WorldWideScience

Sample records for psychiatric treatment self-harming

  1. [Psychiatric treatment of deliberate self-harm in the out-of-hours services].

    Science.gov (United States)

    Walby, Fredrik A; Ness, Ewa

    2009-04-30

    Patients who harm themselves are often considered difficult to treat. There are no evidence-based approaches available for the emergency setting. General practitioners should nevertheless be able to offer interventions directed towards emotional needs in self-harm patients. In this article we suggest how to intervene in such situations. Based on experience from Oslo psychiatric out-of-hours service and with elements from Dialectic Behavioural Therapy, we present a five-step model for treatment of these patients in an out-of-hours service within the primary health care services. The aim of this model is to bring the patient out of the acute crisis and to arrange for further treatment. Assessment, validation or confirmation, problem-solving, avoiding unnecessary hospitalisation, and focus on continuing established treatment, are important elements in the proposed intervention. This can all be carried out in 60 - 90 min. The model may be suitable for training general practitioners to meet and care for patients with self-harm behaviour in the out-hours-services. We have positive experience with the intervention, but systematic research is necessary to assess the effect of the model.

  2. Self-harm.

    Science.gov (United States)

    Skegg, Keren

    The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

  3. Understanding psychiatric nursing care with nonsuicidal self-harming patients in acute psychiatric admission units: the views of psychiatric nurses.

    Science.gov (United States)

    O'Donovan, Aine; Gijbels, Harry

    2006-08-01

    Self-harm in the absence of suicidal intent is an underexplored area in psychiatric nursing research. This article reports on findings of a study undertaken in two acute psychiatric admission units in Ireland. The purpose of this study was to gain an understanding of the practices of psychiatric nurses in relation to people who self-harm but who are not considered suicidal. Semistructured interviews were held with eight psychiatric nurses. Content analysis revealed several themes, some of which will be presented and discussed in this article, namely, the participants' understanding of self-harm, their approach to care, and factors in the acute psychiatric admission setting, which impacted on their care. Recommendations for further research are offered.

  4. Deliberate Self Harm Behavior

    Directory of Open Access Journals (Sweden)

    Fatma Gul Helvaci Celik

    2017-06-01

    Full Text Available The deliberate self-harm behaviour which defined as attempting to own body resulting in tisue damage without conscious desire of peolple to die, is a major public health problem worldwide. The causes of deliberate self- harm, risk factors, the relationship between mental disorders and treatment strategies are not fully known. Deliberate self- harm can be observed together with psychiatric disorders such as borderline personality disorder, histrionic personality disorder, eating disorders and mood disorders. Also, deliberate self-harm must be distinguished from suicidal behavior. Psychologi-cal trauma has been suggested as a risk factor for deliberate self- harm behavior. Trauma and traumatic events have long been associated with deliberate self- harm behavior. The aim of this review article is to investigate the etiology and epidemiology of deliberate self-harm behaviour and relationship between psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(2.000: 209-226

  5. Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England.

    Science.gov (United States)

    Hawton, Keith; Bergen, Helen; Kapur, Navneet; Cooper, Jayne; Steeg, Sarah; Ness, Jennifer; Waters, Keith

    2012-12-01

    Self-harm (intentional self-poisoning and self-injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors associated with these outcomes. We used data collected in the Multicentre Study of Self-harm in England on all self-harm hospital presentations by individuals aged 10-18 years between 2000 and 2007, and national death information on these individuals to the end of 2010. Cox hazard proportional models were used to identify independent and multivariable predictors of repetition of self-harm and of suicide. Repetition of self-harm occurred in 27.3% of individuals (N = 3920) who presented between 2000 and 2005 and were followed up until 2007. Multivariate analysis showed that repetition was associated with age, self-cutting, and previous self-harm and psychiatric treatment. Of 51 deaths in individuals who presented between 2000 and 2007 and were followed up to 2010 (N = 5133) half (49.0%) were suicides. The method used was usually different to that used for self-harm. Multivariate analysis showed that suicide was associated with male gender [Hazard ratio (HR) = 2.4, 95% CI 1.2-4.8], self-cutting (HR = 2.1, 95% CI 1.1-3.7) and prior psychiatric treatment at initial presentation (HR = 4.2, 95% CI 1.7-10.5). It was also associated with self-cutting and history of psychiatric treatment at the last episode before death, and history of previous self harm. Self-cutting as a method of self-harm in children and adolescents conveys greater risk of suicide (and repetition) than self-poisoning although different methods are usually used for suicide. The findings underline the need for psychosocial assessment in all cases. © 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.

  6. Deliberate self-harm before psychiatric admission and risk of suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Agerbo, Esben; Mortensen, Preben Bo

    2013-01-01

    Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15 % of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high...

  7. Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study.

    Science.gov (United States)

    Tørmoen, Anita J; Rossow, Ingeborg; Mork, Erlend; Mehlum, Lars

    2014-01-01

    adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.

  8. Pragmatism rules: the intervention and prevention strategies used by psychiatric nurses working with non-suicidal self-harming individuals.

    Science.gov (United States)

    O'Donovan, A

    2007-02-01

    Self harm in the absence of expressed suicidal intent is an under explored area in psychiatric nursing research. This paper reports on findings of a study undertaken in two acute psychiatric inpatient units in Ireland. The purpose of the study was to gain an understanding of the practices of psychiatric nurses in relation to people who self harm, but who are not considered suicidal. Semi structured interviews were held with eight psychiatric nurses. Content analysis revealed several themes. For the purpose of this paper the prevention and intervention strategies psychiatric nurses engage in when working with non-suicidal self harming individuals are presented. Recommendations for further research are offered.

  9. Self-harm and attempted suicide within inpatient psychiatric services: a review of the literature.

    Science.gov (United States)

    James, Karen; Stewart, Duncan; Bowers, Len

    2012-08-01

    Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  10. Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self-harm among adult psychiatric inpatients with serious mental illness.

    Science.gov (United States)

    Subica, Andrew M; Allen, Jon G; Frueh, B Christopher; Elhai, Jon D; Fowler, J Christopher

    2016-11-01

    Little is known about depression-anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression-anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalization suicide/self-harm behaviours. The bifactor model rendered superior fit to sample data and a robust general factor - accounting for 77.61% of common item variance - providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. Clinical implications Depression-anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress. General distress and specific

  11. Self-Harm and Conventional Gender Roles in Women

    Science.gov (United States)

    Straiton, Melanie L.; Hjelmeland, Heidi; Grimholt, Tine K.; Dieserud, Gudrun

    2013-01-01

    A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women.…

  12. Deliberate Self-harm seen in a Government Licensed Private Psychiatric Hospital and Institute.

    Science.gov (United States)

    Krishnaram, Vaithiyam Devendran; Aravind, Vaithiyam Krishnaram; Vimala, A Rupavathy

    2016-01-01

    Majority of the published studies on suicide deal with identifying the sociodemographic and psychosocial aspects of suicide attempters and those who have completed suicide or to identify the characteristic differences between the two groups. There are very few studies focusing mainly or only on deliberate self harm. Most of these are hospital based studies or in a setting of general hospital psychiatry units. The present study is from Ram Psychiatry Hospital and Institute, a government licensed private psychiatric institute at Madurai, Tamil Nadu. It is a prospective study of individuals with self harm behavior mostly without the intention to kill, attending the psychiatry outpatient department of the hospital for the period of one year (January to December 2014) a total number of 140 cases are registered. Sociodemographic, clinical profiles with Axis I or Axis II diagnosis or otherwise, and the initiating or precipitating cause or mode of self-injury or self-harm are studied. The results are presented and discussed.

  13. Brief Report: The Self Harm Questionnaire--A New Tool Designed to Improve Identification of Self Harm in Adolescents

    Science.gov (United States)

    Ougrin, Dennis; Boege, Isabel

    2013-01-01

    The Self Harm Questionnaire (SHQ) aiming at identification of self-harm in adolescents has been developed and piloted in a sample of 12-17 year olds (n = 100). The adolescents were recruited from both in- and outpatient psychiatric services. Concurrent validity of the SHQ was evaluated by comparing the SHQ results with recorded self harm in the…

  14. Do serum BDNF levels vary in self-harm behavior among adolescents and are they correlated with traumatic experiences?

    Science.gov (United States)

    Kavurma, Canem; Varol Tas, Fatma; Serim Demirgoren, Burcu; Demirci, Ferhat; Akan, Pınar; Eyuboglu, Damla; Guvenir, Taner

    2017-12-01

    The aim of this study was to compare serum brain-derived neurotrophic factor (BDNF) levels between adolescents that harm themselves, those that receive psychiatric treatment but do not harm themselves, healthy adolescents, and childhood traumas and to investigate the relationship between traumatic experiences and serum BDNF levels. The cases were divided into two groups of 40 adolescents exhibiting self-harm behavior (self-harm/diagnosed group) and 30 adolescents receiving psychiatric treatment but not exhibiting self-harm behaviors (non self-harm/diagnosed group). The control group (healthy control group) consisted of 35 healthy adolescents with no psychiatric disorders or self-harm behaviors. The adolescents were asked to fill in the Inventory of Statements About Self Injury (ISAS) and Childhood Trauma Questionnaire (CTQ). For BDNF measurement, blood samples were taken from the cases and controls. The serum BDNF level of self-harming adolescents who used the self-cutting method was significantly lower than that of other groups, and serum BDNF levels decreased with the increase in the emotional neglect and abuse severity of self-harming adolescents during childhood. In our study, serum BDNF levels decreased with the increase in emotional abuse in self-harming adolescents. This finding may indicate that neuroplasticity can be affected by a negative emotional environment during the early period. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Suicidal ideation and self-harm following K2 use.

    Science.gov (United States)

    Thomas, Shannon; Bliss, Sarah; Malik, Mohammed

    2012-11-01

    There is emerging evidence of adverse effects associated with K2 and similar synthetic cannabinoid compounds marketed as herbal alternatives to marijuana. Few studies were identified regarding the psychiatric effects of K2, including suicidal ideation, and to our knowledge none have been written related to self-harm following use of K2. A healthy 20-year-old single Caucasian male with no previous psychiatric diagnoses or treatment was brought by police to the ED with acute agitation, confusion, suicidal ideation, and self-inflicted trauma after smoking K2. Evaluation in the ED was notable for agitation, significant abrasions, respiratory rate of 30, negative UDS, and sinus tachycardia on EKG. Once medically stabilized, he was transferred to the inpatient psychiatric unit for continued monitoring. Upon evaluation on the psychiatric unit the following day, his symptoms had completely resolved, he continued to deny any previous psychiatric history, and was discharged home. K2 and other synthetic cannabinoids have been shown to have significant medical and psychiatric adverse effects and they are still readily available for purchase. Evidence is limited regarding the psychiatric effects; however, synthetic cannabinoid products may potentially lead to suicidal ideation and self-harm behaviors amongst many other psychiatric symptoms.The long-term risks are still unclear, but some studies suggest the possibility of inducing chronic psychotic symptoms and worsening underlying psychiatric illness. Continued research is needed regarding the effects of these substances as well as an increase in public awareness of the risks.

  16. Text Messaging for Psychiatric Outpatients: Effect on Help-Seeking and Self-Harming Behaviors.

    Science.gov (United States)

    Kodama, Toyohiko; Syouji, Hiroko; Takaki, Sachiko; Fujimoto, Hirokazu; Ishikawa, Shinichi; Fukutake, Masaaki; Taira, Masaru; Hashimoto, Takeshi

    2016-04-01

    A mobile phone intervention was developed and tested with 30 psychiatric outpatients with mental illness, who had high ideation for suicide. The intervention involved promoting help-seeking behaviors by sending text messages, including information about social welfare services and reminders about medical appointments, for 6 months. After the intervention period, the number of participants who used social services significantly increased, and more than 80% of participants reported that the text messaging service was helpful and useful. Compared to baseline, participants' self-harming behaviors decreased and the attending psychiatrists rated their suicide ideation as weaker. This is the first intervention study to promote psychiatric patients' help-seeking using text messaging, and although it was not a randomized controlled trial, this intervention has practical value and may lead to the prevention of suicide. Copyright 2016, SLACK Incorporated.

  17. Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms.

    Science.gov (United States)

    Perseius, K-I; Kåver, A; Ekdahl, S; Asberg, M; Samuelsson, M

    2007-10-01

    The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

  18. Deliberate self harm in children.

    Science.gov (United States)

    Krishnakumar, P; Geeta, M G; Riyaz, A

    2011-05-01

    To study the nature of deliberate self-harm (DSH) in children and to identify the associated factors. Child Guidance Clinic attached to the Department of Pediatrics of a teaching hospital in South India. Children with history of deliberate self harm who were referred to the CGC for psychological evaluation during a 10 year period. Children and parents were interviewed together and separately and details regarding age, sex, family and school environment, stresses and nature of self harm were documented. Psychiatric diagnosis was made based on DSM IV diagnostic criteria. Among the 30 children included in the study, 21 were boys and 9 were girls. Majority of children were between the ages of 11 and 13 years, the youngest being 6 years old. 76%of children had history of acute stressful life events and 62%of them had chronic ongoing stress. 62%of children had stress in the family and 41%had stress at school. Stress in the family included death of a parent, conflicts with parents or siblings, mental illness in the family, parental alcoholism and parental disharmony. Stress at school included conflicts with classmates, punishment or negative comments by teachers and learning problems. Psychiatric disorders were present in 52%of children, the commonest being depressive disorder. The commonest mode of DSH was self poisoning, and rat poison (zinc phosphide) was the commonest substance used. Deliberate self harm occurs in young children and the risk factors are comparable to those in adolescents.

  19. Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings.

    Science.gov (United States)

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    This study examined whether relational stressors such as psychosocial stressors, the therapist's absence and a change of therapist are associated with repeat aggressive or self-harming incidents in child and adolescent psychiatric inpatient care. The study data were derived from critical incident reports and chart reviews of 107 inpatients. In multinomial regression analysis, patients with repeat aggressive or self-harming incidents were compared with patients with single incidents. Results suggested that a higher number of psychosocial stressors and a change of therapist, but not the therapist's absence are predictors for repeat aggressive and self-harming incidents. There was a high prevalence of therapist's absence during both, single and repeat, incidents. Repeat aggressive incidents were common in male children and adolescents with disruptive behavior disorders. Repeat self-harming incidents were common in adolescent females with trauma-related disorders. Patients with repeat aggressive or self-harming incidents had a higher number of abnormal intrafamilial relationships and acute life events than patients with single incidents. Interventions to reduce a change of therapist should in particular target children and adolescents with a higher number of psychosocial stressors and/or a known history of traumatic relational experiences. After a first incident, patients should have a psychosocial assessment to evaluate whether additional relational support is needed.

  20. Treatment outcome in psychiatric inpatients: the discriminative value of self-esteem.

    Science.gov (United States)

    Talbot, France; Harris, Gregory E; French, Douglas J

    2009-01-01

    Self-esteem has been identified as an important clinical variable within various psychological and psychiatric conditions. Surprisingly, its prognostic and discriminative value in predicting treatment outcome has been understudied. The current study aims to assess, in an acute psychiatric setting, the comparative role of self-esteem in predicting treatment outcome in depression, anxiety, and global symptom severity, while controlling for socio-demographic variables, pre-treatment symptom severity, and personality pathology. Treatment outcome was assessed with pre- and post-treatment measures. A heterogeneous convenience sample of 63 psychiatric inpatients completed upon admission and discharge self-report measures of depression, anxiety, global symptom severity, and self-esteem. A significant one-way repeated-measures multivariate analysis of variance (MANOVA) followed up by analyses of variance (ANOVAs) revealed significant reductions in depression (eta2 = .72), anxiety (eta2 = .55), and overall psychological distress (eta2 = .60). Multiple regression analyses suggested that self-esteem was a significant predictor of short-term outcome in depression but not for anxiety or overall severity of psychiatric symptoms. The regression model predicting depression outcome explained 32% of the variance with only pre-treatment self-esteem contributing significantly to the prediction. The current study lends support to the importance of self-esteem as a pre-treatment patient variable predictive of psychiatric inpatient treatment outcome in relation with depressive symptomatology. Generalization to patient groups with specific diagnoses is limited due to the heterogeneous nature of the population sampled and the treatments provided. Implications for clinical practice and future research are discussed.

  1. Screen time on school days and risks for psychiatric symptoms and self-harm in mainland Chinese adolescents: A multicenter cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mingli eLiu

    2016-04-01

    Full Text Available Objective To investigate associations of television and of video game or non-educational computer use (VG/CU exposure volumes in a typical school day with psychiatric symptoms and suicidal ideation/self-injurious behavior (self-harm, in mainland Chinese adolescents.Methods Secondary school pupils (N = 13,659; mean age: 15.18 ± 1.89 from 10 urban areas sampled from different regions of mainland China were recruited. The subjects were divided into the follow four screen exposure volume groups for television and VG/CU respectively based on a self-administered questionnaire: 0 h/d, >0 to ≤1 h/d, >1 to ≤2 h/d, and >2 h/d. Demographic and psychiatric symptoms were recorded for each respondent. Odds ratios (ORs and 95% confidence intervals (CIs for several types of psychological problems and self-harm were calculated.Results For television, >2 hours per school day was associated with greater risk of depression in both boys (OR = 1.33, 95%CI: 1.02–1.73 and girls (OR = 1.62, 95%CI: 1.19– 2.21, of anxiety in boys (OR = 1.43, 95%CI: 1.05–1.95, of general emotional, behavioral, and social problems (GEBSPs in girls (OR = 1.55, 95%CI: 1.01–2.39, and of oppositional defiant problems (ODPs in girls (OR = 1.65, 95% CI: 1.09–2.50, compared with the reference group. Conversely, television exposure of >0 to ≤1 hour per school day was associated with lower self-harm risk in boys (OR = 0.81, 95%CI: 0.67–0.99 compared with the no television exposure group. For VG/CU, higher risks of anxiety (OR = 1.40, 95%CI: 1.06–1.86 and of attention deficit/hyperactivity problems (ADHPs (OR = 1.56, 95%CI: 1.02–2.38 were associated with excessive VG/CU time (>2 h per school day in boys compared with the no VG/CU exposure group. Higher risks of self-harm and all other psychiatric problems (including anxiety and ADHPs in girls were associated with any school-day VG/CU exposure, compared to no VG/CU exposure, in both genders.Conclusion For mainland Chinese

  2. Features of everyday life in psychiatric inpatient care for self-harming: an observational study of six women.

    Science.gov (United States)

    Lindgren, Britt-Marie; Aminoff, Carina; Hällgren Graneheim, Ulla

    2015-02-01

    This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was 'being surrounded by disorder', which consisted of 'living in a confusing environment, being subject to routines and rules that offer safety but lack consistency' and 'waiting both in loneliness and in togetherness'. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.

  3. Trichloroacetic Acid Ingestion: Self-Harm Attempt

    Directory of Open Access Journals (Sweden)

    E. R. Black

    2017-01-01

    Full Text Available Objective. Trichloroacetic acid (TCAA, or trichloroethanoic acid, is a chemical analogue of acetic acid where three methyl group hydrogen atoms are replaced by chlorine. TCAAs are also abbreviated and referred to as TCAs, causing confusion with the psychiatric antidepressant drug class, especially among patients. TCAAs exist in dermatological treatments such as chemical peels or wart chemoablation medication. TCAA ingestion or overdose can cause gastric irritation symptoms including vomiting, diarrhea, or lassitude. This symptomatology is less severe than TCA overdose, where symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. Owing to the vast difference in symptoms, the need for clinical intervention differs greatly. While overdose of either in a self-harm attempt can warrant psychiatric hospital admission, the risk of death in TCAA ingestion is far less. Case Report. A patient ingested TCAA in the form of a commercially available dermatological chemical peel as a self-harm attempt, thinking that it was a more injurious TCA. Conclusion. Awareness among physicians, particularly psychiatrists, regarding this relatively obscure chemical compound (TCAA and its use by suicidal patients mistakenly believing it to be a substance that can be significantly more lethal (TCA, is imperative.

  4. Mortality and Self-Harm in Association With Clozapine in Treatment-Resistant Schizophrenia

    DEFF Research Database (Denmark)

    Wimberley, Theresa; Maccabe, James H; Laursen, Thomas M

    2017-01-01

    Objective: This study evaluated rates of all-cause mortality and self-harm in association with clozapine treatment in individuals with treatment-resistant schizophrenia. Method: A population-based cohort of 2,370 individuals with treatment-resistant schizophrenia after Jan. 1, 1996, was followed...... until death, first episode of self-harm, emigration, or June 1, 2013. Time to all-cause death and time tofirst episode of self-harm were analyzed in Cox regression models with timevarying treatment, adjusted for clinical and sociodemographic covariates. Results: The rate of all-cause mortality...... with other antipsychotics (hazard ratio: 1.45, 95% CI: 0.86-2.45). Excess mortality was observed in the year after clozapine discontinuation (hazard ratio: 2.65, 95% CI: 1.47-4.78). The rate of self-harm was higher for nonclozapine antipsychotics than for clozapine (hazard ratio: 1.36, 95% CI: 1...

  5. Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England.

    Directory of Open Access Journals (Sweden)

    Nav Kapur

    Full Text Available Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice.To examine how the management that patients receive in hospital relates to subsequent outcome.We identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford over a 10 year period (2000 to 2009. We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics.35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs: Centre A 0.99 (0.90-1.09; Centre B 0.59 (0.48-0.74; Centre C 0.59 (0.52-0.68. There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas.These findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups.

  6. [Self-harming behaviour].

    Science.gov (United States)

    Kool, Nienke; Pollen, Wim; van Meijel, Berno

    2010-01-01

    To gain a better understanding of self-harm, a 28-year-old female patient and a 19-year-old female patient with self-harming behaviour are presented. The first patient refused treatment of cut wounds when the doctor enquired about the reason for self-harm. The second patient was referred for mental health care. These cases illustrate the complexity of this behaviour for the patient and the caregiver. Self-harm is often a symbol of underlying problems and serves multiple psychological functions. It is mostly used by patients to cope with unbearable emotions for which they have no other solution. The self-harm invokes different feelings in caregivers which tend to influence the attitude of the caregiver towards the patient. It is very important that caregivers are aware of their feelings and use them professionally. People who self-harm should not be judged, but treated respectfully and attention should be paid to their suffering.

  7. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial.

    Science.gov (United States)

    Mehlum, Lars; Tørmoen, Anita J; Ramberg, Maria; Haga, Egil; Diep, Lien M; Laberg, Stine; Larsson, Bo S; Stanley, Barbara H; Miller, Alec L; Sund, Anne M; Grøholt, Berit

    2014-10-01

    We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  8. Association Between Deliberate Self-harm and Violent Criminality.

    Science.gov (United States)

    Sahlin, Hanna; Kuja-Halkola, Ralf; Bjureberg, Johan; Lichtenstein, Paul; Molero, Yasmina; Rydell, Mina; Hedman, Erik; Runeson, Bo; Jokinen, Jussi; Ljótsson, Brjánn; Hellner, Clara

    2017-06-01

    Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. To investigate the association between nonfatal self-harm and violent crime. This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, crime according to the Swedish penal code. The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9). Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.

  9. Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale.

    LENUS (Irish Health Repository)

    Conlon, Mary

    2012-01-31

    The emergency department is an important gateway for the treatment of self-harm patients. Nurses\\' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses\\' attitudes towards deliberate self-harm. The \\'Self-Harm Antipathy Scale\\

  10. Correlates of self-harm behaviour in acutely ill patients with schizophrenia.

    Science.gov (United States)

    Simms, Jane; McCormack, Vinny; Anderson, Richard; Mulholland, Ciaran

    2007-03-01

    This study compared acutely ill patients with schizophrenia with a history of self-harm (N=17) to those without a history of self-harm (N=16) on measures of depression, hopelessness, suicidal ideation, and demographic and psychiatric variables. A subgroup of these patients who experience auditory hallucinations, with and without a history of self-harm, were selected and compared on measures of depression, hopelessness, suicidal ideation and beliefs about voices. Employing a cross-sectional design, in-patients of two local psychiatric hospital, who met DSM-IV-TR criteria for schizophrenia and who were in an acute phase of the illness, were selected. Each patient was assessed using the Beck Depressions Inventory (BDI), Beck Hopelessness Scale (BHS) and the Beck Suicide Scale (BSS). Patients who experienced auditory verbal hallucinations completed the Beliefs About Voices Questionnaire Revised (BAVQ-R). Patients with a history of self-harm completed the Beck Suicide Intent Scale (BSI). Patients with a history of self-harm (N=17) had significantly greater symptoms of depression, greater suicidal thoughts, increased number of hospital admissions, greater duration of illness and were more likely to be married, compared to patients without a history of self-harm (N=16). Among the subgroup of patients who experience auditory hallucinations, those with a history of self-harm (N=9), believed their voice to be more malevolent, had a tendency to resist their voice and experienced significantly greater symptoms of depression and hopelessness compared to those without a history of self-harm (N=6). These findings highlight the importance for screening by clinicians during inpatient hospital stays and for monitoring to be ongoing following discharge. For the subgroup of patients who experience auditory hallucinations, future research should seek to explore the relationship between self-harm and beliefs about voices.

  11. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning

    Directory of Open Access Journals (Sweden)

    Grimholt Tine K

    2012-04-01

    Full Text Available Abstract Background Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. Methods A cohort of patients who self-poisoned (n = 867 over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI, Beck Hopelessness Scale (BHS, and Generalized Self-Efficacy Scale (GSE were used. The participation rate was 28% (n = 242; mean age, 41 years; 66% females. Results Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe. The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. Conclusions Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.

  12. Measures of motivation for psychiatric treatment based on self-determination theory : Psychometric properties in Dutch psychiatric outpatients

    NARCIS (Netherlands)

    Jochems, Eline C.; Mulder, Cornelis L.; Duivenvoorden, Hugo J.; van der Feltz-Cornelis, Christina M.; van Dam, Arno

    2014-01-01

    Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory—The Treatment Entry

  13. "When you're in the hospital, you're in a sort of bubble." Understanding the high risk of self-harm and suicide following psychiatric discharge: a qualitative study.

    Science.gov (United States)

    Owen-Smith, Amanda; Bennewith, Olive; Donovan, Jenny; Evans, Jonathan; Hawton, Keith; Kapur, Nav; O'Connor, Susan; Gunnell, David

    2014-01-01

    Individuals are at a greatly increased risk of suicide and self-harm in the months following discharge from psychiatric hospital, yet little is known about the reasons for this. To investigate the lived experience of psychiatric discharge and explore service users' experiences following discharge. In-depth interviews were undertaken with recently discharged service users (n = 10) in the UK to explore attitudes to discharge and experiences since leaving hospital. Informants had mixed attitudes to discharge, and those who had not felt adequately involved in discharge decisions, or disagreed with them, had experienced urges to self-harm since being discharged. Accounts revealed a number of factors that made the postdischarge period difficult; these included both the reemergence of stressors that existed prior to hospitalization and a number of stressors that were prompted or exacerbated by hospitalization. Although inferences that can be drawn from the study are limited by the small sample size, the results draw attention to a number of factors that could be investigated further to help explain the high risk of suicide and self-harm following psychiatric discharge. Findings emphasize the importance of adequate preparation for discharge and the maintenance of ongoing relationships with known service providers where possible.

  14. Self-harm and overcrowding among prisoners in Geneva, Switzerland.

    Science.gov (United States)

    Wolff, Hans; Casillas, Alejandra; Perneger, Thomas; Heller, Patrick; Golay, Diane; Mouton, Elisabeth; Bodenmann, Patrick; Getaz, Laurent

    2016-01-01

    Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a "deprivation state." The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. This cross-sectional study took place at Geneva's pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment. The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio - and these

  15. Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.

    Science.gov (United States)

    Cheung, Gary; Foster, Gisele; de Beer, Wayne; Gee, Susan; Hawkes, Tracey; Rimkeit, Sally; Tan, Yu Mwee; Merry, Sally; Sundram, Frederick

    2017-08-01

    A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide. Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected. The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months. Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.

  16. Self-harm - an overview of the tools used to assess non-suicidal self-harming behaviors

    Directory of Open Access Journals (Sweden)

    Drzał-Fiałkiewcz Ewelina

    2017-12-01

    Full Text Available Introduction: Non-Suicidal Self-Injury (NSSI is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.

  17. Decision-making in adolescent females who deliberately self-harm

    Directory of Open Access Journals (Sweden)

    Rigler Tristan

    2016-01-01

    Full Text Available Self-harming behaviour most commonly begins in adolescence and is more frequent among adolescent females. We explored the hypothesis that adolescent females who deliberately selfharm were more likely to perform worse on a decision-making task. Previous research in adolescents who self-harm reported impaired decision-making. However, research put little emphasis on older adolescents and the emotional learning. In our research, we presented the Iowa Gambling Task to 35 adolescent females who self-harmed and were treated at a psychiatric clinic, and to 35 healthy female controls. Our results show that in comparison to the control group the adolescents who self-harm took more risky decisions and were less concerned about the outcome. In addition, the clinical group also focused more on immediate gains and showed a reduced ability to learn from poor decisions in the past. Further research is suggested to explore the potential neurological correlates of decision-making and selfharming behaviour.

  18. Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views

    Directory of Open Access Journals (Sweden)

    Platt Stephen

    2007-01-01

    Full Text Available Abstract Background The engagement of service-users in exploring appropriate interventions for self-harm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm. The purpose of this study was to investigate perceptions of interventions for self-harm (formal and informal, prevention and treatment among people who have first-hand experience as a result of their own behaviour. Methods Semi-structured interviews were undertaken with 14 patients admitted to hospital following a repeat act of self-harm. Data analysis was undertaken thematically, drawing broadly on some of the principles and techniques of grounded theory Results The patients were a heterogeneous group with respect to their personal characteristics and the nature of their self-harm. Thirteen of the 14 patient accounts could be assigned to one or more of three overlapping experiential themes: the experience of psychiatric illness, the experience of alcohol dependency, and the experience of traumatic life events and chronic life problems. These themes were related to the nature of patients' self-harm and their experiences of, and attitudes towards, interventions for self-harm and their attitudes towards these. There was a clear preference for specialist community-based interventions, which focus on the provision of immediate aftercare and acknowledge that the management of self-harm may not necessarily involve its prevention. The findings generate the preliminary hypothesis that personal circumstances and life history are major influences on the choice of interventions for self-harm. Conclusion This study attests to the importance of recognising differences within the self-harming population, and acknowledging patients' personal circumstances and life history. These may provide clues to the antecedents of their self-harm, and lead to more acceptable and appropriate treatments.

  19. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial.

    Science.gov (United States)

    Priebe, Stefan; Bhatti, Nyla; Barnicot, Kirsten; Bremner, Stephen; Gaglia, Amy; Katsakou, Christina; Molosankwe, Iris; McCrone, Paul; Zinkler, Martin

    2012-01-01

    A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder. Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU). The primary outcome was the frequency of days with self-harm; secondary outcomes included borderline personality disorder symptoms, general psychiatric symptoms, subjective quality of life, and costs of care. Forty patients each were randomised to DBT and TAU. In an intention-to-treat analysis, there was a statistically significant treatment by time interaction for self-harm (incidence rate ratio 0.91, 95% CI 0.89-0.92, p self-harm decreased by 9% relative to TAU. There was no evidence of differences on any secondary outcomes. The economic analysis revealed a total cost of a mean of 5,685 GBP (6,786 EUR) in DBT compared to a mean of 3,754 GBP (4,481 EUR) in TAU, but the difference was not significant (95% CI -603 to 4,599 GBP). Forty-eight per cent of patients completed DBT. They had a greater reduction in self-harm compared to dropouts (incidence rate ratio 0.78, 95% CI 0.76-0.80, p self-harm in patients with personality disorder, possibly incurring higher total treatment costs. The effect is stronger in those who complete treatment. Future research should explore how to improve treatment adherence. Copyright © 2012 S. Karger AG, Basel.

  20. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    Science.gov (United States)

    Ruocco, Anthony C.; Rodrigo, Achala H.; McMain, Shelley F.; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S.

    2016-01-01

    Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. PMID:27242484

  1. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Anthony Charles Ruocco

    2016-05-01

    Full Text Available Self-harm is a potentially lethal symptom of borderline personality disorder (BPD that often improves with dialectical behavior therapy (DBT. While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

  2. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study.

    Science.gov (United States)

    Ruocco, Anthony C; Rodrigo, Achala H; McMain, Shelley F; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S

    2016-01-01

    Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

  3. Self-relevant disgust and self-harm urges in patients with borderline personality disorder and depression: a pilot study with a newly designed psychological challenge.

    Directory of Open Access Journals (Sweden)

    Sawsan Abdul-Hamid

    Full Text Available Borderline personality disorder (BPD is a common psychiatric condition associated with self-harm. Self-harm is poorly understood and there is currently no treatment for acute presentations with self-harm urges.By using a new task (Self-relevant Task; SRT, to explore emotions related to one's own person (PERSON task and body (BODY task, to study the correlations of these emotions, specifically disgust, with self-harm urge level changes, and to test the task's potential to be developed into an experimental model of self-harming for treatment trials.17 BPD patients, 27 major depressive disorder (MDD patients, and 25 healthy volunteers performed the SRT. Emotion labels were extracted from task narratives and disgust and self-harm urge level changes measured by visual analogue scales. We used validated rating scales to measure symptom severity.The SRT was effective at inducing negative emotions and self-harm urge changes. Self-harm urge changes correlated with borderline symptom severity. Post-task disgust levels on the visual analogue scales were higher in BPD patients than in healthy controls in the PERSON task, and higher than in both control groups in the BODY task. Changes in disgust levels during the task were significantly greater in the patient groups. Post-task disgust levels or changes in disgust were not associated with self-harm urge changes (except the latter in MDD in the PERSON task, but self-harm urge changes and disgust (but no other emotion narrative labels were on a whole sample level.Although associations with the analogue scale measures were not significant, self-disgust reported in the narrative of patients may be associated with a higher probability of self-harm urges. Further research with larger sample sizes is needed to confirm this relationship and to examine whether reducing self-disgust could reduce self-harm urges. The SRT was effective and safe, and could be standardized for experimental studies.

  4. Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies.

    Directory of Open Access Journals (Sweden)

    Celine Larkin

    Full Text Available BACKGROUND: Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition. OBJECTIVE: This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent. DATA SOURCES: PubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form. RESULTS: A total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity. CONCLUSIONS: Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode

  5. Clinical Diagnostic and Sociocultural Dimensions of Deliberate Self-Harm in Mumbai, India

    Science.gov (United States)

    Parkar, Shubhangi R.; Dawani, Varsha; Weiss, Mitchell G.

    2006-01-01

    Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression…

  6. Why Do the Very Old Self-Harm? A Qualitative Study.

    Science.gov (United States)

    Wand, Anne P F; Peisah, Carmelle; Draper, Brian; Brodaty, Henry

    2018-03-15

    To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care. A qualitative study using in-depth interviews. Participants were recruited from two teaching hospitals and associated community services. People aged 80 years or older who had self-harmed within the previous month. Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO. Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment". Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated. Copyright © 2018 American Association for Geriatric Psychiatry. All rights reserved.

  7. Elucidating the association between the self-harm inventory and several borderline personality measures in an inpatient psychiatric sample.

    Science.gov (United States)

    Sellbom, Martin; Sansone, Randy A; Songer, Douglas A

    2017-09-01

    The current study evaluated the utility of the self-harm inventory (SHI) as a proxy for and screening measure of borderline personality disorder (BPD) using several diagnostic and statistical manual of mental disorders (DSM)-based BPD measures as criteria. We used a sample of 145 psychiatric inpatients, who completed the SHI and a series of well-validated, DSM-based self-report measures of BPD. Using a series of latent trait and latent class analyses, we found that the SHI was substantially associated with a latent construct representing BPD, as well as differentiated latent classes of 'high' vs. 'low' BPD, with good accuracy. The SHI can serve as proxy for and a good screening measure for BPD, but future research needs to replicate these findings using structured interview-based measurement of BPD.

  8. Self-harm

    Science.gov (United States)

    Self-harm refers to a person's harming their own body on purpose. About 1 in 100 people hurts himself or herself in this way. More females hurt themselves than males. A person who self-harms usually does not mean to kill himself or herself. But they are at higher risk of attempting suicide if they do ...

  9. Home treatment for acute psychiatric illness.

    Science.gov (United States)

    Dean, C; Gadd, E M

    1990-11-03

    To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are traditionally treated in hospital. All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited. The second year of the study is reported. Electoral ward of Sparkbrook, Birmingham. 99 Patients aged 16-65 with severe acute psychiatric illness. 65 Patients were managed by home treatment alone; 34 required admission to hospital. The location of treatment was significantly (all p less than 0.05) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station). DSM-III-R diagnosis was more weakly associated with outcome. Violence during the episode was significantly related to admission, although deliberate self harm was not. Home treatment is feasible for most patients with acute psychiatric illness. A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors. Admission will still be required for some patients. A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.

  10. Measures of motivation for psychiatric treatment based on self-determination theory: psychometric properties in Dutch psychiatric outpatients.

    Science.gov (United States)

    Jochems, Eline C; Mulder, Cornelis L; Duivenvoorden, Hugo J; van der Feltz-Cornelis, Christina M; van Dam, Arno

    2014-08-01

    Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory-The Treatment Entry Questionnaire (TEQ), Health Care Climate Questionnaire (HCCQ), and the Short Motivation Feedback List (SMFL)-in a sample of 348 Dutch adult outpatients with primary diagnoses of mood, anxiety, psychotic, and personality disorders. Structural equation modeling showed that the empirical factor structures of the TEQ and SMFL were adequately represented by a model with three intercorrelated factors. These were interpreted as identified, introjected, and external motivation. The reliabilities of the Dutch TEQ, HCCQ, and SMFL were found to be acceptable but can be improved on; congeneric estimates ranged from 0.66 to 0.94 depending on the measure and patient subsample. Preliminary support for the construct validities of the questionnaires was found in the form of theoretically expected associations with other scales, including therapist-rated motivation and treatment engagement and with legally mandated treatment. Additionally, the study provides insights into the relations between measures of motivation based on self-determination theory, the transtheoretical model and the integral model of treatment motivation in psychiatric outpatients with severe mental illness. © The Author(s) 2013.

  11. Cutting and Self-Harm

    Science.gov (United States)

    ... Your feelings Feeling sad Cutting and self-harm Cutting and self-harm Self-harm, sometimes called self- ... There are many types of self-injury, and cutting is one type that you may have heard ...

  12. Nonsuicidal Self-Harm among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm

    Science.gov (United States)

    Laye-Gindhu, Aviva; Schonert-Reichl, Kimberly A.

    2005-01-01

    This study examines self-harm in a community sample of adolescents. More specifically, the study identifies the prevalence and types of self-harm, elucidates the nature and underlying function of self-harm, and evaluates the relation of psychological adjustment, sociodemographic, and health-risk variables to self-harm. Self-report questionnaires…

  13. Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harm.

    Science.gov (United States)

    Wright-Hughes, Alexandra; Graham, Elizabeth; Farrin, Amanda; Collinson, Michelle; Boston, Paula; Eisler, Ivan; Fortune, Sarah; Green, Jonathan; House, Allan; Owens, David; Simic, Mima; Tubeuf, Sandy; Nixon, Jane; McCabe, Christopher; Kerfoot, Michael; Cottrell, David

    2015-11-04

    Self-harm is common in the community with a lifetime prevalence of 13 %. It is associated with an elevated risk of overall mortality and suicide. People who harm themselves are high users of public services. Estimates of the 1-year risk of repetition vary between 5 and 15 % per year. Currently, limited evidence exists on the effectiveness of clinical interventions for young people who engage in self-harm. Recent reviews have failed to demonstrate any effect on reducing repetition of self-harm among adolescents receiving a range of treatment approaches. Family factors are particularly important risk factors associated with fatal and non-fatal self-harm among children and adolescents. Family therapy focuses on the relationships, roles and communication patterns between family members, but there have been relatively few studies of specifically family-focused interventions with this population. The Self-Harm Intervention: Family Therapy (SHIFT) Trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (grant no. 07/33/01) following a commissioned call for this research. SHIFT is a pragmatic, phase III, multicentre, individually randomised, controlled trial comparing Family Therapy (FT) with treatment as usual (TAU) for adolescents aged 11 to 17 who have engaged in at least two episodes of self-harm. Both therapeutic interventions were delivered within the National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) in England. Participants and therapists were, of necessity, aware of treatment allocation, but the researchers were blind to the allocations to allow unbiased collection of follow-up data. Primary outcome data (repetition of self-harm leading to hospital attendance 18 months post-randomisation) were collected from the Health and Social Care Information Centre (HSCIC), augmented by directed searches of medical records at Acute Trusts. Secondary outcome data (including suicidal intent

  14. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-10-01

    Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; p<0·0001). Costs were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean

  15. Suicide Following Deliberate Self-Harm.

    Science.gov (United States)

    Olfson, Mark; Wall, Melanie; Wang, Shuai; Crystal, Stephen; Gerhard, Tobias; Blanco, Carlos

    2017-08-01

    The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models. During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days. Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.

  16. Group problem-solving skills training for self-harm: randomised controlled trial.

    Science.gov (United States)

    McAuliffe, Carmel; McLeavey, Breda C; Fitzgerald, Tony; Corcoran, Paul; Carroll, Bernie; Ryan, Louise; O'Keeffe, Brian; Fitzgerald, Eva; Hickey, Portia; O'Regan, Mary; Mulqueen, Jillian; Arensman, Ella

    2014-01-01

    Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up. The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group. This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.

  17. Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

    Science.gov (United States)

    Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey

    2014-11-01

    A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status

  18. Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India.

    Science.gov (United States)

    Parkar, Shubhangi R; Dawani, Varsha; Weiss, Mitchell G

    2006-04-01

    Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression was the most common diagnosis (38.8%), followed by substance use disorders (16.8%), but 44.4% of patients did not meet criteria for an enduring Axis-I disorder (no diagnosis, V-code, or adjustment disorder). Psychache arising from patient-identified sociocultural contexts and stressors complements, but does not necessarily fulfill, criteria for explanatory psychiatric disorders.

  19. Adolescent self-harm and risk factors.

    Science.gov (United States)

    Zhang, Jixiang; Song, Jianwei; Wang, Jing

    2016-12-01

    This study aims to define the characteristics of adolescents who have engaged in self-harm behavior and ascertain the risk factors. From January 2013 to January 2014, 4,176 adolescents from senior middle schools in Linyi, China, were administered four questionnaire surveys to ascertain the following: incidence of self-harm behavior regarding the frequency of different self-harm behaviors by group (never/one to five times/greater than five times in the last 6 months) and then comparing the self-harm behavior of the different subgroups; symptom self-check, comparing the differences between the adolescents with self-harm behavior and without in nine subscales (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear, paranoid, and psychosis); Adolescent Self-Rating Life Events Check List scores; and Egna Minnenav Barndoms Uppfostran (EMBU) scores. Multivariate logistic regression analysis was used to determine the risk factors of self-harm in adolescents. The incidence of adolescent self-harm was 27.60%; the occurrence of adolescent self-harm was closely related to their mental health status, stressful life events, and EMBU. Being female, an urban student, or an only child; having poor school performance or experiences of stressful life events, harsh parenting styles, or excessive interference; and poor mental health were the risk factors for adolescent self-harm. The incidence of adolescent self-harm was high, and their mental health status, stressful life events, and EMBU affected the occurrence of adolescent self-harm, which is an issue that needs greater attention. © 2016 John Wiley & Sons Australia, Ltd.

  20. Level ofaggression and sense of control inself-harming youth receiving psychiatric treatment

    Directory of Open Access Journals (Sweden)

    Agnieszka Gmitrowicz

    2011-12-01

    Full Text Available Acts of autoaggression are a more and more frequent reason for psychiatric hospitalisation of adolescents. Within the last years the number of patients committing acts of deliberate self‑harm without suicidal intensions almost doubled. Deliberate self‑harm (DSH is defined as an act of direct destructiveness, in which a person wants to commit self‑harm immediately, without an intention of killing her/himself. In this paper we present the results of the study on the level and direction of aggression and the sense of control among inpatients (N=187 of the Department of Adolescent Psychiatry, Central University Hospital in Łódź. The studied group consisted of patients with deliberate self‑harm (DSH group, N=88, whereas the control group comprised the patients without such behaviours (non‑DSH group, N=99. For the study we recruited patients who were admitted to the hospital due to various mental disorders – 58 boys, mean age 16.81, SD=1.25, and 129 girls, mean age 16.5, SD=1.38. The mean age of all patients was 16.59 (SD=1.35. Patients with men‑ tal retardation were excluded from the study, due to expected difficulties with understanding the questions. We used the IPSA (Inventory of Psychological Syndrome of Aggression and “Delta” (test invented by Drwal, designed for evalua‑ tion of the sense of control. In the DSH group we found a significantly higher level of aggression, directed both inwards and outwards, a greater tendency of retaliatory behaviours and by far lower sense of internal control of one’s behaviours, as compared to the non‑DSH group. Therapeutic programs for patients with DSH should aim at the reduction of aggres‑ sion and the development of internal control over one’s behaviours.

  1. Making the cut: The production of 'self-harm' in post-1945 Anglo-Saxon psychiatry.

    Science.gov (United States)

    Millard, Chris

    2013-04-01

    'Deliberate self-harm', 'self-mutilation' and 'self-injury' are just some of the terms used to describe one of the most prominent issues in British mental health policy in recent years. This article demonstrates that contemporary literature on 'self-harm' produces this phenomenon (to varying extents) around two key characteristics. First, this behaviour is predominantly performed by those identified as female. Second, this behaviour primarily involves cutting the skin. These constitutive characteristics are traced back to a corpus of literature produced in the 1960s and 1970s in North American psychiatric inpatient institutions; analysis shows how pre-1960 works were substantially different. Finally, these gendered and behavioural assertions are shown to be the result of historically specific processes of exclusion and emphasis.

  2. The association between social relationships and self-harm: a case–control study in Taiwan

    Science.gov (United States)

    2013-01-01

    Background Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case–control study. Methods The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models. Results A total of 124 case–control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94). Conclusions More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere. PMID:23531045

  3. A test of faith in God and treatment: the relationship of belief in God to psychiatric treatment outcomes.

    Science.gov (United States)

    Rosmarin, David H; Bigda-Peyton, Joseph S; Kertz, Sarah J; Smith, Nasya; Rauch, Scott L; Björgvinsson, Thröstur

    2013-04-25

    Belief in God is very common and tied to mental health/illness in the general population, yet its relevance to psychiatric patients has not been adequately studied. We examined relationships between belief in God and treatment outcomes, and identified mediating mechanisms. We conducted a prospective study with n=159 patients in a day-treatment program at an academic psychiatric hospital. Belief in God, treatment credibility/expectancy, emotion regulation and congregational support were assessed prior to treatment. Primary outcomes were treatment response as well as degree of reduction in depression over treatment. Secondary outcomes were improvements in psychological well-being and reduction in self-harm. Belief in God was significantly higher among treatment responders than non-responders F(1,114)=4.81, pGod and reductions in depression. No variables mediated relationships to other outcomes. Religious affiliation was also associated with treatment credibility/expectancy but not treatment outcomes. Belief in God, but not religious affiliation, was associated with better treatment outcomes. With respect to depression, this relationship was mediated by belief in the credibility of treatment and expectations for treatment gains. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Digital Self-Harm Among Adolescents.

