Robert L. Tyson ◽  
Sheldon I. Miller
Keyword(s):  
Emergency Service ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Risk Groups ◽  
Psychiatric Emergency ◽  
Presenting Symptoms ◽  
Completed Suicide ◽  
Prevention Center ◽  
Suicide Prevention Center

Suicide attempts or suicide ideation are often of critical importance in defining a psychiatric emergency. Follow-up studies of the psychiatric emergency population for the subsequent incidence of attempted or completed suicide are needed to identify high and low risk groups and to measure the effectiveness of the psychiatric emergency service. Suicide problems were presenting symptoms in 28.2 percent of psychiatric emergency evaluations seen in a three month period. The 10–29 decades for females and the 10–19 decade for males were represented significantly more often than older decades. Race and marital status were not related to suicide problems. There were seventeen known suicide attempts, but no known suicides in a six month follow-up period. This finding was contrasted with the results of a similar study done nine years previously at the same hospital and with a study done by the Cleveland Suicide Prevention Center, both of which found several suicides in the follow-up period. Possible reasons for the different results are discussed.

Suicide in the 18 Years After Deliberate Self-harm

1996 ◽  
Vol 169 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Gregory M. De Moore ◽  
Andrew R. Robertson
Keyword(s):  
Strong Predictor ◽  
Young Male ◽  
Demographic Information ◽  
Specific Data ◽  
Deliberate Self Harm ◽  
Male Suicide ◽  
Completed Suicide ◽  
Self Harm ◽  
Sydney Australia

BackgroundClinical and demographic information on patients seen as a result of deliberate self-harm (DSH) was collected in an attempt to identify factors in the index episode of DSH predictive of subsequent suicide.MethodSpecific data were prospectively collected on all DSH patients who lived in Blacktown Municipality, Sydney, Australia, and seen from October 1975 to September 1976. Follow-up at 18 years was by evaluation of coroners' records and identification of ‘probable suicide’.ResultsTwo hundred and twenty-three patients harmed themselves on one or more occasions. Follow-up at 18 years showed that 15 of the 223 (6.7%) had completed suicide. The proportion at five and eight years was 4.0% and at 10 years was 4.5%. Identified predictors of suicide were: narcotic overdose; more than one episode of DSH in the year of the study; planned episode; and mental illness. Teenage narcotic-abusing males were at greatest risk, and in females a planned episode was the most powerful predictor.ConclusionsSuicides continued to occur over 18 years. One of the striking differences between this and other studies is the finding of teenage male DSH, associated with narcotic abuse, as a strong predictor of subsequent suicide. These findings are particularly relevant to the issue of young male suicide, which increased from the 1970s onwards in Australia and elsewhere.

scholarly journals General hospital services in the UK for adults presenting after self-harm: little evidence of progress in the past 25 years

2020 ◽  
Vol 217 (6) ◽  
pp. 661-662
Author(s):  
Allan House ◽  
David Owens
Keyword(s):  
Public Health ◽  
Effective Action ◽  
Health Concern ◽  
Hospital Services ◽  
Public Health Concern ◽  
Services Research ◽  
The Past ◽  
Self Harm ◽  
The Uk ◽  
Research And Policy

SummarySelf-harm remains a serious public health concern, not least because of its strong link with suicide. Twenty-five years ago we lamented the deficits in UK services, research and policy. Since then, there has not been nearly enough effective action in any of these three domains. It is time for action.

The Effects of Suicide Ideation Assessments on Urges to Self-Harm and Suicide

Crisis ◽  
2014 ◽  
Vol 35 (2) ◽  
pp. 123-131 ◽  
Author(s):  
Rahel Eynan ◽  
Yvonne Bergmans ◽  
Jesmin Antony ◽  
John R. Cutcliffe ◽  
Henry G. Harder ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Risk ◽  
Suicide Ideation ◽  
Psychiatric Service ◽  
Exclusion Criterion ◽  
Primary Concern ◽  
Assessment Protocol ◽  
Self Harm ◽  
Study Participants

Background: Participants’ safety is the primary concern when conducting research with suicidal or potentially suicidal participants. The presence of suicide risk is often an exclusion criterion for research participants. Subsequently, few studies have examined the effects of research assessments on study participants’ suicidality. Aims: The purpose of this research was to examine the patterns of postassessment changes in self-harm and suicide urges of study participants who were recently discharged from an inpatient psychiatric service. Method: Study participants (N = 120) were recruited from patients with a lifetime history of suicidal behavior admitted with current suicidal ideation or suicide attempt to an inpatient psychiatric service and/or a crisis stabilization unit. Participants were assessed for suicidal ideation with the Suicide Ideation Scale at 1, 3, and 6 months following their discharge from hospital. The risk assessment protocol was administered at the start and at the end of each of the study follow-up assessments. Results: Changes in self-harm and suicide urges following study assessments were small, infrequent, and were most likely to reflect a decrease in suicidality. Similarly, participants rarely reported worsening self-control over suicidal urges, and when they did, the effect was minimal. By the end of the 6-month follow-up period, increases in self-harm and suicidal urges postassessment were not seen. Conclusion: The inclusion of suicidal participants in research interviews rarely increased suicide risk. Research involving suicidal individuals is possible when study protocols are well planned and executed by trained assessors and clinicians who are able to identify participants at risk and provide intervention if necessary. The few participants that required intervention had high levels of suicide ideation and behavior at baseline and almost all reported symptoms of posttraumatic stress disorder. Further study is needed to better characterize this subgroup of participants.

Self-harm and suicide ideation presenters to hospital in Northern Ireland: a registry-based study

The Lancet ◽  
2018 ◽  
Vol 392 ◽  
pp. S41
Author(s):  
Eve Griffin ◽  
Brendan Bonner ◽  
Denise O'Hagan ◽  
Paul Corcoran
Keyword(s):  
Northern Ireland ◽  
Suicide Ideation ◽  
Self Harm
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