    Science.gov (United States)

    Patchin, Justin W; Hinduja, Sameer

    2017-12-01

    Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. "Digital self-harm" is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12-17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  5. Coping styles adopted in stressful situations by self-harming adolescents

    Directory of Open Access Journals (Sweden)

    Karolina Jabłkowska

    2010-03-01

    Full Text Available The state of stress and styles of coping with stress constitute an important component of life of every human being, particularly during adolescence. Effective coping mechanisms enable reduction of severity of stress experienced, while inability to manage stressful situations results in alterations in emotional and physiological domains, disturbances of mental well-being, somatic health and social functioning. Since a few years, we are witnessing a significant aggravation of the phenomenon of auto-aggression among children and adolescents, particularly in populations already undergoing psychiatric treatment. Such behaviours fulfil several functions: they may represent a way to express emotions, a means of adaptation or a style of coping with difficulties encountered in everyday life and emotional tension associated therewith. The aim of this study was to analyse predominating styles of coping with stressful situations, adopted by adolescen patients performing self-harm. The study population encompassed 35 patients, aged 16.60±0.18 years, there of 27 girls and 8 boys, hospitalised at the Department of Adolescent Psychiatry of the Medical University in Łódź, who had a history of deliberate self-harm (DSH. Control group included 32 healthy volunteers aged 16.91±0.16 years, thereof 23 girls and 9 boys. In view of the size of study population, it was subdivided into subgroups depending on whether episodes of DSH were sporadic or repetitive. Data were collected using the Coping Inventory for Stressful Situations (CISS. This questionnaire was designed specifically to explore styles of coping with stress. Self-harming adolescents, both girls and boys, significantly more often adopted emotion-oriented style. Patients with repetitive DSH (over 4 episodes significantly more often adopted emotion-oriented style and/or avoidance-oriented style, particularly in the form of seeking social contacts – social diversion, as compared with those committing

  6. Characteristics of Self-Harm Behaviour among Identified Self-Harming Youth in Care

    Science.gov (United States)

    Grenville, Jeffrey; Goodman, Deborah; Macpherson, Alison K.

    2012-01-01

    The objective of this study was to describe deliberate self-harming (DSH) characteristics in a child-welfare population identified as having threatened or completed self-harm. Secondary data from 621 serious occurrence reports (SOR) that documented 2004-2007 DSH incidents and DSH threats with 252 Canadian youth in care (Y-INC) of the Children's…

  7. Helping Self-Harming Students

    Science.gov (United States)

    Selekman, Matthew D.

    2009-01-01

    Approximately 14 to 17 percent of adolescents today self-harm, deliberately cutting, burning, or bruising themselves. Most self-harming adolescents use the behavior as a coping strategy to get immediate relief from emotional distress or other stressors in their lives. Stressors include fitting in with peers, activity and homework overload, fears…

  8. Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

    Science.gov (United States)

    Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita J; Haga, Egil; Diep, Lien M; Stanley, Barbara H; Miller, Alec L; Sund, Anne M; Grøholt, Berit

    2016-04-01

    We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention - Family Therapy (SHIFT) trial.

    Science.gov (United States)

    Cottrell, David J; Wright-Hughes, Alex; Collinson, Michelle; Boston, Paula; Eisler, Ivan; Fortune, Sarah; Graham, Elizabeth H; Green, Jonathan; House, Allan O; Kerfoot, Michael; Owens, David W; Saloniki, Eirini-Christina; Simic, Mima; Tubeuf, Sandy; Farrin, Amanda J

    2018-03-01

    Self-harm in adolescents is common and repetition rates high. There is limited evidence of the effectiveness of interventions to reduce self-harm. To assess the clinical effectiveness and cost-effectiveness of family therapy (FT) compared with treatment as usual (TAU). A pragmatic, multicentre, individually randomised controlled trial of FT compared with TAU. Participants and therapists were aware of treatment allocation; researchers were blind to allocation. Child and Adolescent Mental Health Services (CAMHS) across three English regions. Young people aged 11-17 years who had self-harmed at least twice presenting to CAMHS following self-harm. Eight hundred and thirty-two participants were randomised to manualised FT delivered by trained and supervised family therapists ( n  = 415) or to usual care offered by local CAMHS following self-harm ( n  = 417). Rates of repetition of self-harm leading to hospital attendance 18 months after randomisation. Out of 832 young people, 212 (26.6%) experienced a primary outcome event: 118 out of 415 (28.4%) randomised to FT and 103 out of 417 (24.7%) randomised to TAU. There was no evidence of a statistically significant difference in repetition rates between groups (the hazard ratio for FT compared with TAU was 1.14, 95% confidence interval 0.87 to 1.49; p  = 0.3349). FT was not found to be cost-effective when compared with TAU in the base case and most sensitivity analyses. FT was dominated (less effective and more expensive) in the complete case. However, when young people's and caregivers' quality-adjusted life-year gains were combined, FT incurred higher costs and resulted in better health outcomes than TAU within the National Institute for Health and Care Excellence cost-effectiveness range. Significant interactions with treatment, indicating moderation, were detected for the unemotional subscale on the young person-reported Inventory of Callous-Unemotional Traits ( p  = 0.0104) and the affective involvement

  10. Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE guidelines being met?

    Directory of Open Access Journals (Sweden)

    Jordan Rita

    2008-10-01

    Full Text Available Abstract Background Most patients contact their general practitioner (GP following presentation to an Emergency Department (ED after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE guidelines on the short-term management of people who self-harm. Methods An audit of medical records (ED and Psychiatric on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital. Results We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist. Conclusion Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS trusts would establish if this is a problem elsewhere.

  11. Group problem-solving skills training for self-harm: randomised controlled trial

    OpenAIRE

    McAuliffe, Carmel; McLeavey, Breda C.; Fitzgerald, Anthony P.; Corcoran, Paul; Carroll, Bernie; Ryan, Louise; Fitzgerald, Eva; O'Regan, Mary; Mulqueen, Jillian; Arensman, Ella

    2014-01-01

    Background: Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. Aims: To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. Method: A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU...

  12. Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study.

    Science.gov (United States)

    Madge, Nicola; Hawton, Keith; McMahon, Elaine M; Corcoran, Paul; De Leo, Diego; de Wilde, Erik Jan; Fekete, Sandor; van Heeringen, Kees; Ystgaard, Mette; Arensman, Ella

    2011-10-01

    There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

  13. Gender, suicide, and the sociocultural context of deliberate self-harm in an urban general hospital in Mumbai, India.

    Science.gov (United States)

    Parkar, Shubhangi R; Dawani, Varsha; Weiss, Mitchell G

    2008-12-01

    Recognizing the complementary effects of social contexts and psychiatric disorders, this study clarifies the role of gender in suicidal behavior in urban Mumbai by considering psychiatric diagnoses and patient-identified sociocultural features. The cultural epidemiological approach suggests the critical impact of situational sociocultural factors that complement the customary psychopathological accounts for those who harm or kill themselves. The cultural epidemiology of deliberate self-harm (DSH), it is argued, is critical to planning for suicide prevention, community mental health and psychiatric practice. This study, based on a cultural epidemiological framework, compares male and female admissions for DSH, evaluating conditions with SCID-I and EMIC interviews. We assessed features and narratives of suicidal behavior, patient-identified underlying problems, their perceived causes and triggers. The study included 92 women and 104 men. A diagnosis of depressive disorder was made for 48.9 percent of women and 39.4 percent of men. Many patients (50.0 percent of women and 41.3 percent of men) did not fulfill the criteria for any diagnosis, or did so only for an adjustment disorder or a V-code. Men typically explained DSH with reference to work problems, financial problems and problem drinking. Women typically discussed domestic problems, in-law relations and victimization. Problem drinking affected women living with men who drank. Social and situational factors appear to play a relatively greater role than psychiatric illness in self-harm and suicide in Mumbai, as in other Asian studies, compared with Europe and North America.

  14. Self-harm and ethnicity: A systematic review.

    Science.gov (United States)

    Al-Sharifi, Ali; Krynicki, Carl R; Upthegrove, Rachel

    2015-09-01

    This review will focus on the rates, clinical characteristics, risk factors and methods of self-harm and suicide in different ethnic groups in the United Kingdom, providing an update synthesis of recent literature. Studies that met the inclusion criteria between 2003 and 2013 were reviewed using the following databases: MEDLINE, PsycINFO, EMBASE and CINAHL. The methodological quality of each study was then assessed using a structured scoring system. A total of 2,362 articles were retrieved, 10 of which matched the inclusion criteria were reviewed. Significant differences were found in the rates of self-harm between ethnic groups with Asian males being least likely to self-harm and Black females being most likely to self-harm. Also, Black and South Asian people were less likely to repeat self-harm. Factors that may help protect or predispose individuals to self-harm or attempt suicide (such as religion, mental health and coping styles) also differ between ethnic groups. There are clear ethnic differences in self-harm and suicide, which may be affected by factors such as cultural pressures and prevalence of mental illness. An awareness of these differences is vital to help prevent further attempts of self-harm and suicide. Further research into differences between ethnic and cultural groups and self-harm continues to be important. © The Author(s) 2015.

  15. Watch-Dog: Detecting Self-Harming Activities From Wrist Worn Accelerometers.

    Science.gov (United States)

    Bharti, Pratool; Panwar, Anurag; Gopalakrishna, Ganesh; Chellappan, Sriram

    2018-05-01

    In a 2012 survey, in the United States alone, there were more than 35 000 reported suicides with approximately 1800 of being psychiatric inpatients. Recent Centers for Disease Control and Prevention (CDC) reports indicate an upward trend in these numbers. In psychiatric facilities, staff perform intermittent or continuous observation of patients manually in order to prevent such tragedies, but studies show that they are insufficient, and also consume staff time and resources. In this paper, we present the Watch-Dog system, to address the problem of detecting self-harming activities when attempted by in-patients in clinical settings. Watch-Dog comprises of three key components-Data sensed by tiny accelerometer sensors worn on wrists of subjects; an efficient algorithm to classify whether a user is active versus dormant (i.e., performing a physical activity versus not performing any activity); and a novel decision selection algorithm based on random forests and continuity indices for fine grained activity classification. With data acquired from 11 subjects performing a series of activities (both self-harming and otherwise), Watch-Dog achieves a classification accuracy of , , and for same-user 10-fold cross-validation, cross-user 10-fold cross-validation, and cross-user leave-one-out evaluation, respectively. We believe that the problem addressed in this paper is practical, important, and timely. We also believe that our proposed system is practically deployable, and related discussions are provided in this paper.

  16. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

    Directory of Open Access Journals (Sweden)

    Shantna Kumari

    2014-01-01

    Full Text Available Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP. Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively. Results: On the modified felt stigma scale, the mean (±standard deviation [SD] score of psychiatric hospital outpatients (31.89 ± 6.51 was significantly higher than the scores of patients attending COP (29.20 ± 6.80. On Rosenberg self-esteem scale, mean (±SD scores of patients with psychosis (17.98 ± 1.69 was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60. There was no significant correlation between stigma and self-esteem. Conclusion: As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.

  17. Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa.

    Science.gov (United States)

    Bühren, K; Schwarte, R; Fluck, F; Timmesfeld, N; Krei, M; Egberts, K; Pfeiffer, E; Fleischhaker, C; Wewetzer, C; Herpertz-Dahlmann, B

    2014-01-01

    Patients with anorexia nervosa (AN) exhibit high rates of psychiatric comorbidity. To disentangle the effects of duration of illness on comorbid psychiatric symptoms, we investigated the rates of comorbid psychiatric disorders, suicidality and self-harm behaviour in adolescent patients with a first onset of AN. In adolescent females (n = 148) with a first onset of AN, body mass index, psychiatric comorbidity (according to DSM-IV), depressive symptoms, suicidality and self-injurious behaviour were assessed. Seventy patients (47.3%) met the criteria for at least one comorbid psychiatric disorder. The binge-purging subtype was associated with increased rates of psychiatric comorbidity, suicidality and self-injurious behaviour. The severity of eating disorder-specific psychopathology influenced current psychiatric comorbidity and suicidal ideation. Prevalence rates of comorbid psychiatric disorders and suicidal ideation are considerably lower among adolescents with AN compared with adults. An early and careful assessment, along with adequate treatment of the eating disorder, might prevent the development of severe psychiatric comorbidities. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

  18. Applying Dialectical Behavior Therapy to Self-Harm in College-Age Men: A Case Study

    Science.gov (United States)

    Cannon, Jennifer L.; Umstead, Lindsey K.

    2018-01-01

    Researchers suggest an increase in self-harm among men. Specifically, college-age men appear to be at risk for self-harming behaviors, and counselors often overlook these behaviors in treatment. In this article, the authors describe the issue of self-harm and illustrate the use of dialectical behavior therapy (DBT; Linehan, 2014) with male college…

  19. The relationship between self-esteem and psychiatric disorders in adolescents.

    Science.gov (United States)

    Guillon, M S; Crocq, Marc-Antoine; Bailey, P E

    2003-03-01

    To examine the relationship between self-esteem and psychiatric disorders in adolescents. Seventy-six adolescents (mean age: 16.02 years; range: 12-20) treated in an inpatient unit and presenting with DSM-IV psychotic disorder, depressive disorder, anxious disorder, anorexia nervosa, personality disorder, or conduct disorder were compared with a control group of 119 adolescents drawn from a normal population. All the subjects were assessed with the French translation of the Coopersmith self-esteem inventory (SEI). Self-esteem was significantly higher in the control than in the clinical population (P = 0.0001). Female patients showed significantly lower SEI scores than male patients. Self-esteem increased significantly after 12 weeks in patients with a first psychotic episode who responded successfully to antipsychotic drug treatment. In the clinical group, a history of suicide attempts and sexual abuse was associated with significantly lower SEI scores. Lack of boy- or girlfriend, dropping out of school, and social withdrawal were also associated with lower self-esteem. The presence of a psychiatric disorder in adolescents is associated with decreased self-esteem. This decrease in self-esteem varies according to the psychiatric disorder. Appropriate treatment can enhance self-esteem in adolescent patients.

  20. Psychometric properties of the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire

    NARCIS (Netherlands)

    Kool, N.; van Meijel, B.; van der Bijl, J.; Koekkoek, B.; Kerkhof, A.

    2015-01-01

    The attitude of nurses and treatment staff is crucial in the treatment of patients who self-harm. However, many patients experience that attitude as negative. The aim of this study was to investigate the psychometric properties of the Dutch version of the Attitude Towards Deliberate Self-Harm

  1. A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skåne randomized controlled trial protocol (BASRCT).

    Science.gov (United States)

    Liljedahl, Sophie I; Helleman, Marjolein; Daukantaité, Daiva; Westrin, Åsa; Westling, Sofie

    2017-06-15

    Brief Admission is a crisis and risk management strategy in which self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder self-admit to hospital at times of increasing risk when other efforts to stay safe are failing. Standardized in the current randomized controlled trial, the intensity of Brief Admission Skåne is implemented in durations of three days, with a maximum frequency of three times a month. Brief Admission is integrated into existing treatment plans in advance of crises to prevent reliance on general psychiatric admissions for risk management, as these may be lengthy, unstructured, and of uncertain therapeutic value. The overall objective of the Brief Admission Skåne randomized controlled trial is to determine if Brief Admission can replace general psychiatric admission for self-harming and suicidal individuals with complex mental illness at times of escalating risk. Other objectives of the study are to evaluate whether Brief Admission increases daily functioning and enhances coping, reduces psychiatric symptoms including frequency and severity of self-harm and suicidal behaviours. A final objective is to determine if Brief Admission is an effective crisis management model for this population. Participants are randomized at an individual level to either Brief Admission Skåne plus Treatment as Usual or Treatment As Usual. Based on a priori power analyses, N = 124 participants will be recruited to the study. Data collection is in progress, and will continue until June 2018. All participant data are single-blinded and will be handled with intention-to-treat analysis. Based on the combined clinical experience of our international research group, the Brief Admission Skåne randomized controlled trial upon which the current protocol is based represents the first initiative to standardize, implement and evaluate Brief Admission amongst self-harming and suicidal individuals, including those with

  2. First Episode of Self-Harm in Older Age : A Report From the 10-Year Prospective Manchester Self-Harm Project

    NARCIS (Netherlands)

    Voshaar, Richard C. Oude; Cooper, Jayne; Murphy, Elizabeth; Steeg, Sarah; Kapur, Nay; Purandare, Nitin B.

    Objective: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  3. First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Cooper, J.; Murphy, E.; Steeg, S.; Kapur, N.; Purandare, N.B.

    2011-01-01

    OBJECTIVE: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  4. 'They don't understand…you cut yourself in order to live.' Interpretative repertoires jointly constructing interactions between adult women who self-harm and professional caregivers.

    Science.gov (United States)

    Lindgren, Britt-Marie; Oster, Inger; Aström, Sture; Hällgren Graneheim, Ulla

    2011-01-01

    The aim of the study was to illuminate interpretative repertoires that jointly construct the interaction between adult women who self-harm and professional caregivers in psychiatric inpatient care. Participant observations and informal interviews were conducted among six women who self-harm and their professional caregivers in two psychiatric inpatient wards, and analysed using the concept of interpretative repertoires from the discipline of discursive psychology. The analysis revealed four interpretative repertoires that jointly constructed the interaction. The professional caregivers used a "fostering repertoire" and a "supportive repertoire" and the women who self-harmed used a "victim repertoire" and an "expert repertoire." The women and the caregivers were positioned and positioned themselves and people around them within and among these interpretative repertoires to make sense of their experiences of the interaction. It was necessary to consider each woman's own life chances and knowledge about herself and her needs. The participants made it clear that it was essential for them to be met with respect as individuals. Professional caregivers need to work in partnership with individuals who self-harm-experts by profession collaborating with experts by experience. Caregivers need to look beyond behavioural symptoms and recognise each individual's possibilities for agency.

  5. Caring for self-harming patients in general practice.

    Science.gov (United States)

    Rowe, Joanne; Jaye, Chrystal

    2017-12-01

    INTRODUCTION Intentional self-harm is an international public health issue with high personal, social and financial costs to society. Poor relationship dynamics are known to have a negative influence on the psyche of people who self-harm, and this can increase anxiety and decrease self-esteem, both shown to be significant contributors to self-harm behaviours. Positive and functional social supports have been proposed as a cost-effective and constructive approach in diminishing self-harming behaviours. AIM This qualitative study investigated the aspects of professional, social, familial and romantic relationships that people who have self-harmed identified as having a positive and constructive effect on their self-harm behaviour. METHODS Twelve participants with a history of self-harming behaviours were recruited through free press advertising in primary care and interviewed. The participants ranged in age from 19 to 70 years, and represented New Zealand (NZ) European and Māori from across the Southern region of NZ. RESULTS This study shows that constructive relationships that inhibit self-harm behaviours are characterised by participants' perceptions of authenticity in their relationships, and knowing that other people genuinely care. Feeling cared for within an authentic therapeutic relationship enabled participants to overcome their perception of being damaged selves and gave them the skills and confidence to develop functional relationships within their communities. A relationship-centred care approach may be useful for general practitioners seeking to develop more effective therapeutic relationships with patients who deliberately self-harm.

  6. Comorbid psychiatric diagnoses among individuals presenting to an addiction treatment program for alcohol dependence.

    LENUS (Irish Health Repository)

    Lyne, John Paul

    2011-01-01

    A retrospective patient record review was conducted to examine comorbid psychiatric diagnoses, and comorbid substance use, among 465 patients below 45 years of age, presenting to a national alcohol addiction treatment unit in Dublin, between 1995 and 2006. Rates were high for depressive disorder (25.3%) particularly among females (35.4%). Lifetime reported use of substances other than alcohol was 39.2%, and further analysis showed significantly higher rates of deliberate self-harm among this group. Lifetime reported use of ecstasy was also significantly associated with depression in this alcohol-dependent population using logistic regression analysis. Implications and limitations of the findings are discussed.

  7. Varenicline and Risk of Self-Harm: A Nested Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Mina Tadrous

    Full Text Available Smoking remains a serious public health concern. Pharmacotherapy for smoking cessation, including bupropion and varenicline, are proven means to increase quit rates. Post-marketing reports describing suicidal behaviours have raised concerns about the safety of varenicline. However, whether varenicline imparts a higher risk of suicide relative to bupropion remains uncertain.A population-based nested case-control study in Ontario, Canada, from April 1, 2011 to March 31, 2015 was conducted. Subjects were residents of Ontario aged 18 years and older with publicly funded drug coverage receiving either bupropion or varenicline for smoking cessation. We defined cases were those with a hospitalization or emergency department visit for suicide or non-fatal self-harm within 90 days of treatment. For each case, we identified up to fifty controls from the same cohort matched on age, sex, history of self-harm, use of selected psychotropic medications, alcohol abuse and prior admission to a mental health unit. Adjusted odds ratio were used to compare the risk of suicide/self-harm of varenicline to bupropion.We identified 331 cases and 5,346 matched-controls. Following adjustment for potential confounders, we found that varenicline was not associated with an increased risk of suicide/self-harm relative to bupropion (adjusted odds ratio 1.15; 95% confidence interval 0.71 to 1.87.Treatment with varenicline does not appear to significantly increase the risk of suicide or self-harm relative to bupropion.

  8. Psychiatric diagnoses, trauma, and suicidiality

    Directory of Open Access Journals (Sweden)

    Elklit Ask

    2007-04-01

    Full Text Available Abstract Background This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. Methods During two months, all consecutive patients (n = 139 in a psychiatric hospital in Western Norway were interviewed (response rate 72%. Results Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. Conclusion Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.

  9. Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention.

    Science.gov (United States)

    Tørmoen, A J; Grøholt, B; Haga, E; Brager-Larsen, A; Miller, A; Walby, F; Stanley, B; Mehlum, L

    2014-01-01

    We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.

  10. The Basic Act for Suicide Prevention: Effects on Longitudinal Trend in Deliberate Self-Harm with Reference to National Suicide Data for 1996–2014

    Directory of Open Access Journals (Sweden)

    Miharu Nakanishi

    2017-01-01

    Full Text Available A suicide prevention strategy was launched in Japan in 2006 to address the high suicide rate, which had increased considerably since 1998. The national strategy from 2007 involved the enhancement of psychiatric treatment services at emergency medical facilities and supportive observation by individuals close to patients. The national suicide rate has decreased gradually since 2008; however, national information regarding the number of patients who had engaged in deliberate self-harm was absent. Therefore, the present study examined the longitudinal trend in hospital admissions due to deliberate self-harm in Japan. Data from the National Patient Survey between 1996 and 2014—a nationally representative cross-sectional survey of inpatient care every 3 years—were used. Data for 13,014 patients were included in the estimation of the number of hospital admissions due to deliberate self-harm. The results show that the estimated number of admissions due to deliberate self-harm increased from 2078 in September 1996 to 3189 in September 2008, when the national number of suicide cases peaked, and decreased to 1783 in 2014. Approximately half of the patients were admitted to hospital because of self-harm via means other than drug poisoning, which had a high mortality rate (5.6%. The proportion of patients receiving public assistance was higher in those who had engaged in deliberate self-harm (8.5% relative to that observed in the general population. Overall, the trend in deliberate self-harm was synchronous with the number of suicide cases over time. As economic poverty has been associated with suicidal ideation and behavior and some recipients of public assistance tend to abuse psychotropic medication, the public assistance program should provide mental health support for recipients of social benefit schemes.

  11. Impulsivity and self-harm in adolescence: a systematic review.

    Science.gov (United States)

    Lockwood, Joanna; Daley, David; Townsend, Ellen; Sayal, Kapil

    2017-04-01

    Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11-25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews identified 4496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity-related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision making may offer most benefit in supporting those who self-harm.

  12. Self-harm in patients with schizophrenia spectrum disorders.

    Science.gov (United States)

    Mork, Erlend; Mehlum, Lars; Barrett, Elizabeth A; Agartz, Ingrid; Harkavy-Friedman, Jill M; Lorentzen, Steinar; Melle, Ingrid; Andreassen, Ole A; Walby, Fredrik A

    2012-01-01

    This study describes the prevalence, clinical characteristics, and gender profile of self-harm in a cross-sectional sample of 388 patients with schizophrenia spectrum disorders. All patients were interviewed and assessed with respect to lifetime self-harm and relevant clinical variables. An overall of 49% of the patients reported self-harm which was associated with female gender, having had a depressive episode, younger age at psychosis onset, alcohol abuse or dependence, current suicidality, awareness of illness, and low adherence to prescribed medication. Higher awareness of having a mental disorder was associated with self-harm in men only, while emotional dysregulation was associated with self-harm in women only. We conclude that while self-harm in patients with schizophrenia spectrum disorders is highly prevalent in both genders, risk factors in men and women differ in several important ways.

  13. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.

    Science.gov (United States)

    Wisner, Katherine L; Sit, Dorothy K Y; McShea, Mary C; Rizzo, David M; Zoretich, Rebecca A; Hughes, Carolyn L; Eng, Heather F; Luther, James F; Wisniewski, Stephen R; Costantino, Michelle L; Confer, Andrea L; Moses-Kolko, Eydie L; Famy, Christopher S; Hanusa, Barbara H

    2013-05-01

    The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Sequential case series of women who recently gave birth. Urban academic women's hospital. During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate

  14. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings

    Science.gov (United States)

    Wisner, Katherine L.; Sit, Dorothy K. Y.; McShea, Mary C.; Rizzo, David M.; Zoretich, Rebecca A.; Hughes, Carolyn L.; Eng, Heather F.; Luther, James F.; Wisniewski, Stephen R.; Costantino, Michelle L.; Confer, Andrea L.; Moses-Kolko, Eyclie L.; Famy, Christopher S.; Hanusa, Barbara H.

    2015-01-01

    Importance The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. Objectives To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Design Sequential case series of women who recently gave birth. Setting Urban academic women’s hospital. Participants During the maternity hospitalization, women were offered screening at 4 to 6 weeks post parturn by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. Main Outcomes and Measures A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: “The thought of harming myself has occurred to me” (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Results Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had co-morbid anxiety disorders. A striking 22.6% had bipolar disorders. Conclusions and Relevance The most common diagnosis in screen

  15. Getting out of (self-) harm's way: A study of factors associated with self-harm among asylum seekers in Australian immigration detention.

    Science.gov (United States)

    Hedrick, Kyli

    2017-07-01

    The monitoring of self-harm among asylum seekers in Australian immigration detention has not occurred routinely or transparently. Thus whilst concerns regarding rates of self-harm among asylum seekers have been frequently raised, a paucity of systematic information regarding key factors associated with self-harm among asylum seekers exists. The present study was designed therefore to fill a number of gaps in government monitoring by examining the government's own archived self-harm data. Via a descriptive analysis of self-harm incident reports from all operational Australian immigration detention facilities over a 20-month period to May 2011, obtained under Freedom of Information, the present study identified that 959 incidents of self-harm occurred during this period. A gender bias towards men was also found. In addition to this, 10 different methods of self-harm were identified, the four most common being: cutting (47%), attempted hanging (19%), head hitting (12%) and self-poisoning by medication (6%). Seven different precipitating factors for self-harm were also identified, the four most common were: detention conditions (39%), processing arrangements (27%), negative decisions (24%) and family separation (3%). These findings point strongly to the health benefits of considering alternatives to held immigration detention, such as community based processing. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  16. Non-suicidal reasons for self-harm: A systematic review of self-reported accounts.

    Science.gov (United States)

    Edmondson, Amanda J; Brennan, Cathy A; House, Allan O

    2016-02-01

    Self-harm is a major public health problem yet current healthcare provision is widely regarded as inadequate. One of the barriers to effective healthcare is the lack of a clear understanding of the functions self-harm may serve for the individual. The aim of this review is to identify first-hand accounts of the reasons for self-harm from the individual's perspective. A systematic review of the literature reporting first-hand accounts of the reasons for self-harm other than intent to die. A thematic analysis and 'best fit' framework synthesis was undertaken to classify the responses. The most widely researched non-suicidal reasons for self-harm were dealing with distress and exerting interpersonal influence. However, many first-hand accounts included reasons such as self-validation, and self-harm to achieve a personal sense of mastery, which suggests individuals thought there were positive or adaptive functions of the act not based only on its social effects. Associations with different sub-population characteristics or with the method of harm were not available from most studies included in the analysis. Our review identified a number of themes that are relatively neglected in discussions about self-harm, which we summarised as self-harm as a positiveexperience and defining the self. These self-reported "positive" reasons may be important in understanding and responding especially to repeated acts of self-harm. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  17. Sibling bullying and risk of depression, anxiety, and self-harm: a prospective cohort study.

    Science.gov (United States)

    Bowes, Lucy; Wolke, Dieter; Joinson, Carol; Lereya, Suzet Tanya; Lewis, Glyn

    2014-10-01

    Being the victim of peer bullying is associated with increased risk of psychopathology, yet it is not known whether similar experiences of bullying increase risk of psychiatric disorder when the perpetrator is a sibling. We tested whether being bullied by a sibling is prospectively associated with depression, anxiety, and self-harm in early adulthood. We conducted a longitudinal study using data from >6900 participants of a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) who reported on sibling bullying at 12 years. Our main outcome measures were depression, anxiety, and self-harm, assessed using the Clinical Interview Schedule-Revised during clinic assessments when participants were 18. Children who were frequently bullied were approximately twice as likely to have depression (odds ratio [OR] = 2.16; 95% confidence interval [CI], 1.33-3.51; P siblings. The ORs were only slightly attenuated after adjustment for a range of confounding individual, family, and peer factors. The population-attributable fractions suggested that 13.0% (95% CI, 1.0%-24.7%) of depression and 19.3% (95% CI, 7.6%-29.6%) of self-harm could be explained by being the victim of sibling bullying if these were causal relationships. Being bullied by a sibling is a potential risk factor for depression and self-harm in early adulthood. Our results suggest that interventions designed to target sibling bullying should be devised and evaluated. Copyright © 2014 by the American Academy of Pediatrics.

  18. Self-Harm Behaviour in Adolescents: Body Image and Self-Esteem

    Science.gov (United States)

    Oktan, Vesile

    2017-01-01

    This research aimed to reveal the relationship between self-harm behaviour, body image, and self-esteem, and examined whether there was a difference between the body image and self-esteem of the adolescents who exhibited self-harm behaviour and those who did not. The study was conducted with the participation of 263 high school students--143…

  19. Alcohol and self-harm in Anuradhapura

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Jayasena, Chandima; Agampodi, Thilini Chanchala

    the personal network of the drinker and lead to secondary traumatization. This can appear as emotional distress, financial difficulties and lead to domestic violence and in some cases self-harm and suicide. This interplay between alcohol and self-harm was investigated in individuals, families and communities...

  20. Investigating the "self" in deliberate self-harm.

    Science.gov (United States)

    Adams, Joanna; Rodham, Karen; Gavin, Jeff

    2005-12-01

    In this study, the authors explored how a group of young people aged 16 to 26 years (who identified themselves as having engaged in deliberate self-harm) made sense of the self by conducting two online focus groups and four e-mail interviews. They analyzed data using interpretive phenomenological analysis. The concept of validation was the primary means of making sense of the self and concerned the desire to be considered legitimate and of worth. This desire was clearly evident across three realms of conflict: (a) the intrinsic or extrinsic self, which marked the distinction between objective fact and subjective opinion; (b) the accepted or denied self; and (c) the notion of normality. It is possible that having one's denied self validated online might lead to an exacerbation of an individual's self-harming behavior. Further work is needed to explore the effects of online discussion forums on such taboo forms of behavior.

  1. The prevalence of previous self-harm amongst self-poisoning patients in Sri Lanka

    DEFF Research Database (Denmark)

    Mohamed, Fahim; Perera, Aravinda; Wijayaweera, Kusal

    2011-01-01

    BACKGROUND: One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study...... was to investigate the prevalence of previous self-harm among a consecutive series of self-harm patients presenting to hospitals in rural Sri Lanka. METHOD: Six hundred and ninety-eight self-poisoning patients presenting to medical wards at two hospitals in Sri Lanka were interviewed about their previous episodes...... of self-harm. RESULTS: Sixty-one (8.7%, 95% CI 6.7-11%) patients reported at least one previous episode of self-harm [37 (10.7%) male, 24 (6.8%) female]; only 19 (2.7%, 95% CI 1.6-4.2%) patients had made more than one previous attempt. CONCLUSION: The low prevalence of previous self-harm is consistent...

  2. Perinatal and psychosocial circumstances associated with risk of attempted suicide, non-suicidal self-injury and psychiatric service use. A longitudinal study of young people.

    LENUS (Irish Health Repository)

    Young, Robert

    2011-11-18

    Abstract Background Past studies using large population based datasets link certain perinatal circumstances (birth weight, parity, etc) with mental health outcomes such as suicide, self-harm and psychiatric problems. Problematically, population datasets omit a number of social confounds. The aim of this study is to replicate past research linking perinatal circumstances and mental health (suicidality and use of psychiatric services) and to determine if such associations remain after adjusting for social circumstances. Methods A longitudinal school-based survey of 2157 young people (surveyed at age 11, 13, 15) followed up in early adulthood (age 19). At age 11 parents of participants provided information about perinatal circumstances (birth weight, birth complications, etc.) and psychiatric service use. Participants provided data about their mental health at age 15 (attempted suicide, suicidal thoughts) and at ages 19 (self-harm, psychiatric service use). In addition, data were collected about their social and psychosocial circumstances (gender, deprivation, religion, sexual behaviour, etc.). Results Predictably, social factors were linked to mental health outcomes. For example, those with same sex partners were more likely (OR 4.84) to self-harm than those without a same sex partner. With a single exception, in both unadjusted and adjusted models, perinatal circumstances were not or only marginally associated with mental health outcomes. The exception was the number of birth complications; young people with two or more complications were approximately 2-3 times more likely than those without complications to use psychiatric services. Conclusions While we failed to replicate results found using large population based datasets, some of our results are compatible with prior research findings. Further, evidence from this study supports the influence of perinatal circumstances (birth complications) on later psychiatric problems, or at least higher than expected contact

  3. Harm Avoidance and Self-Directedness characterize fibromyalgic patients and the symptom severity

    Directory of Open Access Journals (Sweden)

    Paolo eLeombruni

    2016-04-01

    Full Text Available AbstractObjective: Evidence in the literature suggests peculiar personality traits for fibromyalgic patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics.Design: The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact.Main Outcome Measures: Participants responded to the Hospital Anxiety and Depression Scale (HADS, the Temperament and Character Inventory (TCI, the Fibromyalgia Impact Questionnaire (FIQ and the Short-Form-36 Health Survey (SF-36.Results: FM patients scored significantly different from healthy participants on the Harm-Avoidance (HA, Novelty Seeking (NS and Self-Directedness (SD. Two clusters were identified: patients in Cluster 1 (n=37 had higher scores on HA and lower scores on RD, SD and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster 2 (n=46.Conclusion: This study confirms the presence of certain personality traits in the FM population. In particular, high levels of Harm Avoidance and low levels of Self-Directedness characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.

  4. Job Stress and Self-Efficacy among Psychiatric Nursing Working in Mental Health Hospitals at Cairo, Egypt

    Science.gov (United States)

    Zaki, Rania. A.

    2016-01-01

    Nursing stress is considered a problem that affects the practice worldwide. Job stress is a harmful response physically and emotionally when the nurses' skills, resources, and needs could not fulfill the requirement of the job. This study was aimed to assess job stress and self-efficacy among psychiatric nursing working in mental health hospitals…

  5. Could a brief assessment of negative emotions and self-esteem identify adolescents at current and future risk of self-harm in the community? A prospective cohort analysis.

    Science.gov (United States)

    Phillips, Rhiannon; Spears, Melissa R; Montgomery, Alan A; Millings, Abigail; Sayal, Kapil; Stallard, Paul

    2013-06-22

    Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings. Data were collected as part of a clinical trial from young people in school years 8-11 (aged 12-16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children's Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months. Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77). A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in

  6. The Effect of Cognitive Behavior Therapy on Decision Making in Adolescents Who Self-Harm: A Pilot Study

    Science.gov (United States)

    Oldershaw, Anna; Simic, Mima; Grima, Emanuela; Jollant, Fabrice; Richards, Clair; Taylor, Lucy; Schmidt, Ulrike

    2012-01-01

    Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also…

  7. [Self-harm vs. harming others: the lived experiences of a dysfunctional family].

    Science.gov (United States)

    Wu, Hsiu-Chin; Lin, Mei-Feng; Yu, Shu-Hua

    2007-10-01

    The purpose of this study was to explore the lived experiences of self-harm and harm to others from the perspective of two adult offspring and a father, the latter of whom was prone to alcohol abuse and domestic violence and had attempted suicide. Written informed consents were obtained from the subjects after a detailed explanation of the research aims and procedures. A qualitative, phenomenological method was applied for the study. Three subjects were interviewed using a semi-structured interview guide designed by the researchers and based on the aims of the study over a six-month period of home care. A qualitative content analysis based on a phenomenological method was used to identify themes in the data. Two main categories emerged: (1) the mutual harm to the couple subsystem, (2) the misplaced parental-child subsystem. Subsequently, two to four themes were identified from each category. These results provide a better analysis and understanding of the perceived experiences of the harm to the spouse, parental, and sibling subsystems. They should also help health professionals to improve awareness of the lived experiences associated with the issues of self-harm and threats of harm to others. This study could serve as a valuable reference in promoting possible prevention strategies aiming at the reduction of self-harm and harm to others in dysfunctional families within the community.

  8. Deliberate self-harm in the emergency department: experience from Karachi, Pakistan.

    Science.gov (United States)

    Shahid, Muhammad; Khan, Murad M; Saleem Khan, Muhammad; Jamal, Yasir; Badshah, Aaref; Rehmani, Rifat

    2009-01-01

    Suicidal behavior is an understudied subject in Pakistan, a South-Asian developing country with a predominantly Muslim population. This study examined the characteristics and management of patients presenting with Deliberate Self-Harm (DSH) to the Emergency Department (ED) of a tertiary care teaching hospital in Karachi, Pakistan. A retrospective chart review of all patients (n = 98), over a period of 12 months was carried out. The demographic details of patients; method of DSH and, if drugs were used, their type, route, and quantity; reason for DSH; past psychiatric history; and outcome were recorded. The mean age of subjects was 23.5 years. The majority of patients were female; most had used drugs for DSH. After initial treatment in the ED, 34 patients were admitted to medical wards for further treatment, 12 were discharged from ED, while 52 patients left against medical advice. The main reasons for leaving against medical advice were financial constraints and fear of legal issues. Seven patients had at least one previous episode of DSH. Patients who left the ED without psychosocial assessment are at increased risk for repetition of DSH as well as suicide.

  9. Outcomes of a Character Strengths-Based Intervention on Self-Esteem and Self-Efficacy of Psychiatrically Hospitalized Youths.

    Science.gov (United States)

    Toback, Rebecca L; Graham-Bermann, Sandra A; Patel, Paresh D

    2016-05-01

    Mental health treatment approaches based on character strengths can be used to complement the traditional focus on functional impairment. The study tested use of a character strengths-based intervention to enhance the self-esteem and self-efficacy of psychiatrically hospitalized youths. Eighty-one hospitalized adolescents were randomly assigned to intervention or comparison groups. The intervention used the Values in Action Inventory of Strengths for Youth to discover character strengths and incorporate them into coping skills. Self-efficacy and self-esteem were measured at baseline, postintervention, two weeks, and three months. Self-esteem and self-efficacy initially increased in both groups, but only the intervention group showed sustained improvement. The intervention was associated with increased self-efficacy at two weeks and increased self-efficacy and self-esteem at three months. A brief, easily administered character strengths-based intervention may be an adjunctive tool in the treatment of psychiatrically hospitalized youths.

  10. Trends in self-harm in Kuala Lumpur, 2005–2011

    OpenAIRE

    Armitage, Christopher J.; Abdul Rahim, Wirda; Rowe, Richard; O'Connor, Rory C.

    2016-01-01

    Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the...

  11. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners.

    Science.gov (United States)

    Marzano, Lisa; Hawton, Keith; Rivlin, Adrienne; Fazel, Seena

    2011-03-01

    We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in women's prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations. Copyright © 2011 Elsevier Ltd. All rights

  12. Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England.

    Science.gov (United States)

    Hawton, Keith; Bergen, Helen; Geulayov, Galit; Waters, Keith; Ness, Jennifer; Cooper, Jayne; Kapur, Navneet

    2016-02-01

    Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients. We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. None. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Probable Post-traumatic Stress Disorder and Self-harming Behaviour: Potential Barriers to Employment?

    Science.gov (United States)

    Hansen, J S; Simonsen, E

    2017-11-14

    The current study screened for post-traumatic stress disorder (PTSD) and self-harming behaviours, often related to borderline personality disorder (BPD), among individuals in a job centre considered unemployable primarily for psychological reasons. Participants (N = 112) filled in questionnaires on PTSD symptoms (n = 62) and self-harming behaviours (n = 59) as part of participating in team-meetings providing the individuals with a return-to-work plan. Differences in demographic variables between individuals with and without valid protocols were small to moderate. Of the individuals filling in the PTSD questionnaire 40% fulfilled criteria for probable PTSD and 31% of the individuals filling in the questionnaire on self-harming behaviours reported five or more types of self-harming behaviours. Only a minority of these individuals had PTSD or BPD respectively mentioned in their case records. Further investigation of the prevalence of PTSD and self-harming behaviour among individuals considered unemployable is warranted as well as an enhanced focus in jobcentres and other institutions supporting employability on detection and treatment of PTSD and early signs of BPD.

  14. Psychological characteristics of self-harming behavior in Korean adolescents.

    Science.gov (United States)

    Lee, Woo Kyeong

    2016-10-01

    Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Te Ira Tangata: A Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in Maori who present to hospital after self harm

    Directory of Open Access Journals (Sweden)

    Wikiriwhi Karen

    2011-05-01

    Full Text Available Abstract Background Maori, the indigenous people of New Zealand, who present to hospital after intentionally harming themselves, do so at a higher rate than non-Maori. There have been no previous treatment trials in Maori who self harm and previous reviews of interventions in other populations have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and sending regular postcards after the self harm attempt may be an effective treatment. There is also a small literature on sense of belonging in self harm and the importance of culture. This protocol describes a pragmatic trial of a package of measures which include problem solving therapy, postcards, patient support, cultural assessment, improved access to primary care and a risk management strategy in Maori who present to hospital after self harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a representative cohort of patients. The main outcome will be the number of Maori scoring below nine on the Beck Hopelessness Scale. Secondary outcomes will be hospital repetition at one year; self reported self harm; anxiety; depression; quality of life; social function; and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit Maori using a Maori clinical team and protocol. It does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. This study is the first randomised control trial to explicitly use cultural assessment and management. Trial

  16. Self-harm, Unintentional Injury, and Suicide in Bipolar Disorder During Maintenance Mood Stabilizer Treatment: A UK Population-Based Electronic Health Records Study.

    Science.gov (United States)

    Hayes, Joseph F; Pitman, Alexandra; Marston, Louise; Walters, Kate; Geddes, John R; King, Michael; Osborn, David P J

    2016-06-01

    Self-harm is a prominent cause of morbidity in patients with bipolar disorder and is strongly associated with suicide. There is evolving evidence that lithium use may reduce suicidal behavior, in addition to concerns that the use of anticonvulsants may increase self-harm. Information is limited about the effects of antipsychotics when used as mood stabilizer treatment. Rates of unintentional injury are poorly defined in bipolar disorder, and understanding drug associations with this outcome may shed light on mechanisms for lithium's potential antisuicidal properties through reduction in impulsive aggression. To compare rates of self-harm, unintentional injury, and suicide in patients with bipolar disorder who were prescribed lithium, valproate sodium, olanzapine, or quetiapine fumarate. This investigation was a propensity score (PS)-adjusted and PS-matched longitudinal cohort study in a nationally representative UK sample using electronic health records data collected between January 1, 1995, and December 31, 2013. Participants included all patients diagnosed as having bipolar disorder who were prescribed lithium, valproate, olanzapine, or quetiapine as maintenance mood stabilizer treatment. The primary outcome was any form of self-harm. Secondary outcomes were unintentional injury and suicide. Of the 14 396 individuals with a diagnosis of BPD, 6671 were included in the cohort, with 2148 prescribed lithium, 1670 prescribed valproate, 1477 prescribed olanzapine, and 1376 prescribed quetiapine as maintenance mood stabilizer treatment. Self-harm rates were lower in patients prescribed lithium (205; 95% CI, 175-241 per 10 000 person-years at risk [PYAR]) compared with those prescribed valproate (392; 95% CI, 334-460 per 10 000 PYAR), olanzapine (409; 95% CI, 345-483 per 10 000 PYAR), or quetiapine (582; 95% CI, 489-692 per 10 000 PYAR). This association was maintained after PS adjustment (hazard ratio [HR], 1.40; 95% CI, 1.12-1.74 for valproate, olanzapine

  17. The prevalence of self-reported deliberate self harm in Irish adolescents.

    LENUS (Irish Health Repository)

    Morey, Carolyn

    2008-01-01

    BACKGROUND: Deliberate self harm is major public health problem, in particular among young people. Although several studies have addressed the prevalence of deliberate self harm among young people in the community, little is known about the extent to which deliberate self harm comes to the attention of medical services, the self harm methods used and the underlying motives. The aim of this study was to determine the prevalence of deliberate self harm in adolescents and the methods, motives and help seeking behaviour associated with this behaviour. METHODS: A cross-sectional survey using an anonymous self-report questionnaire was administered in 39 schools in the Southern area of the Health Service Executive, Ireland. Of the 4,583 adolescents aged 15-17 years who were invited to participate in the survey, 3,881 adolescents took part (response: 85%). RESULTS: A lifetime history of DSH was reported by 9.1% (n = 333) of the adolescents. DSH was more common among females (13.9%) than males (4.3%). Self cutting (66.0%) and overdose (35.2%) were the most common DSH methods. A minority of participants accessed medical services after engaging in DSH (15.3%). CONCLUSION: DSH is a significant problem in Irish adolescents and the vast majority do not come to the attention of health services. Innovative solutions for prevention and intervention are required to tackle DSH in adolescents.

  18. Intrapersonal factors of adolescents self-harming behaviour

    OpenAIRE

    Volodko, Liubov

    2014-01-01

    Researches often differentiate two groups of self-harming adolescents: those who attempters a suicide, and those who are harming themselves in a non-suicidal way, and they don‘t seek the death. However just a few community-based research, which would directly compare these groups, were done so far, and therefore information about the differences of the psychological peculiarity and self-harming behavior‘s internal factors between the groups is ambivalent. Lifestyle and Coping Skills Questionn...

  19. Adolescent self-harm: a school-based study in Northern Ireland.

    Science.gov (United States)

    O'Connor, Rory C; Rasmussen, Susan; Hawton, Keith

    2014-04-01

    The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. This is a cross-sectional study. The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Predictive Factors of Suicide Attempt and Non-Suicidal Self-Harm in Emergency Department

    Directory of Open Access Journals (Sweden)

    Saad Salman

    2014-09-01

    Full Text Available Introduction: Suicide is the third cause of mortality in America, second leading cause of death in developed countries, and one of the major health problems. Self-harm is self-inflicted damage to one’s self with or without suicidal intent. In the present study, the predictive factors of suicide attempt and non-suicidal self-harm were evaluated in patients referred to emergency department (ED with these problem. Methods: The total number of 45 patients with suicide attempt or self-harm admitted to ED were included. Clinical symptoms, thoughts and behaviors of suicidal, and non-suicidal self-harm in these patients were evaluated at baseline. Suicidality, suicidal intent and ideation, non-suicidal self-injury, social withdrawal, disruptive behavior, and poor family functions were evaluated at admission time. Brief clinical visits were scheduled for the twelfth weeks. In the twelfth week, patients returned for their final visit to determine their maintenance treatment. Finally data were analyzed using chi-squared and multiple logistic regression. Results: Forty five patients were included in the study (56.1% female. The mean age of patients was 23.3±10.2 years (range: 15-75; 33.3% married. Significant association of suicide and self-injury was presented at the baseline and in the month before attempting (p=0.001. The most important predictive factors of suicide and self-harm based on univariate analysis were depression (suicidal and non-suicidal items of Hamilton depression rating scale, anxiety, hopelessness, younger age, history of non-suicidal self-harm and female gender (p<0.05. The participants’ quality of life analysis showed a significant higher quality in physical component summary (p=0.002, mental component summary (p=0.001, and general health (p=0.001 at follow up period. Conclusion: At the time of admission in ED, suicide attempt and non-suicidal self-harm are subsequent clinical markers for the patient attempting suicide again. The

  1. Factors Relating to Self-Efficacy Among Psychiatric Nurses.

    Science.gov (United States)

    Yada, Hironori; Kobayashi, Mako; Odachi, Ryo; Yamane, Toshie

    This study aimed to clarify the factors related to self-efficacy experienced by psychiatric nurses. Analysis of qualitative descriptive data from a free self-description questionnaire administered to 16 psychiatric nurses working in psychiatric hospitals revealed 24 codes across the following 8 categories as factors that increase self-efficacy: A1. possibility of practical use in nursing, A2. nursing judgment, A3. improvement of psychiatric symptoms, A4. the patients presenting a positive attitude, A5. building a relationship of trust with the patients, A6. building a relationship of trust with other nurses, A7. work progressing according to plan and A8. team medical practice. Twenty-five codes across the following 10 categories were identified as factors that decrease self-efficacy: B1. lack of communication, B2. uncertainty in caregiving, B3. recurrence of psychiatric symptoms, B4. feeling overpowered by a patient, B5. sense of being too busy to work adequately, B6. difficulty in bringing about self-improvement, B7. sense of loss regarding one's role as a nurse, B8. lack of physical strength, B9. mechanical performance of nursing and B10. fluctuating view of nursing due to mistakes. These factors require intervention for psychiatric nurses' self-efficacy.

  2. Cruel disease, cruel medicine: self-treatment of cutaneous leishmaniasis with harmful chemical substances in Suriname.

    Science.gov (United States)

    Ramdas, Sahienshadebie

    2012-09-01

    Why are potentially harmful, non-biomedical chemical substances, such as battery acid, chlorine, herbicides, and insecticides, used in the treatment of cutaneous leishmaniasis (CL)? What drives people to use these products as medicine? This article is about perceptions of CL, and the quest for a cure, in Suriname, South America. It highlights the associative style of reasoning behind health seeking and discusses the use of harmful chemical substances as medicines. Cutaneous leishmaniasis, a parasitic disease, affects 1 to 1.5 million people globally. It has a spectrum of clinical manifestations, but the most prominent and disfiguring elements are extensive dermatological ulceration and scar formation from lesions. The data upon which this article is based are derived from anthropological research carried out in different parts of Suriname between September 2009 and December 2010. Data was collected through mainly qualitative methods, including interviewing 205 CL patients using structured questionnaires at the Dermatological Service in the capital Paramaribo. Almost all people with CL said they tried self-treatment, varying from the use of ethno-botanical products to non-biomedical chemical solutions. This article presents and interprets the views and practices of CL patients who sought treatment using harsh chemicals. It argues that a confluence of contextual factors - environmental, occupational, infrastructural, geographical, socio-cultural, economic, socio-psychological - leads to the use of harmful chemical substances to treat CL sores. This study is the first in Suriname - and one of the few done globally - focusing on social and cultural aspects related to CL health seeking. It aims to encourage health policy makers and health professionals to carefully initiate, provide, and evaluate CL treatment and prevention programs. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Recent self-harm and psychological measures in the emergency department

    Directory of Open Access Journals (Sweden)

    Jason R. Randall

    2014-11-01

    Full Text Available The assessment of self-harm risk is a common, difficult, and perplexing task for many physicians, especially those working in emergency departments (ED. Attempts have been made to determine objective methods for assessing patients with suicidal ideation or self-harm though there is still a lack of knowledge about objective assessments of these patients. A study was conducted where 181 suicidal patients were enrolled in two EDs within the city of Edmonton, Canada. Initial interviews were conducted in the ED which collected basic demographics and medical history as well as psychometric measures including the Beck Hopelessness Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, Drug Abuse Screening Test 10, and CAGE questionnaire. The results of these measures were compared between those who presented to the ED with self-harm and those who presented only with ideation. Those with recent self-harm scored lower on many of the scales and subscales of distress and impulsivity measured compared to those with no recent self-harm. Possible explanations for this difference include differences in psychological traits between the two groups and possible cathartic effects of self-harm. The lower scores obtained by those that present with self-harm may complicate attempts to use psychometric tools to determine future self-harm risk.

  4. Characteristics and trends of self-harming behaviour in young people.

    Science.gov (United States)

    Cleaver, Karen

    Deliberate self-harm is recognized as a serious public health issue in young people. There is evidence that young people who self-harm are more likely to repeat self-harm, and this in turn increases their risk of completed suicide. Prevalence studies have identified that the rate of self-harm among young people is on the increase, information largely based on data arising from review and analysis of hospital attendances. However, community-based studies indicate that the prevalence is much higher, with those seen in emergency departments representing the 'tip of the iceberg' (Hawton and Rodham, 2006). Young people's motives for self-harm are discussed, as are research findings which indicate that nurses can have negative attitudes towards patients who self-harm. The article considers the implications of this for young people and identifies areas for future research.

  5. Why Suicide? The Analysis of Motives for Self-Harm.

    Science.gov (United States)

    Abbas, Mohammed J; Mohanna, Mostafa A; Diab, Tarig A; Chikoore, Millicent; Wang, Michael

    2018-03-01

    There is a gap in understanding the meaning and motives behind suicidal behaviour. Using the Ideal Type methodology, Jean Baechler systematically examined the internal logic of suicidal and self-harming behaviours. He developed a typology of eleven typical meanings/motives: Flight, Grief, Self-punishment, Vengeance, Crime, Blackmail, Appeal, Sacrifice, Transfiguration, Ordeal and Game. To develop and validate a standardized instrument to measure the motives/meanings of suicidal and self-harming behaviours, using Baechler's typology. We developed a self-fill Likert questionnaire (Ideal Typical Meaning Questionnaire, ITMQ) covering ten of Baechler's eleven types. The questionnaire was completed by 147 patients within four weeks of attempting suicide or self-harm. The Death Attitude Profile-Revised (DAP-R) questionnaire was used to examine the concurrent validity of the Flight and the Transfiguration types and to explore the association between suicidal/self-harming motives and views about death. The final 25-item ITMQ has an eight-factor structure (Appeal/Blackmail, Ordeal/Game, Vengeance, Self-punishment, Sacrifice, Flight, Grief and Transfiguration) supporting Baechler's theory. The types have adequate reliability. Correlations with the DAP-R gave some support for the concurrent validity of the Flight and Transfiguration types. The ITMQ is a measure of suicidal and self-harming motives/meanings based on a sound conceptual framework and could significantly contribute to the understanding of suicidal and self-harming behaviour in research and clinical settings.

  6. Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.

    Science.gov (United States)

    Koning, Kate Louise; McNaught, Angela; Tuffin, Keith

    2017-11-03

    To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcripts was carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.

  7. Gender roles, suicidal ideation, and self-harming in young adults.

    Science.gov (United States)

    Straiton, Melanie L; Roen, Katrina; Hjelmeland, Heidi

    2012-01-01

    This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regression analyses showed that negative femininity positively predicted self-harm and recent suicidal ideation status. Positive femininity was unrelated. Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinity was negatively related to self-harming only. The findings suggest that it is not the conventional feminine gender role per se that is associated with suicidality but specific negatively evaluated aspects. Conceptualizing gender as a multivariate construct may be useful in the gender socialization theory of suicidal behavior.

  8. Explaining Self-Harm: Youth Cybertalk and Marginalized Sexualities and Genders

    Science.gov (United States)

    McDermott, Elizabeth; Roen, Katrina; Piela, Anna

    2015-01-01

    This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people's cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found…

  9. Self-Esteem Deficits Among Psychiatric Patients

    Directory of Open Access Journals (Sweden)

    Muhammad Rizwan

    2015-04-01

    Full Text Available The objective of the present study was to investigate the difference in the level of self-esteem among patients with psychiatric disorders and normal controls. After a detailed literature review, it was hypothesized that there would be a significant difference in the level of self-esteem among patients with psychiatric disorders and normal controls. The sample of the present study consisted of 260 participants, who were further divided into two groups: clinical group (n = 140 and normal controls (n = 120. The age range of the participants in both the samples were 18 to 25 years (with the mean age of 22.14 years for psychiatric patients and 21.18 years for normal controls, and they belonged to middle socioeconomic status. The clinical group consisted of diagnosed psychiatric patients according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR criteria and further divided into four subgroups, including patients of (a schizophrenia (n = 40, (b major depressive disorder (n = 40, (c obsessive-compulsive disorder (n = 40, and (d opioid dependence disorder (n = 20. The semi-structured interview form of Institute of Clinical Psychology, University of Karachi, and Rosenberg Self-Esteem Scale were used. Descriptive Statistics and one-way ANOVA were applied to analyze and interpret the data in statistical terminology. Results indicate significant differences among patients with psychiatric disorders and normal controls on the variable of self-esteem (F = 30.513, df = 4, 255, p< .05. The finding has implications for clinical interventions and also suggests avenues for future research.

  10. Nurses' attitudes towards self-harm: a literature review

    NARCIS (Netherlands)

    Karman, P.; Kool, N.; Poslawsky, I.E.; van Meijel, B.

    2015-01-01

    Accessible summary: People who self-harm experience many problems and needs related to management of emotional and practical stress. A positive attitude among nurses is especially important given the close contact they have with people who self-harm. This article is based on a review of the

  11. Primary School Children and Self Harm: The Emotional Impact upon Education Professionals, and Their Understandings of Why Children Self Harm and How This Is Managed

    Science.gov (United States)

    Simm, Rebecca; Roen, Katrina; Daiches, Anna

    2010-01-01

    There is evidence suggesting that self harm among young people is beginning earlier, in childhood and adolescent years. This paper reports on a qualitative study of primary school staff responses to self harm among children. Some studies with adolescents show self harm presents challenges to education professionals who may lack training or…

  12. Nurses’ attitudes towards self-harm: a literature review

    NARCIS (Netherlands)

    P. Karman; prof Berno van Meijel; I.E. Poslawsky; Nienke Kool

    2014-01-01

    Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses’ attitudes towards

  13. Childhood physical abuse, non-suicidal self-harm and attempted suicide amongst regular injecting drug users.

    Science.gov (United States)

    Darke, Shane; Torok, Michelle

    2013-12-01

    Childhood physical abuse (CPA), non-suicidal self-harm and attempted suicide are all highly prevalent amongst injecting drug users (IDU). This paper reported on the association of CPA with self-harm and attempted suicide. Cross-sectional study, with 300 IDU administered a structured interview examining the prevalence of CPA, non-suicidal self-harm and suicide attempts. CPA was reported by 74.3%, and severe CPA by 40.3%. A history of non-suicidal self-harm was reported by 23.7%, and 25.7% had attempted suicide. Non-suicidal self-harm preceded the suicide attempt in 83.3% of cases where both had occurred. Independent correlates of non-suicidal self-harm were: female gender (OR 3.62), avoided home due to conflict (OR 2.28) and more extensive polydrug use (OR 1.32). Independent correlates of attempted suicide were: severe CPA (OR 3.18), frequent CPA (OR 2.54), avoided home due to conflict (OR 3.95), female gender (OR 2.99), a positive screen for Conduct Disorder (OR 3.53), and more extensive polydrug use (OR 1.52). Those presenting to treatment agencies are highly likely to have a history of CPA, that may still influence their behaviours. Screening for histories of CPA and non-suicidal self-harm appears warranted when determining suicide risk for this population. At the population level, reductions in the rate of CPA, could possibly reduce the rate of subsequent suicidality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Self-Esteem of 8-14-Year-Old Children with Psychiatric Disorders: Disorder- and Gender-Specific Effects.

    Science.gov (United States)

    Stadelmann, Stephanie; Grunewald, Madlen; Gibbels, Charlotte; Jaeger, Sonia; Matuschek, Tina; Weis, Steffi; Klein, Annette Maria; Hiemisch, Andreas; von Klitzing, Kai; Döhnert, Mirko

    2017-02-01

    In this study, we investigated the relation between global and domain-specific self-esteem and psychiatric disorders. A sample of 577 children aged 8-14 years was recruited via psychiatric hospitals and from the general population. Parents were given a diagnostic interview to assess children's psychiatric diagnoses (current/past). Parents and children completed questionnaires on child symptoms. Children completed a questionnaire on global and domain-specific self-esteem (scales: scholastic competence, social acceptance, athletic performance and physical appearance, global self-esteem). Self-esteem of children with current psychiatric disorders was lower than that of healthy controls (η p 2 between 0.01 and 0.08). Concerning scholastic competence, social acceptance and global self-esteem, children with past psychiatric disorders scored also lower than healthy controls. Different current psychiatric disorders showed specific but small effects on dimensions of self-esteem (β between -0.08 and 0.19). Moreover, we found a gender × group interaction, indicating that girls with depressive and adjustment disorders were specifically impaired in their global self-esteem and perception of their physical appearance. Findings might help clinicians to focus on particular domains of self-esteem during the diagnostic process and to define adequate treatment goals.

  15. Non-Suicidal Self-Injury and Indirect Self-Harm among Danish High School Students

    DEFF Research Database (Denmark)

    Møhl, Bo; la Cour, Peter; Skandsen, Annika

    2014-01-01

    Background: Non-suicidal self-injury (NSSI) and indirect self-harm are prevalent among adolescents, but it is rare to see them described as related topics. Objective: The purpose of this study was to investigate whether there is a correlation between the frequencies of NSSI and indirect self-harm...... (e.g., eating problems, alcohol and drug use) and how this may be influenced by gender. Method: Questionnaires about NSSI (e.g., cutting, burning, scratching, hitting oneself) and indirect self-harm were distri­buted to high school students in theCopenhagen area (N = 5650; response rate 53%; females...... 60.8%). Results: A total of 21.5% of the survey respondents had engaged in NSSI (lifetime prevalence), and 16.2% had practiced NSSI within the previous year. Gender differences in NSSI methods were identified. A total of 53.9% of the students had engaged in one or more types of indirect self-harm...

  16. Violence, self-harm, victimisation and homelessness in patients admitted to an acute inpatient unit in South Australia.

    Science.gov (United States)

    Ash, David; Galletly, Cherrie; Haynes, John; Braben, Peter

    2003-06-01

    To measure the incidence of traumatic and potentially socially disruptive events prior to admission to a psychiatric hospital. One hundred and nineteen patients were interviewed and further information was obtained from case notes. Data were collected concerning rates of violence, self-harm, threats of violence or self-harm, physical assault and homelessness. The patients' mean age was 35 years, 70% were male and 77% were currently single. More than half were legally detained. The most common diagnoses were substance abuse disorders, schizophrenia and related psychoses and mood disorders. Eighteen per cent of patients were physically violent at the time of admission. They were more likely to have a diagnosis of substance abuse. Significantly more men (30%) than women (8%) made threats of violence. Eighteen per cent of patients had physically harmed themselves. Significantly more women (70%) than men (40%) had threatened to harm themselves. Eight per cent of patients had been physically assaulted prior to admission. Twenty-seven per cent of patients were homeless. These patients were severely disabled with high rates of comorbidity. Socially disruptive behaviours were common, and almost a quarter of the patients were homeless. This study highlights the need for development of targeted services in the community.

  17. The association between self-image and defence mechanisms in a group of adolescent patients receiving psychiatric treatment

    OpenAIRE

    Bartosz Treger; Feliks Matusiak; Maciej Pilecki; Monika Rogoż

    2015-01-01

    Objectives The aim of the study was to explore the relationship between various areas of self-image and defence mechanisms in adolescents. The study included a division into groups according to whether or not they were receiving psychiatric treatment. Methods Data were obtained from two groups: a clinical group (30 persons), consisting of adolescent patients of the Adolescent Inpatient Ward of the Child and Adolescent Psychiatry Clinic and a control group (40 persons), adolescents a...

  18. An Empirical Analysis of Internet Message Boards for Self-Harming Behavior.

    Science.gov (United States)

    Eichenberg, Christiane; Schott, Markus

    2017-01-01

    Much debate surrounds the potential effects of self-harm forum use. Arguments in favor highlight factors such as providing access to a supportive community. However critical voice highlighting potential dangers such as forums serving as a platform to promote self-harm, clearly dominate the debate. Using an online questionnaire, the goal of the current study was to examine sociodemographic characteristics, the psychopathology of forum users, motives for participating, and subjective effects of self-harm forum use. A total of 309 self-harm forum users participated in this study. 3 heterogeneous user types with differing motives for visiting the forum and different usage effects were identified. The results question the assumptions that self-harm forums are a source of harm and point to their predominantly constructive and preventive functions.

  19. Suicidal behavior and self-harm in girls with eating disorders

    Directory of Open Access Journals (Sweden)

    Koutek J

    2016-04-01

    Full Text Available Jiri Koutek, Jana Kocourkova, Iva Dudova Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic Abstract: Comorbid psychopathology, including self-harm and suicidal behavior, is often found in patients with eating disorders. To better understand the reasons for high comorbid psychopathology among eating disorders, self-harm, and suicidal behavior, we examined this comorbidity in female patients hospitalized with eating disorders. In a sample of 47 girls admitted for anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa, 72% had depressive symptoms, 11% had obsessive-compulsive symptoms, 9% had anxiety disorder, 23% had substance abuse, and 57% had disharmonious personality development. Suicidal behavior was present in 60% of patients and self-harm in 49%. Association was found between self-harm and suicidality. In all, 68% of girls with eating disorders had a positive score in the Children’s Depression Inventory questionnaire and 62% of them in the Child Adolescent Suicidal Potential Index questionnaire. Clinical examination of girls with eating disorders should focus on identifying the risk of suicidal behavior and self-harm. Keywords: eating disorders, child, adolescent, self-harm, suicidal behavior

  20. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER

    DEFF Research Database (Denmark)

    Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina

    2016-01-01

    were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS: At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14......BACKGROUND: Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN: The DiaS trial was designed...... as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical...

  1. Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners.

    Science.gov (United States)

    James, Karen; Samuels, Isaac; Moran, Paul; Stewart, Duncan

    2017-05-01

    Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  2. Intoxication with alcohol at the time of self-harm and pre-existing involvement with mental health services are associated with a pre-disposition to repetition of self-harming behavior in a large cohort of older New Zealanders presenting with an index episode of self-harm.

    Science.gov (United States)

    Ames, David

    2017-08-01

    The paper on predictors of repeat self-harm and suicide by Cheung et al. (2017), which has been chosen by the editorial team as paper of the month for this issue of International Psychogeriatrics, makes a very useful contribution to the study of self-harm and suicide in late life. Of 339 individuals presenting with an index episode of self-harm to one of seven Emergency Departments (EDs) in New Zealand, close to 15% harmed themselves again within one year and for nearly one in six of these 50 people, the repeat episode was fatal. Having alcohol in the blood and already being engaged with mental health services at the time of the index episode both had some utility in predicting the occurrence of a further self-harm episode. While it is encouraging that mental health services look to have been focusing on those who turned out to be at highest risk, clinicians may need to be particularly vigilant when following up individuals who had been drinking alcohol at the time of an initial self-harm presentation. This study also emphasizes the high risk of recurrent self-harm and completed suicide in those older adults who harm themselves and survive the initial episode. It deserves to be widely cited and gives some direction for future research on interventions designed to diminish the recurrence of self-harm in those of our patients who have presented to an ED with an initial self-harm episode.

  3. Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: associations with self-reported child maltreatment and sexual risk behaviors.

    Science.gov (United States)

    Oshri, Assaf; Tubman, Jonathan G; Jaccard, James

    2011-11-01

    Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

  4. Appreciating Complexity in Adolescent Self-Harm Risk Factors: Psychological Profiling in a Longitudinal Community Sample.

    Science.gov (United States)

    Stanford, Sarah; Jones, Michael P; Hudson, Jennifer L

    2018-05-01

    Past research identifies a number of risk factors for adolescent self-harm, but often fails to account for overlap between these factors. This study investigated the underlying, broader concepts by identifying different psychological profiles among adolescents. We then compared new self-harm rates over a six-month period across different psychological profiles. Australian high school students (n = 326, 68.1% female) completed a questionnaire including a broad range of psychological and socioenvironmental risk and protective factors. Non-hierarchical cluster analysis produced six groups with different psychological profiles at baseline and rate of new self-harm at follow-up. The lowest rate was 1.4% in a group that appeared psychologically healthy; the highest rate was 37.5% in a group that displayed numerous psychological difficulties. Four groups with average self-harm had varied psychological profiles including low impulsivity, anxiety, impulsivity, and poor use of positive coping strategies. Identifying multiple profiles with distinct psychological characteristics can improve detection, guide prevention, and tailor treatment.

  5. Suicide and Self-Harm Related Internet Use.

    Science.gov (United States)

    Padmanathan, Prianka; Biddle, Lucy; Carroll, Robert; Derges, Jane; Potokar, John; Gunnell, David

    2018-05-31

    The rise in Internet use adds a new dimension to suicide prevention. We investigated suicide/self-harm (S/Sh)-related Internet use among patients presenting to hospital with self-harm. We asked 1,198 adult and 315 child and adolescent patients presenting to hospital following self-harm in a city in South West England about Internet use associated with their hospital presentation. Associations between Internet use and sociodemographic and clinical characteristics were investigated using multivariable logistic regression models. Focus groups with clinicians explored the acceptability and utility of asking about Internet use. The prevalence of S/Sh-related Internet use was 8.4% (95% CI: 6.8-10.1%) among adult hospital presentations and 26.0% (95% CI = 21.3-31.2%) among children's hospital presentations. In both samples, S/Sh-related Internet use was associated with higher levels of suicidal intent. Mostly, clinicians found it acceptable to ask about Internet use during psychosocial assessments and believed this could inform perceptions of risk and decision-making. It is unclear whether the findings in this study are applicable to the general self-harm patient population because only those who had psychosocial assessments were included. S/Sh-related Internet use is likely to become increasingly relevant as the Internet-native generation matures. Furthermore, Internet use may be a proxy marker for intent.

  6. Hurtful Emotions: Understanding Self-Harm

    Science.gov (United States)

    ... Issues Subscribe September 2017 Print this issue Hurtful Emotions Understanding Self-Harm En español Send us your ... help you learn new ways to cope with emotion. See the Wise Choices box for tips on ...

  7. Negative Intrusive Thoughts and Dissociation as Risk Factors for Self-Harm

    Science.gov (United States)

    Batey, Helen; May, Jon; Andrade, Jackie

    2010-01-01

    Relationships between self-harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation and childhood trauma, had lower self-worth, and reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly…

  8. The impact of familial expressed emotion on clinical and personal recovery among patients with psychiatric disorders: The mediating roles of self-stigma content and process.

    Science.gov (United States)

    Chan, Kevin Ka Shing; Lam, Chun Bun

    2018-05-24

    The present study examined the associations of familial expressed emotion (EE) with clinical and personal recovery among patients with psychiatric disorders, as well as the potential mechanisms underlying these associations. Guided by the content-process theory of self-stigma, we hypothesized that EE would be negatively associated with clinical and personal recovery and that these associations would be mediated by self-stigma content and process. A total of 311 patients with psychiatric disorders completed questionnaires on their perceptions of EE, self-stigma, and recovery. Structural equation modeling demonstrated that EE was positively associated with self-stigma content and process, which were in turn negatively associated with clinical and personal recovery. The indirect effects of EE on clinical and personal recovery, via self-stigma content and process, were also significant. Multigroup analyses further demonstrated that the impact of EE on self-stigma and recovery was generalizable across patients with psychotic and nonpsychotic disorders. Theoretically, our findings revealed the potential pathways through which EE may adversely affect psychiatric recovery. Practically, our findings highlighted the importance of designing multipronged intervention programs to reduce familial EE and its potential harmful impact on psychiatric patients. In addition to helping family members improve their knowledge about psychiatric disorders and adjust their communication styles, practitioners should help psychiatric patients develop resilience against EE, mitigate self-stigma, and achieve recovery. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  9. Dealing with difficult days: Functional coping dynamics in self-harm ideation and enactment.

    Science.gov (United States)

    Nielsen, Emma; Sayal, Kapil; Townsend, Ellen

    2017-01-15

    Self-harm affords people a means of coping. However, little is known about how functional coping dynamics differ between stressful situations in which people self-harm (enactment), think about harming (ideation), or experience no self-harmful thoughts or behaviours. Participants (N = 1,157) aged 16-49 years (M = 18.21, SD = 3.24) with a recent history of self-harm (past 3 months) reported how they coped in response to their most significant recent stressor (3 months). Almost 40% of participants, all of whom had self-harmed in the last 3 months, had no self-harm experience (thoughts or behaviours) in response to their most significant stressor in that time frame. In multivariate analysis, adjusting for symptoms of depression and anxiety, reappraisal coping was predictive of self-harm thoughts. Approach, emotion regulation and reappraisal coping were predictive of self-harm behaviour. Emotion regulation coping differentiated self-harm ideation and enactment groups. The cross-sectional design of the study precludes the ability to make inferences regarding causality. Further, there is no agreed definition of 'recent' self-harm. Taken together, the findings suggest that functional coping dynamics may be differentially associated with self-harm ideation and enactment. This is important, given that understanding the transitions between ideation and enactment has been identified as a critical frontier in suicide prevention. Further, results indicate that seemingly innocuous events may have a profound impact as tipping points for enaction; this has implications for clinical practice, including the co-production of safety plans. Copyright © 2016. Published by Elsevier B.V.

  10. Harm reduction as a strategy for supporting people who self-harm on mental health wards : the views and experiences of practitioners

    OpenAIRE

    James, Karen; Samuels, Isaac; Moran, Paul; Stewart, Duncan

    2017-01-01

    Background: Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. Methods: We explored practitioners’ views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a rando...

  11. The paradox of public holidays: Hospital-treated self-harm and associated factors.

    Science.gov (United States)

    Griffin, Eve; Dillon, Christina B; O'Regan, Grace; Corcoran, Paul; Perry, Ivan J; Arensman, Ella

    2017-08-15

    Recent research on the patterns of self-harm around public holidays is lacking. This study used national data to examine the patterns of hospital-treated self-harm during public holidays, and to examine associated factors. Data on self-harm presentations to all emergency departments were obtained from the National Self-Harm Registry Ireland. The association between self-harm presentations and public holidays was examined using univariate and multivariate Poisson regression analyses. A total of 104,371 presentations of self-harm were recorded between 2007 and 2015. The mean number of self-harm presentations was 32 on public holidays. St. Patrick's Day had the highest number of presentations compared to all other public holidays, with a daily mean of 44 presentations. Across all years, self-harm presentations during public holidays had a 24% increased risk of involving alcohol consumption compared to all other days and this effect was most pronounced during the Christmas period. The association with alcohol remained significant at a multivariate level. Presentations on public holidays were more likely to attend out of normal working hours. An increase in male presentations involving self-cutting was observed on public holidays and there was an over-representation of males presenting for the first time. It is likely that extent of alcohol involvement in self-harm presentations reported here is an underestimate, as it was dependent on the information being recorded by the attending clinician. Public holidays are associated with an elevated number of self-harm presentations to hospital, with presentations to hospital involving alcohol significantly increased on these days. Hospital resources should be targeted to address increases during public holidays, including during out-of-hours. Involvement of alcohol may delay delivery of care to these patients in emergency settings. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka

    Directory of Open Access Journals (Sweden)

    Lushan V. Hettiarachchi

    2018-01-01

    Full Text Available Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3 detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention, bullying victimization, physical and sexual abuse (victimization and perpetration, and exposure to self-harm/suicide by others. Seventy-seven participants (43% reported a lifetime history of self-harm, 19 of whom (25% who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.

  13. Genetic and Environmental Contributions to Self-Reported Thoughts of Self-Harm and Suicide

    NARCIS (Netherlands)

    Althoff, R.R.; Hudziak, J.J.; Willemsen, G.; Hudziak, V.; Bartels, M.; Boomsma, D.I.

    2012-01-01

    Thoughts of self-harm and suicidal behavior are thought to be influenced by both genetics and environment. Molecular genetic studies are beginning to address the question of which genes may be involved and whether different genes may be expressed in men and women. We examined thoughts of self-harm

  14. Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies.

    Science.gov (United States)

    Ostrow, Laysha; Nemec, Patricia B; Smith, Carina

    2018-05-29

    Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.

  15. Out of the blue: Untangling the association between impulsivity and planning in self-harm.

    Science.gov (United States)

    Rawlings, Jodie; Shevlin, Mark; Corcoran, Rhiannon; Morriss, Richard; Taylor, Peter James

    2015-09-15

    Planned and unplanned acts of self-harm may have distinct clinical and psychological correlates. Trait impulsivity is one factor that might be expected to determine whether self-harm is planned. Research so far has focussed on suicide attempts and little is known about how individuals engaging in planned and unplanned acts of self-harm differ. The aim of the current study was to examine how individuals who report planned self-harm, unplanned self-harm, and no self-harm differ in terms of impulsivity and affective symptoms (depression, anxiety, and activated mood). An online survey of University students (n = 1350) was undertaken including measures of impulsivity, affective symptoms and self-harm. Analyses made use of a multinomial logistic regression model with affective and cognitive forms of impulsivity estimated as latent variables. Trait affective impulsivity, but not cognitive, was a general risk factor for whether self-harm occurred. There was no evidence of differences between planned and unplanned self-harm. Affective symptoms of depression and anxiety mediated the relationship between affective impulsivity and self-harm. The study was cross-sectional, relied on a student sample which may not generalise to other populations. Trait affective impulsivity is associated with self-harm but it appears to be mediated by depression and anxiety symptoms. The exact relationships between trait affective impulsivity, depression, anxiety and self-harm require further longitudinal research in clinical populations but might lead to improved risk assessment and new therapeutic approaches to self-harm. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Developing, implementing and evaluating a model for an outpatient self-harm service.

    Science.gov (United States)

    Brand, Fiona; Lascelles, Karen

    2017-05-10

    Aim To reduce the incidence of self-harming behaviour and improve well-being and experience of care for individuals who present regularly to the emergency department in one hospital following self-harm, by providing outpatient care. Method This was a 12-month nurse-led practice development project to develop, implement and evaluate a brief-intervention outpatient service for individuals who presented to the emergency department following self-harm and who were identified as being at risk of further self-harm. The service improvement was informed by an action research process and the principles of appreciative inquiry. Findings The project provided a short-term outpatient follow-up service, known as Brief Interventions in Repeat Self Harm (BIRSH), to patients who presented to the emergency department following self-harm, and who were considered at risk of further self-harm. The intervention enabled the clinician to validate the patient's distress and offer them short-term outpatient follow-up care. The BIRSH sessions were offered to 38 patients. A total of 26 patients attended one or more BIRSH session, and all of these individuals showed a reduction in the number of presentations to the emergency department following self-harm in the six months following the intervention, compared to the six months before the intervention. Conclusion The BIRSH outpatient service appears to have been a contributory factor in reducing self-harm for patients who engaged with the service. The service improvement was informed by an action research process and the principles of appreciative inquiry, which provided a positive, focused approach to the practice development project.

  17. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

    Science.gov (United States)

    Slemon, Allie; Jenkins, Emily; Bungay, Vicky

    2017-10-01

    The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

  18. Deliberate Self-Harm within an International Community Sample of Young People: Comparative Findings from the Child & Adolescent Self-Harm in Europe (CASE) Study

    Science.gov (United States)

    Madge, Nicola; Hewitt, Anthea; Hawton, Keith; de Wilde, Erik Jan; Corcoran, Paul; Fekete, Sandor; van Heeringen, Kees; De Leo, Diego; Ystgaard, Mette

    2008-01-01

    Background: Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people. Method: Over 30,000…

  19. A Systematic Review of Social Media Use to Discuss and View Deliberate Self-Harm Acts.

    Science.gov (United States)

    Dyson, Michele P; Hartling, Lisa; Shulhan, Jocelyn; Chisholm, Annabritt; Milne, Andrea; Sundar, Purnima; Scott, Shannon D; Newton, Amanda S

    2016-01-01

    To conduct a systematic review of studies of social media platforms used by young people to discuss and view deliberate self-harm. 11 electronic databases were searched from January 2000 to January 2012 for primary research; in June 2014 an updated search of Medline was conducted. Grey literature sources were also searched. Search results were screened by two reviewers. Data were extracted by one reviewer and verified by another. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Due to heterogeneity in study objectives and outcomes, results were not pooled; a narrative analysis is presented. 26 studies were included. Most were conducted in Canada or the UK (30.8% each), used qualitative designs (42.3%), and evaluated discussion forums (73.1%). Participants were most often aged 19-21 years (69.2%), female (mean 68.6%), and 19.2% had a documented history of depression. The social media platforms evaluated were commonly supportive and provided a sense of community among users. Support included suggestions for formal treatment, advice on stopping self-harming behavior, and encouragement. Harms included normalizing and accepting self-harming behavior; discussion of motivation or triggers, concealment, suicidal ideation or plans; and live depictions of self-harm acts. Although this evidence is limited by its descriptive nature, studies identify beneficial and detrimental effects for young people using social media to discuss and view deliberate self-harm. The connections users make online may be valuable to explore for therapeutic benefit. Prospective, longitudinal investigations are needed to identify short- and long-term potential harms associated with use.

  20. A Systematic Review of Social Media Use to Discuss and View Deliberate Self-Harm Acts.

    Directory of Open Access Journals (Sweden)

    Michele P Dyson

    Full Text Available To conduct a systematic review of studies of social media platforms used by young people to discuss and view deliberate self-harm.11 electronic databases were searched from January 2000 to January 2012 for primary research; in June 2014 an updated search of Medline was conducted. Grey literature sources were also searched. Search results were screened by two reviewers. Data were extracted by one reviewer and verified by another. Methodological quality was assessed using the Mixed Methods Appraisal Tool.Due to heterogeneity in study objectives and outcomes, results were not pooled; a narrative analysis is presented. 26 studies were included. Most were conducted in Canada or the UK (30.8% each, used qualitative designs (42.3%, and evaluated discussion forums (73.1%. Participants were most often aged 19-21 years (69.2%, female (mean 68.6%, and 19.2% had a documented history of depression. The social media platforms evaluated were commonly supportive and provided a sense of community among users. Support included suggestions for formal treatment, advice on stopping self-harming behavior, and encouragement. Harms included normalizing and accepting self-harming behavior; discussion of motivation or triggers, concealment, suicidal ideation or plans; and live depictions of self-harm acts.Although this evidence is limited by its descriptive nature, studies identify beneficial and detrimental effects for young people using social media to discuss and view deliberate self-harm. The connections users make online may be valuable to explore for therapeutic benefit. Prospective, longitudinal investigations are needed to identify short- and long-term potential harms associated with use.

  1. Psychiatric disorders of patients seeking obesity treatment

    Directory of Open Access Journals (Sweden)

    Lin Hung-Yen

    2013-01-01

    Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

  2. Prevalence and Correlates of Self-Harm in the German General Population.

    Directory of Open Access Journals (Sweden)

    Astrid Müller

    Full Text Available The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15, the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4, and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49% acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2 = 5.38, p = 0.020. Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4, higher impulsivity scores (BIS-15, and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming

  3. Prevalence and Correlates of Self-Harm in the German General Population.

    Science.gov (United States)

    Müller, Astrid; Claes, Laurence; Smits, Dirk; Brähler, Elmar; de Zwaan, Martina

    2016-01-01

    The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2 = 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more

  4. How people who self-harm negotiate the inpatient environment: the mental healthcare workers perspective.

    Science.gov (United States)

    Thomas, J B; Haslam, C O

    2017-09-01

    WHAT IS KNOWN ABOUT THE SUBJECT?: Self-harm plays a function, commonly in the form of distress management. There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue. This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress. It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around. Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can

  5. Mental health nurses' attitudes toward self-harm: Curricular implications

    Directory of Open Access Journals (Sweden)

    David G. Shaw

    2016-10-01

    Methods: The study aimed to explore the attitudes of mental health nurses toward service users who self-harm in secure environments, and to inform mental health curriculum development. It was conducted in a large forensic mental health unit, containing medium and low secure facilities, to the west of London, UK. A qualitative multi-method approach was adopted, underpinned by interpretative phenomenological analysis. Data were obtained from mental health nurses using individual interviews and focus groups, and analysis followed a step-by-step thematic approach using interpretative phenomenological analysis. Results: Nurses' attitudes toward self-harm varied but were mainly negative, and this was usually related to limited knowledge and skills. The results of the study, framed by the Theory of Planned Behaviour, led to the development of a proposed educational model entitled ‘Factors Affecting Self-Harming Behaviours’ (FASH. Conclusion: The FASH Model may inform future curriculum innovation. Adopting a holistic approach to education of nurses about self-harm may assist in developing attitudes and skills to make care provision more effective in secure mental health settings.

  6. Stock Market Fluctuations and Self-Harm among Children and Adolescents in Hong Kong.

    Science.gov (United States)

    Wong, Wilfred Hing-Sang; Lee, James Chun-Yin; Ho, Frederick Ka-Wing; Li, Tim Man-Ho; Ip, Patrick; Chow, Chun-Bong

    2017-06-09

    Although a few studies investigated the impact of stock market fluctuations on population health, the question of whether stock market fluctuations have an impact on self-harm in children and adolescents remain unanswered. This study therefore investigated the association between stock market fluctuations and self-harm among children and adolescents in Hong Kong. Daily self-harm attendance records were retrieved from all 18 local Accident and Emergency Departments (AED) from 2001 to 2012. 4931 children and adolescents who committed self-harm were included. The results indicated positive correlation between daily change in stock market index, Hang Seng Index (∇HSI, per 300 points), and daily self-harm incident risk of children and adolescents, without time lag between the two. The incident risk ratio for ∇HSI was 1.09 ( p = 0.0339) in children and 1.06 ( p = 0.0246) in adolescents. Importantly, non-trading days were found to impose significant protective effect in both groups against self-harm risk. Our results showed that stock market fluctuations were related to self-harm behaviors in children and adolescents. Parents and professionals should be educated about the potential harm of stock market fluctuations and the importance of effective parenting in reducing self-harm among children and adolescents.

  7. Effects of comorbidity and early age of onset in young people with Bipolar Disorder on self harming behaviour and suicide attempts.

    Science.gov (United States)

    Moor, Stephanie; Crowe, Marie; Luty, Sue; Carter, Janet; Joyce, Peter R

    2012-02-01

    The age of the first episode of illness in Bipolar Disorder has been shown to be an important predictor of outcome with early onset, particularly onset before puberty, associated with greater comorbidity, a poorer quality of life and greatest impairment in functioning. Baseline data from a psychotherapy study was used to examine the prevalence of other comorbid psychiatric conditions and the impact of onset at an early age on both self harming behaviour and suicide attempts in young people with Bipolar Disorder. This study of 100 adolescents and young adults (aged 15-36 years) with Bipolar Disorder showed that comorbid conditions were very common, even at the start of their bipolar illness. Comorbidity increased as the age of onset decreased with very early onset (self harmed and attempted suicide with high lethal intent. Self harming behaviour was predicted by having a lifetime diagnoses of Borderline Personality Disorder and Panic Disorder along with an early age of onset of Bipolar Disorder. In contrast, previous suicide attempts were predicted by greater comorbidity and not by very early (<13 years) age of onset. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. IQ and adolescent self-harm behaviours in the ALSPAC birth cohort.

    Science.gov (United States)

    Chang, Shu-Sen; Chen, Ying-Yeh; Heron, Jon; Kidger, Judi; Lewis, Glyn; Gunnell, David

    2014-01-01

    Low IQ is associated with an increased risk of suicide and suicide attempt in adults, but less is known about the relationship between IQ and aspects of suicidal/self-harm behaviours in adolescence. We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective UK cohort. Binomial and multinomial logistic regression models were used to examine the association of IQ measured at age 8 with suicide-related outcomes amongst 4810 adolescents aged 16-17 years. There was some evidence that associations differed in boys and girls (p values for interaction ranged between 0.06 and 0.25). In boys higher IQ was associated with increased risk of suicidal thoughts (adjusted odds ratio per 10 point increase in IQ score=1.14, 95% Confidence Interval [CI] 1.01-1.28) and suicidal plans (1.15, 95% CI 0.93-1.43), although statistical evidence for the latter association was limited. There was also evidence for an association with non-suicidal self-harm (1.24, 95% CI 1.08-1.45) but not suicidal self-harm (1.04, 95% CI 0.86-1.25). In girls higher IQ was associated with increased risk of non-suicidal self-harm (1.11, 95% CI 1.02-1.22) but not suicidal thoughts, suicidal plans or suicidal self-harm. Loss to follow up and questionnaire non-response may have led to selection bias. In contrast to previous studies of IQ-suicide associations in adults, we found that higher IQ was associated with an increased risk of non-suicidal self-harm in male and female adolescents and suicidal thoughts in males. Associations of IQ with self-harm differed for self-harm with and without suicidal intent, suggesting that the aetiology of these behaviours may differ. © 2013 Elsevier B.V. All rights reserved.

  9. [Psychiatric treatment sentences.

    DEFF Research Database (Denmark)

    Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben

    2010-01-01

    INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...

  10. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder.

    Science.gov (United States)

    McMain, Shelley F; Links, Paul S; Gnam, William H; Guimond, Tim; Cardish, Robert J; Korman, Lorne; Streiner, David L

    2009-12-01

    The authors sought to evaluate the clinical efficacy of dialectical behavior therapy compared with general psychiatric management, including a combination of psychodynamically informed therapy and symptom-targeted medication management derived from specific recommendations in APA guidelines for borderline personality disorder. This was a single-blind trial in which 180 patients diagnosed with borderline personality disorder who had at least two suicidal or nonsuicidal self-injurious episodes in the past 5 years were randomly assigned to receive 1 year of dialectical behavior therapy or general psychiatric management. The primary outcome measures, assessed at baseline and every 4 months over the treatment period, were frequency and severity of suicidal and nonsuicidal self-harm episodes. Both groups showed improvement on the majority of clinical outcome measures after 1 year of treatment, including significant reductions in the frequency and severity of suicidal and nonsuicidal self-injurious episodes and significant improvements in most secondary clinical outcomes. Both groups had a reduction in general health care utilization, including emergency visits and psychiatric hospital days, as well as significant improvements in borderline personality disorder symptoms, symptom distress, depression, anger, and interpersonal functioning. No significant differences across any outcomes were found between groups. These results suggest that individuals with borderline personality disorder benefited equally from dialectical behavior therapy and a well-specified treatment delivered by psychiatrists with expertise in the treatment of borderline personality disorder.

  11. Self-harm in British South Asian women: psychosocial correlates and strategies for prevention

    OpenAIRE

    Waheed W; Husain MI; Husain Nusrat

    2006-01-01

    Abstract Objective To review the rates of self-harm in British South Asian women, look into the factors that contribute to these high rates of self-harm and discuss possible strategies for prevention and provision of culturally sensitive service for South Asian women who harm themselves. Method Review. Results South Asian women are significantly more likely to self harm between ages 16–24 years than white women. Across all age groups the rates of self harm are lower in South Asian men as comp...

  12. The impact of prison staff responses on self-harming behaviours: prisoners' perspectives.

    Science.gov (United States)

    Marzano, Lisa; Ciclitira, Karen; Adler, Joanna

    2012-03-01

    To further understanding of how health and correctional staff responses to self-harming behaviours influence prisoners and their subsequent actions. Participant-centred, qualitative methods were used to explore the complex and under-researched perspectives of self-harming male prisoners. Semi-structured interviews were conducted with 20 adult male prisoners who had engaged in repetitive, non-suicidal self-harm during their current prison sentence, or considered doing so. The interviews were analyzed drawing on principles of thematic analysis and discourse analysis. With some exceptions, prison officers, nurses, and doctors are portrayed by prisoners as being ill-prepared to deal with repetitive self-harm, often displaying actively hostile attitudes and behaviours. These findings underscore the need for appropriate training, support and supervision for staff working with self-harming prisoners. ©2011 The British Psychological Society.

  13. Correlates of self-harm and suicide attempts in justice-involved young people

    Science.gov (United States)

    Spivak, Benjamin; Borschmann, Rohan; Kinner, Stuart A.; Hachtel, Henning

    2018-01-01

    The purpose of this study was to ascertain the prevalence and correlates of self-harm among young people in detention in Australia. The sample included 215 (177 male; 38 female) young people who were in youth detention in the state of Victoria, Australia. Participants were administered a series of questionnaires related to self-harm, mental health, socio-environmental experiences and behaviours. Overall, one-third (33%) of the sample reported previous self-harm and 12% reported at least one suicide attempt. In a multivariate logistic regression analysis, a history of childhood trauma, contact with mental health services, and low educational interest significantly increased the likelihood of self-harm. Young people who reported a suicide attempt scored significantly higher on the measure of childhood trauma than did youth who had engaged in non-suicidal self-harm. Findings demonstrate a strong connection between childhood traumatic experiences and suicidal behaviours for youth in detention. Trauma histories and mental health concerns must be considered when identifying youth at increased risk of self-harm. PMID:29447289

  14. Deliberate Self-Harm in Adolescence: A Challenge for Schools

    Science.gov (United States)

    Best, Ron

    2006-01-01

    Acts of deliberate self-harm (DSH) by adolescents are thought to be on the increase. Many of those who self-harm are of school age and it is to be expected that schools (and their teachers) will be aware of the problem and will respond appropriately as part of their pastoral-care provision. However, a recent survey of research in pastoral care and…

  15. Emergency staff reactions to suicidal and self-harming patients.

    Science.gov (United States)

    Pompili, Maurizio; Girardi, Paolo; Ruberto, Amedeo; Kotzalidis, Giorgio D; Tatarelli, Roberto

    2005-08-01

    Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.

  16. A Systematic Review of Social Media Use to Discuss and View Deliberate Self-Harm Acts

    Science.gov (United States)

    Dyson, Michele P.; Hartling, Lisa; Shulhan, Jocelyn; Chisholm, Annabritt; Milne, Andrea; Sundar, Purnima; Scott, Shannon D.; Newton, Amanda S.

    2016-01-01

    Objective To conduct a systematic review of studies of social media platforms used by young people to discuss and view deliberate self-harm. Study Design 11 electronic databases were searched from January 2000 to January 2012 for primary research; in June 2014 an updated search of Medline was conducted. Grey literature sources were also searched. Search results were screened by two reviewers. Data were extracted by one reviewer and verified by another. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results Due to heterogeneity in study objectives and outcomes, results were not pooled; a narrative analysis is presented. 26 studies were included. Most were conducted in Canada or the UK (30.8% each), used qualitative designs (42.3%), and evaluated discussion forums (73.1%). Participants were most often aged 19–21 years (69.2%), female (mean 68.6%), and 19.2% had a documented history of depression. The social media platforms evaluated were commonly supportive and provided a sense of community among users. Support included suggestions for formal treatment, advice on stopping self-harming behavior, and encouragement. Harms included normalizing and accepting self-harming behavior; discussion of motivation or triggers, concealment, suicidal ideation or plans; and live depictions of self-harm acts. Conclusions Although this evidence is limited by its descriptive nature, studies identify beneficial and detrimental effects for young people using social media to discuss and view deliberate self-harm. The connections users make online may be valuable to explore for therapeutic benefit. Prospective, longitudinal investigations are needed to identify short- and long-term potential harms associated with use. PMID:27191728

  17. [Psychiatric comorbidities and quality of life in adult individuals with high potential: Relationships with self-esteem].

    Science.gov (United States)

    Lancon, Christophe; Martinelli, Marion; Michel, Pierre; Debals, Matthias; Auquier, Pascal; Guedj, Eric; Boyer, Laurent

    2015-05-01

    The objectives of this study were: 1) to describe the psychiatric comorbidities in adult individuals with high potential; 2) to assess self-esteem and quality of life in comparison with general population; 3) to study the relationships between intelligent quotient (IQ), self-esteem, psychiatric comorbidities and quality of life. This cross-sectional study was conducted in the psychiatric department of a public university hospital (Marseille, France). An outpatient hospital service has been specifically opened to test intelligence since 2012. During a period of six months, it was proposed to all the major individuals with high intellectual potential to receive a psychiatric evaluation using the Mini International Neuropsychiatric Interview (MINI) and to complete self-report questionnaires assessing depression (Beck scale), anxiety (STAI), self-esteem (Rosenberg scale) and quality of life (SF-36). Relationships between IQ, self-esteem, psychiatric comorbidities and quality of life were analyzed using a Bayesian path analysis. Twenty-eight subjects were included, 8 had an IQ between 115 and 130, and 20 had an IQ>130. Fifty-seven percent of individuals had generalized anxiety, 21.4% a current major depressive episode, and 75% a past major depressive episode. Subjects had a low self-esteem and quality of life levels significantly lower than those in the French general population. Subjects with higher self-esteem levels had more depressive (β=0.726, Pself-esteem was defensive and inadequate. Our study found a high frequency of psychiatric disorders associated with low levels of self-esteem and quality of life. A psychological treatment focusing on self-esteem may have a beneficial effect on anxiety, depression and quality of life. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Risk factors and correlates of deliberate self-harm behavior: a systematic review.

    Science.gov (United States)

    Fliege, Herbert; Lee, Jeong-Ran; Grimm, Anne; Klapp, Burghard F

    2009-06-01

    Deliberate self-harm behavior--without suicidal intent--is a serious health problem and may be studied as a clinical phenomenon in its own right. Empirical studies of sociodemographic and psychological correlates and risk factors are systematically reviewed. We searched Medline, PsycINFO, PSYNDEX (German psychological literature), and reference lists. We targeted self-induced bodily harm without conscious suicidal intent. Studies on suicidal behavior or self-poisoning were only included if they also assessed nonsuicidal self-harm. Fifty-nine original studies met the criteria. Deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. Evidence on gender is complex. Only 5 studies realize a prospective design (6 months to 10 years) and test predictors. The majority use cross-sectional and retrospective methods. No longitudinal study (separately) examines new incidence. Evidence of correlates encompasses distal/proximal, person/environment, and state/trait factors. Many studies report associations between current self-harm behavior and a history of childhood sexual abuse. Adolescent and adult self-harmers experience more frequent and more negative emotions, such as anxiety, depression, and aggressiveness, than persons who do not self-harm. Two studies yield specific interactions between childhood trauma and current traits and states such as low emotional expressivity, low self-esteem, and dissociation with respect to a vulnerability to self-harm. Evidence of distal, biographical stressors is fairly strong. Proximal stressors have rarely been investigated; protective factors, hardly at all. Despite many findings of correlates, the data do not yet justify terming them risk factors. Longitudinal studies are needed.

  19. Registration, psychiatric evaluation and adherence to psychiatric treatment after suicide attempt

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Søgaard, Mette

    2005-01-01

    Persons who are treated at hospital after attempted suicide comprise a high-risk group for suicide. The proposal for a National Programme for Prevention of Suicide and Suicide Attempt in Denmark recommends that all persons who attempt suicide should be offered treatment and that treatment should....... Only few patients were not referred to any treatment at all, but among the patients referred to psychiatric treatment, only those admitted involuntarily received treatment in 100% of the planned cases. For outpatient treatment in the suicide prevention clinic, the percentage that attended planned...... be implemented, using a supportive and guiding principle. The aim of the present study is to investigate whether patients receive psychiatric evaluation after a suicide attempt, and whether they receive the psychiatric treatment to which they are referred. In the Copenhagen Hospital Corporation in four emergency...

  20. Sociodemographic and Clinical Characteristics of Persons Presenting with Deliberate Self-harm to the Accident and Emergency Department of the University Hospital of the West Indies

    Directory of Open Access Journals (Sweden)

    M Henry

    2015-03-01

    Full Text Available Objective: The primary objective of this study was to determine the sociodemographic and clinical characteristics of all persons who presented to the Accident and Emergency Department of the University Hospital of the West Indies with a history of deliberate harm over a six-month period. Methods: The dockets of patients presenting with deliberate self-harm were collected and reviewed for the information. A questionnaire was designed to extract the information. Data were analysed using SPSS version 17 and RXC programme. Results: Of the total number of dockets reviewed (n = 61, 78% of patients were below age 40 years, with a mean age of 28 years. Sixty-four per cent were female, 82% were single, 83% lived with someone, 80% had a secondary school level of education and 72% were unemployed. Overdose of medications was the main method of harm. Seventy-five per cent of patients did not use illicit substances. There was a significant association found between reason for self-harm and psychiatric illness (p < 0.001. Conclusion: Given these preliminary results, it would be useful to conduct a wider, island-wide study to determine the extent of self-harming behaviour in Jamaica so that appropriate interventions can be implemented to reduce this problem.

  1. The addictive model of self-harming (non-suicidal and suicidal behavior

    Directory of Open Access Journals (Sweden)

    Hilario eBlasco-Fontecilla

    2016-02-01

    Full Text Available Introduction: Behavioral addictions such as gambling, sun-tanning, shopping, internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse. Recent literature suggests that both non-suicidal self-injury (NSSI and suicidal behavior (SB can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors.Method: This is a narrative review. The authors performed literature searches on PubMed and Google for suicidal behavior, self-harming, addiction, and major repeaters. Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts represent a distinctive suicidal phenotype, and are the individuals at risk of developing an addiction to SB. Results: The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as addictions, and the putative mechanisms underlying them.Conclusion: Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual’s self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.

  2. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior.

    Science.gov (United States)

    Blasco-Fontecilla, Hilario; Fernández-Fernández, Roberto; Colino, Laura; Fajardo, Lourdes; Perteguer-Barrio, Rosa; de Leon, Jose

    2016-01-01

    Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.

  3. Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households.

    Directory of Open Access Journals (Sweden)

    Nisha Naicker

    Full Text Available Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa.Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD study. Logistic regression analysis using the HEAD study data (2006-2011 was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm.A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR 5.72; 95% CI 1.64-19.97; that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39-33.56 and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14-16.47.This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.

  4. The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents.

    Science.gov (United States)

    Ramleth, Ruth-Kari; Groholt, Berit; Diep, Lien M; Walby, Fredrik A; Mehlum, Lars

    2017-01-01

    Studies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians' assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms. A total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD ( n  = 10) were compared with adolescents with sub-threshold BPD ( n  = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period). At baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation

  5. Adverse incidents, patient flow and nursing variables on acute psychiatric wards: the Tompkins Acute Ward study

    NARCIS (Netherlands)

    Bowers, L.; Simpson, A.; Warren, J.; Allan, T.; Nijman, H.L.I.

    2007-01-01

    Background: Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice. Aims: To explore the relationship between adverse incidents on acute psychiatric

  6. Age-related differences in self-harm presentations and subsequent management of adolescents and young adults at the emergency department.

    Science.gov (United States)

    Diggins, Emma; Kelley, Rachael; Cottrell, David; House, Allan; Owens, David

    2017-01-15

    Characteristics of self-harm differ across ages, but there is little work identifying age-related differences in younger people. Young people entering adolescence face emotionally and developmentally different challenges to those entering adulthood. This study investigates how Emergency Department (ED) presentations and management of self-harm differ through adolescence and early adulthood. 3782 consecutive self-harm episodes involving 2559 people aged 12-25 years were identified from an existing database of Leeds ED attendances from 2004 to 2007. Odds ratios for each of four age bands were compared to the remaining young people. The female to male ratio was 6.3:1 at 12-14 years old, decreasing with successive age groups to 1.2:1 at 22-25 years old. Self-poisoning was commoner in those under 18 years old. 18-25 year olds were more likely to self-poison with prescribed medications, mixed overdoses, alcohol or recreational drugs. 18-25 year olds more often required medical treatment for the effects of the self-harm. 12-14 year olds were more often seen urgently by ED medical staff and offered high intensity mental health aftercare. Repetition of self-harm was commonest in 12-14 year olds, although multiple repetition of self-harm was commonest in 22-25 year olds. Data were not collected on whether the aftercare offered was received. The study sample included hospital attenders only. The large excess of females over males in young people's self-harm is only true at the younger age range. Older adolescents present with more severe acts of self-harm, yet receive the lowest intensity of assessment and after care. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. [Adult attention deficit/hyperactivity disorder, associated symptoms and comorbid psychiatric disorders: diagnosis and pharmacological treatment].

    Science.gov (United States)

    Paslakis, G; Schredl, M; Alm, B; Sobanski, E

    2013-08-01

    Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm--a cross-sectional study.

    Science.gov (United States)

    Mork, Erlend; Walby, Fredrik A; Harkavy-Friedman, Jill M; Barrett, Elizabeth A; Steen, Nils E; Lorentzen, Steinar; Andreassen, Ole A; Melle, Ingrid; Mehlum, Lars

    2013-10-09

    To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. Using a cross-sectional design, 251 patients (18-61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.

  9. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER-A RANDOMIZED OBSERVER-BLINDED CLINICAL TRIAL.

    Science.gov (United States)

    Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina; Jessen, Helle K L; Krakauer, Kristine; Gluud, Christian; Thomsen, Rasmus R; Randers, Lasse; Nordentoft, Merete

    2016-06-01

    Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. The DiaS trial was designed as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14). When assessing the effect of DBT versus CAMS treatment on the individual components of the primary outcome, we observed no significant differences in the number of NSSI (OR: 1.60; 95% CI: 0.70-3.90; P = .31) or number of attempted suicides (OR: 2.24; 95% CI: 0.80-7.50; P = .12). In adults with borderline personality traits and disorder and a recent suicide attempt, DBT does not seem superior compared with CAMS for reduction of number of self-harm or suicide attempts. However, further randomized clinical trials may be needed. © 2016 Wiley Periodicals, Inc.

  10. Family environment, expressed emotion and adolescent self-harm: a review of conceptual, empirical, cross-cultural and clinical perspectives.

    Science.gov (United States)

    Michelson, Daniel; Bhugra, Dinesh

    2012-04-01

    Self-harm in young people is a complex and pervasive problem with a number of co-existing risk factors. Although research has implicated a range of family variables in understanding the onset, maintenance and prevention of adolescent self-harm, relatively little attention has been given to the expressed emotion (EE) construct. Based on a narrative review and synthesis of peer-reviewed literature up to and including 2011, this paper considers the conceptual background and empirical evidence for the role of family environment in the expression of adolescent self-harm, with a particular focus on EE. The clinical implications of this literature for working with young people and families from different cultures are also addressed. In summary, the surveyed research provides insufficient evidence for a direct causal link between family environment and adolescent self-harm, with questions raised about the temporal sequencing of measured variables, specificity of implicated family risk factors, and the nature and role of protective factors in families. Emerging evidence for an association between high EE and adolescent self-harm requires replication in well-controlled, prospective studies. There is also a lack of empirically-supported, family-based treatment modalities for adolescents who self-harm. Intervention strategies should be guided by personalised formulation, taking into account individual vulnerabilities, strengths and social contexts, as well as cultural norms for family environment.

  11. Completed suicides and self-harm in Malaysia: a systematic review.

    Science.gov (United States)

    Armitage, Christopher J; Panagioti, Maria; Abdul Rahim, Wirda; Rowe, Richard; O'Connor, Rory C

    2015-01-01

    Most of the research into suicide and self-harm has been conducted in the United States and Europe, yet the volume of research does not reflect the distribution of suicide globally, with Asia accounting for up to 60% of all suicides. The present study systematically reviews the literature to assess the prevalence and correlates of suicidal acts in Malaysia in Southeast Asia. Five relevant databases were searched from inception up to February 2014, and a narrative synthesis of the results from the included studies was performed. Studies were eligible for inclusion if they were correlational survey research and archival/observational research describing self-harm and suicide. Outcomes included completed suicides and self-harm including suicide attempts and self-poisoning, suicide plans and suicidal ideation. In total, 39 studies met the inclusion criteria. The principal findings were that the prevalence of suicide in Malaysia is approximately 6-8 per 100,000 population per year and that there is an excess of suicide among men, people younger than 40 years and the Indian minority group. The past-month prevalence rates of suicidal ideation, plans and attempts are 1.7, 0.9% and 0.5%, respectively, whereas the past-year prevalence rates of suicidal ideation range between 6% and 8%. The present research marks a first step towards understanding the prevalence and correlates of suicide and self-harm in Malaysia. However, the heterogeneity of the included studies was high. Further research into the antecedents, consequences and interventions for suicide and self-harm in the Malaysian context is required. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Substance use in adulthood following adolescent self-harm: a population-based cohort study

    Science.gov (United States)

    Moran, P; Coffey, C; Romaniuk, H; Degenhardt, L; Borschmann, R; Patton, G C

    2015-01-01

    Objective To determine whether adolescents who self-harm are at increased risk of heavy and dependent substance use in adulthood. Method Fifteen-year prospective cohort study of a random sample of 1943 adolescents recruited from secondary schools across the state of Victoria, Australia. Data pertaining to self-harm and substance use was obtained at seven waves of follow-up, from mean age 15.9 years to mean age 29.1 years. Results Substance use and self-harm were strongly associated during the adolescent years (odds ratio (OR): 3.3, 95% CI 2.1–5.0). Moreover, adolescent self-harmers were at increased risk of substance use and dependence syndromes in young adulthood. Self-harm predicted a four-fold increase in the odds of multiple dependence syndromes (sex- and wave-adjusted OR: 4.2, 95% CI: 2.7–6.6). Adjustment for adolescent anxiety/depression attenuated but did not eliminate most associations. Adolescent substance use confounded all associations, with the exception of multiple dependence syndromes, which remained robustly associated with adolescent self-harm (fully adjusted odds ratio: 2.0, 95% CI: 1.2–3.2). Conclusion Adolescent self-harm is an independent risk factor for multiple dependence syndromes in adulthood. This level of substance misuse is likely to contribute substantially to the premature mortality and disease burden experienced by individuals who self-harm. PMID:24954250

  13. Internet Addiction among Adolescents May Predict Self-Harm/Suicidal Behavior: A Prospective Study.

    Science.gov (United States)

    Pan, Pei-Yin; Yeh, Chin-Bin

    2018-06-01

    To explore the role of Internet addiction in the development of self-harm/suicidal behavior among adolescents after 1-year of follow-up. We conducted this 1-year, prospective cohort study of 1861 adolescents (mean age 15.93 years) attending a senior high school in Taiwan; 1735 respondents (93.2%) were classified as having no history of self-harm/suicidal attempts in the initial assessment and were referred to as the "noncase" cohort. The Chen Internet Addiction Scale was used to identify individuals with Internet addiction. The participants were evaluated for self-harm/suicidal behavior again 1 year later and the "noncase" cohort was selected for statistical analysis. To examine the relationship between Internet addiction and self-harm/suicidal behavior, multivariate logistic regression analysis was performed using Internet addiction at baseline as the predictor for newly developed self-harm/suicidal behavior in the next year, after adjustment for potential confounding variables. The prevalence rate of Internet addiction at baseline was 23.0%. There were 59 students (3.9%) who were identified as having developed new self-harm/suicidal behaviors on follow-up assessments. After controlling for the effects of potential confounders, the relative risk of newly emerging self-harm/suicidal behavior for participants who were classified as Internet addicted was 2.41 (95% CI 1.16-4.99, P = .018) when compared with those without Internet addiction. Our findings indicate that Internet addiction is prospectively associated with the incidence of self-harm/suicidal behavior in adolescents. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication.

    Science.gov (United States)

    Bauer, Jeanett Østerby; Stenborg, Dina; Lodahl, Tue; Mønsted, Mik Mathias

    2016-11-01

    Agitation is frequent in the acute psychiatric setting. The observation and treatment of agitation is important to avoid harm to patients or staff, to reduce distress of the patient, and to reduce the risk of coercion, especially physical restraint. To evaluate the effect of intramuscular treatment with psychotropics on agitation in a non-selected acute psychiatric population. The Positive and Negative Syndrome Scale Excitement Component (PANSS-EC) was implemented in the acute psychiatric ward at Psychiatric Center Copenhagen to improve assessment and treatment of agitation. During a period of almost ~2 years the staff was requested to assess agitation before and after administration of intramuscular injections. PANSS-EC was obtained at baseline and within 2 hours after injection for 135 injections with antipsychotics or benzodiazepines administered to 101 acute, non-selected psychiatric patients with high occurrence of co-morbid substance abuse. Mean PANSS-EC at baseline was 26.53 ± 4.87, and mean reduction in PANSS-EC was 14.99 ± 8.48 (p patients were subjected to physical restraint. Patients subjected to restraint had a significantly higher PANSS-EC score. Patients who received a subsequent injection had a significantly lower decline in PANSS-EC score. Besides two cases of acute dystonia following haloperidol injections, no serious side-effects were observed. Treatment of agitation with intramuscular injections of psychotropics was in general effective in this non-selected, highly agitated psychiatric population, and injections were well tolerated.

  15. Self-Esteem and Suicide Ideation in Psychiatric Outpatients

    Science.gov (United States)

    Bhar, Sunil; Ghahramanlou-Holloway, Marjan; Brown, Gregory; Beck, Aaron T.

    2008-01-01

    Depression, hopelessness, and low self-esteem are implicated as vulnerability factors for suicide ideation. The association of self-esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self-esteem, suicide ideation, hopelessness, and…

  16. Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data.

    Science.gov (United States)

    Owens, Christabel; Hansford, Lorraine; Sharkey, Siobhan; Ford, Tamsin

    2016-03-01

    Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. To examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted. © The Royal College of Psychiatrists 2016.

  17. Self-harm risk between adolescence and midlife in people who experienced separation from one or both parents during childhood.

    Science.gov (United States)

    Astrup, Aske; Pedersen, Carsten B; Mok, Pearl L H; Carr, Matthew J; Webb, Roger T

    2017-01-15

    Experience of child-parent separation predicts adverse outcomes in later life. We conducted a detailed epidemiological examination of this complex relationship by modelling an array of separation scenarios and trajectories and subsequent risk of self-harm. This cohort study examined persons born in Denmark during 1971-1997. We measured child-parent separations each year from birth to 15th birthday via complete residential address records in the Civil Registration System. Self-harm episodes between 15th birthday and early middle age were ascertained through linkage to psychiatric and general hospital registers. Incidence rate ratios (IRRs) from Poisson regression models were estimated against a reference category of individuals not separated from their parents. All exposure models examined indicated an association with raised self-harm risk. For example, large elevations in risk were observed in relation to separation from both parents at 15th birthday (IRR 5.50, 95% CI 5.25-5.77), experiencing five or more changes in child-parent separation status (IRR 5.24, CI 4.88-5.63), and having a shorter duration of familial cohesion during upbringing. There was no significant evidence for varying strength of association according to child's gender. Measuring child-parent separation according to differential residential addresses took no account of the reason for or circumstances of these separations. These novel findings suggest that self-harm prevention initiatives should be tailored toward exposed persons who remain psychologically distressed into adulthood. These high-risk subgroups include individuals with little experience of familial cohesion during their upbringing, those with the most complicated trajectories who lived through multiple child-parent separation transitions, and those separated from both parents during early adolescence. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  18. Revisiting profile of deliberate self-harm at a tertiary care hospital after an interval of 10 years.

    Science.gov (United States)

    Singh, Paramjeet; Shah, Raghav; Midha, Purav; Soni, Ajitabh; Bagotia, Sunil; Gaur, Kusum Lata

    2016-01-01

    Sociocultural factors complement psychopathological factors that result in deliberate self-harm (DSH). A study of change in these factors over time is essential for preventive action. To identify factors influencing DSH, which have shown significant variation over a period of 10 years. Two hospital-based cross-sectional analytic types of observational studies were performed at two different times at an interval of 10 years. Sociodemographic profile, factors related to DSH, stressful life events, and psychiatric disorders were assessed in two groups of patients drawn from the same tertiary care hospital, 100 consecutive patients in 2002 and 117 in 2012. The observations were compared to identify factors that have undergone significant change. Descriptive statistics along with Chi-square test was used in this study. A significant decrease in the overall number of married subjects (60% vs. 43%) and an increase in the number of unmarried females (34% vs. 61%) were seen. A significant increase in the overall number of rural subjects (17% vs. 34%) and especially in a number of rural females (7% vs. 23%) was also seen. An increase in subjects from middle socioeconomic class (15% vs. 29%) and education up to secondary school (9% vs. 25%) was also seen. A significantly higher number of subjects had a psychiatric disorder (50% vs. 81%) with a significant increase in diagnoses of depression (36% vs. 67%). Family and social issues remain the most common antecedent stressful events. Chemical methods are still the most preferred means, but a higher number (8% vs. 18%) report a history of self-harm. Variations in factors responsible for DSH identified in this comparative study have preventive implications.

  19. Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder.

    Science.gov (United States)

    Rao, Sathya; Broadbear, Jillian H; Thompson, Katherine; Correia, Anna; Preston, Martin; Katz, Paul; Trett, Robert

    2017-10-01

    Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods. Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category. Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( pself harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD.

  20. Do Coping Strategies Mediate the Relationship Between Parental Attachment and Self-Harm in Young People?

    Science.gov (United States)

    Glazebrook, Katie; Townsend, Ellen; Sayal, Kapil

    2016-01-01

    Insecure attachment is associated with self-harm in young people, but little research has explored the pathways through which this relationship develops. We investigated whether attachment impacts on self-harm via its effect on coping strategies and appraisal of problem-solving abilities. A total of 314 students aged 18-20 years completed an online survey with measures of parental attachment, emotion-focused and problem-focused coping strategies, and psychological distress and self-harm. A mediational model was not supported as there were no direct effects between parental attachment and self-harm. However, analysis of specific indirect pathways revealed that perceived parental attachment impacts on self-harm through problem-focused coping. Higher quality of attachment was associated with greater reliance on problem-focused (adaptive) coping, which in turn was associated with a decreased risk of having self-harmed. Furthermore, poorer paternal attachment was associated with lower appraisal of problem-solving skills, which in turn was associated with an increased risk of having self-harmed. Individuals with insecure attachment may be more vulnerable to self-harm because they lack other more constructive coping strategies for relieving stress.

  1. Exploring the use and effects of deliberate self-harm websites: an Internet-based study.

    Science.gov (United States)

    Harris, Isobel Marion; Roberts, Lesley Martine

    2013-12-20

    In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites. Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them. Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis. In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects. This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should

  2. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000-2007.

    Science.gov (United States)

    Bergen, Helen; Hawton, Keith; Waters, Keith; Cooper, Jayne; Kapur, Navneet

    2010-12-01

    Self-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres. To investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide. Data on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007. Rates of self-harm declined significantly over 8 years for males in three centres (Oxford: -14%; Manchester: -25%; Derby: -18%) and females in two centres (Oxford: -2% (not significant); Manchester: -13%; Derby: -17%), in keeping with national trends in suicide. A decreasing proportion and number of episodes involved self-poisoning alone, and an increasing proportion and number involved other self-injury (e.g. hanging, jumping, traffic related). Episodes involving self-cutting alone showed a slight decrease in numbers over time. Trends in alcohol use at the time of self-harm and repetition within 1 year were stable. There were decreasing rates of non-fatal self-harm over the study period that paralleled trends in suicide in England. This was reflected mainly in a decline in emergency department presentations for self-poisoning.

  3. Depressive Symptoms and Deliberate Self-Harm in a Community Sample of Adolescents: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Lars-Gunnar Lundh

    2011-01-01

    Full Text Available The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness.

  4. Predictors of self-esteem in adolescents with a psychiatric referral.

    Science.gov (United States)

    Akdemir, Devrim; Çak, Tuna; Aslan, Cihan; Aydos, Büşra Sultan; Nalbant, Kevser; Çuhadaroğlu-Çetin, Füsun

    2016-01-01

    In the literature self-esteem is found to be lower in clinically referred adolescents compared to adolescents without any psychiatric disorder. The aim of this study is to examine self-esteem and associated socio-demographical and psychological factors in clinically referred adolescents in Turkey. Three hundred forty-nine adolescents aged between 12 and 18 years admitted to the Department of Child and Adolescent Psychiatry with a psychiatric complaint were enrolled. Rosenberg Self-Esteem Scale (RSES), Brief Symptom Inventory (BSI), Parenting Style Scale (PSS) and Sense of Identity Assessment Form (SIAF) were used for the evaluation. Self-esteem was lower in: girls, adolescents without siblings, living in non-nuclear families, with a past suicide attempt, and with history of a non-suicidal self-injurious behavior (NSSI). Self-esteem was negatively correlated with identity confusion on SIAF and positively correlated with acceptance/involvement on PSS. Significant predictors of self-esteem were gender, presence of a sibling, history of a NSSI and SIAF scores. Interactions between self-esteem and gender, psychiatric symptoms, parenting and identity development are complex in clinically referred adolescents. Further elucidation of the mechanisms through which these characteristics modify self-esteem will be necessary to guide families and clinicians to help adolescents to maintain high self-esteem levels.

  5. Longitudinal Assessment of Self-Harm Statements of Youth in Foster Care: Rates, Reporters, and Related Factors.

    Science.gov (United States)

    Gabrielli, Joy; Hambrick, Erin P; Tunno, Angela M; Jackson, Yo; Spangler, Amanda; Kanine, Rebecca M

    2015-12-01

    Self-harm in youth is a risk factor related to mental health and future morbidity, yet, relatively little is known about the rates and course of self-harm in youth residing in foster care. This study examined self-harm talk in foster youth based on caregiver and child report for 135 children between the ages of 8- and 11-years old. Longitudinal data on course of self-harm talk from both youth and caregivers also are provided. Caregivers identified that 24% of youth participants had disclosed a desire to die or to hurt themselves. Youth self-report revealed that 21% of children indicated a desire for self-harm, and rates of self-harm from both reporters decreased over time. While overall rates were similar across reporters, findings show discrepancies between youth self-report and caregiver report within individuals. Also, caregivers for youth in residential facilities were more likely to report youth self-harm talk than caregivers from foster home settings.

  6. Self-harm and suicidal behavior in borderline personality disorder with and without bulimia nervosa.

    Science.gov (United States)

    Reas, Deborah L; Pedersen, Geir; Karterud, Sigmund; Rø, Øyvind

    2015-06-01

    Few studies have investigated whether a diagnosis of Bulimia nervosa (BN) confers additional risk of life-threatening behaviors such as self-harm and suicidal behavior in borderline personality disorder (BPD). Participants were 483 treatment-seeking women diagnosed with BPD according to the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997; Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; APA, 1994) and admitted to the Norwegian Network of Psychotherapeutic Day Hospitals between 1996 and 2009. Of these, 57 (11.8%) women met DSM-IV diagnostic criteria for BN according to the Mini-International Neuropsychiatric Interview (M.I.N.I.; Sheehan et al., 1998) and they were compared with women with BPD and other Axis I disorders. We found that comorbid BN is uniquely and significantly associated with increased risk of suicidal behavior among women being treated for BPD. Findings underscore the importance of routinely screening for BN among women seeking treatment for BPD, as co-occurring bulimia appears to be a significant marker for immediate life-threatening behaviors in this already high-risk population, which is a significant public health issue. A significantly greater proportion of women with BPD-BN reported suicidal ideation at intake (past 7 days), engaged in self-harm behavior during treatment, and attempted suicide during treatment. All bivariate associations remained significant in the logistic regression models after controlling for mood, anxiety, and substance-related disorders. The presence of a concurrent diagnosis of BN among women with BPD is significantly and uniquely associated with recent suicidal ideation, and self-harm behavior and suicide attempts during treatment after controlling for major classes of mental disorders. Co-occurring BN appears to represent a significant marker for immediate life-threatening behaviors in women seeking treatment for BPD

  7. Risk of suicide according to level of psychiatric treatment

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten Rygaard; Madsen, Trine; Agerbo, Esben

    2014-01-01

    PURPOSE: Knowledge of the epidemiology of suicide is a necessary prerequisite of suicide prevention. We aimed to conduct a nationwide study investigating suicide risk in relation to level of psychiatric treatment. METHODS: Nationwide nested case-control study comparing individuals who died from...... suicide between 1996 and 2009 to age-, sex-, and year-matched controls. Psychiatric treatment in the previous year was graded as "no treatment," "medicated," "outpatient contact," "psychiatric emergency room contact," or "admitted to psychiatric hospital." RESULTS: There were 2,429 cases and 50......,323 controls. Compared with people who had not received any psychiatric treatment in the preceding year, the adjusted rate ratio (95 % confidence interval) for suicide was 5.8 (5.2-6.6) for people receiving only psychiatric medication, 8.2 (6.1-11.0) for people with at most psychiatric outpatient contact, 27...

  8. A Population-Based Study of the Prevalence and Correlates of Self-Harm in Juvenile Detention.

    Directory of Open Access Journals (Sweden)

    Hygiea Casiano

    Full Text Available Suicide is the number one cause of death among incarcerated youth. We examined the demographic and forensic risk factors for self-harm in youth in juvenile detention using a Canadian provincial correctional database.We analyzed data from de-identified youth aged 12 to 18 at the time of their offense who were in custody in a Manitoba youth correctional facility between January 1, 2005 and December 30, 2010 (N = 5,102. Univariate and multivariate logistic regression analyses determined the association between staff-identified self-harm events in custody and demographic and custodial variables. Time to the event was examined based on the admission date and date of event.Demographic variables associated with self-harm included female sex, lower educational achievement, older age, and child welfare involvement. Custodial variables associated with self-harm included higher criminal severity profiles, younger age at first incarceration, longer sentence length, disruptive institutional behavior, and a history of attempting escape. Youth identified at entry as being at risk for suicide were more likely to self-harm. Events tended to occur earlier in the custodial admission.Self-harm events tended to occur within the first 3 months of an admission stay. Youth with more serious offenses and disruptive behaviors were more likely to self-harm. Individuals with problematic custodial profiles were more likely to self-harm. Suicide screening identified youth at risk for self-harm. Strategies to identify and help youth at risk are needed.

  9. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Lind, Bertel Dam; Stuart, Elizabeth A

    2015-01-01

    BACKGROUND: Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. METHODS......: In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992-2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity...... score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. FINDINGS: 5678 recipients of psychosocial therapy (followed up for 42·828 person...

  10. Probable Post-traumatic Stress Disorder and Self-harming Behaviour

    DEFF Research Database (Denmark)

    Hansen, J S; Simonsen, E

    2018-01-01

    The current study screened for post-traumatic stress disorder (PTSD) and self-harming behaviours, often related to borderline personality disorder (BPD), among individuals in a job centre considered unemployable primarily for psychological reasons. Participants (N = 112) filled in questionnaires...... on PTSD symptoms (n = 62) and self-harming behaviours (n = 59) as part of participating in team-meetings providing the individuals with a return-to-work plan. Differences in demographic variables between individuals with and without valid protocols were small to moderate. Of the individuals filling...

  11. 28 CFR 549.43 - Involuntary psychiatric treatment and medication.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Involuntary psychiatric treatment and... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.43 Involuntary psychiatric treatment and medication. Title 18 U.S.C. 4241-4247 and federal court...

  12. Gender differences in psychiatric disorders and clusters of self-esteem among detained adolescents.

    Science.gov (United States)

    Van Damme, Lore; Colins, Olivier F; Vanderplasschen, Wouter

    2014-12-30

    Detained minors display substantial mental health needs. This study focused on two features (psychopathology and self-esteem) that have received considerable attention in the literature and clinical work, but have rarely been studied simultaneously in detained youths. The aims of this study were to examine gender differences in psychiatric disorders and clusters of self-esteem, and to test the hypothesis that the cluster of adolescents with lower (versus higher) levels of self-esteem have higher rates of psychiatric disorders. The prevalence of psychiatric disorders was assessed in 440 Belgian, detained adolescents using the Diagnostic Interview Schedule for Children-IV. Self-esteem was assessed using the Self-perception Profile for Adolescents. Model-based cluster analyses were performed to identify youths with lower and/or higher levels of self-esteem across several domains. Girls have higher rates for most psychiatric disorders and lower levels of self-esteem than boys. A higher number of clusters was identified in boys (four) than girls (three). Generally, the cluster of adolescents with lower (versus higher) levels of self-esteem had a higher prevalence of psychiatric disorders. These results suggest that the detection of low levels of self-esteem in adolescents, especially girls, might help clinicians to identify a subgroup of detained adolescents with the highest prevalence of psychopathology.

  13. [An investigation on self-harm episodes and their relationship with suicidal psychology and behaviors in 2713 college students].

    Science.gov (United States)

    Su, Pu-Yu; Hao, Jia-Hu; Huang, Zhao-Hui; Tao, Fang-Biao

    2010-11-01

    To investigate the episodes and influencing factors on self-harm and to explore the relationship between self-harm episodes and suicidal psychology and behaviors in college students. Four universities were selected using cluster sampling method in Anqing city and Chaohu city. Totally, 2713 college students completed this survey. Data were analyzed by Pearson Chi-square and logistic regression. In the last six months, rates of highly lethal self-harm, less lethal self-harm with visible tissue damage, self-injury without visible tissue damage, self-harmful behaviors with latency damage, other self-harmful behaviors with menticide were 1.9%, 5.5%, 15.3%, 21.2% and 17.0% respectively. The total rate of self-harm was 31.3%. 73.1% of the students with self harmful experiences had the above mentioned behaviors more than 3 times in the last six months. The top 3 reasons for taking self-harm actions were: having learning problems (43.1%), failed love affairs (25.0%) and having conflicts with others (23.9%). There were different influencing factors among different kinds of self-harm episodes. Depression was the risk factor of self-harm. The higher score of having high self-esteem was the protective factor of all kinds of self-harm actions except highly lethal ones. Higher score of difficulties in identifying feelings was one of the risk factors. The rates of suicidal psychology and behaviors in students with self-harm were significantly higher than those in students without those behaviors. Result from linear χ(2) test indicated that the graveness of tissue damage of self-harm was higher along with the rates of suicidal psychology and behaviors (P self-esteem was the protective factor related to most of the self-harm cases.

  14. Positive attitudes and self-harming behavior of adolescents in a juvenile detention house in Taiwan.

    Science.gov (United States)

    Tsai, Mei-Hua; Fang, Kai-Chi; Lu, Chia-Hui; Chen, Chih-Dao; Hsieh, Chi-Pan; Chen, Tsung-Tai

    2011-08-01

    This study aimed to evaluate the less stigmatizing positivity construct screening measurement and its association with recent self-harming behaviors among adolescents. Participants were 193 detained Taiwanese adolescents. Questionnaires consisted of a deliberate self-harm inventory, a positivity construct measurement, a depression scale, data concerning risky health behaviors and demographics. The prevalence rate of recent self-harming behavior among adolescents in the detention house was 43.5%. The logistic model showed that age, gender and level of positivity demonstrated significant odds ratios for self-harm behavior. Results showed that younger age and female gender increased self-harming behavior. In addition, low score on positivity construct screening measurement increased the probability of self-harming behavior. Furthermore, these adolescents also engaged in risky health behaviors and were more depressed. Parental and school awareness for these risky behaviors should be enhanced and appropriate early interventions implemented to prevent negative health outcomes.

  15. Self-harm in young adolescents (12-16 years): onset and short-term continuation in a community sample.

    Science.gov (United States)

    Stallard, Paul; Spears, Melissa; Montgomery, Alan A; Phillips, Rhiannon; Sayal, Kapil

    2013-12-02

    To investigate the prevalence of self-harm in young adolescents and factors associated with onset and continuity over a one year period. Prospective longitudinal study. Participants were young adolescents (n = 3964) aged 12-16 years attending 8 secondary schools in the Midlands and South West of England. Over a one year period 27% of young adolescents reported thoughts of self-harm and 15% reported at least one act of self-harm. Of those who self-harmed, less than one in five (18%) had sought help for psychological problems of anxiety or depression. Compared with boys, girls were at increased risk of developing thoughts (OR 1.61, 95% CI 1.26-2.06) and acts (OR 1.40, 95% CI 1.06-1.84) of self-harm, particularly amongst those girls in school year 9 (aged 13/14, thoughts adjusted Odds Ratio (aOR) 1.97, 95% CI 1.27-3.04; acts aOR 2.59, 95% CI 1.52-4.41). Of those reporting thoughts of self-harm at baseline, 60% also reported these thoughts at follow-up. Similarly 55% of those who reported an act of self-harm at baseline also reported that they had self-harmed at follow-up. Insecure peer relationships increased the likelihood that boys and girls would develop self-harming behaviours, as did being bullied for boys. Low mood was associated with the development of self-harming thoughts and behaviours for boys and girls, whilst a strong sense of school membership was associated with a reduced risk of developing thoughts of self-harm for boys and increased the likelihood of self-harming thoughts and behaviours ceasing for girls. Self harm in young adolescents is common with one in four reporting self-harming thoughts and one in six engaging in self-harming behaviour over a one year period. Self-harm is already established by 12/13 years of age and for over half of our sample, self-harming thoughts and behaviour persisted over the year. Secure peer and strong school relationships were associated with less self-harm. Few seek help for psychological problems, suggesting a

  16. Emotion regulation, depression and self-harming behaviours in people with borderline personality disorder: the moderating role of action vs. state orientation

    Directory of Open Access Journals (Sweden)

    Sybilla Blasczyk-Schiep

    2016-01-01

    Full Text Available Background The aim of this research is to determine the level of emotion regulation, studied through the method of variable action orientation vs. state and its relationship with depressiveness and dimension of the reasons for living and self-harming behaviour of patients with borderline personality disorder. Participants and procedure The research studied 61 patients diagnosed with an emotionally unstable personality of borderline type. The research used the Polish adaptation of tests to measure the action vs. state orientation (SSI-K, the self-harming behaviour (SHI, depression (BDI and the reasons for living vs. suicidal tendency (RFL-I. Results In people with borderline personality disorder, the level of emotion regulation (action vs. state orientation, reasons for living and depression are predictors of self-harming behaviour. The experience of a depressive episode or lack thereof does not have a relationship with the increase of self-harming. Analysis of the interaction between variables showed that the reasons for living and the action orientation after failure are related to the reduction of self-harming behaviour in all subjects. In depressed people, state orientation is associated with an increase in the action orientation with decreased self-destructive behaviours. Conclusions High levels of reasons for living in interaction with the action orientation have a negative relationship with the self-harming behaviour of patients diagnosed with borderline personality disorder. Among those subjects, depressive patients, a statistically lower level of self-harm is related to the action orientation. These results suggest that therapeutic treatment is important to activate both reasons for living as well as action orientation as effective dimensions in preventing self-harming.

  17. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Lykke Mortensen, Erik; Nordentoft, Merete

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life...... and effect size were observed on all rating scales (p-value

  18. The Use of Dialectical Behavior Therapy and Prolonged Exposure to Treat Comorbid Dissociation and Self-Harm: The Case of a Client With Borderline Personality Disorder and Posttraumatic Stress Disorder.

    Science.gov (United States)

    Granato, Hollie F; Wilks, Chelsey R; Miga, Erin M; Korslund, Kathryn E; Linehan, Marsha M

    2015-08-01

    There is a high rate of comorbidity between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD; Pagura et al., 2010). Preliminary studies have evaluated the treatment of PTSD in a BPD population and found positive outcomes for the integration of dialectical behavior therapy (DBT) and prolonged exposure (PE). This case study illustrates the implementation of a PE protocol into standard DBT treatment, specifically focusing on the management of self-harm and severe dissociation for a client with co-occurring PTSD and BPD. The client entered into treatment with severe and persistent dissociation and a recent history of self-harm, and the case includes consideration of two separate pauses in PTSD treatment related to elevated dissociation and self-harm behaviors. The client successfully completed the DBT PE protocol and results indicate significant improvements in PTSD symptoms as well as outcomes related to self-harm and dissociation. These findings demonstrate the efficacy of combining DBT with PE for clients with comorbid BPD and PTSD and exemplify how complex clients with BPD who present with severe dissociation and self-harm behavior can safely and successfully receive treatment for PTSD. © 2015 Wiley Periodicals, Inc.

  19. A Pilot Study on the Efficacy of Volunteer Mentorship for Young Adults With Self-Harm Behaviors Using a Quasi-Experimental Design.

    Science.gov (United States)

    Law, Yik-Wa; Yip, Paul S F; Lai, Carmen C S; Kwok, Chi Leung; Wong, Paul W C; Liu, Kwong-Sun; Ng, Pauline W L; Liao, Carmen W M; Wong, Tai-Wai

    2016-11-01

    Studies have shown that postdischarge care for self-harm patients is effective in reducing repeated suicidal behaviors. Little is known about whether volunteer support can help reduce self-harm repetition and improve psychosocial well-being. This study investigated the efficacy of volunteer support in preventing repetition of self-harm. This study used a quasi-experimental design by assigning self-harm patients admitted to the emergency departments to an intervention group with volunteer support and treatment as usual (TAU) for 9 months and to a control group of TAU. Outcome measures include repetition of self-harm, suicidal ideation, hopelessness, and level of depressive and anxiety symptoms. A total of 74 cases were recruited (38 participants; 36 controls). There were no significant differences in age, gender, and clinical condition between the two groups at the baseline. The intervention group showed significant improvements in hopelessness and depressive symptoms. However, the number of cases of suicide ideation and of repetition of self-harm episodes was similar for both groups at the postintervention period. Postdischarge care provided by volunteers showed significant improvement in hopelessness and depression. Volunteers have been commonly involved in suicide prevention services. Further research using rigorous methods is recommended for improving service quality in the long term.

  20. Differences in risk factors for self-harm with and without suicidal intent: Findings from the ALSPAC cohort

    Science.gov (United States)

    Mars, Becky; Heron, Jon; Crane, Catherine; Hawton, Keith; Kidger, Judi; Lewis, Glyn; Macleod, John; Tilling, Kate; Gunnell, David

    2014-01-01

    Background There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. Method Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. Results Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. Limitations i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. Conclusion Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm. PMID:25108277

  1. Sharply Reduced but Still Heavy Self-Harm Burdens in Hubei Province, China, 1990–2015

    Directory of Open Access Journals (Sweden)

    Jingju Pan

    2018-02-01

    Full Text Available The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of Disease Study 2015 and Hubei Disease Surveillance Points system. All self-harm burdens including mortality, years of life lost (YLLs, prevalence, years lived with disability (YLDs, and disability adjusted life-years (DALYs consistently demonstrated downward trends in Hubei from 1990 to 2015, with a bigger decline gap observed among females and narrower decreasing amplitudes among the elderly. Hubei experienced much higher age-standardized rates for self-harm mortality (22.0 per 100,000, YLLs (560.1 per 100,000 and DALYs (563.9 per 100,000 than the national (9.0, 292.3 and 295.0 per 100,000 respectively and global levels (11.5, 453.3 and 457.9 per 100,000 respectively in 2015. Self-harm burdens have begun shifting from females to males and the elderly suffered more self-harm burdens than other age groups. Alcohol use accounted for 20.9% of all self-harm DALYs for males, whereas intimate partner violence accounted for 24.4% of all self-harm DALYs for females. Poisoning, mainly pesticide self-poisoning, was still the most common method of suicide. Effective interventions by multi-sectoral collaboration are urgently needed to reduce the alarmingly heavy self-harm burdens in Hubei.

  2. Recommended next care following hospital-treated self-harm: Patterns and trends over time.

    LENUS (Irish Health Repository)

    Arensman, Ella

    2018-01-01

    The specific objectives of this study were to examine variation in the care of self-harm patients in hospital settings and to identify the factors that predict recommended next care following self-harm.

  3. Therapy-related assessment of self-harming behaviors in eating disordered patients: a case illustration.

    Science.gov (United States)

    Claes, Laurence; Vandereycken, Walter; Vertommen, Hans

    2002-01-01

    Understanding an individual's self-harming behaviors should be the basis for selecting person-specific therapeutic interventions. For that purpose, the assessment is aimed at identifying the self-harming behaviors and related symptoms as well as analyzing the external (situational) and internal (cognitive and emotional) conditions that contribute directly to the instigation of the self-harming behaviors. In this article, we demonstrate the use of a new assessment procedure that may guide the selection of therapeutic interventions. Data collection and processing are illustrated by an individual case study of an eating-disordered patient showing different types of self-harming behavior such as vomiting, alcohol abuse, cutting, and suicide attempts.

  4. Improving communication and practical skills in working with inpatients who self-harm : A pre-test/post-test study of the effect of a training programme

    NARCIS (Netherlands)

    Ad Kerkhof; Bauke Koekkoek; prof Berno van Meijel; Jaap van der Bijl; Nienke Kool

    2014-01-01

    Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and

  5. Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme

    NARCIS (Netherlands)

    Kool, N.; van Meijel, B.; Koekkoek, B.; van der Bijl, J.; Kerkhof, A.J.F.M.

    2014-01-01

    Background:Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and

  6. Incidence Rates of Deliberate Self-Harm in Denmark 1994–2011

    DEFF Research Database (Denmark)

    Morthorst, Britt Reuter; Soegaard, Bodil; Nordentoft, Merete

    2016-01-01

    Background: The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate selfharm have been presented. Aim: To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records...... incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed....

  7. The ACCESS study a Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in people who present to hospital after self-harm: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Parag Varsha

    2011-05-01

    Full Text Available Abstract Background People who present to hospital after intentionally harming themselves pose a common and important problem. Previous reviews of interventions have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and regular written communications after the self-harm attempt may be an effective treatment. This protocol describes a large pragmatic trial of a package of measures which include problem solving therapy, regular written communication, patient support, cultural assessment, improved access to primary care and a risk management strategy in people who present to hospital after self-harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a large representative cohort of patients. The main outcome will be hospital attendance following repetition of self-harm, in the 12 months after recruitment with secondary outcomes of self reported self-harm, hopelessness, anxiety, depression, quality of life, social function and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit large numbers and does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. However the primary analysis is a true intention to treat analysis of everyone randomised which includes both those who consent and do not consent to participate in the study. This provides information about how the intervention will work in practice in a representative population which is a major advance in this study compared to what has

  8. Psychosocial therapy and causes of death after deliberate self-harm

    DEFF Research Database (Denmark)

    Birkbak, J; Stuart, E A; Lind, B D

    2016-01-01

    BACKGROUND: Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD: In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic...... in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS: At the end of follow-up, 391 (6.......5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS: Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death...

  9. The association between self-image and defence mechanisms in a group of adolescent patients receiving psychiatric treatment.

    Science.gov (United States)

    Treger, Bartosz; Matusiak, Feliks; Pilecki, Maciej; Rogoż, Monika

    2015-01-01

    The aim of the study was to explore the relationship between various areas of self-image and defence mechanisms in adolescents. The study included a division into groups according to whether or not they were receiving psychiatric treatment. Data were obtained from two groups: a clinical group (30 persons), consisting of adolescent patients of the Adolescent Inpatient Ward of the Child and Adolescent Psychiatry Clinic and a control group (40 persons), adolescents attending upper secondary school. The Defence Style Questionnaire DSQ-40 and the Offer Self Image Questionnaire were used in the study. Results showed no differences, in the maturity levels of the defence mechanisms, between the two groups. Subjects from the clinical group had a significantly lower self-image of themselves than subjects from the control group.. In both groups, the use of mature defence mechanisms was accompanied by a positive self-image, while the use of less mature defence mechanisms was associated with a lower self-image. Comparison of the groups revealed different relationships between the aspects of self-image and used defence mechanisms, in particular the mechanism of projection. Number of significant correlations was greater in the clinical group. In the context of lower self-image, the study revealed the importance of such defence mechanisms as projection, acting out, somatization or schizoid fantasies. The obtained results seem to confirm a hypothesis that the assessment of the maturity of defence mechanisms in the period of adolescence is less clear and clinically useful.

  10. Risk factors associated with repetition of self-harm in black and minority ethnic (BME) groups: a multi-centre cohort study.

    Science.gov (United States)

    Cooper, Jayne; Steeg, Sarah; Webb, Roger; Stewart, Suzanne L K; Applegate, Eve; Hawton, Keith; Bergen, Helen; Waters, Keith; Kapur, Navneet

    2013-06-01

    Little information is available to inform clinical assessments on risk of self-harm repetition in ethnic minority groups. In a prospective cohort study, using data collected from six hospitals in England for self-harm presentations occurring between 2000 and 2007, we investigated risk factors for repeat self-harm in South Asian and Black people in comparison to Whites. During the study period, 751 South Asian, 468 Black and 15,705 White people presented with self-harm in the study centres. Repeat self-harm occurred in 4379 individuals, which included 229 suicides (with eight of these fatalities being in the ethnic minority groups). The risk ratios for repetition in the South Asian and Black groups compared to the White group were 0.6, 95% CI 0.5-0.7 and 0.7, 95% CI 0.5-0.8, respectively. Risk factors for repetition were similar across all three groups, although excess risk versus Whites was seen in Black people presenting with mental health symptoms, and South Asian people reporting alcohol use and not having a partner. Additional modelling of repeat self-harm count data showed that alcohol misuse was especially strongly linked with multiple repetitions in both BME groups. Ethnicity was not recorded in a third of cases which may introduce selection bias. Differences may exist due to cultural diversity within the broad ethnic groups. Known social and psychological features that infer risk were present in South Asian and Black people who repeated self-harm. Clinical assessment in these ethnic groups should ensure recognition and treatment of mental illness and alcohol misuse. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. The use of observation on patients who self-harm: Lessons from a ...

    African Journals Online (AJOL)

    Background: Observation is an important approach to care that is commonly used in inpatient learning disability services to prevent self-harming behaviours. It is often implemented when there is a perceived increase risk of self-harm. Most nurses who implement observation have little or no training in the use of this practice.

  12. Cognitive-behavioural therapy for deliberate self-harm

    NARCIS (Netherlands)

    Slee, Nadja

    2008-01-01

    This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95%

  13. Influence of psychiatric diagnosis on treatment uptake and interferon side effects in patients with hepatitis C.

    Science.gov (United States)

    Wu, Jing Yuan J; Shadbolt, Bruce; Teoh, Narci; Blunn, Anne; To, Caroline; Rodriguez-Morales, Ilys; Chitturi, Shivakumar; Kaye, Graham; Rodrigo, Kalyana; Farrell, Geoff

    2014-06-01

    Pegylated-interferon-α/ribavirin (PEG-IFN/RBV) treatment can cure hepatitis C virus (HCV) infection but has frequent neuropsychiatric side-effects. Patients with pre-existing psychiatric illness may not be offered therapy. We established prevalence of self-reported psychiatric comorbidity among HCV-infected patients in a hospital-liver clinic, and determined the impact of such diagnoses on uptake and tolerance to PEG-IFN/RBV. All HCV cases referred for assessment in Australian Capital Territory/surrounding regions April 2004-March 2012 were entered into a clinical database. We conducted univariate and multivariate analyses of variables correlating with uptake of antiviral therapy and frequency of treatment-related side-effects. Of 773 referred patients, 235 (30%) described pre-existing psychiatric illness. Among these, 26% received antiviral therapy, compared with 30% of 538 without psychiatric comorbidity. History of depression (usually validated by liaison psychiatry) was associated with higher incidence of treatment-related neuropsychiatric side-effects (odds ratio 2.79 [1.35-5.70], P schizophrenia: three (11%) received antiviral therapy, compared with 30% admitting depression and 20% with bipolar affective disorder (all assessed by psychiatrist). In most schizophrenia cases, the reason for not offering antiviral treatment was psychological illness, yet none of five treated (these three plus two others in a psychiatric rehabilitation facility) experienced worsening psychiatric symptoms. A history of depression is common with hepatitis C but does not affect initiation of antiviral treatment, despite substantially increased risk of psychiatric side-effects. In contrast, pre-existing schizophrenia appears to influence treatment decisions, despite little evidence that PEG-IFN/RBV exacerbates the psychiatric condition, and well-supervised antiviral therapy can have good outcomes.

  14. Self harm and attempted suicide in adults: 10 practical questions and answers for emergency department staff

    OpenAIRE

    Mitchell, A J; Dennis, M

    2006-01-01

    Self harm is a complex behaviour that can be best thought of as a maladaptive response to acute and chronic stress, often but not exclusively linked with thoughts of dying. Patients presenting with self harm usually have current psychosocial difficulties, are likely to be suffering from mental health problems, and are at significant risk of further self harm and suicide. Recent guidelines suggest that all self harm attendees should receive an initial risk assessment at triage in the emergency...

  15. Prison suicides and self-harming behaviours in Italy, 1990-2002.

    Science.gov (United States)

    Preti, Antonio; Cascio, Maria Teresa

    2006-04-01

    Data on suicides, attempted suicides and other self-harming behaviours that occurred in Italian prisons from 1990 to 2002 was studied on official records, as documented by the Ministry of Justice. Over the study interval, completed suicide rates in Italian prisons were constantly about ten times higher than among the general population, but over time they did not increase significantly despite nearly a doubling in the absolute number of inmates. The rate of completed suicides in overcrowded prisons was about ten times higher than in non-overcrowded ones. Attempted suicides were about ten times higher than completed suicides, with females being significantly more likely to attempt to take their own lives and males being more likely to complete suicide. Self-injuring acts without the intent to die involve about one in every ten individuals, with foreigners (non-EU citizens mostly) being twice as likely to self-harm than residents. A better identification of the people suffering from mental disorders and a reduction in prison overcrowding are two key issues that need to be implemented to reduce the impact of suicide and self-harming behaviours among convicts.

  16. Investigating the role of executive attentional control to self-harm in a non-clinical cohort with borderline personality features.

    Directory of Open Access Journals (Sweden)

    Jennifer eDrabble

    2014-08-01

    Full Text Available Self-injurious behavior (or self-harm is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD. Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.

  17. The Effect of EMDR and CBT on Low Self-esteem in a General Psychiatric Population: A Randomized Controlled Trial.

    Science.gov (United States)

    Griffioen, Brecht T; van der Vegt, Anna A; de Groot, Izaäk W; de Jongh, Ad

    2017-01-01

    Although low self-esteem has been found to be an important factor in the development and maintenance of psychopathology, surprisingly little is known about its treatment. This study investigated the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy and Cognitive Behavioural Therapy (CBT), regarding their capacities in enhancing self-esteem in a general psychiatric secondary health care population. A randomized controlled trial with two parallel groups was used. Participants were randomly allocated to either 10 weekly sessions of EMDR ( n = 15) or CBT ( n = 15). They were assessed pre-treatment, after each session, post treatment and at 3 months follow-up on self-esteem (Rosenberg Self-esteem Scale and Credibility of Core Beliefs), psychological symptoms (Brief Symptom Inventory), social anxiety, and social interaction (Inventory of Interpersonal Situations) (IIS). The data were analyzed using repeated measures ANOVA for the complete cases ( n = 19) and intention-to-treat ( n = 30) to examine differences over time and between conditions. Both groups, EMDR as well as CBT, showed significant improvements on self-esteem, increasing two standard deviations on the main parameter (RSES). Furthermore, the results showed significant reductions in general psychiatric symptoms. The effects were maintained at 3 months follow-up. No between-group differences could be detected. Although the small sample requires to exercise caution in the interpretation of the findings, the results suggest that, when offering an adequate number of sessions, both EMDR and CBT have the potential to be effective treatments for patients with low self-esteem and a wide range of comorbid psychiatric conditions. This study was registered at www.trialregister.nl with identifier NTR4611.

  18. The Effect of EMDR and CBT on Low Self-esteem in a General Psychiatric Population: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Brecht T. Griffioen

    2017-11-01

    Full Text Available Although low self-esteem has been found to be an important factor in the development and maintenance of psychopathology, surprisingly little is known about its treatment. This study investigated the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR therapy and Cognitive Behavioural Therapy (CBT, regarding their capacities in enhancing self-esteem in a general psychiatric secondary health care population. A randomized controlled trial with two parallel groups was used. Participants were randomly allocated to either 10 weekly sessions of EMDR (n = 15 or CBT (n = 15. They were assessed pre-treatment, after each session, post treatment and at 3 months follow-up on self-esteem (Rosenberg Self-esteem Scale and Credibility of Core Beliefs, psychological symptoms (Brief Symptom Inventory, social anxiety, and social interaction (Inventory of Interpersonal Situations (IIS. The data were analyzed using repeated measures ANOVA for the complete cases (n = 19 and intention-to-treat (n = 30 to examine differences over time and between conditions. Both groups, EMDR as well as CBT, showed significant improvements on self-esteem, increasing two standard deviations on the main parameter (RSES. Furthermore, the results showed significant reductions in general psychiatric symptoms. The effects were maintained at 3 months follow-up. No between-group differences could be detected. Although the small sample requires to exercise caution in the interpretation of the findings, the results suggest that, when offering an adequate number of sessions, both EMDR and CBT have the potential to be effective treatments for patients with low self-esteem and a wide range of comorbid psychiatric conditions. This study was registered at www.trialregister.nl with identifier NTR4611.

  19. Responding to Self-Harm: A Documentary Analysis of Agency Policy and Procedure

    Science.gov (United States)

    Paul, Sally; Hill, Malcolm

    2013-01-01

    This paper reports on the findings of a documentary analysis of policies and procedures relating to self-harm from a range of organisations working with young people in the UK. It identifies the extent to which policies and/or procedures relating to self-harm are available for service providers and offers a wider understanding of the concepts of…

  20. Oral health status and treatment needs of psychiatric inpatients in Ranchi, India

    Directory of Open Access Journals (Sweden)

    Bhuvan Jyoti

    2012-01-01

    Full Text Available Background: Oral health has an impact on general health, self-esteem and quality of life, but it often has a low priority in the context of mental health and in some phases of illness, the priority may be nonexistent Patients with psychiatric illness have poor oral hygiene than general population. Very few studies have been reported regarding the oral health among Indian psychiatric inpatients. Aim: To assess the oral health status of long-term psychiatric inpatients in a psychiatric institute and to evaluate the treatment requirements of psychiatric inpatients for maintaining the oral hygiene. Materials and methods: Psychiatric inpatients were examined and data was collected using the WHO standardized dental evaluation form in the psychiatric institute. Results: One hundred and forty-one patents (53% female: mean age: 36.56 ± 13.28 years: 47% male: mean age: 37.36 ± 12.49 years: length of illness: More than 5 years, 35.5%: less than 5 years, 84.5% were included in the study. 73% being schizophrenics. Dental canes was found in 55.3% patients. Calculus was present in 94.3% patients. Missing teeth was found in 22.7% patients. Mucosal lesions and oral ulcers were seen in 5.7 and 1 4% of total examined patients respectively. Percentages of patient requiring extractions were 34.8%. oral prophylaxis 98.6%. conservative treatment 31.9% and prosthesis 20.6%. Age was significantly correlated with number of decayed (r = 0.294, p < 0.01 and missing teeth (r = 0.436, p < 0.01. Length of illness was significantly correlated with number of decayed (r = 0.258. p < 0.01 and missing teeth (r = 0.229. p < 0.0 1 Conclusion: Oral health is an important and integral part of health care. Members of multidisciplinary team should be encouraged to assist psychiatric patients in maintaining their oral health with good oral hygiene and access to dental treatment taking into account their special needs.

  1. Factors influencing perceived effectiveness in dealing with self-harming patients in a sample of emergency department staff.

    Science.gov (United States)

    Egan, Rachel; Sarma, Kiran M; O'Neill, Meena

    2012-12-01

    Past self-harming behavior is one of the most significant predictors of future suicide. Each year in Ireland there are approximately 11,000 presentations of self-harm to emergency departments (EDs) across the country. This study examines predictors of perceived personal effectiveness in dealing with self-harming patients as reported by ED staff. The predictors are derived from past research and are influenced by Bandura's Social Cognitive Theory. One hundred twenty-five ED medical staff (28 doctors and 97 nurses) from five EDs in the West and South of Ireland completed a questionnaire. Predictor variables included in the design, and informed by past research, included knowledge of self-harm and suicidal behavior and confidence in dealing with incidents of self-harm. Standard multiple regression suggested a statistically significant model fit between the two predictors and the criterion variable, accounting for 24% of total variance. Knowledge and Confidence were significant contributors to perceived personal effectiveness in dealing with self-harming patients. Little is known regarding specific factors that influence perceived effectiveness in dealing with self-harming patients in the ED setting. These findings have implications for psycho-education and training content for staff. The findings suggest that increasing knowledge of self-harm and confidence in dealing with self-harming patients can lead to more positive perceived personal effectiveness in responding to clients' needs. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Self-harm in young adolescents (12–16 years): onset and short-term continuation in a community sample

    Science.gov (United States)

    2013-01-01

    Background To investigate the prevalence of self-harm in young adolescents and factors associated with onset and continuity over a one year period. Method Prospective longitudinal study. Participants were young adolescents (n = 3964) aged 12–16 years attending 8 secondary schools in the Midlands and South West of England. Results Over a one year period 27% of young adolescents reported thoughts of self-harm and 15% reported at least one act of self-harm. Of those who self-harmed, less than one in five (18%) had sought help for psychological problems of anxiety or depression. Compared with boys, girls were at increased risk of developing thoughts (OR 1.61, 95% CI 1.26-2.06) and acts (OR 1.40, 95% CI 1.06-1.84) of self-harm, particularly amongst those girls in school year 9 (aged 13/14, thoughts adjusted Odds Ratio (aOR) 1.97, 95% CI 1.27-3.04; acts aOR 2.59, 95% CI 1.52-4.41). Of those reporting thoughts of self-harm at baseline, 60% also reported these thoughts at follow-up. Similarly 55% of those who reported an act of self-harm at baseline also reported that they had self-harmed at follow-up. Insecure peer relationships increased the likelihood that boys and girls would develop self-harming behaviours, as did being bullied for boys. Low mood was associated with the development of self-harming thoughts and behaviours for boys and girls, whilst a strong sense of school membership was associated with a reduced risk of developing thoughts of self-harm for boys and increased the likelihood of self-harming thoughts and behaviours ceasing for girls. Conclusion Self harm in young adolescents is common with one in four reporting self-harming thoughts and one in six engaging in self-harming behaviour over a one year period. Self-harm is already established by 12/13 years of age and for over half of our sample, self-harming thoughts and behaviour persisted over the year. Secure peer and strong school relationships were associated with less self-harm. Few seek help for

  3. Smartphone apps as a new psychiatric treatment

    DEFF Research Database (Denmark)

    Dalum, Anette Ellegaard; Arnfred, Sidse Marie

    2014-01-01

    Søg 1 - 1 ud af 1 Smartphone apps as a new psychiatric treatment. Anette Ellegaard Dalum, Sidse Arnfred, 2014, vol. 176, nummer 34, 2014. Ugeskrift for laeger Artikel Importer Fjern......Søg 1 - 1 ud af 1 Smartphone apps as a new psychiatric treatment. Anette Ellegaard Dalum, Sidse Arnfred, 2014, vol. 176, nummer 34, 2014. Ugeskrift for laeger Artikel Importer Fjern...

  4. The Relationship Between Problem-Solving Ability and Self-Harm Amongst People with Mild Intellectual Disabilities.

    Science.gov (United States)

    Rees, Joanna; Langdon, Peter E

    2016-07-01

    The purpose of this study was to investigate the relationship between depression, hopelessness, problem-solving ability and self-harming behaviours amongst people with mild intellectual disabilities (IDs). Thirty-six people with mild IDs (77.9% women, Mage  = 31.77, SD = 10.73, MIQ  = 62.65, SD = 5.74) who had a history of self-harm were recruited. Participants were asked to complete measures of depression, hopelessness and problem-solving ability. Cutting was most frequently observed, and depression was prevalent amongst the sample. There was a significant positive relationship between depression and hopelessness, while there was no significant relationship between self-harm and depression or hopelessness. Problem-solving ability explained 15% of the variance in self-harm scores. Problem-solving ability appears to be associated with self-harming behaviours in people with mild IDs. © 2015 John Wiley & Sons Ltd.

  5. Self-harm in British South Asian women: psychosocial correlates and strategies for prevention

    Directory of Open Access Journals (Sweden)

    Waheed W

    2006-05-01

    Full Text Available Abstract Objective To review the rates of self-harm in British South Asian women, look into the factors that contribute to these high rates of self-harm and discuss possible strategies for prevention and provision of culturally sensitive service for South Asian women who harm themselves. Method Review. Results South Asian women are significantly more likely to self harm between ages 16–24 years than white women. Across all age groups the rates of self harm are lower in South Asian men as compared to South Asian women. These women are generally younger, likely to be married and less likely to be unemployed or use alcohol or other drugs. They report more relationship problems within the family. South Asian women are less likely to attend the ER with repeat episode since they hold the view that mainstream services do not meet their needs. Conclusion South Asian women are at an increased risk of self harm. Their demographic characteristics, precipitating factors and clinical management are different than whites. There is an urgent need for all those concerned with the mental health services for ethnic minorities to take positive action and eradicate the barriers that prevent British South Asians from seeking help. There is a need to move away from stereotypes and overgeneralisations and start from the user's frame of reference, taking into account family dynamics, belief systems and cultural constraints.

  6. Motivation for physical activity of psychiatric patients when physical activity was offered as part of treatment.

    Science.gov (United States)

    Sørensen, M

    2006-12-01

    This study examined motivation variables, self-determination and self-schema, in relation to physical activity, among psychiatric patients with experience with physical activity as part of their treatment. Participants were patients (N=109) from 15 psychiatric hospitals or day-care institutions. Data were collected by questionnaires. A positive relationship between physical activity level, positive experiences of the activity and higher degree of self-determination and exercise self-schema was expected. Intrinsically regulated motives (motivated by the experience of the activity in itself) were positively and significantly related to physical activity level and the experience of decrease in symptoms during physical activity, and extrinsically regulated motives were negatively correlated with physical activity level. Intrinsically regulated motives gave an odds ratio of 20.0 for being physically active rather than inactive. Holding an exercise self-schema gave an odds ratio of 6.1 for being physically active. The majority of the patients (57.4%) reported that physical activity decreased their illness symptoms, but a few (11.9%) reported negative effects. The findings demonstrated that psychiatric patients do not differ from the normal population in relation to motivational mechanisms, even if they may experience more barriers to physical activities because of their illness. Therefore, in trying to motivate psychiatric patients, it is important to make physical activity as intrinsically motivating as possible by focusing on the positive experiences of the activity itself, as well as helping to develop an exercise self-schema.

  7. An Analysis of Depression, Self-Harm, and Suicidal Ideation Content on Tumblr.

    Science.gov (United States)

    Cavazos-Rehg, Patricia A; Krauss, Melissa J; Sowles, Shaina J; Connolly, Sarah; Rosas, Carlos; Bharadwaj, Meghana; Grucza, Richard; Bierut, Laura J

    2017-01-01

    Social networking about depression can be indicative of self-reported depression and/or can normalize risk behaviors such as self-harm and suicidal ideation. To gain a better understanding of the depression, self-harm, and suicidal content that is being shared on Tumblr. From April 16 to May 10, 2014, 17 popular depression-related Tumblr accounts were monitored for new posts and engagement with other Tumblr users. A total of 3,360 posts were randomly selected from all historical posts from these accounts and coded based on themes ascertained by the research team. The 17 Tumblr accounts posted a median number of 185 posts (range = 0-2,954). Content was engaged with (i.e., re-blogged or liked) a median number of 1,677,362 times (range = 0-122,186,504). Of the 3,360 randomly selected posts, 2,739 (82%) were related to depression, suicide, or self-harm. Common themes were self-loathing (412, 15%), loneliness/feeling unloved (405, 15%), self-harm (407, 15%), and suicide (372, 14%). This study takes an important first step at better understanding the displayed depression-related references on Tumblr. The findings signal a need for suicide prevention efforts to intervene on Tumblr and use this platform in a strategic way, given the depression and suicidal content that was readily observed on Tumblr.

  8. Youth Justice staff attitudes towards screening for self-harm.

    Science.gov (United States)

    Knowles, Sarah E; Townsend, Ellen; Anderson, Martin P

    2012-09-01

    Young offenders are recognised as a high-risk group for suicidal behaviour. It is essential that the screening used to identify those at risk and refer them to mental health services is effective, especially in community settings where service utilisation is low. Staff attitudes towards screening for suicide and self-harm are likely to influence how a young offender engages with the screening process. Our study is the first to explore community youth justice staff attitudes towards, and perceptions of, screening for self-harmful behaviour. Eight semi-structured interviews were conducted at an English Youth Offending Team in June 2006 with staff who had used the suicide screening tool with young offenders. Data were analysed using Interpretative Phenomenological Analysis. Staff attitudes towards working within the screening system varied along two dimensions. The first 'active/passive' dimension related to perceived confidence in dealing with self-harm. The second 'positive/negative' dimension related to perceptions of the benefits of screening and the effectiveness of mental health provision for young offenders. Results indicate that barriers to effective screening must be tackled at both individual and organisational levels. The model of attitudes presented here could be used to increase understanding of how staff can be supported to engage effectively with the screening system. © 2012 Blackwell Publishing Ltd.

  9. Determining treatment levels of comorbid psychiatric conditions in ...

    African Journals Online (AJOL)

    Background: Psychiatric co-morbidities occur more frequently in patients with epilepsy but are usually undertreated. Treatment of these disorders is key to reducing mortality via suicide and other causes. This study determined the levels of treatment of psychiatric comorbidities at clinics in Lusaka, Zambia. Methodology: This ...

  10. Treatment profiles in a Danish psychiatric university hospital department

    DEFF Research Database (Denmark)

    Okkels, Niels; Mogensen, Rasmus Beyer; Crean, Lea Catherine

    2017-01-01

    BACKGROUND: Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown. AIMS: To describe patterns in the treatment of patients in a large psychiatric......-eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82...... widely across all settings and patient categories. However, psychotropic medication clearly dominates as the most frequently applied treatment....

  11. IS TREATMENT-RESISTANCE IN PSYCHIATRIC DISORDERS A TRAP FOR POLYPHARMACY?

    OpenAIRE

    Jašović-Gašić, Miroslava

    2015-01-01

    Background: Nowadays, more and more mental health professionals manage patients who fail treatment for major psychiatric disorders. There is not a consensus on how to deal with treatment-resistance patients, but usually psychiatrists result to polypharmacy. Method: In reviewing the evidence based clinical research we will try to answer some questions about treatment-resistant psychiatric disorders. Treatment-resistant symptoms complicate the clinical course of all psychiatric diso...

  12. The impact of self-harm by young people on parents and families: a qualitative study.

    Science.gov (United States)

    Ferrey, Anne E; Hughes, Nicholas D; Simkin, Sue; Locock, Louise; Stewart, Anne; Kapur, Navneet; Gunnell, David; Hawton, Keith

    2016-01-06

    Little research has explored the full extent of the impact of self-harm on the family. This study aimed to explore the emotional, physical and practical effects of a young person's self-harm on parents and family. We used qualitative methods to explore the emotional, physical and practical effects of a young person's self-harm on their parents and family. We conducted a thematic analysis of thirty-seven semistructured narrative interviews with parents of young people who had self-harmed. After the discovery of self-harm, parents described initial feelings of shock, anger and disbelief. Later reactions included stress, anxiety, feelings of guilt and in some cases the onset or worsening of clinical depression. Social isolation was reported, as parents withdrew from social contact due to the perceived stigma associated with self-harm. Parents also described significant impacts on siblings, ranging from upset and stress to feelings of responsibility and worries about stigma at school. Siblings had mixed responses, but were often supportive. Practically speaking, parents found the necessity of being available to their child often conflicted with the demands of full-time work. This, along with costs of, for example, travel and private care, affected family finances. However, parents generally viewed the future as positive and hoped that with help, their child would develop better coping mechanisms. Self-harm by young people has major impacts on parents and other family members. Clinicians and staff who work with young people who self-harm should be sensitive to these issues and offer appropriate support and guidance for families. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. The Social Norms of Suicidal and Self-Harming Behaviours in Scottish Adolescents.

    Science.gov (United States)

    Quigley, Jody; Rasmussen, Susan; McAlaney, John

    2017-03-15

    Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating behaviours) perceived social norms have been found to strongly predict individuals' engagement in those behaviours, although discrepancies often exist between perceived and reported norms. Interventions which align perceived norms more closely with reported norms have been effective in reducing damaging behaviours. The current study aimed to explore whether the Social Norms Approach is applicable to suicidal and self-harming behaviours in adolescents. Participants were 456 pupils from five Scottish high-schools (53% female, mean age = 14.98 years), who completed anonymous, cross-sectional surveys examining reported and perceived norms around suicidal and self-harming behaviour. Friedman's ANOVA with post-hoc Wilcoxen signed-ranks tests indicated that proximal groups were perceived as less likely to engage in or be permissive of suicidal and self-harming behaviours than participants' reported themselves, whilst distal groups tended towards being perceived as more likely to do so. Binary logistic regression analyses identified a number of perceived norms associated with reported norms, with close friends' norms positively associated with all outcome variables. The Social Norms Approach may be applicable to suicidal and self-harming behaviour, but associations between perceived and reported norms and predictors of reported norms differ to those found in other behavioural domains. Theoretical and practical implications of the findings are considered.

  14. The Social Norms of Suicidal and Self-Harming Behaviours in Scottish Adolescents

    Directory of Open Access Journals (Sweden)

    Jody Quigley

    2017-03-01

    Full Text Available Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating behaviours perceived social norms have been found to strongly predict individuals’ engagement in those behaviours, although discrepancies often exist between perceived and reported norms. Interventions which align perceived norms more closely with reported norms have been effective in reducing damaging behaviours. The current study aimed to explore whether the Social Norms Approach is applicable to suicidal and self-harming behaviours in adolescents. Participants were 456 pupils from five Scottish high-schools (53% female, mean age = 14.98 years, who completed anonymous, cross-sectional surveys examining reported and perceived norms around suicidal and self-harming behaviour. Friedman’s ANOVA with post-hoc Wilcoxen signed-ranks tests indicated that proximal groups were perceived as less likely to engage in or be permissive of suicidal and self-harming behaviours than participants’ reported themselves, whilst distal groups tended towards being perceived as more likely to do so. Binary logistic regression analyses identified a number of perceived norms associated with reported norms, with close friends’ norms positively associated with all outcome variables. The Social Norms Approach may be applicable to suicidal and self-harming behaviour, but associations between perceived and reported norms and predictors of reported norms differ to those found in other behavioural domains. Theoretical and practical implications of the findings are considered.

  15. How and Why Young People Use Social Media in Relation to Self Harm and to What Effect?

    OpenAIRE

    Brett-Taylor, Lucy

    2015-01-01

    Social media use and self-harm prevalence are both highest among young people. Many explanatory models of self-harm have been proposed which are helpful in understanding the functions self-harm serve. Social media is a relatively new phenomenon requiring further research to increase understanding of the psychological processes associated with its use. The connection between self-harm and social media has received increased media attention in recent years and is of clinical and social importan...

  16. An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study.

    Science.gov (United States)

    Sørensen, Jane Brandt; Rheinländer, Thilde; Sørensen, Birgitte Refslund; Pearson, Melissa; Agampodi, Thilini; Siribaddana, Sisira; Konradsen, Flemming

    2014-10-07

    Sri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm. To capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story interviews with up to 20 individuals who have non-fatally self-harmed and where alcohol directly or indirectly was involved in the incidence as well as with their significant others; observations in communities and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm. The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. The results will be disseminated in scientific peer-reviewed articles in collaboration with Sri Lankan and other international research partners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Prevention of: self harm in British South Asian women: study protocol of an exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP

    Directory of Open Access Journals (Sweden)

    Nagaraj Diwaker

    2011-06-01

    Full Text Available Abstract Background Suicide is a major public health problem worldwide. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide. Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. There are concerns about the current service provision and its appropriateness for this community due to the low numbers that get involved with the services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group. The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm. Methods We plan to test a culturally adapted Problem Solving Therapy (C- MAP in British South Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU. Outcome assessments will be carried out at 3 and 6 months. A sub group of the participants will be invited for qualitative interviews. Discussion This study will test the feasibility and acceptability of the C- MAP in British South Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a

  18. Prevention of: self harm in British South Asian women: study protocol of an exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP).

    Science.gov (United States)

    Husain, Nusrat; Chaudhry, Nasim; Durairaj, Steevart V; Chaudhry, Imran; Khan, Sarah; Husain, Meher; Nagaraj, Diwaker; Naeem, Farooq; Waheed, Waquas

    2011-06-21

    Suicide is a major public health problem worldwide. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide. Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. There are concerns about the current service provision and its appropriateness for this community due to the low numbers that get involved with the services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group.The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm. We plan to test a culturally adapted Problem Solving Therapy (C- MAP) in British South Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU). Outcome assessments will be carried out at 3 and 6 months. A sub group of the participants will be invited for qualitative interviews. This study will test the feasibility and acceptability of the C- MAP in British South Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a definitive RCT using repetition of self harm and cost

  19. Understanding vulnerability to self-harm in times of economic hardship and austerity: a qualitative study.

    Science.gov (United States)

    Barnes, M C; Gunnell, D; Davies, R; Hawton, K; Kapur, N; Potokar, J; Donovan, J L

    2016-02-17

    Self-harm and suicide increase in times of economic recession, but little is known about why people self-harm when in financial difficulty, and in what circumstances self-harm occurs. This study aimed to understand events and experiences leading to the episode of self-harm and to identify opportunities for prevention or mitigation of distress. Participants' homes or university rooms. 19 people who had attended hospital following self-harm in two UK cities and who specifically cited job loss, economic hardship or the impact of austerity measures as a causal or contributory factor. Semistructured, in-depth interviews. Interviews were audio recorded, transcribed and analysed cross-sectionally and as case studies. Study participants described experiences of severe economic hardship; being unable to find employment or losing jobs, debt, housing problems and benefit sanctions. In many cases problems accumulated and felt unresolvable. For others an event, such as a call from a debt collector or benefit change triggered the self-harm. Participants also reported other current or past difficulties, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem. These contributed to their sense of despair and worthlessness and increased their vulnerability to self-harm. Participants struggled to gain the practical help they felt they needed for their economic difficulties or therapeutic support that might have helped with their other co-existing or historically damaging experiences. Economic hardships resulting from the recession and austerity measures accumulated or acted as a 'final straw' to trigger self-harm, often in the context of co-existing or historically damaging life-experiences. Interventions to mitigate these effects should include providing practical advice about economic issues before difficulties become insurmountable and providing appropriate psychosocial support for vulnerable

  20. Exploring the Therapeutic Affordances of Self-Harm Online Support Communities: An Online Survey of Members

    Science.gov (United States)

    Bullock, Emma

    2017-01-01

    Background A growing number of online communities have been established to support those who self-harm. However, little is known about the therapeutic affordances arising from engagement with these communities and resulting outcomes. Objective The aim of this study was to explore the presence of therapeutic affordances as reported by members of self-harm online support communities. Methods In total, 94 respondents (aged 13-63 years, mean=23.5 years; 94% female) completed an online survey exploring their experiences of engaging with a self-harm online support community. Respondents varied in terms of how long they had been accessing an online community, with 22% (21/94) accessing less than 1 year, 39% (37/94) 1 to 2 years, 14% (13/94) 2 to 3 years, and 24.5% (23/94) more than 3 years. Responses were analyzed using deductive thematic analysis. Results The results of our analysis describe each of the five therapeutic affordances that were present in the data, namely (1) connection, the ability to make contact with others who self-harm for the purposes of mutual support and in so doing reduce feelings of loneliness and isolation; (2) adaptation, that is, how use of online support varies in relation to the personal circumstances of the individual user; (3) exploration, that is, the ability to learn about self-harm and learn about strategies to reduce or stop self-harming behavior; (4) narration, that is, the ability to share experiences, as well as read about the experiences of others; and (5) self-presentation, that is, how and what users present about themselves to others in the online community. Conclusions Our findings suggest that engagement with self-harm online support communities may confer a range of therapeutic benefits for some users, which may serve to minimize the psychosocial burden of self-harm and promote positive coping strategies. In addition, the online nature of the support available may be helpful to those who are unable to access face

  1. A CASE OF THE SELF- HARMING BEHAVIOUR CREATED WITH COMPULSIVE SYNCOPE EPISODES

    Directory of Open Access Journals (Sweden)

    Cetiner OZCAN

    2011-06-01

    Full Text Available In this case report, self-harming behavioural pattern with recurrent syncope episodes in a 15 years old adolescent has been reviewed. In self-harm behavior, tissue damage can often be seen macroscopically. Whereas in this case, the extraordinary situation is possibility of occurrence of the hypoxic encephalopathyc changes with syncope episodes created by the patient, without macroscopic tissue damage. [J Contemp Med 2011; 1(2.000: 78-80

  2. Socio-Demographic and Mental Health Profile of Admitted Cases of Self-Inflicted Harm in the US Population

    Directory of Open Access Journals (Sweden)

    Chris Hanuscin

    2018-01-01

    Full Text Available Self-inflicted harm (SIH has a substantial lifetime prevalence, it is associated with tremendous costs, and its rate is increasing on a national scale. To examine the characteristics of those admitted for SIH in the US and to investigate the factors that potentially modify the methods used for SIH. This was a retrospective analysis of admitted cases of SIH including suicide attempts between 2007 and 2012 using the National Trauma Data Bank. We included a total of 204,633 cases admitted for SIH. Our participants were 75.1% males. Those aged 15–24 (21%, 25–34 (22%, 35–44 (19%, 45–54 (19%, and 55–64 (10% years comprised the largest age groups among our cases—70.8%, 11.5%, 11.1%, and 6.6% were, respectively, Caucasians, Hispanics, Blacks, and Asian/Others. Analyses of the SIH methods revealed that Blacks were less likely to self-poison [Odds Ratio (OR: 0.78] compared to Whites, whereas individuals with psychiatric disorders or substance abuse carried 2.5 and 2.0-fold higher risk, respectively. Blacks were also less likely to use anoxic methods (OR: 0.69, whereas patients with psychiatric disorders or substance abuse carried 1.5-fold higher risk. Being Black, Hispanic, and Asian (OR: 0.58, 0.55, and 0.55, respectively as well as having psychiatric disorders (OR: 0.80 were associated with lower risks of using firearms, whereas its risk was increased with increasing age. Blacks (OR: 0.77 were less likely to cut or pierce in contrast to Hispanics (OR: 1.4, Asians/Others (OR: 1.29, and those with psychiatric disorders (2.5-fold higher risk or drug abuse (2-fold higher risk. Blacks (OR: 1.11, Hispanics (OR: 1.13, and Asians/Others (OR: 1.57 were more likely to jump from high places, whereas those with substance abuse were less likely (OR: 0.77. Among patients admitted for SIH, males, those aged 15–64 years, and Whites comprised the largest sex, age, and racial/ethnic groups, respectively. We also found that several factors including race

  3. Mental health nurses' attitudes toward self-harm: Curricular ...

    African Journals Online (AJOL)

    David G. Shaw

    Mental health curriculum. Interpretative phenomenological analysis. Nurses ... This paper reports on a qualitative study into the attitudes of ... There are a couple of published accounts based on ... the stimulus is self-harm and the health professional (nurse) ... iours, including sex and exercise (Connor & Norman, 2005).

  4. A brief intervention is sufficient for many adolescents seeking help from low threshold adolescent psychiatric services

    Directory of Open Access Journals (Sweden)

    Laukkanen Eila

    2010-09-01

    Full Text Available Abstract Background There has been a considerable increase in the need for psychiatric services for adolescents. Primary health care practitioners have a major role in detecting, screening and helping these adolescents. An intervention entitled SCREEN is described in this article. The SCREEN intervention was developed to help practitioners to detect and screen adolescent needs, to care for adolescents at the primary health care level and to facilitate the referral of adolescents to secondary care services in collaboration between primary and secondary health care. Secondly, the article presents the background and clinical characteristics of youths seeking help from the SCREEN services, and compares the background factors and clinical characteristics of those patients referred and not referred to secondary care services. Methods The SCREEN intervention consisted of 1 to 5 sessions, including assessment by a semi-structured anamnesis interview, the structured Global Assessment Scale, and by a structured priority rating scale, as well as a brief intervention for each adolescent's chosen problem. Parents took part in the assessment in 39% of cases involving girls and 50% involving boys. During 34 months, 2071 adolescents (69% females entered the intervention and 70% completed it. The mean age was 17.1 years for boys and 17.3 years for girls. Results For 69% of adolescents, this was the first contact with psychiatric services. The most common reasons for seeking services were depressive symptoms (31%. Self-harming behaviour had occurred in 25% of girls and 16% of boys. The intervention was sufficient for 37% of those who completed it. Psychosocial functioning improved during the intervention. Factors associated with referral for further treatment were female gender, anxiety as the main complaint, previous psychiatric treatment, self-harming behaviour, a previous need for child welfare services, poor psychosocial functioning and a high score in the

  5. What Can Psychiatric Disorders Tell Us about Neural Processing of the Self?

    Science.gov (United States)

    Zhao, Weihua; Luo, Lizhu; Li, Qin; Kendrick, Keith M

    2013-01-01

    Many psychiatric disorders are associated with abnormal self-processing. While these disorders also have a wide-range of complex, and often heterogeneous sets of symptoms involving different cognitive, emotional, and motor domains, an impaired sense of self can contribute to many of these. Research investigating self-processing in healthy subjects has facilitated identification of changes in specific neural circuits which may cause altered self-processing in psychiatric disorders. While there is evidence for altered self-processing in many psychiatric disorders, here we will focus on four of the most studied ones, schizophrenia, autism spectrum disorder (ASD), major depression, and borderline personality disorder (BPD). We review evidence for dysfunction in two different neural systems implicated in self-processing, namely the cortical midline system (CMS) and the mirror neuron system (MNS), as well as contributions from altered inter-hemispheric connectivity (IHC). We conclude that while abnormalities in frontal-parietal activity and/or connectivity in the CMS are common to all four disorders there is more disruption of integration between frontal and parietal regions resulting in a shift toward parietal control in schizophrenia and ASD which may contribute to the greater severity and delusional aspects of their symptoms. Abnormalities in the MNS and in IHC are also particularly evident in schizophrenia and ASD and may lead to disturbances in sense of agency and the physical self in these two disorders. A better future understanding of how changes in the neural systems sub-serving self-processing contribute to different aspects of symptom abnormality in psychiatric disorders will require that more studies carry out detailed individual assessments of altered self-processing in conjunction with measurements of neural functioning.

  6. Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

    NARCIS (Netherlands)

    Bowers, L.; Jeffery, D.; Simpson, A.; Daly, C.; Warren, J.; Nijman, H.L.I.

    2007-01-01

    Aim. This paper reports in examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week oil acute Psychiatric wards. Background. Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and

  7. The impact of self-harm by young people on parents and families: a qualitative study

    OpenAIRE

    Ferrey, Anne E; Hughes, Nicholas D; Simkin, Sue; Locock, Louise; Stewart, Anne; Kapur, Navneet; Gunnell, David; Hawton, Keith

    2016-01-01

    Objectives: Little research has explored the full extent of the impact of self-harm on the family. This study aimed to explore the emotional, physical and practical effects of a young person’s self-harm on parents and family. Design and Participants: We used qualitative methods to explore the emotional, physical and practical effects of a young person’s self-harm on their parents and family. We conducted a thematic analysis of thirty-seven semi-structured narrative interviews with parents...

  8. Self Harm – mistreatment in services/or addiction/therapy – qualitative research

    OpenAIRE

    Gregoriou, Kyriakos

    2010-01-01

    Abstract The study aims to discover the defining attributes, possible antecedents and possible consequences of the concept “self harm and adolescent”. The importance of this is highlighted by the empirical referents, which clearly show the existence of the concept and the need for further research and information on the concept. This is done by critically analysing twenty-three articles, all based on adolescent self harm in a western setting. The defining attributes depression; deliber...

  9. Self-esteem and suicide ideation in psychiatric outpatients.

    Science.gov (United States)

    Bhar, Sunil; Ghahramanlou-Holloway, Marjan; Brown, Gregory; Beck, Aaron T

    2008-10-01

    Depression, hopelessness, and low self-esteem are implicated as vulnerability factors for suicide ideation. The association of self-esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self-esteem, suicide ideation, hopelessness, and depression. Self-esteem was operationalized as beliefs about oneself (self-based self-esteem) and beliefs about how other people regard oneself (other-based self-esteem). Each dimension of self-esteem was negatively associated with suicide ideation after controlling for depression and hopelessness. Of the two dimensions of self-esteem, other-based self-esteem was the more robust predictor of suicide ideation. These findings suggest that even in the context of depression and hopelessness, low self-esteem may add to the risk for suicide ideation.

  10. Self-reported peer victimization and suicidal ideation in adolescent psychiatric inpatients: the mediating role of negative self-esteem.

    Science.gov (United States)

    Jones, Heather A; Bilge-Johnson, Sumru; Rabinovitch, Annie E; Fishel, Hazel

    2014-10-01

    The current study investigated relationships among self-reported peer victimization, suicidality, and depression in adolescent psychiatric inpatients. Sixty-seven adolescent psychiatric inpatients at a Midwestern children's hospital completed measures of bullying and peer victimization, suicidal ideation, and depression during their inpatient stay. Analyses indicated significant moderate correlations among victimization, suicidal ideation, and depression in adolescents. Results from mediational analyses found that negative self-esteem mediated the relationship between peer victimization and suicidal ideation. To date, this study is the first to directly examine the mechanisms underlying the relationship between peer victimization and suicidal ideation in adolescent psychiatric inpatients. © The Author(s) 2013.

  11. Harm reduction psychotherapy: extending the reach of traditional substance use treatment.

    Science.gov (United States)

    Tatarsky, Andrew

    2003-12-01

    Harm reduction is a paradigm-shifting idea that has the potential to significantly improve the treatment of problem substance users. The essence of harm reduction is the recognition that treatment must start from the client's needs and personal goals and that all change that reduces the harms associated with substance use can be regarded as valuable. The paper presents harm reduction's rationale, principles, treatment implications, and application to psychotherapy. The author describes his model of Integrative Harm Reduction Psychotherapy, an approach that integrates a strategic skills-building focus with an exploration of the multiple meanings of substance use and the importance of the therapeutic alliance.

  12. Exploring the Therapeutic Affordances of Self-Harm Online Support Communities: An Online Survey of Members.

    Science.gov (United States)

    Coulson, Neil S; Bullock, Emma; Rodham, Karen

    2017-10-13

    A growing number of online communities have been established to support those who self-harm. However, little is known about the therapeutic affordances arising from engagement with these communities and resulting outcomes. The aim of this study was to explore the presence of therapeutic affordances as reported by members of self-harm online support communities. In total, 94 respondents (aged 13-63 years, mean=23.5 years; 94% female) completed an online survey exploring their experiences of engaging with a self-harm online support community. Respondents varied in terms of how long they had been accessing an online community, with 22% (21/94) accessing less than 1 year, 39% (37/94) 1 to 2 years, 14% (13/94) 2 to 3 years, and 24.5% (23/94) more than 3 years. Responses were analyzed using deductive thematic analysis. The results of our analysis describe each of the five therapeutic affordances that were present in the data, namely (1) connection, the ability to make contact with others who self-harm for the purposes of mutual support and in so doing reduce feelings of loneliness and isolation; (2) adaptation, that is, how use of online support varies in relation to the personal circumstances of the individual user; (3) exploration, that is, the ability to learn about self-harm and learn about strategies to reduce or stop self-harming behavior; (4) narration, that is, the ability to share experiences, as well as read about the experiences of others; and (5) self-presentation, that is, how and what users present about themselves to others in the online community. Our findings suggest that engagement with self-harm online support communities may confer a range of therapeutic benefits for some users, which may serve to minimize the psychosocial burden of self-harm and promote positive coping strategies. In addition, the online nature of the support available may be helpful to those who are unable to access face-to-face support. ©Neil S Coulson, Emma Bullock, Karen Rodham

  13. Self-harm in adolescence: protective health assets in the family, school and community.

    Science.gov (United States)

    Klemera, Ellen; Brooks, Fiona M; Chester, Kayleigh L; Magnusson, Josefine; Spencer, Neil

    2017-07-01

    The aim of this paper was to examine if the multiple environments of the adolescent including family, peers, school and neighbourhood might function as protective health assets against self-harming behaviour during adolescence. The present study utilised data collected from 1608 respondents aged 15 years as part of the England WHO Health Behaviour in School-aged Children (HBSC) Study. Multilevel modelling was undertaken using the package MLwiN (version 2.33) to investigate the potential domains and dimensions of family life, school culture and environment, and neighbourhood factors that may operate as protective health assets. The results indicated that while peer support did not appear to operate as a protective health asset in the context of self-harm, key dimensions of adolescent/parent interaction and adolescent experience of the school culture and their neighbourhood were associated with reduced likelihood of self-harming behaviours during adolescence. The Findings highlight the significance of belonging and connectedness as important constituent elements of protective health assets for young people. Interventions that address the multiple environments of the young person, may offer an effective means to reduce the levels of self-harm.

  14. Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm

    NARCIS (Netherlands)

    Opmeer, Brent C.; Hollingworth, William; Marques, Elsa M. R.; Margelyte, Ruta; Gunnell, David

    2017-01-01

    Objectives To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. Design Retrospective before and after cohort study using routinely collected Self-Harm Surveillance

  15. Mental health nurses' attitudes toward self-harm: Curricular implications

    Directory of Open Access Journals (Sweden)

    David G. Shaw

    2016-12-01

    Conclusion: The FASH Model may inform future curriculum innovation. Adopting a holistic approach to education of nurses about self-harm may assist in developing attitudes and skills to make care provision more effective in secure mental health settings.

  16. A sequence analysis of patterns in self-harm in young people with and without experience of being looked after in care.

    Science.gov (United States)

    Wadman, Ruth; Clarke, David; Sayal, Kapil; Armstrong, Marie; Harroe, Caroline; Majumder, Pallab; Vostanis, Panos; Townsend, Ellen

    2017-11-01

    Young people in the public care system ('looked-after' young people) have high levels of self-harm. This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months. Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm. Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended. Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this. Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm

  17. Involuntary psychiatric admission based on risk rather than need for treatment: report from the Dublin Involuntary Admission Study (DIAS).

    LENUS (Irish Health Repository)

    Kelly, BD

    2018-04-01

    Involuntary psychiatric admission in Ireland is based on the presence of mental disorder plus serious risk to self\\/others and\\/or need for treatment. This study aimed to examine differences between use of risk and treatment criteria, about which very little is known.

  18. Effect of alcohol dose on deliberate self-harm in men and women.

    Science.gov (United States)

    Berman, Mitchell E; Fanning, Jennifer R; Guillot, Casey R; Marsic, Angelika; Bullock, Joshua; Nadorff, Michael R; McCloskey, Michael S

    2017-09-01

    Nonexperimental survey and field research support the notion that alcohol use may be associated with deliberate self-harm (DSH) across the spectrum of lethality, from nonsuicidal self-injury (NSSI) through suicide. Nonexperimental studies, however, provide limited information about potential causal relationships between alcohol consumption and DSH. Two previous experiments showed that a relatively high-dose of alcohol increases the likelihood of engaging in DSH in men, with DSH defined by the self-administration of a "painful" shock (the self-aggression paradigm [SAP]; Berman & Walley, 2003; McCloskey & Berman, 2003). In this study, we examined whether (a) lower doses of alcohol also elicit DSH, (b) this effect occurs for women as well as men, and (c) individual differences in past nonsuicidal self-injury (NSSI) moderate alcohol's effects on DSH. Nonalcohol dependent men and women (N = 210) were assigned either to .00%, .05%, .075%, or .100% blood alcohol concentration (BAC) drink conditions and completed a self-rating scale of NSSI (the Deliberate Self-Harm Inventory [DSHI]; Gratz, 2001). As in previous SAP studies, DSH was operationalized by shock setting behavior during a competitive reaction time (RT) game. Overall, a greater proportion of participants in the .075% and .100% (but not .050%) alcohol conditions self-selected a "painful" shock to administer compared to participants in the placebo condition. NSSI predicted self-administration of painful shocks, but did not moderate the alcohol effect. Results provide experimental evidence to support the notion that interventions for self-harm should include processes to monitor and limit alcohol intake. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Anger as a predictor of psychological distress and self-harm ideation in inmates: a structured self-assessment diary study.

    Science.gov (United States)

    Humber, Naomi; Emsley, Richard; Pratt, Daniel; Tarrier, Nicholas

    2013-11-30

    Suicidal ideation and behaviour are common among inmates. Anger is found at exaggerated levels and has been associated with suicidal ideation and behaviour in inmate samples suggesting its possible salience in the prediction of suicide. The study investigated relationships between anger, psychological distress, and self-harm/suicidal ideation among inmates. The principles of Ecological Momentary Assessment were considered and a structured self-assessment diary was utilised to examine relationships between the variables of interest. Participants completed a structured self-assessment diary for six consecutive days which included momentary ratings of items describing psychological states of concurrent affects, thoughts, and appraisals related to anger, psychological distress, and self-harm/suicidal ideation. Psychometric assessment measures were also conducted. Temporal associations between predictors and outcomes were investigated. Multilevel modelling analyses were performed. Increased anger was significantly associated with concurrent high levels of self-harm ideation in inmates, when controlling for depression and hopelessness. Temporal analyses also revealed that anger at one time point did not predict suicidal ideation at the next time point. Elucidating the temporal nature of the relationship between anger, psychological distress, and self-harm/suicidal ideation has advanced understanding of the mechanisms of suicidal behaviour, by demonstrating an increased risk of suicide when a male inmate is angry. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Preventing compulsory admission to psychiatric inpatient care: Perceived coercion, empowerment and self-reported mental health functioning after 12 months of preventive monitoring

    Directory of Open Access Journals (Sweden)

    Barbara eLay

    2015-11-01

    Full Text Available Objective: To evaluate effects of a preventive monitoring program targeted to reduce compulsory re-hospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment and self-reported mental health functioning at 12 months. Methods: The program consists of individualized psycho-education, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients. Results: Study participants reported lower levels of perceived coercion, negative pressures and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations and social role functioning (significant time effects. However, improvements were not confined to the intervention group, but seen also in the TAU group (no significant group or interaction effects. Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others. Conclusion: Our findings suggest that changes in the subjective perspective were fuelled primarily by participation in this study, rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between 'objective' measures (compulsory readmissions and patients’ perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.

  1. Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents

    Directory of Open Access Journals (Sweden)

    Furukawa TA

    2012-11-01

    Full Text Available Norio Watanabe,1,* Atsushi Nishida,2,* Shinji Shimodera,3 Ken Inoue,4 Norihito Oshima,5 Tsukasa Sasaki,6 Shimpei Inoue,3 Tatsuo Akechi,1 Toshi A Furukawa,7 Yuji Okazaki81Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Department of Schizophrenia Research, Tokyo Institute of Psychiatry, Tokyo, 3Department of Neuropsychiatry, Kochi Medical School, Kochi, 4Department Public Health, Fujita Health University School of Medicine, Aichi, 5Office for Mental Health Support, Division for Counseling and Support, University of Tokyo, Tokyo, 6Health Service Center, University of Tokyo, Tokyo, 7Department of Cognitive-Behavioral Medicine, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, 8Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan *These authors contributed equally to this workBackground: The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help.Methods: A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors.Results: A total of 18,104 students (8620 aged 12–15 years, 9484 aged 15–18 years, accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and

  2. Can we use neurocognition to predict repetition of self-harm, and why might this be clinically useful? A perspective.

    Directory of Open Access Journals (Sweden)

    Angharad Natalie De Cates

    2016-01-01

    Full Text Available Over 800,000 people die by suicide each year globally, with non-fatal self-harm 20 times more common. With each episode of self-harm, the risks of future self-harm and suicide increase, as well as personal and healthcare costs. Therefore, early delineation of those at high-risk of future self-harm is important. Historically, research has focused on clinical and demographic factors, but risk assessments based on these have low sensitivity to predict repetition. Various neurocognitive factors have been associated with self-harming behavior, but it is less certain if we can use these factors clinically (i as risk markers to predict future self-harm and (ii to become therapeutic targets for interventions.Recent systematic reviews and meta-analyses of behavioral tasks and fMRI studies point to an emerging hypothesis for neurocognition in self-harm: an underactive pre-frontal cortex is unable to respond appropriately to non-emotional stimuli, or inhibit a hyperactive emotionally- / threat-driven limbic system. However, there is almost no imaging data examining repetition of self-harm. Extrapolating from the non-repetition data, there may be several potential neurocognitive targets for interventions to prevent repeat self-harm: cognitive training; pharmacological regimes to promote non-emotional neurocognition; or other techniques, such as repetitive transcranial magnetic stimulation (rTMS. Hence, there is an urgent need for imaging studies examining repetition and to test specific hypotheses. Until we investigate the functional neurocognitive basis underlying repetition of self-harm in a systematic manner using second-generational imaging techniques, we will be unable to inform third-generational imaging and potential future clinical applications.

  3. [Dialectical-behavioral outpatient therapy for adolescents with impulsive and self-harming behavior].

    Science.gov (United States)

    Maffezzoni, Marco; Steinhausen, Hans-Christoph

    2017-11-01

    A slightly modified version of the Dialectical-Behavioral Therapy for Adolescents (DBT-A) for impulsive and self-injurious adolescents has been implemented in the Child and Adolescent Psychiatric Service in Zurich, Switzerland, since 2005. This DBT-A comprises individual therapy, skills training, and a single parent meeting over a 6-month period. This article reports on the translation of this approach into clinical practice and presents an evaluation based on the clinical quality of control assessments. Participants of the treatment program were 43 female adolescents aged 14 to 19 living in the Zurich area and showing impulsive and self-injurious behavior and problems regulating their emotions and relationships. Each skill group contained 4-6 adolescents. Our mostly positive experiences with this approach were supplemented by evaluation data from a quality control group based on self- and parent-report of a total of 19 participants. There is convincing evidence that DBT-A leads to reductions in both general and specific psychopathology.

  4. Identifying indicators of harmful and problem gambling in a Canadian sample through receiver operating characteristic analysis.

    Science.gov (United States)

    Quilty, Lena C; Avila Murati, Daniela; Bagby, R Michael

    2014-03-01

    Many gamblers would prefer to reduce gambling on their own rather than to adopt an abstinence approach within the context of a gambling treatment program. Yet responsible gambling guidelines lack quantifiable markers to guide gamblers in wagering safely. To address these issues, the current investigation implemented receiver operating characteristic (ROC) analysis to identify behavioral indicators of harmful and problem gambling. Gambling involvement was assessed in 503 participants (275 psychiatric outpatients and 228 community gamblers) with the Canadian Problem Gambling Index. Overall gambling frequency, duration, and expenditure were able to distinguish harmful and problematic gambling at a moderate level. Indicators of harmful gambling were generated for engagement in specific gambling activities: frequency of tickets and casino; duration of bingo, casino, and investments; and expenditures on bingo, casino, sports betting, games of skill, and investments. Indicators of problem gambling were similarly produced for frequency of tickets and casino, and expenditures on bingo, casino, games of skill, and investments. Logistic regression analyses revealed that overall gambling frequency uniquely predicted the presence of harmful and problem gambling. Furthermore, frequency indicators for tickets and casino uniquely predicted the presence of both harmful and problem gambling. Together, these findings contribute to the development of an empirically based method enabling the minimization of harmful or problem gambling through self-control rather than abstinence.

  5. Non-suicidal self-injury (Nssi in adolescent inpatients: assessing personality features and attitude toward death

    Directory of Open Access Journals (Sweden)

    Ferrara Mauro

    2012-03-01

    Full Text Available Abstract Background Non-suicidal self-injury (NSSI is a common concern among hospitalized adolescents, and can have significant implications for short and long-term prognosis. Little research has been devoted on how personality features in severely ill adolescents interact with NSSI and "attitude toward life and death" as a dimension of suicidality. Developing more specific assessment methodologies for adolescents who engage in self-harm without suicidal intent is relevant given the recent proposal of a non-suicidal self-injury (NSSI disorder and may be useful in predicting risk in psychiatrically impaired subjects. Methods Consecutively hospitalized adolescents in a psychiatric unit (N = 52; 71% females; age 12-19 years, reporting at least one recent episode of self-harm according to the Deliberate Self-harm Inventory, were administered the Structured Clinical Interview for DSM Mental Disorders and Personality Disorders (SCID I and II, the Children's Depression Inventory and the Multi-Attitude Suicide Tendency Scale (MAST. Results Mean age onset of NSSI in the sample was 12.3 years. All patients showed "repetitive" NSSI (high frequency of self-harm, covering different modalities. Results revealed that 63.5% of adolescents met criteria for Borderline Personality Disorder (BPD and that the rest of the sample also met criteria for personality disorders with dysregulated traits. History of suicide attempts was present in 46.1% of cases. Elevated depressive traits were found in 53.8%. Results show a statistically significant negative correlation between the score on the "Attraction to Life" subscale of the MAST and the frequency and diversification of self-harming behaviors. Conclusions Most adolescent inpatients with NSSI met criteria for emotionally dysregulated personality disorders, and showed a reduced "attraction to life" disposition and significant depressive symptoms. This peculiar psychopathological configuration must be addressed in the

  6. Ego development, self-perception, and self-complexity in adolescence: a study of female psychiatric inpatients.

    Science.gov (United States)

    Evans, D W; Brody, L; Noam, G G

    2001-01-01

    A study of two groups of female psychiatric inpatients, differing in level of ego development, explored domains of self-perception that best predicted global self-worth and symptom clusters that best predicted second-order factors of self perception. Findings revealed quantitative and qualitative differences in self-complexities, and more positive self-perceptions among the higher ego-level group in scholastic competence, job competence, and behavioral conduct. Results are discussed from a developmental perspective.

  7. [Self-Reflection From Group Dialogue: The Lived Experience of Psychiatric/Mental Health Nurses].

    Science.gov (United States)

    Chiang, Hsien-Hsien

    2015-08-01

    Self-reflection is an essential element of reflective practice for group facilitators. However, this element typically exists largely at the personal level and is not addressed in group dialogues of nurses. The purpose of this study was to explore the self-reflection of psychiatric nurses in a supervision group. A phenomenological approach was used to investigate the dialogues across 12 sessions in terms of discussion content and the reflective journals of the psychiatric nurse participants. The findings showed that two forms of self-reflection included: Embodied self-reflection derived from the physical sensibility and discursive self-reflection derived from the group dialogues. The embodied and discursive self-reflections promote self-awareness in nurses. The embodiment and initiation in the group facilitates the process of self-becoming through the group dialogue, which promotes self-examination and self-direction in healthcare professionals.

  8. Immediate therapist self-disclosure bolsters the effect of brief integrative psychotherapy on psychiatric symptoms and the perceptions of therapists: A randomized clinical trial.

    Science.gov (United States)

    Ziv-Beiman, Sharon; Keinan, Giora; Livneh, Elad; Malone, Patrick S; Shahar, Golan

    2017-09-01

    We report a first randomized clinical trial examining the effect of immediate and non-immediate therapist self-disclosure in the context of a brief integrative psychotherapy for mild to moderate distress. A total of 86 patients with mild to moderate forms of distress were randomly divided into three 12-session integrative psychotherapy conditions based primarily on [Hill, C. E. (2009). Helping skills: Facilitating, exploration, insight, and action (3rd ed.). Washington, DC: American Psychological Association.] three-stage model. Therapists trained in this treatment modality were instructed to use either immediate self-disclosure (expressing feelings towards the patient/treatment/therapeutic relationship) or non-immediate self-disclosure (expressing personal or factual information regarding the therapist's life outside the treatment). In the comparison condition, the therapists were instructed to refrain from self-disclosure altogether. Immediate therapist self-disclosure reduced psychiatric symptoms among patients with elevated pretreatment symptoms (as assessed by the Brief Symptoms Inventory) and bolstered a favorable perception of the therapist. Therapists in both the immediate and non-immediate self-disclosure group evaluated themselves more favorably than their counterparts in the non-disclosure group. Therapist self-disclosure, particularly of the immediate type, might enhance the effect of brief integrative treatment on psychiatric symptoms of high symptomatic patients and contribute to favorable perception of therapists.

  9. Public perceptions of self-harm: a test of an attribution model of public discrimination

    OpenAIRE

    Nielsen, Emma; Townsend, Ellen

    2017-01-01

    This cross-sectional, questionnaire-based study applied Corrigan, Markowitz, Watson, Rowan, and Kubiak’s (2003) attribution model of public discrimination toward individuals with mental ill-health to explore public perceptions of self-harm—an underresearched topic, given the size and scale of the problem of self-harm.Participants (community-based adult sample, N=355, aged 18–67 years) were presented with 1 of 10, first-person, vignettes describing an episode of adolescent self-harm and comple...

  10. Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions

    DEFF Research Database (Denmark)

    Madsen, Lizell Bustamante; Eddleston, Michael; Hansen, Kristian Schultz

    2018-01-01

    Background: Death following self-harm constitutes a major global public health challenge and there is an urgent need for governments to implement cost-effective, national suicide prevention strategies. Aim: To conduct a systematic review and quality appraisal of the economic evaluations...... of interventions aimed at preventing suicidal behavior. Method: A systematic literature search was performed in several literature databases to identify relevant articles published from 2003 to 2016. Drummond's 10-item appraisal tool was used to assess the methodological quality of the included studies. Results....... The discussion of suicide and self-harm prevention should be as nuanced as possible, including health economics along with cultural, social, and political aspects....

  11. Predictors of treatment response to an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder.

    Science.gov (United States)

    Gratz, Kim L; Dixon-Gordon, Katherine L; Tull, Matthew T

    2014-01-01

    Despite evidence for the efficacy of several treatments for deliberate self-harm (DSH) within borderline personality disorder (BPD), predictors of response to these treatments remain unknown. This study examined baseline demographic, clinical, and diagnostic predictors of treatment response to an adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD. A recent RCT provided evidence for the efficacy of this ERGT (relative to a treatment-as-usual only waitlist condition). Participants in this study include the full intent-to-treat sample who began ERGT (across treatment and waitlist conditions; n = 51). Baseline diagnostic and clinical data were collected at the initial assessment, and outcome measures of DSH and self-destructive behaviors, emotion dysregulation/avoidance, and BPD symptoms (among others) were administered at pretreatment, posttreatment, and 3- and 9-months posttreatment. Notably, both demographic variables and characteristics of participants' ongoing therapy in the community had minimal impact on treatment response. However, several indicators of greater severity in domains relevant to this ERGT (i.e., baseline emotion dysregulation and BPD criteria, lifetime and recent DSH, and past-year hospitalization and suicide attempts) predicted better responses during treatment and follow-up across the primary targets of treatment. Likewise, several co-occurring disorders (i.e., social phobia, panic disorder, and a cluster B personality disorder) predicted greater improvements in BPD symptoms during treatment or follow-up. Finally, although co-occurring generalized anxiety disorder, posttraumatic stress disorder, and cluster A and C personality disorders were associated with poorer treatment response during follow-up, most of these effects reflected a lack of continued improvements during this period (vs. worsening of symptoms).

  12. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review

    Science.gov (United States)

    Glendenning, Alexander Charles; Marchant, Amanda; Montgomery, Paul; Stewart, Anne; Wood, Sophie; Lloyd, Keith; Hawton, Keith

    2018-01-01

    Background Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. Objective The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. Methods An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. Results A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who

  13. Psychiatric manifestations of Graves' hyperthyroidism: pathophysiology and treatment options.

    Science.gov (United States)

    Bunevicius, Robertas; Prange, Arthur J

    2006-01-01

    Graves' disease is an autoimmune disorder that is the most common cause of hyperthyroidism. Other symptoms associated with the disease are goitre, ophthalmopathy, and psychiatric manifestations such as mood and anxiety disorders and, sometimes, cognitive dysfunction. Graves' hyperthyroidism may result in these latter manifestations via the induction of hyperactivity of the adrenergic nervous system. This review addresses the psychiatric presentations, and their pathophysiology and treatment, in patients with hyperthyroidism, based on literature identified by a PubMed/MEDLINE database search. Although the focus is on mental symptoms associated with Graves' disease, it is not always clear from the literature whether patients had Graves' disease: in some studies, the patients were thought to have Graves' disease based on clinical findings such as diffuse goitre or ophthalmopathy or on measurements of thyroid antibodies in serum; however, in other studies, no distinction was made between Graves' hyperthyroidism and hyperthyroidism from other causes. Antithyroid drugs combined with beta-adrenoceptor antagonists are the treatments of choice for hyperthyroidism, as well as for the psychiatric disorders and mental symptoms caused by hyperthyroidism. A substantial proportion of patients have an altered mental state even after successful treatment of hyperthyroidism, suggesting that mechanisms other than hyperthyroidism, including the Graves' autoimmune process per se and ophthalmopathy, may also be involved. When psychiatric disorders remain after restoration of euthyroidism and after treatment with beta-adrenoceptor antagonists, specific treatment for the psychiatric symptoms, especially psychotropic drugs, may be needed.

  14. Self-harm: Prevalence estimates from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

    Science.gov (United States)

    Zubrick, Stephen R; Hafekost, Jennifer; Johnson, Sarah E; Lawrence, David; Saw, Suzy; Sawyer, Michael; Ainley, John; Buckingham, William J

    2016-09-01

    To (1) estimate the lifetime and 12-month prevalence of self-harm without suicide intent in young people aged 12-17 years, (2) describe the co-morbidity of these behaviours with mental illness and (3) describe their co-variation with key social and demographic variables. A nationally representative random sample of households with children aged 4-17 years recruited in 2013-2014. The survey response rate was 55% with 6310 parents and carers of eligible households participating. In addition, 2967 (89%) of young people aged 11-17 completed a self-report questionnaire with 2653 of the 12- to 17-year-olds completing questions about self-harm behaviour. In any 12-month period, about 8% of all 12- to 17-year-olds (an estimated 137,000 12- to 17-year-olds) report engaging in self-harming behaviour without suicide intent. This prevalence increases with age to 11.6% in 16- to 17-year-olds. Eighteen percent (18.8%; 95% confidence interval [CI] = [14.5, 23.0]) of all 12- to 17-year-old young people with any mental health disorder measured by parent or carer report said that they had engaged in self-harm in the past 12 months. Among young people who were measured by self-report and met criteria for the Diagnostic and Statistical Manual of Mental Disorders' major depressive disorder almost half (46.6%; 95% CI = [40.0, 53.1]) also reported that they had engaged in self-harm in the past 12 months. Suicide risk among those who self-harm is significantly elevated relative to the general population. The demonstrated higher risks in these young people for continued harm or possible death support the need for ongoing initiatives to reduce self-harm through mental health promotion, improved mental health literacy and continuing mental health reform to ensure services are accessible to, and meet the needs of families and young persons. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  15. An examination of emergency department nurses' attitudes towards deliberate self-harm in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McCarthy, Linda

    2010-01-01

    The purpose of this study was to examine emergency department (ED) nurses\\' attitudes towards individuals presenting with deliberate self-harm (DSH), including the relationship between attitudes and factors such as age, academic achievements, length of experience, and self-harm education.

  16. Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis.

    Science.gov (United States)

    O'Connor, Sophie; Glover, Lesley

    2017-09-01

    This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. Three main themes derived from the data. 'The impact of the system' influenced the extent to which staff were 'Fearing the harm from self-harm', or were 'Working alongside the whole person'. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, 'Working alongside the whole person' primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with

  17. Substance Use and Mental Health Outcomes for Comorbid Patients in Psychiatric Day Treatment

    Directory of Open Access Journals (Sweden)

    Stephen Magura

    2009-10-01

    Full Text Available The study’s purpose was to determine treatment outcomes for patients who present with drug use vs. those presenting with no drug use at admission to a psychiatric day treatment program. Consecutively admitted patients completed confidential interviews which included psychological distress and quality of life measures and provided urine specimens for toxicology at admission and six month follow-up. Subjects positive by past 30 day self-report or urinalysis were categorized as drug users. Major psychiatric diagnoses were: major depression 25%; bipolar, 13%; other mood 13%; schizoaffective 13%; schizophrenia 13%. Drug use at admission was: cocaine 35%; marijuana 33%; opiates 18%, (methamphetamines, 6% For each of these drugs, the percentage of patients positive at admission who remitted from using the drug significantly exceeded the percentage negative at baseline who initiated using the drug. Overall, there were significant decreases in psychological distress and significant improvement on quality of life, but no change on positive affect. There were no significant differences between drug users and non-drug users on symptom reduction and improvement in quality of life. Psychiatric day treatment appears to benefit comorbid patients by reducing the net number of patients who actively use certain common drugs and by improving psychological status and quality of life to the same degree as for non-drug using patients.

  18. Substance Use and Mental Health Outcomes for Comorbid Patients in Psychiatric Day Treatment

    Directory of Open Access Journals (Sweden)

    Stephen Magura

    2009-01-01

    Full Text Available The study's purpose was to determine treatment outcomes for patients who present with drug use vs. those presenting with no drug use at admission to a psychiatric day treatment program. Consecutively admitted patients completed confidential interviews which included psychological distress and quality of life measures and provided urine specimens for toxicology at admission and six month follow-up. Subjects positive by past 30 day self-report or urinalysis were categorized as drug users. Major psychiatric diagnoses were: major depression 25%; bipolar, 13%; other mood 13%; schizoaffective 13%; schizophrenia 13%. Drug use at admission was: cocaine 35%; marijuana 33%; opiates 18%, (methamphetamines, 6% For each of these drugs, the percentage of patients positive at admission who remitted from using the drug significantly exceeded the percentage negative at baseline who initiated using the drug. Overall, there were significant decreases in psychological distress and significant improvement on quality of life, but no change on positive affect. There were no significant differences between drug users and non-drug users on symptom reduction and improvement in quality of life. Psychiatric day treatment appears to benefit comorbid patients by reducing the net number of patients who actively use certain common drugs and by improving psychological status and quality of life to the same degree as for non-drug using patients.

  19. Self-harm and risk of motor vehicle crashes among young drivers : findings from the DRIVE Study

    NARCIS (Netherlands)

    Martiniuk, Alexandra L. C.; Ivers, Rebecca Q.; Glozier, Nick; Patton, George C.; Lam, Lawrence T.; Boufous, Soufiane; Senserrick, Teresa; Williamson, Ann; Stevenson, Mark; Norton, Robyn

    2009-01-01

    Background: Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers. Methods: We prospectively linked survey data

  20. Psychiatric care in the German prison system.

    Science.gov (United States)

    Lehmann, Marc

    2012-01-01

    The purpose of this paper is to describe the nature of medical care within the German penal system. German prison services provide health care for all inmates, including psychiatric care. The reached level of equivalence of care and ethical problems and resource limitations are discussed and the way of legislation in this field since 2006 reform on federal law is described. The article summarizes basic data on German prison health care for mentally ill inmates. The legislation process and factors of influence are pointed out. A description of how psychiatric care is organized in German prisons follows. It focuses on the actual legal situation including European standards of prison health care and prevention of torture, psychiatric care in German prisons themselves, self harm and addiction. Associated problems such as blood born diseases and tuberculosis are included. The interactions between prison staff and health care personal and ethic aspects are discussed. The legislation process is still going on and there is still a chance to improve psychiatric care. Mental health problems are the major challenge for prison health care. Factors such as special problems of migrants, shortage of professionals and pure statistic data are considered. The paper provides a general overview on psychiatric services in prison and names weak points and strengths of the system.

  1. Routine hospital data - is it good enough for trials? An example using England's Hospital Episode Statistics in the SHIFT trial of Family Therapy vs. Treatment as Usual in adolescents following self-harm.

    Science.gov (United States)

    Wright-Hughes, Alexandra; Graham, Elizabeth; Cottrell, David; Farrin, Amanda

    2018-04-01

    Use of routine data sources within clinical research is increasing and is endorsed by the National Institute for Health Research to increase trial efficiencies; however there is limited evidence for its use in clinical trials, especially in relation to self-harm. One source of routine data, Hospital Episode Statistics, is collated and distributed by NHS Digital and contains details of admissions, outpatient, and Accident and Emergency attendances provided periodically by English National Health Service hospitals. We explored the reliability and accuracy of Hospital Episode Statistics, compared to data collected directly from hospital records, to assess whether it would provide complete, accurate, and reliable means of acquiring hospital attendances for self-harm - the primary outcome for the SHIFT (Self-Harm Intervention: Family Therapy) trial evaluating Family Therapy for adolescents following self-harm. Participant identifiers were linked to Hospital Episode Statistics Accident and Emergency, and Admissions data, and episodes combined to describe participants' complete hospital attendance. Attendance data were initially compared to data previously gathered by trial researchers from pre-identified hospitals. Final comparison was conducted of subsequent attendances collected through Hospital Episode Statistics and researcher follow-up. Consideration was given to linkage rates; number and proportion of attendances retrieved; reliability of Accident and Emergency, and Admissions data; percentage of self-harm episodes recorded and coded appropriately; and percentage of required data items retrieved. Participants were first linked to Hospital Episode Statistics with an acceptable match rate of 95%, identifying a total of 341 complete hospital attendances, compared to 139 reported by the researchers at the time. More than double the proportion of Hospital Episode Statistics Accident and Emergency episodes could not be classified in relation to self-harm (75%) compared

  2. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete

    2017-01-01

    trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during......People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time...... admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors...

  3. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review.

    Science.gov (United States)

    John, Ann; Glendenning, Alexander Charles; Marchant, Amanda; Montgomery, Paul; Stewart, Anne; Wood, Sophie; Lloyd, Keith; Hawton, Keith

    2018-04-19

    Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that

  4. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown.

    Directory of Open Access Journals (Sweden)

    Amanda Marchant

    Full Text Available Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis.Forty-six independent studies (51 articles of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants; negative for 18 studies (119524 participants; and mixed for 17 studies (35235 participants. In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified.There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach

  5. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

    Science.gov (United States)

    Marchant, Amanda; Hawton, Keith; Stewart, Ann; Montgomery, Paul; Singaravelu, Vinod; Lloyd, Keith; Purdy, Nicola; Daine, Kate

    2017-01-01

    Background Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people. Methods We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis. Results Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified. Conclusions There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery

  6. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown.

    Science.gov (United States)

    Marchant, Amanda; Hawton, Keith; Stewart, Ann; Montgomery, Paul; Singaravelu, Vinod; Lloyd, Keith; Purdy, Nicola; Daine, Kate; John, Ann

    2017-01-01

    Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people. We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis. Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified. There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people

  7. Prevalence, Course, Incidence, and 1-Year Prediction of Deliberate Self-Harm and Suicide Attempts in Early Norwegian School Adolescents

    Science.gov (United States)

    Larsson, Bo; Sund, Anne Mari

    2008-01-01

    In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively,…

  8. How does self stigma differ across people with psychiatric diagnoses and rheumatoid arthritis, and how does it impact on self-esteem and empowerment?

    Science.gov (United States)

    Corker, Elizabeth; Brown, June; Henderson, Claire

    2016-12-01

    Self stigmatising attitudes have been found in people who have psychiatric diagnoses, however, research assessing self stigma in physical illnesses is rare. It is known that receiving a diagnosis of rheumatoid arthritis (RA) can affect a person's identity and self esteem. This study aimed to compare levels of self stigma, self esteem and empowerment between people diagnosed with psychiatric illnesses and people diagnosed with RA to establish whether self stigma, and specifically endorsement of negative stereotypes, is associated with self esteem and empowerment across these two groups. A total of 202 participants (psychiatric group n = 102; RA group n = 100) were interviewed using the Internalised Stigma of Mental Illness scale (ISMI), or the Internalized Stigma of Mental Illness scale- Rheumatoid Arthritis (ISMI-RA), the Index of Self Esteem (ISE) and the Mental Health Confidence Scale (MHCS). Overall, the psychiatric group had higher self stigma scores (2.5 vs. 2.2, p < .01), lower self esteem (48.7 vs. 36.8, p < .001) and lower empowerment scores (3.8 vs. 4.3, p < .001) than the RA group. However, sizable proportions of both groups had high self stigma scores. ISMI/ISMI-RA was associated with the ISE and the MHCS. The stereotype endorsement subscale of the ISMI/ISMI-RA was not related to self esteem or empowerment in either group. Interventions that aim to decrease self stigma and increase self esteem could focus on alienation.

  9. Intensification of sewage treatment processes from harmful substances

    International Nuclear Information System (INIS)

    Asadov, S.M.

    2007-01-01

    Full text: Intensive development of power, chemical, oil, machine-building and other industries results in increase of industrial toxic emissions. Local pollutions as a result of emissions of the industrial enterprises in many cases surpass the maximum permissible sanitary norms. E.g. works connected to an oil recovery, have led to pollution of huge territories of the Azerbaijan Republic, including Caspian Sea. Development of scientific bases of optimization of operating practices of industrial sewage treatment will allow to liquidate the harmful impurities. It is necessary for preservation of the environment to increase the clearing and sewage quality degree. During modeling a real process of sewage treatment from polluting impurities we need to build more and more complex models. It demands in return the application of applied mathematics methods for process of clearing of liquids. General theory and technology of sewage treatment, in particular, from heavy metals, radioactive nuclides now are absent. Achievement of an object provides for solution of the following problems: a) Research of laws of influence of various technological and physical and chemical parameters on efficiency of waste treatment from heavy metals and radioactive nuclides; b) Development of the effective reagents, allowing to remove from sewage cations of toxic heavy metals and radioactive nuclides; c) Construction of statistical models of an experimental material on clearing concrete sewage; d) Modeling of searches of optimum modes of sewage treatment processes from heavy metals ions; e) Development of optimum processes of sewage treatment from toxic heavy metals ions. The mentioned above problems are scantily studied both in experimental, and in the theoretical point of view. Expected scientific novelty of the offered project can be made in the following: Technological modes of carrying out of deep clearing processes of real sewage from toxic impurities, in particular from heavy metals ions

  10. Correlates of Suicidal Ideation and Self-harm in Early Childhood in a Cohort at Risk for Child Abuse and Neglect.

    Science.gov (United States)

    Paul, Elise; Ortin, Ana

    2017-12-27

    This study provides prevalence and persistence rates of suicidal ideation and self-harm, and examines how child maltreatment types, mental health symptoms, and age 4 suicidal ideation and self-harm are associated with each suicidal outcome among 6-year-old children. Participants were 1,090 caregivers assessed when their children were 4 and 6 years old from the Longitudinal Studies of Child Abuse and Neglect. Data were collected from the Child Behavior Checklist, Parent-Child Conflict Tactics Scales, and Child Protective Services. Persistence rates within each suicidal outcome were high. Failure to provide -a physical neglect subtype- was the only maltreatment type that independently predicted self-harm. Depressive/anxious symptoms and age 4 suicidal ideation were independently associated with age 6 suicidal ideation, whereas attention problems and age 4 self-harm predicted age 6 self-harm. Our findings align with the consensus emerging from adolescent studies that risk factors associate differentially with suicidal ideation and self-harm.

  11. Self-harm as a means to manage the public and private selves: A qualitative study of help seeking by adults

    Science.gov (United States)

    Ogden, Jane; Bennett, Alice

    2015-01-01

    Adults (n = 25) completed online free text boxes about their self-harming behaviour. Thematic analysis identified three dominant themes: ‘managing the private self’, ‘managing the public self’ and ‘moving on’. Transcending these themes was the notion of thresholds of change. Self-harm enables people to manage both their private and public selves. When thresholds of change are surpassed, the public self communicates a need for help. Self-harm exists within a precarious balance of well-being and can be a form of self-care. Help seeking is instigated when this balance is disrupted and continued if it offers a better form of self-management than the individual’s own self-harming behaviour. PMID:28070372

  12. The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder

    NARCIS (Netherlands)

    C.L. Taylor (Clare L.); L.M. van Ravesteyn (Leontien); M.P. Lambregtse-van den Berg (Mijke); R.J. Stewart (Robert J.); L.M. Howard (Louise M.)

    2016-01-01

    textabstractWomen with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation

  13. The non-display of authentic distress: public-private dualism in young people's discursive construction of self-harm.

    Science.gov (United States)

    Scourfield, Jonathan; Roen, Katrina; McDermott, Elizabeth

    2011-07-01

    This article draws from focus groups and interviews investigating how young people talk about self-harm. Some of the research participants had personal experience of self-harm but this was not a prerequisite for their inclusion in the study. Thematic coding was used initially to organise and give an overview of the data, but the data were subsequently analysed using a discourse analytic approach. The article focuses on the young people's constructions of deliberate self-harm such as 'cutting'. Throughout the focus groups and interviews, a dichotomy was set up by the young people between authentic, private self-harm which is rooted in real distress (and warrants a sympathetic response) and public, self-indulgent attempts to seek attention. This dualistic construction is discussed in some detail and located in various socio-cultural contexts. It is argued that the dualism illustrates contemporary ambivalence about mental health and youth. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  14. The neuropsychology of self-reflection in psychiatric illness.

    Science.gov (United States)

    Philippi, Carissa L; Koenigs, Michael

    2014-07-01

    The development of robust neuropsychological measures of social and affective function-which link critical dimensions of mental health to their underlying neural circuitry-could be a key step in achieving a more pathophysiologically-based approach to psychiatric medicine. In this article, we summarize research indicating that self-reflection (the inward attention to personal thoughts, memories, feelings, and actions) may be a useful model for developing such a paradigm, as there is evidence that self-reflection is (1) measurable with self-report scales and performance-based tests, (2) linked to the activity of a specific neural circuit, and (3) dimensionally related to mental health and various forms of psychopathology. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Medico legal aspects of self-injection of metallic mercury in cases of suicide or self-harming.

    Science.gov (United States)

    Da Broi, Ugo; Moreschi, Carlo; Colatutto, Antonio; Marcon, Barbara; Zago, Silvia

    2017-08-01

    Metallic mercury may be self-injected for suicidal or self-harm purposes or sometimes for superstitious or other inadvisable reasons. Local tissue or systemic consequences such as mercurialism can frequently occur in cases of subcutaneous or deep injection, while death due to pulmonary embolism and cardiac, brain, hepatic or renal toxicity may occur in cases of high dosage intravenous administration. The aim of this review is to focus on the diagnostic difficulties facing coroners and forensic pathologists when the courts require confirmation that evidence of self-injection of metallic mercury is the result of suicide or self-harming. Forensic examination performed on the corpses of victims who died in or out of hospital or on surviving injured or intoxicated victims showing signs of mercurialism, demands the careful evaluation of the death scene, of all related circumstances and of the clinical and autopsy data. Close interaction between forensic pathologists and toxicologists is also needed to identify and quantify mercury levels in blood, urine and tissue. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  16. A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial

    Science.gov (United States)

    Porter, Joanna; Grist, Rebecca

    2018-01-01

    Background Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation. Objective This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning. Methods We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety. Results All core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse

  17. Self-harm as a means to manage the public and private selves: A qualitative study of help seeking by adults

    Directory of Open Access Journals (Sweden)

    Jane Ogden

    2015-09-01

    Full Text Available Adults ( n  = 25 completed online free text boxes about their self-harming behaviour. Thematic analysis identified three dominant themes: ‘managing the private self’, ‘managing the public self’ and ‘moving on’. Transcending these themes was the notion of thresholds of change. Self-harm enables people to manage both their private and public selves. When thresholds of change are surpassed, the public self communicates a need for help. Self-harm exists within a precarious balance of well-being and can be a form of self-care. Help seeking is instigated when this balance is disrupted and continued if it offers a better form of self-management than the individual’s own self-harming behaviour.

  18. Risk-factor differences for nonsuicidal self-injury and suicide attempts in Mexican psychiatric patients

    Directory of Open Access Journals (Sweden)

    Fresán A

    2016-07-01

    Full Text Available Ana Fresán,1 Beatriz Camarena,2 Thelma Beatriz González-Castro,3 Carlos Alfonso Tovilla-Zárate,4 Isela E Juárez-Rojop,5 Lilia López-Narváez,5 Alicia E González-Ramón,4 Yazmín Hernández-Díaz3 1Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City, 2Departamento de Genética Psiquiátrica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City, 3División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, 4División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, 5Hospital General de Yajalón, Secretaría de Salud, Yajalón, Chiapas, México Background: The present study compared sociodemographic characteristics, comorbidities with substance use, and impulsivity features in three groups of psychiatric patients – suicide attempters, nonsuicidal self-injury, and nonsuicidal without self-injury – to determine the predictive factors for nonsuicidal self-injury or suicide behavior.Patients and methods: Demographic features and self-reported substance use were assessed in 384 Mexican psychiatric patients. Impulsivity features were evaluated using the Plutchik Impulsivity Scale. Comparison analyses between groups were performed and a logistic regression model used to determine the factors associated with nonsuicidal with self-injury behavior and suicidal behavior.Results: Different predictive factors were observed for nonsuicidal self-injury and suicidal behavior. Females were more likely to present nonsuicidal self-injury behaviors (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18–0.93; P=0.03. For suicide attempters, the factors associated were younger age (OR 0.89, 95% CI 0.85–0.93; P<0.001, less than 6 years of schooling (OR 0.2, 95% CI 0.06–0.6; P=0.004, and higher impulsivity traits, such as self-control (OR 1.19, 95% CI 1.03

  19. Danish emergency nurses' attitudes towards self-harm - a cross-sectional study

    DEFF Research Database (Denmark)

    Perbøll, Penille Wimmer; Hammer, N. M.; Østergaard, Birte

    2015-01-01

    AIM: The aim of this study was to examine Danish emergency nurses' attitudes toward people hospitalized after an acetaminophen poisoning. Furthermore, the study examined the relationship between attitudes and factors such as age, gender, and education on self-harm. METHODS: A cross-sectional design...... was applied. Nurses from seven emergency departments (EDs) in a region in Denmark were asked to complete the Danish version of Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ). RESULTS: Of the 254 eligible nurses working in the ED, 122 returned the questionnaires, leaving the response rate at 48......%. Results show that the emergency nurses generally held positive attitudes toward patients with acetaminophen poisoning. Nurses with longer ED experience held more positive attitudes, and women scored significantly higher than men on the whole scale. Only 19% of the respondents had received education...

  20. Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway.

    Science.gov (United States)

    Oeye, Christine; Bjelland, Anne Karen; Skorpen, Aina; Anderssen, Norman

    2009-03-01

    Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.

  1. Key Considerations for Using No-Harm Contracts with Clients Who Self-Injure

    Science.gov (United States)

    Hyldahl, Rebecca S.; Richardson, Brent

    2011-01-01

    One of the more controversial issues in working with people who self-injure is whether counselors should use no-harm contracts. Important therapeutic considerations include the efficacy of such contracts or agreements in preventing self-injury, the emotional and behavioral responses of clients, and the perceived protection these contracts or…

  2. Survival, Signaling, and Security: Foster Carers' and Residential Carers' Accounts of Self-Harming Practices Among Children and Young People in Care.

    Science.gov (United States)

    Evans, Rhiannon E

    2018-05-01

    Research on clinicians' interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals' narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of "looked-after"; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people's social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.

  3. Identifying harmful drinking using a single screening question in a psychiatric consultation-liaison population.

    Science.gov (United States)

    Massey, Suena H; Norris, Lorenzo; Lausin, Melissa; Nwaneri, Chinyere; Lieberman, Daniel Z

    2011-01-01

    Harmful drinking is common in medical inpatients, yet commonly missed due in part to time pressures. A screening question about past year heavy drinking recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has been validated in primary care and emergency room settings. We tested the psychometric properties of a modified single screening question (SSQ) in hospitalized patients referred to a consultation-liaison service. A psychiatry attending (n = 40), a psychiatry resident (n = 30) and a medical student (n = 30) administered the SSQ, followed by a self-report 10-item Alcohol Use Disorders Identification Test (AUDIT) to a sample of 100 consultation-liaison patients who were able to give informed consent for participation. Using the AUDIT as a reference, the sensitivity and specificity of the SSQ to detect harmful drinking in this sample were .96 and .82, respectively. Gender differences in specificity were not found. The single question also had a strong correlation with dependence (r(b) = .457, p past year heavy drinking can rapidly identify harmful drinking in alert nonpsychotic consultation-liaison patients. Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  4. Guilt and shame: experiences of parents of self-harming adolescents.

    Science.gov (United States)

    McDonald, Glenda; O'Brien, Louise; Jackson, Debra

    2007-12-01

    This paper reports the findings of a qualitative study that used a hermeneutic phenomenological methodology to develop insights into the experience of parents of young people who engage in self-harming behaviour. Six mothers (and one father who accompanied his wife) participated in the study. Findings reveal that mothers experienced guilt and shame, and that these feelings shaped their reactions and responses. These mothers described experiencing emotional dilemmas, such as the degree to which they could be responsible, uncertainty about how to understand self harm, and the best course of action to take with their child. They also encountered difficulties in combating the negative emotional effects for themselves and other family members. Findings provide insights that can help nurses and family health workers to understand and assist parents with greater effectiveness; by maintaining a non-judgemental stance, acknowledging the difficulties of their experiences, encouraging confidence in their parenting abilities, and promoting effective stress management strategies.

  5. Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking.

    Science.gov (United States)

    Paavonen, Vesa; Luoto, Kaisa; Lassila, Antero; Leinonen, Esa; Kampman, Olli

    2018-04-07

    Temperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients. We screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model. Poorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model. Possibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the 'failed' self.

    Science.gov (United States)

    McDermott, Elizabeth

    2015-11-01

    International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) 'tell' their selves as 'failed'. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective. © The Author(s) 2014.

  7. The Associations Between Children's and Adolescents' Suicidal and Self-Harming Behaviors, and Related Behaviors Within Their Social Networks: A Systematic Review.

    Science.gov (United States)

    Quigley, Jody; Rasmussen, Susan; McAlaney, John

    2017-01-01

    Social influences-including the suicidal and self-harming behaviors of others-have been highlighted as a risk factor for suicidal and self-harming behavior in young people, but synthesis of the evidence is lacking. A systematic review of 86 relevant papers was conducted. Considerable published evidence was obtained for positive associations between young people's suicidal and self-harming behavior and that of people they know, with those reporting knowing people who had engaged in suicidal or self-harming behaviors more likely to report engaging in similar behaviors themselves. Findings are discussed in relation to a number of methodological and measurement issues-including the role of normative perceptions-and implications for the prevention of suicidal and self-harming behavior are considered.

  8. Former patients' experiences of recovery from self-harm as an individual, prolonged learning process: a phenomenological hermeneutical study.

    Science.gov (United States)

    Tofthagen, Randi; Talseth, Anne Grethe; Fagerstrøm, Lisbeth Maria

    2017-10-01

    To explore, describe and understand former patients' experiences of recovery from self-harm. Previous research shows that a person's development towards a more secure self-image, mastery of their emotions, an understanding of what triggers self-harm and mastery of new ways to cope with problems are central to recovery. Recovery from self-harm is still a relatively new field of research. A phenomenological hermeneutical approach. Eight participants were interviewed in 2013. Inclusion criteria were as follows: to have committed no self-harm during the past 2 years, to have experienced recovery and to be 18 or older. We analysed data using a phenomenological hermeneutical method. The findings resulted in three themes with subthemes. The first theme, the turning point, occurred at the start of the recovery process. Participants learned to choose life, verbally express their inner pain and reconcile with their life histories. In the second theme, coping with everyday life, participants learned how to choose alternative actions instead of self-harm and attend to their basic, physical needs. In the third theme, valuing close relationships and relationships with mental health nurses, participants learned to receive support from close relationships with others and mental health nurses. A tentative model illustrates the comprehensive understanding of the recovery process, described as an individual, prolonged learning process. To achieve recovery, persons who self-harm need guidance and knowledge of how to realize a personal learning process. More research is needed on how mental health nurses can support individual transition processes and thereby facilitate recovery. © 2017 John Wiley & Sons Ltd.

  9. Self-verification and depression among youth psychiatric inpatients.

    Science.gov (United States)

    Joiner, T E; Katz, J; Lew, A S

    1997-11-01

    According to self-verification theory (e.g., W.B. Swann, 1983), people are motivated to preserve stable self-concepts by seeking self-confirming interpersonal responses, even if the responses are negative. In the current study of 72 youth psychiatric inpatients (36 boys; 36 girls; ages 7-17, M = 13.18; SD = 2.59), the authors provide the 1st test of self-verification theory among a youth sample. Participants completed self-report questionnaires on depression, self-esteem, anxiety, negative and positive affect, and interest in negative feedback from others. The authors made chart diagnoses available, and they collected peer rejection ratings. Consistent with hypotheses, the authors found that interest in negative feedback was associated with depression, was predictive of peer rejection (but only within relatively longer peer relationships), was more highly related to cognitive than emotional aspects of depression, and was specifically associated with depression, rather than being generally associated with emotional distress. The authors discuss implications for self-verification theory and for the phenomenology of youth depression.

  10. Can brief behavioral health interventions reduce suicidal and self-harm ideation in primary care patients?

    Science.gov (United States)

    Dueweke, Aubrey R; Rojas, Sasha M; Anastasia, Elizabeth A; Bridges, Ana J

    2017-09-01

    We examined whether brief behavioral health visits reduced suicidal and self-harm ideation among primary care patients and compared the effectiveness of interventions that targeted ideation directly (i.e., safety planning) with those that targeted ideation indirectly through management of underlying mental illness (e.g., behavioral activation). We examined first- and last-visit data from 31 primary care patients with suicidal or self-harm ideation seen by behavioral health consultants. Patients reported significantly lower frequencies of suicidal and self-harm ideation at their final visit than at their initial visit. Patients whose ideation was targeted directly showed greater improvements than patients whose ideation was targeted indirectly. Although preliminary, results suggest mild to moderate suicidal ideation could be addressed in primary care through integration of behavioral health consultants into the medical team. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  11. Self-esteem and interpersonal functioning in psychiatric outpatients.

    Science.gov (United States)

    Bjørkvik, Jofrid; Biringer, Eva; Eikeland, Ole-Johan; Nielsen, Geir Høstmark

    2009-06-01

    This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients (n= 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems-Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.

  12. Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients.

    Science.gov (United States)

    Berlin, Heather A; Rolls, Edmund T

    2004-08-01

    To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.

  13. Deliberate Self-Harm (DSH): a follow-up study of Irish children.

    LENUS (Irish Health Repository)

    Cassidy, C

    2012-02-01

    This study aimed to look at rates of repetition in children presenting with Deliberate Self-Harm (DSH) to a paediatric A&E department. Children presenting with DSH to a paediatric A&E between 2000 and 2005 were invited to participate in the study. Telephone interviews collected information on demographic details and mental health functioning, including repetition of DSH. Data was obtained from 39 parents and 10 children (31 girls and 8 boys, mean age 15) 1 in 5 females (20%) had made a repeat attempt of DSH and 1 in 10 (10%) had repeated more than once. No males repeated self-harm. On going parental concern rather than clinician risk assessment at index episode predicted subsequent DSH. Given the poor predictive value of clinician risk assessment, all attempts of DSH must be taken seriously, especially those associated with ongoing parental concern.

  14. Deliberate Self-Harm (DSH): a follow-up study of Irish children.

    LENUS (Irish Health Repository)

    Cassidy, C

    2009-04-01

    This study aimed to look at rates of repetition in children presenting with Deliberate Self-Harm (DSH) to a paediatric A&E department. Children presenting with DSH to a paediatric A&E between 2000 and 2005 were invited to participate in the study. Telephone interviews collected information on demographic details and mental health functioning, including repetition of DSH. Data was obtained from 39 parents and 10 children (31 girls and 8 boys, mean age 15) 1 in 5 females (20%) had made a repeat attempt of DSH and 1 in 10 (10%) had repeated more than once. No males repeated self-harm. On going parental concern rather than clinician risk assessment at index episode predicted subsequent DSH. Given the poor predictive value of clinician risk assessment, all attempts of DSH must be taken seriously, especially those associated with ongoing parental concern.

  15. The role of schools in children and young people's self-harm and suicide: systematic review and meta-ethnography of qualitative research.

    Science.gov (United States)

    Evans, Rhiannon; Hurrell, Chloe

    2016-05-14

    Evidence reports that schools influence children and young people's health behaviours across a range of outcomes. However there remains limited understanding of the mechanisms through which institutional features may structure self-harm and suicide. This paper reports on a systematic review and meta-ethnography of qualitative research exploring how schools influence self-harm and suicide in students. Systematic searches were conducted of nineteen databases from inception to June 2015. English language, primary research studies, utilising any qualitative research design to report on the influence of primary or secondary educational settings (or international equivalents) on children and young people's self-harm and suicide were included. Two reviewers independently appraised studies against the inclusion criteria, assessed quality, and abstracted data. Data synthesis was conducted in adherence with Noblit and Hare's meta-ethnographic approach. Of 6744 unique articles identified, six articles reporting on five studies were included in the meta-ethnography. Five meta-themes emerged from the studies. First, self-harm is often rendered invisible within educational settings, meaning it is not prioritised within the curriculum despite students' expressed need. Second, where self-harm transgresses institutional rules it may be treated as 'bad behaviour', meaning adequate support is denied. Third, schools' informal management strategy of escalating incidents of self-harm to external 'experts' serves to contribute to non-help seeking behaviour amongst students who desire confidential support from teachers. Fourth, anxiety and stress associated with school performance may escalate self-harm and suicide. Fifth, bullying within the school context can contribute to self-harm, whilst some young people may engage in these practices as initiation into a social group. Schools may influence children and young people's self-harm, although evidence of their impact on suicide remains

  16. The influences of chronic illness and ego development on self-esteem in diabetic and psychiatric adolescent patients.

    Science.gov (United States)

    Jacobson, A M; Hauser, S T; Powers, S; Noam, G

    1984-12-01

    Self-esteem as measured by the Coopersmith Self-Esteem Inventory [Coopersmith, S. (1967),The Antecedents of Self-Esteem, Freeman, San Francisco] and ego development as measured by the Washington University Sentence Completion Test [Loevinger, J., and Wessler, R. (1970),Measuring Ego Development, Vol. I, Jossey-Bass, San Francisco] were evaluated in three groups of early adolescents: diabetic patients, nonpsychotic psychiatric patients, and a nonpatient group of high-school students. We found that low levels of ego development were associated with low levels of global and domain-specific self-esteem in all three subject groups. Levels of self-esteem among diabetic patients were not significantly different from those of nonpatients. While psychiatric patients had significantly lower self-esteem levels than the other groups, this difference was accounted for by preconformists, i.e., those at the lowest stages of ego development. Psychiatric patients reaching higher ego levels showed self-esteem levels indistinguishable from those of the diabetics and nonpatients.

  17. Self-injurious behavior as a habit and its treatment.

    Science.gov (United States)

    Orian, C

    1989-10-01

    The definition of self-injurious behavior applies to persons who hurt or harm themselves without the motive of suicide or of sexual deviation. The different aspects of self-injurious behavior and the theories explaining them are reviewed. For 5 years a young, intelligent woman had inflicted injuries upon herself with sharp instruments while ostensibly caring for her face and legs. The short-term hypnobehavioral treatment included keeping daily reports of her self-inflicted injuries and of her thoughts while executing them, finding alternative activities to replace her habit, and practicing self-hypnosis once a day. Increasing the level of understanding of her inner conflict and accenting ways of breaking the habit by means of positive autosuggestion proved very effective. The treatment was successful after 13 sessions.

  18. An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Rheinländer, Thilde; Sørensen, Birgitte Refslund

    2014-01-01

    and families; six focus group discussions with community members; and key-informant interviews with 15–25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm. Ethics and dissemination: The study has received ethical approval from...

  19. Optional thinking ability among hospital-treated deliberate self-harm patients: a 1-year follow-up study.

    Science.gov (United States)

    McAuliffe, Carmel; Corcoran, Paul; Hickey, Portia; McLeavey, Breda C

    2008-03-01

    To investigate the association between optional thinking (the ability to generate alternative solutions to interpersonal problems) in deliberate self-harm (DSH) patients and repeated self-harm. A prospective study of the association between optional thinking in interpersonal problem solving and repeated DSH within 12 months. A non-consecutive sample (N=152) of DSH patients presenting to the Accident and Emergency department of an acute hospital in Cork city, Ireland, was assessed using a structured interview schedule including the Suicide Intent Scale, the Hopelessness Scale, and the Optional Thinking Test. Repetition within 1 year was established by checking Accident and Emergency records at all three city hospitals. Participants were categorized as repeaters if they engaged in at least one further hospital-treated DSH episode, or non-repeaters. Approximately two-thirds (63.1%) of the sample had engaged in at least one act of DSH prior to their index episode. During follow-up 31 individuals (20.4%) repeated. History of self-harm was significantly associated with prospective repetition when considered alongside all the other predictor variables. Among first evers, low scores on the optional thinking test were significantly associated with the increased risk of repetition within 12 months. Among those with previous DSH, there was no evidence of an association between optional thinking and repetition within 12 months. Poor optional thinking is associated with increased risk of repeated deliberate self-harm in those who present with a first self-harm episode. Interventions to improve optional thinking skills, delivered soon after a first DSH presentation, may be useful in preventing repetition.

  20. Not only body weight perception but also body mass index is relevant to suicidal ideation and self-harming behavior in Japanese adolescents.

    Science.gov (United States)

    Kinoshita, Kuni; Kinoshita, Yoshihiro; Shimodera, Shinji; Nishida, Atsushi; Inoue, Ken; Watanabe, Norio; Oshima, Norihito; Akechi, Tatsuo; Sasaki, Tsukasa; Inoue, Shimpei; Furukawa, Toshiaki A; Okazaki, Yuji

    2012-04-01

    Whether a low body mass index (BMI) is directly associated with a high risk of suicidal ideation or self-harming behavior in adolescents is still inconclusive. This study has, therefore, evaluated the relevance of BMI to suicidal ideation and self-harming behavior after controlling for body weight perception (BWP) and other potential confounding factors. BMI, BWP, suicidal ideation, and self-harming behavior were all assessed using a self-report questionnaire administered to 18,104 Japanese adolescents. Potential confounding factors were also evaluated. The data were then analyzed using bivariate and multivariate logistic regression. Low BMI was associated with suicidal ideation and deliberate self-harm when controlling for sex, age, drug use, emotional distress, and BWP. Low BMI may be an independent risk factor for suicidal ideation and deliberate self-harming behavior in Japanese adolescents.

  1. Validation of the Chinese SAD PERSONS Scale to predict repeated self-harm in emergency attendees in Taiwan.

    Science.gov (United States)

    Wu, Chia-Yi; Huang, Hui-Chun; Wu, Shu-I; Sun, Fang-Ju; Huang, Chiu-Ron; Liu, Shen-Ing

    2014-02-17

    Past and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings. One hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the sixth month. The controls, 284 people without self-harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis. The CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care. The Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical

  2. Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design

    Directory of Open Access Journals (Sweden)

    McGorry Patrick D

    2008-09-01

    Full Text Available Abstract Background Although deliberate self-harm is prevalent among young people, many who engage in deliberate self-harm receive sub-optimal care. Although schools are a well placed setting to support young people who engage in self-harm there are no specific training packages designed to assist school welfare staff to support these young people. The current study aimed to design, deliver and evaluate a training course specifically for school staff. Methods The study employed a longitudinal design. Two hundred and thirteen people participated in the training and evaluation. A questionnaire was administered at baseline, immediately after the training and at 6-month follow-up in order to determine if the training led to improvements in confidence when working with young people who self-harm, perceived skill, knowledge of, and attitudes towards people who self harm. Results Prior to the course, the majority of participants demonstrated relatively high levels of confidence, perceived skill and knowledge of self-harm and endorsed relatively positive attitudes towards people who engage in self-harm. Despite this, significant improvements were observed in terms of increased confidence, increased perceptions of skill along with increased knowledge of deliberate self-harm. These improvements were sustained over the follow-up period. Conclusion The results demonstrated that the provision of specifically designed training can help school welfare staff to feel better equipped to support young people who are engaging in deliberate self-harm.

  3. Safe in our hands?: a study of suicide and self-harm in asylum seekers.

    Science.gov (United States)

    Cohen, Juliet

    2008-05-01

    This study examined the incidence of suicide and self-harm in asylum seekers in the UK, both those in detention and in the community. The investigation revealed that data recording is seriously flawed or sometimes non-existent. However, the scanty data those were available from Immigration Removal Centres, coroners' records and Prison Ombudsman's reports showed high levels of self-harm and suicide for detained asylum seekers as compared with the United Kingdom prison population. It is suggested that this could be attributed to routine failure to observe and mitigate risk factors. The author makes the following recommendations: coroners should record asylum seeker status and ethnicity of deceased, self-harm monitoring in the community should record asylum seeker status and ethnicity, health care in immigration removal centres should meet the same standards as UK prisons as a minimum, allegation of torture by immigration detainees should trigger a case management review and risk assessment for continued detention, and this process should be open to audit, and interpreters should be used for mental state examinations unless their English has been shown to the fluent.

  4. Structured learning and self-reflection: strategies to decrease anxiety in the psychiatric mental health clinical nursing experience.

    Science.gov (United States)

    Ganzer, Christine Anne; Zauderer, Cheryl

    2013-01-01

    The purpose of this qualitative study was to test a teaching-learning strategy to help nursing students decrease stress and anxiety that may be brought about by the psychiatric mental health clinical experience. Undergraduate nursing students are known to experience affective stress prior to their first psychiatric mental health clinical practicum. A stressful learning environment can affect the success of the student's clinical performance. Thirty nursing students participated in this study. A structured preclinical workshop combined with self-reflection provided insight into students' perceptions of the psychiatric mental health clinical experience. Overall, students reported that participating in the teaching-learning strategy and self-reflection helped mitigate Combining structured learning with self-reflection is a useful tool for helping nursing students increase self-awareness and ease anxiety that may interfere with learning.

  5. Rising to the human rights challenge in compulsory treatment--new approaches to mental health law in Australia.

    Science.gov (United States)

    Callaghan, Sascha; Ryan, Christopher J

    2012-07-01

    To analyse, and explain to Australasian psychiatrists, recent proposed changes to the terms of coercive treatment for mental illness in Tasmania and Victoria and to place the proposals in the context of a broader human rights framework that is likely to impact the future shape of mental health legislation more generally. The Australian law reform proposals are reviewed against the requirements of numerous human rights instruments, including the recently ratified United Nations Convention on the Rights of Persons with Disabilities. Ethical and legal arguments are made to support the proposed changes and to introduce others, taking into account academic commentary on mental health law and recent empirical work on the ability to usefully categorise patients by their likelihood of harm to self and others. The Victorian and Tasmanian draft mental health bills propose a new basis for compulsory psychiatric treatment in Australasia. If they become law, coercive psychiatric treatment could only be applied to patients who lack decision-making capacity. The Tasmanian draft bill also sets a new benchmark for timely independent review of compulsory treatment. However both jurisdictions propose to retain an 'additional harm' test which must be satisfied before patients may be treated without consent. This differs from non-psychiatric cases, where if patients are unable to consent to medical treatment for themselves, they will be entitled to receive coercive treatment if it is in their best interests. The proposed changes under the Tasmanian and Victorian draft mental health bills will ensure that, in line with local and international human rights obligations, only patients who lack decision-making capacity may be coercively treated for mental illness. However the continuing 'additional harm' criteria may breach human rights obligations by imposing a discriminatory threshold for care on patients who are unable to consent to treatment for themselves. This could be avoided by

  6. Effectiveness of assertive case management on repeat self-harm in patients admitted for suicide attempt: Findings from ACTION-J study.

    Science.gov (United States)

    Furuno, Taku; Nakagawa, Makiko; Hino, Kosuke; Yamada, Tomoki; Kawashima, Yoshitaka; Matsuoka, Yutaka; Shirakawa, Osamu; Ishizuka, Naoki; Yonemoto, Naohiro; Kawanishi, Chiaki; Hirayasu, Yoshio

    2018-01-01

    Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Enhancing Clients' Communication Regarding Goals for Using Psychiatric Medications.

    Science.gov (United States)

    Deegan, Patricia E; Carpenter-Song, Elizabeth; Drake, Robert E; Naslund, John A; Luciano, Alison; Hutchison, Shari L

    2017-08-01

    Discordance between psychiatric care providers' and clients' goals for medication treatment is prevalent and is a barrier to person-centered care. Power statements-short self-advocacy statements prepared by clients in response to a two-part template-offer a novel approach to help clients clarify and communicate their personal goals for using psychiatric medications. This study described the power statement method and examined a sample of power statements to understand clients' goals for medication treatment. More than 17,000 adults with serious mental illness at 69 public mental health clinics had the option to develop power statements by using a Web application located in the clinic waiting areas. A database query determined the percentage of clients who entered power statements into the Web application. The authors examined textual data from a random sample of 300 power statements by using content analysis. Nearly 14,000 (79%) clients developed power statements. Of the 277 statements in the sample deemed appropriate for content analysis, 272 statements had responses to the first part of the template and 230 had responses to the second part. Clients wanted psychiatric medications to help control symptoms in the service of improving functioning. Common goals for taking psychiatric medications (N=230 statements) were to enhance relationships (51%), well-being (32%), self-sufficiency (23%), employment (19%), hobbies (15%), and self-improvement (10%). People with serious mental illness typically viewed medications as a means to pursue meaningful life goals. Power statements appear to be a simple and scalable technique to enhance clients' communication of their goals for psychiatric medication treatment.

  8. [Feeling of Liberty and Internalized Stigma: Comparison of Inpatient and Outpatient Cases Receiving Psychiatric Treatment].

    Science.gov (United States)

    Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat

    2016-01-01

    In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.

  9. SELF-HARM AS A SIGN OF STAGING CRIMINAL EVENTS

    Directory of Open Access Journals (Sweden)

    Vitaly Fadeev

    2015-12-01

    Full Text Available The article considers the problems of conducting investigative activities related to the dramatization of a criminal event, characterized by the application of self-harm to induce the employee of a consequence of misconceptions about the criminal event. At the same time, there is a need to study places of alleged crimes with the help of modern techniques and information technologies that enable more detail to model events.

  10. Adolescents' Deliberate Self-Harm, Interpersonal Stress, and the Moderating Effects of Self-Regulation: A Two-Wave Longitudinal Analysis

    Science.gov (United States)

    Jutengren, Goran; Kerr, Margaret; Stattin, Hakan

    2011-01-01

    The predictive effects of peer victimization and harsh parenting on deliberate self-harm were examined. As derived from the experiential avoidance model, the study also tested whether these links were moderated by individual self-regulation approaches. Data were collected at two points in time from 880 junior high school students (mean age =…

  11. The use of observation on patients who self-harm: Lessons from a learning disability service

    Directory of Open Access Journals (Sweden)

    Peter T. Sandy

    2016-10-01

    Aim: To explore nurses' knowledge and understanding of the use of observation on patients who self-harm in a learning disability service in the United Kingdom. Design: and methods: This study adopted a qualitative approach, and utilised interpretative phenomenological analysis as a design and as a tool of analysis. The study was conducted in a secure learning disability service in the United Kingdom. Data were obtained from registered nurses using individual interviews (n = 20 and focus groups (n = 3 x 5 = 15. Data were analysed thematically using the principles of interpretative phenomenological analysis. Results: Three superordinate themes emerged from data analysis: 1 observation: its meaning, 2 observation: does it prevent self-harm? 3 Observation: making it work. Conclusion: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses' daily therapeutic activities in inpatient learning disability services.

  12. Association of Self-reported Impulsivity to Nonsuicidal Self-Injury, Suicidality, and Mortality in Adolescent Psychiatric Inpatients.

    Science.gov (United States)

    Alasaarela, Lauri; Hakko, Helinä; Riala, Kaisa; Riipinen, Pirkko

    2017-05-01

    This study examines the association of self-reported impulsivity to nonsuicidal self-injury, suicidal ideation, suicide attempts, and completed suicides in a clinical sample of 508 Finnish adolescents (aged 12-17) treated in psychiatric inpatient care between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime interview was used to gather information on psychiatric disorders, impulsivity, and suicidality of the adolescents. Mortality data were obtained from the national cause of death register. In adolescent girls, impulsivity was significantly associated with suicidal ideation and attempts and completed suicides in adolescent boys. Of adolescent boys with impulsivity, 10.4% had died by suicide during the follow-up time. For preventive purposes, health care professionals are encouraged asked adolescents targeted questions about impulsivity and to consider the associated risk of suicidality identified in this study.

  13. Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors

    Directory of Open Access Journals (Sweden)

    Angela C. Jones

    2012-01-01

    Full Text Available The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131, a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.

  14. The prediction of discharge from in-patient psychiatric rehabilitation: a case-control study

    Directory of Open Access Journals (Sweden)

    Mountain Debbie A

    2011-09-01

    Full Text Available Abstract Background At any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study. Methods We compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups. Results We found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge. Conclusions People admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This

  15. Exposure to, and searching for, information about suicide and self-harm on the Internet: Prevalence and predictors in a population based cohort of young adults

    Science.gov (United States)

    Mars, Becky; Heron, Jon; Biddle, Lucy; Donovan, Jenny L.; Holley, Rachel; Piper, Martyn; Potokar, John; Wyllie, Clare; Gunnell, David

    2015-01-01

    Background There is concern over the potential impact of the Internet on self-harm and suicidal behaviour, particularly in young people. However, little is known about the prevalence and patterns of suicide/self-harm related Internet use in the general population. Methods Cross sectional study of 3946 of the 8525 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were sent a self-report questionnaire including questions on suicide/self-harm related Internet use and self-harm history at age 21 years. Results Suicide/self-harm related Internet use was reported by 22.5% (886/3946) of participants; 11.9% (470/3946) had come across sites/chatrooms discussing self-harm or suicide, 8.2% (323/3946) had searched for information about self-harm, 7.5% (296/3946) had searched for information about suicide and 9.1% (357/3946) had used the Internet to discuss self-harm or suicidal feelings. Suicide/self-harm related Internet use was particularly prevalent amongst those who had harmed with suicidal intent (70%, 174/248), and was strongly associated with the presence of suicidal thoughts, suicidal plans, and history of self-harm. Sites offering help, advice, or support were accessed by a larger proportion of the sample (8.2%, 323/3946) than sites offering information on how to hurt or kill yourself (3.1%, 123/3946). Most individuals (81%) who had accessed these potentially harmful sites had also accessed help sites. Limitations (i) There were differences between questionnaire responders and non-responders which could lead to selection bias and (ii) the data were cross-sectional, and we cannot conclude that associations are causal. Conclusions Suicide/self-harm related Internet use is common amongst young adults, particularly amongst those with suicidal thoughts and behaviour. Both harmful and helpful sites were accessed, highlighting that the Internet presents potential risks but also offers opportunities for suicide prevention. PMID:26150198

  16. Relation between stages of change and motivation in the treatment of psychiatric patients1

    Directory of Open Access Journals (Sweden)

    Gavrilov-Jerković Vesna

    2007-01-01

    Full Text Available Main aim of this research was to investigate the relation between psychiatric patients’ motivation for their participation in treatment and a stage of change they were in. Hypothesis on relation quality of examined variables have been defined from the perspective of transtheoretical model created by Prochaska and associates. Decision balance, specific and general self-efficacy and inclination to relapse have been examined as indicators of motivation. One hundred and twenty-nine psychiatric patients with diagnosis of neurosis or personality disorders have been examined in this research. Results have shown that stages of changes are significantly related to inspected motivational variables. Patients in higher stages of readiness express specific motivational profile characterized by the proactive optimism, which means that they rely on their own resources and expect positive outcome of the treatment. Patients in lower stages of readiness express motivational profile characterized by passive resignation receptiveness, by inclination towards demoralization and low trust in their own strength. Results of this research are in conformity with the basic hypothesis of transtheoretical model of change. .

  17. Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area.

    Science.gov (United States)

    Economou, Marina; Bergiannaki, Joanna Despina; Peppou, Lily Evangelia; Karayanni, Ismini; Skalkotos, George; Patelakis, Athanasios; Souliotis, Kyriakos; Stefanis, Costas

    2016-05-01

    The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder. This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions. A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions. The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one's personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely. Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications. © The Author(s) 2016.

  18. Psilocybin-Assisted Therapy: A Review of a Novel Treatment for Psychiatric Disorders.

    Science.gov (United States)

    Thomas, Kelan; Malcolm, Benjamin; Lastra, Dan

    2017-01-01

    Recent research suggests that functional connectivity changes may be involved in the pathophysiology of psychiatric disorders. Hyperconnectivity in the default mode network has been associated with psychopathology, but psychedelic serotonin agonists like psilocybin may profoundly disrupt these dysfunctional neural network circuits and provide a novel treatment for psychiatric disorders. We have reviewed the current literature to investigate the efficacy and safety of psilocybin-assisted therapy for the treatment of psychiatric disorders. There were seven clinical trials that investigated psilocybin-assisted therapy as a treatment for psychiatric disorders related to anxiety, depression, and substance use. All trials demonstrated reductions in psychiatric rating scale scores or increased response and remission rates. There were large effect sizes related to improved depression and anxiety symptoms. Psilocybin may also potentially reduce alcohol or tobacco use and increase abstinence rates in addiction, but the benefits of these two trials were less clear due to open-label study designs without statistical analysis. Psilocybin-assisted therapy efficacy and safety appear promising, but more robust clinical trials will be required to support FDA approval and identify the potential role in clinical psychiatry.

  19. The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12-17.

    Science.gov (United States)

    Zubrick, Stephen R; Hafekost, Jennifer; Johnson, Sarah E; Sawyer, Michael G; Patton, George; Lawrence, David

    2017-10-01

    There is a significant overlap between non-suicidal self-harm and suicidal ideation and behavior in young people with both symptom continuity and symptom duration implicated in this association. A population sample of Australian 12-17 year olds. Interviewers collected measures for DSM disorders, symptom duration and continuity, and background information from their parents, while young people self-reported symptoms of depression, non-suicidal self-harm and suicidal ideation and behaviors. This report focusses on the 265 young people who met the DSM criteria for Major Depressive Disorder based on their own self-reports. Relative to young people who had at least one period 2 months or longer without symptoms since first onset, young people who had the continuous presence of depressive symptoms since their first onset had significantly higher odds for life-time self-harm, 12-month self-harm, multiple self-harm, suicidal ideation and suicide attempt within the past 12 months. The duration of depressive symptoms and the continuity of these symptoms each independently contribute to elevating the risks of non-suicidal self-harming and suicidal ideation and behaviors. Reliance on self-report from the young people and time constraints prohibiting administering diagnostic modules other than the Major Depressive Disorder and estimating self-reported co-morbidity. Among young people with a Major Depressive Disorder, self-reports about duration of depressive symptoms as well as the continuity of symptoms, each independently contributes to elevated risks of non-suicidal self-harming and suicidal ideation and behaviors. As well, un-remitting as opposed to episodic symptoms in this group of young people are common and are a powerful indicator of suffering associated with both self-harm and suicidal behavior. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Adolescents Who Self-Harm: Professional Staff Knowledge, Attitudes and Training Needs

    Science.gov (United States)

    Timson, Debbie; Priest, Helena; Clark-Carter, David

    2012-01-01

    This study aimed to investigate professional staff attitudes and knowledge about adolescents who engage in self-harming behaviour and to identify training needs. Previous research has suggested that medical and health care staff perceptions may reinforce the stigma associated with such behaviour and therefore jeopardise the effectiveness of…

  1. Overlapping Genetic and Environmental Influences on Nonsuicidal Self-injury and Suicidal Ideation : Different Outcomes, Same Etiology?

    NARCIS (Netherlands)

    Maciejewski, D.F.; Creemers, H.E.; Lynskey, M.T.; Madden, P.A.; Heath, A.C.; Statham, D.J.; Martin, N.G.; Verweij, C.J.H.

    2014-01-01

    IMPORTANCE Nonsuicidal self-injury (NSSI) and suicidal self-injury are very harmful behaviors and are associated with several psychiatric disorders. In the recently developed fifth edition of the DSM, NSSI and suicidal behavior disorder are for the first time introduced as conditions in their own

  2. Self-harm in children placed in a Court-Mandated Holding and Education Centre: analysis of socio-demographic variables and influence of implementation of judicial measures

    OpenAIRE

    García, G.

    2015-01-01

    Objectives: To analyze and understand the existence of self-harming behavior in a detention centre for minors. Methods: Review of self-harm cases detected in a population of 94 inmates in 2013. Results: 26.5% of young offenders have conducted some form of self injury. 28% of individuals with self harming behaviors have more than 6 episodes over the period of internment. Self-beating is the most common type of self-harm performed by this group. Inmates serving sentences in the therapeutic sect...

  3. The Associations Between Children's and Adolescents’ Suicidal and Self-Harming Behaviors, and Related Behaviors Within Their Social Networks: A Systematic Review

    OpenAIRE

    Quigley, J.; Rasmussen, S.; McAlaney, John

    2017-01-01

    © 2017, Copyright © International Academy for Suicide Research.Social influences—including the suicidal and self-harming behaviors of others—have been highlighted as a risk factor for suicidal and self-harming behavior in young people, but synthesis of the evidence is lacking. A systematic review of 86 relevant papers was conducted. Considerable published evidence was obtained for positive associations between young people's suicidal and self-harming behavior and that of people they know, wit...

  4. Appetite loss as a potential predictor of suicidal ideation and self-harm in adolescents: A school-based study.

    Science.gov (United States)

    Kitagawa, Yuko; Ando, Shuntaro; Yamasaki, Syudo; Foo, Jerome Clifford; Okazaki, Yuji; Shimodera, Shinji; Nishida, Atsushi; Togo, Fumiharu; Sasaki, Tsukasa

    2017-04-01

    Suicide is a leading cause of death in adolescents, but detection of its risk is often challenging. Many mental illnesses share the common symptom of appetite loss and it is also known that people who suffer from these illnesses are at greater risk of suicide. However, the relationship between appetite loss and suicide risk has yet to be examined. For adolescents in particular, questions about appetite loss may be easier to answer than sensitive questions regarding mental health. The present study aims to investigate the association of appetite loss with suicidal ideation and self-harm in adolescents. Rates of adolescents with suicidal ideation or self-harm associated with appetite-loss were examined in 18,250 Japanese junior and senior high school students (aged 12-18) using a self-report questionnaire. Insomnia, a physical symptom which has previously been associated with suicide risk, was also controlled for in the analysis. Results showed that rates of adolescents with suicidal ideation or self-harm significantly increased according to the degree of self-reported appetite loss. Similar results were observed for insomnia. Odds ratios (ORs) for suicidal ideation and self-harm were 5.5 and 4.1 for adolescents with appetite loss compared to those without it, and the ORs were 5.5 and 3.5 for those with insomnia compared to those without it, respectively, adjusting for sex and age (p appetite loss was highly associated with suicidal ideation and self-harm in adolescents; adolescents reporting physical symptoms such as loss of appetite or insomnia should be given careful attention. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. The role of schools in children and young people’s self-harm and suicide: systematic review and meta-ethnography of qualitative research

    Directory of Open Access Journals (Sweden)

    Rhiannon Evans

    2016-05-01

    Full Text Available Abstract Background Evidence reports that schools influence children and young people’s health behaviours across a range of outcomes. However there remains limited understanding of the mechanisms through which institutional features may structure self-harm and suicide. This paper reports on a systematic review and meta-ethnography of qualitative research exploring how schools influence self-harm and suicide in students. Methods Systematic searches were conducted of nineteen databases from inception to June 2015. English language, primary research studies, utilising any qualitative research design to report on the influence of primary or secondary educational settings (or international equivalents on children and young people’s self-harm and suicide were included. Two reviewers independently appraised studies against the inclusion criteria, assessed quality, and abstracted data. Data synthesis was conducted in adherence with Noblit and Hare’s meta-ethnographic approach. Of 6744 unique articles identified, six articles reporting on five studies were included in the meta-ethnography. Results Five meta-themes emerged from the studies. First, self-harm is often rendered invisible within educational settings, meaning it is not prioritised within the curriculum despite students’ expressed need. Second, where self-harm transgresses institutional rules it may be treated as ‘bad behaviour’, meaning adequate support is denied. Third, schools’ informal management strategy of escalating incidents of self-harm to external ‘experts’ serves to contribute to non-help seeking behaviour amongst students who desire confidential support from teachers. Fourth, anxiety and stress associated with school performance may escalate self-harm and suicide. Fifth, bullying within the school context can contribute to self-harm, whilst some young people may engage in these practices as initiation into a social group. Conclusions Schools may influence children

  6. Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits.

    Science.gov (United States)

    Manzini, Arianna; Vears, Danya F

    2018-03-01

    Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.

  7. Quantitative benefit-harm assessment for setting research priorities: the example of roflumilast for patients with COPD.

    Science.gov (United States)

    Puhan, Milo A; Yu, Tsung; Boyd, Cynthia M; Ter Riet, Gerben

    2015-07-02

    When faced with uncertainties about the effects of medical interventions regulatory agencies, guideline developers, clinicians, and researchers commonly ask for more research, and in particular for more randomized trials. The conduct of additional randomized trials is, however, sometimes not the most efficient way to reduce uncertainty. Instead, approaches such as value of information analysis or other approaches should be used to prioritize research that will most likely reduce uncertainty and inform decisions. In situations where additional research for specific interventions needs to be prioritized, we propose the use of quantitative benefit-harm assessments that illustrate how the benefit-harm balance may change as a consequence of additional research. The example of roflumilast for patients with chronic obstructive pulmonary disease shows that additional research on patient preferences (e.g., how important are exacerbations relative to psychiatric harms?) or outcome risks (e.g., what is the incidence of psychiatric outcomes in patients with chronic obstructive pulmonary disease without treatment?) is sometimes more valuable than additional randomized trials. We propose that quantitative benefit-harm assessments have the potential to explore the impact of additional research and to identify research priorities Our approach may be seen as another type of value of information analysis and as a useful approach to stimulate specific new research that has the potential to change current estimates of the benefit-harm balance and decision making.

  8. Disruptive behavioural disorders, self harm and suicidal ideation among German adolescents in psychiatric care.

    Science.gov (United States)

    Kirkcaldy, Bruce D; Brown, Jennifer; Siefen, Rainer G

    2006-01-01

    The present study examines the unique and shared risk factors for suicidal behaviour, self-injury, and externally focussed aggressive behaviour among German youths and adolescents of both sexes. Also explored is the issue of multiple maladaptive behaviours and whether or not these are interrelated. The period of the sample comprised 2002-2003 admissions (N = 3694) to a clinic for child and adolescent psychiatry and psychosomatics. Measures were taken from medical-psychological documentation ("Ba-Do") and self-report questionnaire and included items relating to self-injurious behaviour, suicidal intent and socially disruptive and threatening behaviour (FAPS). Self and expert ratings of suicidal and self-injurious behaviour were significantly statistically correlated. Overt aggression was unrelated to suicidal behaviour. Suicidal and self-injurious behaviour were more common among female than male adolescents. Age, disharmony within the family and excessive parental demands were major global determinants of suicidal behaviour for both genders, but unrelated to self-injurious or socially disruptive behaviour, the latter being more associated with parental under-involvement and feelings of hostile rejection. Intelligence and age were significant predictors of overt aggression among females; intellectual functioning, number of siblings and disability among family members emerged as major determinants of suicidal behaviour among males. Findings are discussed in terms of practice interventions.

  9. Psychiatric Co-Morbidities in Pregnant Women with Opioid Use Disorders: Prevalence, Impact, and Implications for Treatment.

    Science.gov (United States)

    Arnaudo, Camila L; Andraka-Christou, Barbara; Allgood, Kacy

    2017-01-01

    This review seeks to investigate three questions: What is the prevalence of comorbid psychiatric diagnoses among pregnant women with opioid use disorder (OUD)? How do comorbid psychiatric illnesses impact pregnant women with OUD? And how do comorbid psychiatric illnesses affect the ability of pregnant women with OUD to adhere to and complete OUD treatment? Based on this literature review, 25-33% of pregnant women with OUD have a psychiatric comorbidity, with depression and anxiety being especially common. However, of the 17 studies reviewed only 5 have prevalence rates of dual diagnosis in pregnant women with OUD as their primary outcome measures, their N's were typically small, methods for determining psychiatric diagnosis were variable, and many of the studies were undertaken with women presenting for treatment which carries with its implicit selection bias. Of the women enrolled in treatment programs for SUD, those with psychiatric comorbidity were more likely to have impaired psychological and family/social functioning than those without psychiatric comorbidity. Greater severity of comorbid psychiatric illness appears to predict poorer adherence to treatment, but more research is needed to clarify this relationship with the psychiatric illness is less severe. While cooccurrence of psychiatric disorders in pregnant women with opioid use disorder appears to be common, large population-based studies with validated diagnostic tools and longitudinal assessments are needed to obtain definitive rates and characteristics of cooccurring illnesses. Integrated prenatal, addiction, and psychiatric treatment in a setting that provides social support to pregnant patients with OUD is most effective in maintaining women in treatment. More research is still needed to identify optimal treatment settings, therapy modalities, and medication management for dually diagnosed pregnant women with OUD.

  10. Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits.

    Science.gov (United States)

    Goldberg, Brett R; Serper, Mark R; Sheets, Michelle; Beech, Danielle; Dill, Charles; Duffy, Kristine G

    2007-05-01

    Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.

  11. Psychosocial interventions for self-harm in adults.

    Science.gov (United States)

    Hawton, Keith; Witt, Katrina G; Taylor Salisbury, Tatiana L; Arensman, Ella; Gunnell, David; Hazell, Philip; Townsend, Ellen; van Heeringen, Kees

    2016-05-12

    Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm. To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH. The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent (within six months) episode of SH resulting in presentation to clinical services. We used Cochrane's standard methodological procedures. We included 55 trials, with a total of 17,699 participants. Eighteen trials investigated cognitive-behavioural-based psychotherapy (CBT-based psychotherapy; comprising cognitive-behavioural, problem-solving therapy or both). Nine investigated interventions for multiple repetition of SH/probable personality disorder, comprising emotion-regulation group-based psychotherapy, mentalisation, and dialectical behaviour therapy (DBT). Four investigated case management, and 11 examined remote contact interventions (postcards, emergency cards, telephone contact). Most other interventions were evaluated in only single small trials of moderate to very low quality.There was a significant treatment effect for CBT-based psychotherapy compared to TAU at final follow-up in terms of fewer participants repeating SH (odds ratio (OR) 0.70, 95% confidence interval (CI) 0

  12. The use of observation on patients who self-harm: Lessons from a ...

    African Journals Online (AJOL)

    Peter Thomas Sandy

    who self-harm in a learning disability service in the United Kingdom. Design: and ... is both a custodial activity and a forum that offers an opportunity for nurses to ..... a very good reason for intervening when patients are in acute states of ...

  13. PERSONALITY TRAITS, ANGER AND PSYCHIATRIC SYMPTOMS RELATED TO QUALITY OF LIFE IN PATIENTS WITH NEWLY DIAGNOSED DIGESTIVE SYSTEM CANCER

    Directory of Open Access Journals (Sweden)

    Noemi Peres HONORATO

    2017-03-01

    Full Text Available ABSTRACT BACKGROUND The presence of psychiatric symptoms, anger, and personality characteristics are factors that affect the quality of life of newly diagnosed digestive system cancer patients. OBJECTIVE This study aims to identify which stable characteristics of the individual’s personality interfere with quality of life, even when reactive emotional characteristics of falling ill are controlled. METHODS A cross-sectional study was performed at the Oncology Clinic ( Hospital das Clínicas , Marília/SP, Brazil, in which 50 adult patients with digestive system cancer and diagnosed less than 6 months answered the State-Trait Anger Expression Inventory, Temperament and Character Inventory, Hospital Anxiety and Depression Scale and WHOQOL-BREF. Multiple regression was performed to verify if quality of life was related to stable characteristics of the subject’s personality (anger trait, temperament and character after controlling to the transient emotional aspects (anger state, psychiatric symptoms. RESULTS The quality of life psychological health score was higher in presence of self-directedness character and reward dependence temperament and quality of life environment score was higher in presence of self-directedness character and lower in presence of harm avoidance temperament. CONCLUSION The psychological well-being and the adaptive needs to the environment that favoring a better quality of life were reinforced mainly by the self-directedness character; which means that patients more autonomous cope better with the disease. On the other hand, the harm avoidance temperament (meaning the patient has fear of aversive situations impaired the adaptive capacity to deal with the changes of the day-to-day imposed by the disease. Understanding these personality traits is important to the health professionals drive the patient to more successful treatment.

  14. [Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients].

    Science.gov (United States)

    Passamar, M; Tellier, O; Vilamot, B

    2011-12-01

    Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. The time spent on the initial meeting and assessment is essential. The evolution of professional practices in mental health allows us to distinguish three kinds of sedation (vigilance, behaviour and psychical) that guide the choice and the mode of psychotropic drug use. The harmful effects of an ever-increasing use of sedation is debated. The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment. Copyright © 2011. Published by Elsevier Masson SAS.

  15. Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups

    Science.gov (United States)

    2017-01-01

    In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion, although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical

  16. Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups.

    Science.gov (United States)

    Assari, Shervin

    2017-11-13

    In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion , although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical

  17. Schizophrenia and Deliberate Self-Harm: A Systematic Review of Risk Factors

    Science.gov (United States)

    Haw, Camilla; Hawton, Keith; Sutton, Lesley; Sinclair, Julia; Deeks, Jonathan

    2005-01-01

    Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were…

  18. The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders

    Science.gov (United States)

    Maples-Keller, Jessica L.; Bunnell, Brian E.; Kim, Sae-Jin; Rothbaum, Barbara O.

    2016-01-01

    Virtual reality, or VR, allows users to experience a sense of presence in a computer-generated three-dimensional environment. Sensory information is delivered through a head mounted display and specialized interface devices. These devices track head movements so that the movements and images change in a natural way with head motion, allowing for a sense of immersion. VR allows for controlled delivery of sensory stimulation via the therapist and is a convenient and cost-effective treatment. The primary focus of this article is to review the available literature regarding the effectiveness of incorporating VR within the psychiatric treatment of a wide range of psychiatric disorders, with a specific focus on exposure-based intervention for anxiety disorders. A systematic literature search was conducted in order to identify studies implementing VR based treatment for anxiety or other psychiatric disorders. This review will provide an overview of the history of the development of VR based technology and its use within psychiatric treatment, an overview of the empirical evidence for VR based treatment, the benefits for using VR for psychiatric research and treatment, recommendations for how to incorporate VR into psychiatric care, and future directions for VR based treatment and clinical research. PMID:28475502

  19. Self-harm in children placed in a Court-Mandated Holding and Education Centre: analysis of socio-demographic variables and influence of implementation of judicial measures

    Directory of Open Access Journals (Sweden)

    G. García

    2015-10-01

    Full Text Available Objectives: To analyze and understand the existence of self-harming behavior in a detention centre for minors. Methods: Review of self-harm cases detected in a population of 94 inmates in 2013. Results: 26.5% of young offenders have conducted some form of self injury. 28% of individuals with self harming behaviors have more than 6 episodes over the period of internment. Self-beating is the most common type of self-harm performed by this group. Inmates serving sentences in the therapeutic section tend to present spillover effects in terms of self-injury. Discussion: The population held in prison show higher percentages of self-harm than amongst the general population. The chosen type of behavior is determined by the institution. Inmates that present greater mental fragility tend to perform these behaviors and in greater number.

  20. Problem solving ability and repetition of deliberate self-harm: a multicentre study.

    NARCIS (Netherlands)

    McAuliffe, C.; Corcoran, P.; Keeley, H.S.; Arensman, E.; Bille Brahe, U.; de Leio, D.; Fekete, S.; Hawton, K.; Hjelmeland, H.; Kelleher, M.; Kerkhof, A.J.F.M.; Lonnqvist, J.; Michel, K.; Salander Renberg, E.; Schmidtke, A.; van Heeringen, K.; Wasserman, D.

    2006-01-01

    Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated

  1. Adolescent Deliberate Self-Harm: Linkages to Emotion Regulation and Family Emotional Climate

    Science.gov (United States)

    Sim, Leslie; Adrian, Molly; Zeman, Janice; Cassano, Michael; Friedrich, William N.

    2009-01-01

    Parents' responses to their children's emotional expressivity have been shown to significantly influence children's subsequent psychosocial functioning. This study hypothesized that adolescents' deliberate self-harm (DSH) may be an outcome associated with poor emotion regulation as well as an invalidating family environment. The mediational role…

  2. A gender-specific analysis of suicide methods in deliberate self-harm

    Directory of Open Access Journals (Sweden)

    Kiran K Kumar

    2017-01-01

    Full Text Available Background: Deliberate self-harm (DSH is a major public health concern. Gender differences in suicide methods are a controversial realm with various regional and cultural variations. This study compared and assessed the methods used in DSH attempters as undertaken by men and women, and investigated the possible role of gender and other clinical variables in the selection of suicide method. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The sociodemographic details were recorded in the semi-structured pro forma. Detailed assessment of psychiatric morbidity and DSH was done by clinical interview and validated by Mini International Neuropsychiatric Interview-Plus 5.0 and Beck Suicide Intent Scale. Data were analyzed using SAS version 9.2 and SPSS version 17.0. The sample was disaggregated by gender to compare the known correlates of suicide risk on the two most common methods of suicide – poison consumption and drug overdose using multivariate analyses. Results: The analysis revealed that majority of the attempters were in the age group of 11–40 years (91%. Females (63% outnumbered males (37%; poisoning was the most common type of method (50.5%, followed by drug overdose (35%. There were no statistical differences between the two genders with respect to other sociodemographic variables. Males from urban/semi-urban background (odds ratio [OR] = 4.059 and females living alone (OR = 5.723 had high odds ratio of attempting suicide by poison consumption. Females from urban/semi-urban background (P = 0.0514 and male subjects from nuclear families had an increased odds ratio (OR = 4.482 to attempt suicide by drug overdose. There were no statistical differences when the two genders were compared for other variables such as intentionality, lethality, impulsivity, and number of attempts. Conclusions: It appears that gender differences among DSH attempters appear less pronounced in

  3. [A girl with self-harm treated with N-acetylcysteine (NAC)].

    Science.gov (United States)

    Rus, C P

    Deliberate and recurrent self-harm could be regarded as addictive behaviour that can be treated with medication. In addiction, the dopaminergic mesolimbic reward system is activated. Pain caused by cutting stimulates the reward system through the opioid system. Glutamatergic neurotransmission follows the same pathway and plays a role in addiction as well. In this case-study a 17-year-old girl was successfully treated with N-acetylcysteine (nac) in order to reduce the frequency of self-cutting. In addition, in this case nac reduced the symptoms of attention deficit/hyperactivity disorder and depression. nac modulates the glutamatergic neurotransmission. This article provides possible explanations for the effect of nac in this case.

  4. Targeting emotion dysregulation in the treatment of self-injury.

    Science.gov (United States)

    Gratz, Kim L

    2007-11-01

    Clinically useful definitions of emotion regulation with respect to deliberate self-harm (referred to here as self-injury) focus on adaptive ways of responding to emotional distress rather than on the control of emotions or dampening of emotional arousal. According to one such definition, emotion regulation is a multifaceted construct involving a) the awareness, understanding, and acceptance of emotions; b) ability to engage in goal-directed behaviors, and inhibit impulsive behaviors, when experiencing negative emotions; c) the flexible use of situationally appropriate strategies to modulate the intensity and/or duration of emotional responses rather than to eliminate emotions entirely; and d) willingness to experience negative emotions as part of pursuing meaningful activities in life (Gratz & Roemer, 2004). This article addresses the role of emotion dysregulation in self-injury and discusses two treatments for self-injury that explicitly focus on increasing emotion regulation. These treatments are based on the premise that the reduction of emotion dysregulation will decrease the need for maladaptive behaviors that function to regulate emotions, such as self-injury. A case illustration describing how one of these treatments (an acceptance-based, emotion regulation group therapy) is used to treat self-injury is provided.

  5. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

    DEFF Research Database (Denmark)

    Lind, Bertel; Erlangsen, Anette; Stuart, Elisabeth

    2014-01-01

    Background Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. Methods...... In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992—2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity...... score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. Findings 5678 recipients of psychosocial therapy (followed up for 42·828 person...

  6. The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders.

    Science.gov (United States)

    Maples-Keller, Jessica L; Bunnell, Brian E; Kim, Sae-Jin; Rothbaum, Barbara O

    After participating in this activity, learners should be better able to:• Evaluate the literature regarding the effectiveness of incorporating virtual reality (VR) in the treatment of psychiatric disorders• Assess the use of exposure-based intervention for anxiety disorders ABSTRACT: Virtual reality (VR) allows users to experience a sense of presence in a computer-generated, three-dimensional environment. Sensory information is delivered through a head-mounted display and specialized interface devices. These devices track head movements so that the movements and images change in a natural way with head motion, allowing for a sense of immersion. VR, which allows for controlled delivery of sensory stimulation via the therapist, is a convenient and cost-effective treatment. This review focuses on the available literature regarding the effectiveness of incorporating VR within the treatment of various psychiatric disorders, with particular attention to exposure-based intervention for anxiety disorders. A systematic literature search was conducted in order to identify studies implementing VR-based treatment for anxiety or other psychiatric disorders. This article reviews the history of the development of VR-based technology and its use within psychiatric treatment, the empirical evidence for VR-based treatment, and the benefits for using VR for psychiatric research and treatment. It also presents recommendations for how to incorporate VR into psychiatric care and discusses future directions for VR-based treatment and clinical research.

  7. Risk and protective factors associated with intentional self-harm among older community-residing home care clients in Ontario, Canada.

    Science.gov (United States)

    Neufeld, Eva; Hirdes, John P; Perlman, Christopher M; Rabinowitz, Terry

    2015-10-01

    We aim to concurrently examine risk and protective factors associated with intentional self-harm among community-residing older adults receiving home care services in Ontario, Canada. Administrative health data from the home care sector were linked to hospital administrative data to carry out the analyses. Home care data are collected in Ontario using the Resident Assessment Instrument-Home Care (RAI-HC), an assessment tool that identifies strengths, preferences and needs of long-stay home care clients. The sample included Ontario home care clients aged 60 years or older assessed with the RAI-HC between 2007 and 2010 (N = 222,149). Multivariable analyses were performed using SAS. Hospital records of intentional self-harm (ISH) were present in 9.3 cases per 1000 home care clients. Risks of ISH included younger age (60-74 years; OR = 3.14, CI: 2.75-3.59), psychiatric diagnosis (OR = 2.29, CI: 2.06-2.54), alcohol use and dependence (OR = 1.69, CI: 1.34-2.14), psychotropic medication (OR = 1.94, CI: 1.75-2.15) and depressive symptoms (OR = 1.58, CI: 1.40-1.78). Protective effects were found for marital status and positive social relationships, yet these effects were more pronounced for men. Cognitive performance measures showed the odds of ISH 1.86 times higher for older adults with moderate to severe cognitive impairment. This study based on provincial data points to tangible areas for preventative assessment by frontline home care professionals. Of interest were the risk and protective factors that differed by sex. As demand for home care in Canada is expected to increase, these findings may inform home care professionals' appraisal and approach to suicide prevention among community-residing older adults. Copyright © 2015 John Wiley & Sons, Ltd.

  8. The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people.

    Science.gov (United States)

    Daine, Kate; Hawton, Keith; Singaravelu, Vinod; Stewart, Anne; Simkin, Sue; Montgomery, Paul

    2013-01-01

    There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

  9. Psychiatric Disorders and Treatments: A Primer for Teachers.

    Science.gov (United States)

    Forness, Steven R.; Walker, Hill M.; Kavale, Kenneth A.

    2003-01-01

    This article for teachers provides basic information on psychiatric disorders and treatments. It covers oppositional defiant and conduct disorders, attention deficit/hyperactivity disorder, depression or other mood disorders, anxiety disorders, schizophrenia or other psychotic disorders, and autistic spectrum disorders. Insets provide additional…

  10. Sleep problems in children and adolescents with epilepsy: Associations with psychiatric comorbidity.

    Science.gov (United States)

    Hansen, Berit Hjelde; Alfstad, Kristin Å; van Roy, Betty; Henning, Oliver; Lossius, Morten I

    2016-09-01

    Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime functioning, and overall quality of life. Knowledge of factors contributing to sleep problems is likely to improve treatment. The aim of this study was to investigate associations between psychiatric comorbidity and parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy. Participants were children and adolescents (N=94), aged 10-19years, with generalized or focal epilepsy who had been referred to a tertiary epilepsy treatment center in Norway. Participants underwent a thorough clinical assessment and 24h of EEG registration. Information on sleep problems was obtained from parents using the Children's Sleep Habit Questionnaire (CSHQ) and from self-reporting using the Sleep Self-Report (SSR) questionnaire. Psychiatric diagnoses were established using the semistructured psychiatric interview Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (Kiddie-SADS-PL). Both the total and subdomain CSHQ and SSR scores were high in comparison with scores from population-based samples. Having one or more psychiatric disorder(s) was significantly associated with elevated scores on both the CSHQ and the SSR. With the exception of parent-reported parasomnias, associations between sleep problems and psychiatric disorders remained significant after adjusting for relevant epilepsy variables. Psychiatric comorbidity explained about one-third of the variance of the reported sleep problems in children and adolescents with epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Ethnicity, self reported psychiatric illness, and intake of psychotropic drugs in five ethnic groups in Sweden.

    Science.gov (United States)

    Bayard-Burfield, L; Sundquist, J; Johansson, S E

    2001-09-01

    This study hypothesises that the presumed increased risk of self reported longstanding psychiatric illness and intake of psychotropic drugs among Iranian, Chilean, Turkish, and Kurdish adults, when these groups are compared with Polish adults, can be explained by living alone, poor acculturation, unemployment, and low sense of coherence. Data from a national sample of immigrants/refugees, who were between the ages of 20-44 years old, upon their arrival in Sweden between 1980 and 1989. Unconditional logistic regression was used in the statistical modelling. Sweden. 1059 female and 921 male migrants from Iran, Chile, Turkey, Kurdistan and Poland and a random sample of 3001 Swedes, all between the ages of 27-60 years, were interviewed in 1996 by Statistics Sweden. Compared with Swedes, all immigrants had an increased risk of self reported longstanding psychiatric illness and for intake of psychotropic drugs, with results for the Kurds being non-significant. Compared with Poles, Iranian and Chilean migrants had an increased risk of psychiatric illness, when seen in relation to a model in which adjustment was made for sex and age. The difference became non-significant for Chileans when marital status was taken into account. After including civil status and knowledge of the Swedish language, the increased risks for intake of psychotropic drugs for Chileans and Iranians disappeared. Living alone, poor knowledge of the Swedish language, non-employment, and low sense of coherence were strong risk factors for self reported longstanding psychiatric illness and for intake of psychotropic drugs. Iranian, Chilean, Turkish and Kurdish immigrants more frequently reported living in segregated neighbourhoods and having a greater desire to leave Sweden than their Polish counterparts. Evidence substantiates a strong association between ethnicity and self reported longstanding psychiatric illness, as well as intake of psychotropic drugs. This association is weakened by marital status

  12. Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study

    Directory of Open Access Journals (Sweden)

    André R. Simioni

    2017-08-01

    Full Text Available Objectives: Little is known about the prevalence and correlates of deliberate self-harm (DSH in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y in a community-based study. Methods: Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC and their mothers were assessed in structured interviews. Current (last month and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children’s clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors. Results: The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1% and lifetime DSH was 1.6% (1.8% and 1.5%, respectively. Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD and oppositional defiant disorder (ODD, even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder. Conclusion: Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

  13. Lifetime Self-Harm Behaviors Are Not More Prevalent in Bariatric Surgery Candidates than in Community Controls with Obesity

    Directory of Open Access Journals (Sweden)

    Astrid Müller

    2018-04-01

    Full Text Available Objective: The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG compared to community controls with obesity (obese community group; OCG. Methods: The Self-Harm Inventory (SHI was administered to the PSG (n = 139, BMI ≥ 35 kg/m2 and to the OCG (n = 122, BMI ≥ 35 kg/m2. Results: Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02. No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG. At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1 = 3.91, p = 0.048. The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline, and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio. Conclusion: The results suggest that self-harm (including suicidal attempts is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity.

  14. Psychiatric symptoms and response quality to self-rated personality tests: Evidence from the PsyCoLaus study.

    Science.gov (United States)

    Dupuis, Marc; Meier, Emanuele; Rudaz, Dominique; Strippoli, Marie-Pierre F; Castelao, Enrique; Preisig, Martin; Capel, Roland; Vandeleur, Caroline L

    2017-06-01

    Despite the fact that research has demonstrated consistent associations between self-rated measures of personality dimensions and mental disorders, little has been undertaken to investigate the relation between psychiatric symptoms and response patterns to self-rated tests. The aim of this study was to investigate the association between psychiatric symptoms and response quality using indices from our functional method. A sample of 1,784 participants from a Swiss population-based cohort completed a personality inventory (NEO-FFI) and a symptom checklist of 90 items (SCL-90-R). Different indices of response quality were calculated based on the responses given to the NEO-FFI. Associations among the responses to indices of response quality, sociodemographic characteristics and the SCL-90-R dimensions were then established. Psychiatric symptoms were associated with several important differences in response quality, questioning subjects' ability to provide valid information using self-rated instruments. As suggested by authors, psychiatric symptoms seem associated with differences in personality scores. Nonetheless, our study shows that symptoms are also related to differences in terms of response patterns as sources of differences in personality scores. This could constitute a bias for clinical assessment. Future studies could still determine whether certain subpopulations of subjects are more unable to provide valid information to self-rated questionnaires than others. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  15. Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity.

    Science.gov (United States)

    Weingarden, Hilary; Scahill, Lawrence; Hoeppner, Susanne; Peterson, Alan L; Woods, Douglas W; Walkup, John T; Piacentini, John; Wilhelm, Sabine

    2018-07-01

    Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Bullying Victimization and Adolescent Self-Harm: Testing Hypotheses from General Strain Theory

    Science.gov (United States)

    Hay, Carter; Meldrum, Ryan

    2010-01-01

    Self-harm is widely recognized as a significant adolescent social problem, and recent research has begun to explore its etiology. Drawing from Agnew's (1992) social psychological strain theory of deviance, this study considers this issue by testing three hypotheses about the effects of traditional and cyber bullying victimization on deliberate…

  17. Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions.

    Science.gov (United States)

    Aydin Er, Rahime; Sehiralti, Mine; Aker, Ahmet Tamer

    2013-03-01

    Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  18. Self-harm and self-poisoning in southern India

    DEFF Research Database (Denmark)

    Bose, Anuradha; Sandal Sejbaek, Camilla; Suganthy, Pearline

    2009-01-01

    over a period of 2 years. RESULTS AND CONCLUSION: The overall suicide rate was 71.4 per 100 000 population; the highest burden was among men. Most people died through hanging (81, 54%) and self-poisoning (46, 31%). Of the 46 who died from self-poisoning, 78.3% had taken pesticides and 19.7% had eaten...... poisonous plants. Eighty per cent of the self-poisoning cases obtained the poisonous substance in or in close proximity to the home, highlighting the importance of safe storage in the domestic environment. Of the 110 fatal and non-fatal self-poisoning cases, 87 (57.5%) were taken for treatment; 50 (57.......4%) went to government hospitals and 37 (42.5%) to private facilities. This indicates the importance of including the private sector in the efforts to improve case management. Furthermore, the fact that 31 (67%) of the self-poisoning patients, who eventually died, were alive after 4 h provides an incentive...

  19. The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people.

    Directory of Open Access Journals (Sweden)

    Kate Daine

    Full Text Available BACKGROUND: There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. METHODS: An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. RESULTS: Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. CONCLUSIONS: Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

  20. The Power of the Web: A Systematic Review of Studies of the Influence of the Internet on Self-Harm and Suicide in Young People

    Science.gov (United States)

    Daine, Kate; Hawton, Keith; Singaravelu, Vinod; Stewart, Anne; Simkin, Sue; Montgomery, Paul

    2013-01-01

    Background There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. Methods An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. Results Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to ‘cyber-bully’ peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. Conclusions Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people. PMID:24204868

  1. Recidivism after treatment in a forensic youth-psychiatric setting: the effect of treatment characteristics

    NARCIS (Netherlands)

    van der Put, C.E.; Asscher, J.J.; Stams, G.J.J.M.; van der Laan, P.H.; Breuk, R.; Jongman, E.; Doreleijers, T.

    2013-01-01

    The aim of this study was to examine the effect of treatment characteristics on recidivism in a forensic youth-psychiatric outpatient clinic. The treatment offered comprised functional family therapy (FFT), individual cognitive behavioural therapy (CBT), or CBT in combination with parent training.

  2. Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users' Experience.

    Science.gov (United States)

    Grist, Rebecca; Porter, Joanna; Stallard, Paul

    2018-02-23

    Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track

  3. Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience

    Science.gov (United States)

    2018-01-01

    Background Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as

  4. Emergency mental health nursing for self-harming refugees and asylum seekers.

    Science.gov (United States)

    Procter, Nicholas G

    2005-09-01

    This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

  5. Effect of hopelessness on the links between psychiatric symptoms and suicidality in a vulnerable population at risk of suicide.

    Science.gov (United States)

    Gooding, Patricia; Tarrier, Nicholas; Dunn, Graham; Shaw, Jennifer; Awenat, Yvonne; Ulph, Fiona; Pratt, Daniel

    2015-12-15

    The aim of this study was to examine the impact of two risk factors working together on a measure of suicide probability in a highly vulnerable group who were male prisoners identified as being at risk of self harm. The first risk factor was psychiatric symptoms, including general psychiatric symptoms and symptoms of personality disorder. The second risk factor was psychological precursors of suicidal thoughts and behaviours which were defeat, entrapment, and hopelessness. Sixty-five male prisoners from a high secure prison in NW England, UK, were recruited, all of whom were considered at risk of suicide by prison staff. General psychiatric symptoms and symptoms of personality disorders predicted the probability of suicide. Hopelessness amplified the strength of the positive relationship between general psychiatric symptoms and suicide probability. These amplification effects acted most strongly on suicidal ideation as opposed to negative self evaluations or hostility. In contrast, defeat, entrapment and hopelessness did not affect the relationship between personality disorders and suicide probability. Clinical assessments of highly vulnerable individuals, as exemplified by prisoners, should include measures of a range of general psychiatric symptoms, together with measures of psychological components, in particular perceptions of hopelessness. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

    Science.gov (United States)

    McAuliffe, Carmel; Corcoran, Paul; Keeley, Helen S; Arensman, Ella; Bille-Brahe, Unni; De Leo, Diego; Fekete, Sandor; Hawton, Keith; Hjelmeland, Heidi; Kelleher, Margaret; Kerkhof, Ad J F M; Lönnqvist, Jouko; Michel, Konrad; Salander-Renberg, Ellinor; Schmidtke, Armin; Van Heeringen, Kees; Wasserman, Danuta

    2006-01-01

    While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

  7. Suicidal or Self-Harming Ideation in Military Personnel Transitioning to Civilian Life

    Science.gov (United States)

    Mansfield, Alyssa J.; Bender, Randall H.; Hourani, Laurel L.; Larson, Gerald E.

    2011-01-01

    Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results…

  8. Clinical Correlates and Repetition of Self-Harming Behaviors among Female Adolescent Victims of Sexual Abuse

    Science.gov (United States)

    Cyr, Mireille; McDuff, Pierre; Wright, John; Theriault, Chantal; Cinq-Mars, Caroline

    2005-01-01

    This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups…

  9. Research on the influence that communication in psychiatric encounters has on treatment.

    Science.gov (United States)

    Cruz, Mario; Pincus, Harold Alan

    2002-10-01

    The purpose of this article is to inform mental health professionals about the empirical literature on medical and psychiatric encounters and the influence of communicative behaviors on specific encounter outputs and treatment outcomes. A comprehensive review of the health communications literature from 1950 to 2001, using MEDLINE and PsycINFO, was conducted to identify relevant articles on the communication skills of psychiatrists and other physicians. These searches were augmented by personal correspondence with experts on changes in practice patterns in psychiatry and on medical and psychiatric communications research. A review of references within each article and information from the experts identified other relevant articles. Selection was then narrowed to include reports of studies that used structured written instruments that captured relevant physician and patient perceptions of the physician-patient relationship, content analysis of audio- or videotapes of communication in medical or psychiatric encounters, or interaction analysis systems used to categorize audio- or videotaped communicative behaviors in medical or psychiatric encounters. Twenty-five articles in medicine and 34 articles in psychiatry were selected. Medical communication researchers have observed associations between physicians' communicative skills and patients' satisfaction, patients' adherence to treatment recommendations, treatment outputs, and patients' willingness to file malpractice claims. The research has also shown that primary care physicians can be more responsive to patients' concerns without lengthening visits. In psychiatry, the literature can be organized into four discrete categories of research: negotiated treatment and the customer approach, therapeutic alliance, Gottschalk-Gleser content analysis of patients' speech, and content analysis of psychiatric interviews.

  10. [Limitations and Problems with Treatment of Eating Disorders in a Psychiatric Hospital].

    Science.gov (United States)

    Amayasu, Hideaki; Okubo, Momoe; Itai, Takahiro

    2015-01-01

    Treating patients who have eating disorders in psychiatric hospitals is difficult for several reasons. The first reason is that there is a shortage of qualified psychiatrists. For each psychiatrist, there are approximately thirty hospitalized patients. In addition to this limited number of psychiatrists, funding in psychiatric hospitals only provides for a limited number of other medical staff when compared with funding available for general hospitals. The second reason is that there is a problem with the national medical treatment fee system. Specifically, in the current system, patients are not permitted to stay in hospitals long-term; outpatient treatment is preferred. The third reason is that psychiatric hospitals are not equipped to deal with patients who have physical illnesses. The following two case studies highlight the problems and limitations associated with treating patients who have eating disorders. Ways in which psychiatric hospitals can collaborate with other organizations, including low enforcement officials, are also considered. Although it is clear that an integrated and collaborative approach is necessary, implementation of such a system is still a long way from being realized, and greater effort is needed to provide patients suffering from eating disorders with the best possible treatment.

  11. Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran.

    Science.gov (United States)

    Khazaie, Habibolah; Rezaie, Leeba; de Jong, Desiree M

    2013-01-01

    Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment. In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview. Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (Preasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (Preasons for dropping out and strategies to reduce rates of dropouts is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Age and methods of fatal self harm (FSH). Is there a link?

    Science.gov (United States)

    Tadros, G; Salib, E

    2000-09-01

    To examine the methods of fatal self harm (FSH) used by the elderly compared to young adults. We compared the methods of FSH used by all the elderly over 60 years of age to those used by all younger adults, over 16 and under 60, in the city of Birmingham and Solihull over a period of 4 years, 1995-1998. We applied the term FSH to all deceased who were subjects of Coroner's inquests and attracted verdicts of suicide and open verdicts. A significantly higher proportion of the elderly who fatally harmed themselves did so by drowning and asphyxia compared to the younger age group (p suicide among elderly men and women were hanging and self-poisoning by overdose, respectively. The study shows that the most common method of suicide in the elderly is poisoning by drug overdose. It raises the question about the quantity of drugs prescribed for the elderly, e.g. antidepressants, sedatives and pain killers. The study did not confirm previous reports that violent methods are used more frequently with increasing age. Copyright 2000 John Wiley & Sons, Ltd.

  13. Hazardous alcohol users during pregnancy: psychiatric health and personality traits.

    Science.gov (United States)

    Magnusson, Asa; Göransson, Mona; Heilig, Markus

    2007-07-10

    We examined alcohol use disorders, psychiatric symptoms and personality traits in women reporting alcohol use during pregnancy. In a pilot cohort (n=139), subjects were screened for alcohol use disorders, and assessed for psychopathology, personality traits, and alcohol use during the first trimester. Those reporting consumption exceeding a conservative threshold for harmful use were offered a diagnostic psychiatric interview. The main findings of the pilot study were replicated using a large sample of women in the third trimester (n=715), who were screened for alcohol use disorders, had their consumption during pregnancy assessed, and were assessed for personality traits. In the pilot cohort, only a minority of women who consumed significant amounts of alcohol during pregnancy fulfilled alcohol dependence criteria, or had scores on the Alcohol Use Disorder Identification Test typically associated with such a diagnosis. Psychiatric morbidity was also unremarkable as assessed by self-reported symptom intensity. The distinguishing feature was high novelty seeking. The results were robustly confirmed in the replication study. Most women with significant alcohol consumption during pregnancy do not seem to be alcohol dependent. Instead, use during pregnancy may reflect impulsive personality traits, and be correlated with additional risk behaviors.

  14. Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment

    Science.gov (United States)

    North, Carol S; Hong, Barry A; Alpers, David H

    2007-01-01

    This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in

  15. Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment

    Institute of Scientific and Technical Information of China (English)

    Carol S North; Barry A Hong; David H Alpers

    2007-01-01

    This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. Bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder).One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness.Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions.Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS

  16. Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers

    Directory of Open Access Journals (Sweden)

    Britt-Marie Lindgren

    2010-09-01

    Full Text Available The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents’ narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in ‘limit situations’ comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner's dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being ‘broken’, being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters’ recovery.

  17. Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers.

    Science.gov (United States)

    Lindgren, Britt-Marie; Aström, Sture; Graneheim, Ulla Hällgren

    2010-09-24

    The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents' narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in 'limit situations' comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner's dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being 'broken', being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters' recovery.

  18. Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life.

    Science.gov (United States)

    Reuters, Vaneska Spinelli; Almeida, Cloyra de Paiva; Teixeira, Patrícia de Fátima dos Santos; Vigário, Patrícia dos Santos; Ferreira, Márcia Martins; Castro, Carmen Lucia Natividade de; Brasil, Marco Antônio; Costa, Antônio José Leal da; Buescu, Alexandru; Vaisman, Mário

    2012-03-01

    To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.

  19. Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada.

    Science.gov (United States)

    Rosychuk, Rhonda J; Johnson, David W; Urichuk, Liana; Dong, Kathryn; Newton, Amanda S

    2016-07-11

    Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit. We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan. The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p self-harm (differences: girls -108.3/100,000; p self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

  20. Harmful Waste Process

    International Nuclear Information System (INIS)

    Ki, Mun Bong; Lee, Shi Jin; Park, Jun Seok; Yoon, Seok Pyo; Lee, Jae Hyo; Jo, Byeong Ryeol

    2008-08-01

    This book gives descriptions of processing harmful waste, including concerned law and definition of harmful waste, current conditions and generation of harmful waste in Korea, international condition of harmful waste, minimizing of generation of harmful waste, treatment and storage. It also tells of basic science for harmful waste disposal with physics, chemistry, combustion engineering, microbiology and technique of disposal such as physical, chemical, biological process, stabilizing and solidification, incineration and waste in landfill.

  1. Psychological distress, self-harming behavior, and suicidal tendencies in adults with disorders of sex development.

    Science.gov (United States)

    Schützmann, Karsten; Brinkmann, Lisa; Schacht, Melanie; Richter-Appelt, Hertha

    2009-02-01

    Evaluation of psychological distress has received relatively little attention in research on persons with disorders of sex development (DSD). Results of previous studies varied considerably, but most studies did not find increased levels of psychological distress. We conducted a pilot study based on a sample of 37 persons with diverse forms of DSD recruited via various strategies. The Brief Symptom Inventory (BSI) was used to assess self-reported psychological distress. Psychological distress varied broadly across all diagnostic subgroups. Overall, the BSI Global Severity Index indicated higher distress in the sample of persons with DSD compared to a non-clinical norm population of women, with an effect size of d = 0.67. According to predefined BSI criteria, 59% of participants were classified as a clinical case. Self-harming behavior and suicidal tendencies were also assessed and compared to a community based sample of women, including subgroups of traumatized women with a history of physical or sexual abuse. The prevalence rates of self-harming behavior and suicidal tendencies in the DSD sample exceeded the rates of the non-traumatized comparison subgroup, with rates comparable to the traumatized comparison groups of women with physical or sexual abuse. As possible explanations for the higher distress found here compared to most previous studies, differences in measures and sample recruitment are discussed. Our results suggest that adults with DSD are markedly psychologically distressed with rates of suicidal tendencies and self-harming behavior on a level comparable to non-DSD women with a history of physical or sexual abuse, but sample recruitment procedures do not permit a firm generalization.

  2. Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan.

    Science.gov (United States)

    Chiang, Shu-Chuan; Chan, Hung-Yu; Chang, Yuan-Ying; Sun, Hsiao-Ju; Chen, Wei J; Chen, Chih-Ken

    2007-02-01

    The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.

  3. [Shared decision-making and individualized goal setting - a pilot trial using PRISM (Pictorial Representation of Illness and Self Measure) in psychiatric inpatients].

    Science.gov (United States)

    Büchi, S; Straub, S; Schwager, U

    2010-12-01

    Although there is much talk about shared decision making and individualized goal setting, there is a lack of knowledge and knowhow in their realization in daily clinical practice. There is a lack in tools for easy applicable tools to ameliorate person-centred individualized goal setting processes. In three selected psychiatric inpatients the semistructured, theory driven use of PRISM (Pictorial Representation of Illness and Self Measure) in patients with complex psychiatric problems is presented and discussed. PRISM sustains a person-centred individualized process of goal setting and treatment and reinforces the active participation of patients. The process of visualisation and synchronous documentation is validated positively by patients and clinicians. The visual goal setting requires 30 to 45 minutes. In patients with complex psychiatric illness PRISM was used successfully to ameliorate individual goal setting. Specific effects of PRISM-visualisation are actually evaluated in a randomized controlled trial.

  4. The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial.

    Science.gov (United States)

    Andreasson, Kate; Krogh, Jesper; Rosenbaum, Bent; Gluud, Christian; Jobes, David A; Nordentoft, Merete

    2014-05-29

    In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective

  5. [Use of social media by psychiatric in-patients : Case report and further perspectives].

    Science.gov (United States)

    Czech, O M; Podoll, K; Schneider, F

    2017-08-03

    Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.

  6. Ceftriaxone treatment for two neurosyphilis cases presenting with cognitive and psychiatric symptoms

    Directory of Open Access Journals (Sweden)

    Melek Kandemir

    2011-06-01

    Full Text Available Syphilis is a disease caused by the spirochetal bacterium Treponema Pallidum subspecies pallidum. The route of transmission of syphilis is almost always through sexual contact. The incidence of syphilis decreased significantly with the introduction of penicilin in the 1940s but rose sharply again with the advent of HIV infection in the 1980s. Tertiary or late syphilis develops years after the initial infection and can involve any organ system. Neurologic involvement occurs in up to 10 percent of patients with untreated syphilis. General paresis, the clinical form of neurosyphilis most associated with psychiatric symptoms, occurs with parenchymatous disease and involves neuronal loss as opposed to the vascular lesions or inflammatory changes characteristic of most other forms of neurosyphilis. In the classic description, after early psychiatric manifestations such as mood changes, psychosis, or cognitive changes, demantia becomes prominent. Penicillin is the only drug that has proved effective in the treatment of neurosyphilis. Ceftriaxone is used as an alternative treatment in patients with penicilin allergy. This article reports two cases of neurosyphilis one of whom is presented with dementia and the other with psychiatric symptoms. Both of them are treated with ceftriaxone. Our purpose is to reveal the fact that ceftriaxone is a succesful alternative treatment for the cases with penicilin allergy and to emphasize the importance of neurosyphilis in the differential diagnosis for the psychiatric cases that are resistant to treatment

  7. Ethnic density and deliberate self harm; a small area study in south east London

    NARCIS (Netherlands)

    Neeleman, J; Wilson-Jones, C; Wessely, S

    Study objective-Relative risks are frequently used to convey how strongly outcomes like mental illness and suicidal behaviour are associated with personal characteristics Like ethnic background. This study examined whether RRs for deliberate self harm (DSH) in ethnic groups vary between small areas

  8. Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients.

    Science.gov (United States)

    Knapen, Jan; Van de Vliet, Peter; Van Coppenolle, Herman; David, Ans; Peuskens, Joseph; Pieters, Guido; Knapen, Koen

    2005-01-01

    The first objective of this study was to compare the changes in physical self-concept, global self-esteem, depression and anxiety after participation in one of two 16-week psychomotor therapy programs for nonpsychotic psychiatric inpatients. The second objective was to study the relationship between changes in these variables. One hundred and ninety-nine inpatients were randomly assigned to either a personalized psychomotor fitness program, consisting of aerobic exercise and weight training, or a general program of psychomotor therapy, consisting of different forms of physical exercises and relaxation training. Physical self-concept was evaluated using the Dutch version of the Physical Self-Perception Profile at baseline, after 8 weeks, and after completion of the 16-week interventions. At the same time points, additional variables of global self-esteem, depression and anxiety were assessed by means of the Rosenberg Self-Esteem Inventory, the Beck Depression Inventory and the Trait Anxiety Inventory, respectively. After 16 weeks, both groups showed significant improvements in all outcome measures (p values ranged from 0.01 to self-esteem and decreased depression and anxiety levels (p self-esteem, depression and anxiety supports the potential role of the physical self-concept in the recovery process of depressed and anxious psychiatric inpatients. Copyright (c) 2005 S. Karger AG, Basel.

  9. An emergency department intervention to protect an overlooked group of children at risk of significant harm.

    LENUS (Irish Health Repository)

    Kaye, P

    2012-02-01

    BACKGROUND: Parental psychiatric disorder, especially depression, personality disorder and deliberate self-harm, is known to put children at greater risk of mental illness, neglect or physical, emotional and sexual abuse. Without a reliable procedure to identify children of parents presenting with these mental health problems, children at high risk of significant harm can be easily overlooked. Although deliberate self-harm constitutes a significant proportion of emergency presentations, there are no guidelines which address the emergency physician\\'s role in identifying and assessing risk to children of these patients. METHODS: A robust system was jointly developed with the local social services child protection team to identify and risk-stratify children of parents with mental illness. This allows us to intervene when we identify children at immediate risk of harm and to ensure that social services are aware of potential risk to all children in this group. The referral process was audited repeatedly to refine the agreed protocol. RESULTS: The proportion of patients asked by the emergency department personnel about dependent children increased and the quality of information received by the social services child protection team improved. CONCLUSIONS: All emergency departments should acknowledge the inadequacy of information available to them regarding patients\\' children and consider a policy of referral to social services for all children of parents with mental health presentations. This process can only be developed through close liaison within the multidisciplinary child protection team.

  10. Stability of Comorbid Psychiatric Diagnosis among Youths in Treatment and Aftercare for Alcohol Use Disorders

    Science.gov (United States)

    Hawke, Josephine M.; Kaminer, Yifrah; Burke, Rebecca; Burleson, Joseph A.

    2008-01-01

    Objectives: To examine the stability of comorbid psychiatric diagnoses among a sample of 50 adolescents in cognitive-behaviorally-based treatment for alcohol and other substance use disorders (AOSUD). Methods: A standardized psychiatric interview was administered at baseline and 12 month later to obtain current comorbid psychiatric disorders. Chi…

  11. Managing young people with self-harming or suicidal behaviour.

    Science.gov (United States)

    Fisher, Gemma

    2016-02-01

    This literature review aimed to determine the risk factors being used to identify children and young people who are at increased risk of engaging in self-harm and suicidal behaviour, so that optimal care can be provided for this patient group in children's medical ward settings. The two main themes that emerged were mental and neurodevelopmental disorders, and external factors. Management strategies to aid healthcare professionals in caring for this patient group were also identified. The review concludes by highlighting the need to provide healthcare professionals with continuing education about the mental health problems of children and young people, including risk factors and management strategies.

  12. N-acetylcysteine in the treatment of psychiatric disorders: current status and future prospects.

    Science.gov (United States)

    Minarini, Alessandro; Ferrari, Silvia; Galletti, Martina; Giambalvo, Nina; Perrone, Daniela; Rioli, Giulia; Galeazzi, Gian Maria

    2017-03-01

    N-acetylcysteine (NAC) is widely known for its role as a mucolytic and as an antidote to paracetamol overdose. There is increasing interest in the use of NAC in the treatment of several psychiatric disorders. The rationale for the administration of NAC in psychiatric conditions is based on its role as a precursor to the antioxidant glutathione, and its action as a modulating agent of glutamatergic, dopaminergic, neurotropic and inflammatory pathways. Areas covered: This study reviews the available data regarding the use of NAC in different psychiatric disorders including substance use disorders, autism, obsessive-compulsive spectrum disorders, schizophrenia, depression, bipolar disorder. Promising results were found in trials testing the use of NAC, mainly as an add-on treatment, in cannabis use disorder in young people, depression in bipolar disorder, negative symptoms in schizophrenia, and excoriation (skin-picking) disorder. Despite initial optimism, recent findings regarding NAC efficacy in autism have been disappointing. Expert opinion: These preliminary positive results require further confirmation in larger samples and with longer follow-ups. Given its high tolerability and wide availability, NAC represents an important target to investigate in the field of new adjunctive treatments for psychiatric conditions.

  13. Suicide and the 'Poison Complex': Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic.

    Science.gov (United States)

    Widger, Tom

    2015-01-01

    Suicide prevention efforts in Asia have increasingly turned to 'quick win' means restriction, while more complicated cognitive restriction and psychosocial programs are limited. This article argues the development of cognitive restriction programs requires greater consideration of suicide methods as social practices, and of how suicide cognitive schemata form. To illustrate this, the article contributes an ethnographically grounded study of how self-poisoning becomes cognitively available in Sri Lanka. I argue the overwhelming preference for poison as a method of self-harm in the country is not simply reflective of its widespread availability, but rather how cognitive schemata of poison-a 'poison complex'-develops from early childhood and is a precondition for suicide schemata. Limiting cognitive availability thus requires an entirely novel approach to suicide prevention that draws back from its immediate object (methods and causes of self-harm) to engage the wider poison complex of which suicide is just one aspect.

  14. [The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder].

    Science.gov (United States)

    Kaess, Michael; Ghinea, Denisa; Fischer-Waldschmidt, Gloria; Resch, Franz

    2017-07-01

    The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder Self-harm and risk-taking behaviors are frequently occurring problems in adolescents' everyday life and commonly challenge the present child and adolescent health-care system. Those behaviors are typical features of borderline-personality disorder (BPD), a severe mental disorder that is associated with immense psychological strain, increased risk of mortality and poor psychosocial functioning. Despite controversy in the past, recent evidence shows that BPD is a valid and reliable diagnosis in adolescence. Consequently, specified and effective intervention programs for this age group are necessary. Instead, present health-care services for children and adolescents in Germany are usually characterized by long waiting periods for specialized outpatient treatments and unnecessary expanses of unnecessary long inpatient stays. Alternatively, and in order to prevent serious long-term consequences, new concepts - integrated in an ambulatory setting and close to patients' daily routines - should focus on early detection and treatment of adolescents at-risk presenting with borderline personality features. The specialist outpatient clinic AtR!Sk at the University Hospital Heidelberg ensures a low-threshold initial contact service, comprehensive and accurate diagnosis of BPD features, and rapidly "tailored" therapy for young people presenting with any types of risk-taking and self-harm behavior. AtR!Sk - as a pioneering approach in south Germany - provides evidence-based early detection and intervention for adolescent BPD.

  15. The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness.

    Science.gov (United States)

    Reissner, Volker; Jost, Diana; Krahn, Ulrike; Knollmann, Martin; Weschenfelder, Ann-Kathrin; Neumann, Anja; Wasem, Jürgen; Hebebrand, Johannes

    2015-09-25

    5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders. 112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life. In both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, preintegration in school and on the differential indicators for outpatient versus inpatient treatment.

  16. Exposing therapists to trauma-focused treatment in psychosis: effects on credibility, expected burden, and harm expectancies

    Directory of Open Access Journals (Sweden)

    David P. G. van den Berg

    2016-09-01

    Full Text Available Background: Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. Objective: This feasibility study explores the impact of specialized training on therapists’ beliefs about trauma-focused treatment within a randomized controlled trial. Method: Therapist-rated (n=16 credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. Results: Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists’ expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD in patients with psychotic disorders (n=79, pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. Conclusions: These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists’ credibility, burden, and harm beliefs concerning trauma-focused treatment.

  17. Self-harming behavior of a parent with borderline personality disorder assessed using revealed preference and attributional approaches: a case study.

    Science.gov (United States)

    Tustin, R Don

    2002-08-01

    This article discusses a case study involving a parent with Borderline Personality Disorder who exhibited self-harming behaviors. Assessment and intervention were based both on a review of the client's attributions about causes of her own behavior as being either internalizing or externalizing, and on a review of motivation of the behaviors using functional analysis. Antecedent situations for self-harming behaviors were identified to provide a basis for reviewing the client's attributions of reasons for disordered behavior. A new technique of functional analysis was applied using the principle of revealed preference arising from behavioral economics. Revealed preference identified outcomes that were valued by the client, enabling new responses to be identified to attain these reinforcers. Attribution re-training was provided. Significant reductions in self-harming behaviors were achieved during brief therapy and were maintained during follow-up.

  18. Narcissism and relational representations among psychiatric outpatients.

    Science.gov (United States)

    Kealy, David; Ogrodniczuk, John S; Joyce, Anthony S; Steinberg, Paul I; Piper, William E

    2015-06-01

    Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.

  19. Parents of young people with self-harm or suicidal behaviour who seek help - a psychosocial profile.

    LENUS (Irish Health Repository)

    Morgan, Sophia

    2013-04-23

    Deliberate Self-Harm (DSH) is a common problem among children and adolescents in clinical and community populations, and there is a considerable amount of literature investigating factors associated with DSH risk and the effects of DSH on the child. However, there is a dearth of research examining the impact of DSH on parents, and there are few support programmes targeted at this population. This cross-sectional study examines the profile of a sample of parents of young people with DSH who participated in a support programme (Supporting Parents and Carers of young people with self-harm: the SPACE programme), with the goal of investigating pre-test parental well-being, family communication, parental satisfaction, perceived parental social support, and child strengths and difficulties.

  20. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys.

    Science.gov (United States)

    Angermeyer, Matthias C; van der Auwera, Sandra; Carta, Mauro G; Schomerus, Georg

    2017-02-01

    Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

  1. The Effect of the Psychiatric Nursing Approach Based on the Tidal Model on Coping and Self-esteem in People with Alcohol Dependency: A Randomized Trial.

    Science.gov (United States)

    Savaşan, Ayşegül; Çam, Olcay

    2017-06-01

    People with alcohol dependency have lower self-esteem than controls and when their alcohol use increases, their self-esteem decreases. Coping skills in alcohol related issues are predicted to reduce vulnerability to relapse. It is important to adapt care to individual needs so as to prevent a return to the cycle of alcohol use. The Tidal Model focuses on providing support and services to people who need to live a constructive life. The aim of the randomized study was to determine the effect of the psychiatric nursing approach based on the Tidal Model on coping and self-esteem in people with alcohol dependency. The study was semi-experimental in design with a control group, and was conducted on 36 individuals (18 experimental, 18 control). An experimental and a control group were formed by assigning persons to each group using the stratified randomization technique in the order in which they were admitted to hospital. The Coping Inventory (COPE) and the Coopersmith Self-Esteem Inventory (CSEI) were used as measurement instruments. The measurement instruments were applied before the application and three months after the application. In addition to routine treatment and follow-up, the psychiatric nursing approach based on the Tidal Model was applied to the experimental group in the One-to-One Sessions. The psychiatric nursing approach based on the Tidal Model is an approach which is effective in increasing the scores of people with alcohol dependency in positive reinterpretation and growth, active coping, restraint, emotional social support and planning and reducing their scores in behavioral disengagement. It was seen that self-esteem rose, but the difference from the control group did not reach significance. The psychiatric nursing approach based on the Tidal Model has an effect on people with alcohol dependency in maintaining their abstinence. The results of the study may provide practices on a theoretical basis for improving coping behaviors and self-esteem and

  2. Risk of self-harm and nonfatal suicide attempts, and completed suicide in patients with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, A; Hansen, P. R.; Gislason, G. H.

    2016-01-01

    Background: Psoriasis is a common inflammatory skin disease, and inflammation may affect suicidal behaviour. Current data on the incidence and risk of suicidal behaviour in patients with psoriasis are scarce. Objectives: We investigated the association between psoriasis and the risk of self......-harm and suicide attempts and suicides. Methods: All Danish patients aged ≥ 18 years with mild or severe psoriasis (cases) from 1 January 1997 to 31 December 2011 were matched on age, sex and calendar time 1 : 5 with healthy controls. The outcome was a diagnosis of self-harm or a nonfatal suicide attempt......, or completed suicide. Incidence rates per 10 000 person-years were calculated, and incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated by Poisson regression models. Results: The study cohort comprised 408 663 individuals, including 57 502 and 11 009 patients with mild and severe...

  3. Self-harming in depressed patients: pattern analysis.

    Science.gov (United States)

    Parker, G; Malhi, Gin; Mitchell, Philip; Kotze, Beth; Wilhelm, Kay; Parker, Kay

    2005-10-01

    As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high 'acting out' behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

  4. Crack and Cocaine Use among Adolescents in Psychiatric Treatment: Associations with HIV Risk

    Science.gov (United States)

    Tolou-Shams, Marina; Feldstein Ewing, Sarah W. Tarantino, Nicholas; Brown, Larry K.

    2010-01-01

    Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age = 14.9 years) treated in intensive psychiatric treatment settings to understand the…

  5. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

    Directory of Open Access Journals (Sweden)

    Trine Madsen

    2017-03-01

    Full Text Available People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.

  6. Victimization, Posttraumatic Stress Disorder Symptomatology, and Later Nonsuicidal Self-Harm in a Birth Cohort

    Science.gov (United States)

    Nada-Raja, Shyamala; Skegg, Keren

    2011-01-01

    This longitudinal population-based study examined pathways to nonsuicidal self-harm (NSSH) in relation to childhood sexual abuse (CSA), assault victimization in early adulthood, posttraumatic stress disorder symptomatology (PTSD), and other mental disorders. At age 21, 476 men and 455 women completed interviews on assault victimization, PTSD, and…

  7. Treatment of anxiety disorders by psychiatrists from the American Psychiatric Practice Research Network

    Directory of Open Access Journals (Sweden)

    Katherine Sorsdahl

    2013-06-01

    Full Text Available Objective: Anxiety disorders are highly prevalent in the United States, and if untreated, result in a number of negative outcomes. This study aimed to investigate psychiatrists' current treatment practices for patients with anxiety disorders in the United States. Methods: Psychiatrist-reported data from the 1997 and 1999 American Psychiatric Institute for Research and Education Practice Research Network (PRN Study of Psychiatric Patients and Treatments (SPPT were examined, focusing on patients diagnosed with anxiety disorders. Information related to diagnostic and clinical features and treatments provided were obtained. Results: Anxiety disorders remain underdiagnosed and undertreated, since only 11.4% of the sample received a principal diagnosis of an anxiety disorder in a real world setting. Posttraumatic stress disorder was associated with particularly high comorbidity and disability, and social anxiety disorder was relatively rarely diagnosed and treated. Although combined pharmacotherapy and psychotherapy was commonly used to treat anxiety disorders, anxiolytics were more commonly prescribed than selective serotonin reuptake inhibitors (SSRIs. Conclusions: These data provide a picture of diagnosis and practice patterns across a range of psychiatric settings and suggest that anxiety disorders, despite being among the most prevalent of psychiatric disorders remain underdiagnosed and undertreated particularly in respect of the use of psychotherapeutic interventions.

  8. Psychiatric and addiction consultation for patients in critical care.

    Science.gov (United States)

    Kaiser, Susan

    2012-03-01

    Practicing within the paradigm of compartmentalized specially treatment without a collaborative practice is ineffective for the chemical dependency and dual diagnosis population. Chemical dependency is not well understood as a disease, evidenced by barriers cited from the 2005 Survey on Drug Use and Health. Recovery from addiction and dual diagnosis logically demands an integrated and science-based treatment approach with unified standards for care and improved educational standards for preparation of care providers. Consultation and collaboration with addiction and psychiatric specialists is needed to establish consistency in standards for treatment and holistic care, essential for comorbidity. Continued learning and research about the complexity of the addiction process and comorbidity will provide continued accurate information about the harmful effects of alcoholism and drug abuse which in turn will empower individuals to make informed choices and result in better treatment and social policies.

  9. Understanding migraine and psychiatric comorbidity.

    Science.gov (United States)

    Seng, Elizabeth K; Seng, Cynthia D

    2016-06-01

    This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders. Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma. Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.

  10. Group Therapy for Repeated Deliberate Self-Harm in Adolescents: Failure of Replication of a Randomized Trial

    Science.gov (United States)

    Hazell, Philip L.; Martin, Graham; McGill, Katherine; Kay, Tracey; Wood, Alison; Trainor, Gemma; Harrington, Richard

    2009-01-01

    A study revealing the superiority of group therapy to routine care in preventing the recurrence of self-harming behavior among adolescents is unsuccessfully replicated. The study's findings contradicted those of the original study.

  11. Psychiatric Disorders and Sexual Risk among Adolescents in Mental Health Treatment

    Science.gov (United States)

    Brown, Larry K.; Hadley, Wendy; Stewart, Angela; Lescano, Celia; Whiteley, Laura; Donenberg, Geri; DiClemente, Ralph

    2010-01-01

    Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and…

  12. Psychiatric Aspects of Infertility

    Directory of Open Access Journals (Sweden)

    Hacer Sezgin

    2014-06-01

    Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185

  13. MENSTRUAL PHASE OF WOMEN AND DEATH DUE TO DELIBERATE SELF HARM: AN AUTOPSY STUDY

    OpenAIRE

    Sujith Sreenivas

    2015-01-01

    The study was conducted by determining the phase of menstruation of women, who committed suicide by subjecting the uterus for gross and histopathological examination. An understanding whether there was an increased incidence of deliberate self - harm during any particular phase of menstruation was made by this study. AIMS: Determination of me...

  14. Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease.

    Science.gov (United States)

    Krooks, J A; Weatherall, A G; Holland, P J

    2018-06-01

    Approximately half of all patients presenting to dermatologists exhibit signs and symptoms of psychiatric conditions that are either primary or secondary to cutaneous disease. Because patients typically resist psychiatric consult, dermatologists often are on the front line in evaluating and treating these patients. Accordingly, distinguishing the specific underlying or resulting psychiatric condition is essential for effective treatment. The etiology, epidemiology, clinical presentation, diagnosis, and first-line treatment of specific primary psychiatric causes of dermatologic conditions, including delusional infestation, Morgellons syndrome, olfactory reference syndrome, body dysmorphic disorder, excoriation disorder, trichotillomania, and dermatitis artefacta are discussed here, followed by a discussion of the recommended treatment approach with an overview of the different first-line therapies discussed in this review, specifically cognitive behavioral therapy, atypical antipsychotics, selective serotonin reuptake inhibitors, and tricyclic antidepressants. Included is a guide for dermatologists to use while prescribing these medications.

  15. Implementation and outcome of child psychotherapy compared with other psychiatric treatments in a naturalistic clinical setting.

    Science.gov (United States)

    Ryynänen, Taimi; Alen, Markku; Koivumaa-Honkanen, Heli; Joskitt, Leena; Ebeling, Hanna

    2015-04-01

    Mental health problems of children are commonly treated by psychotherapy and other psychosocial treatments. Studies comparing different treatments in naturalistic clinical settings are few, however. We assessed the differences: 1) in symptoms and diagnoses; 2) in treatment outcome between psychotherapy and other psychosocial treatments; and 3) evaluated the effect of family background and life circumstances on the outcome. The data were collected from the psychiatric hospital records of Oulu University Hospital, Finland. All 118 children (aged psychotherapy from the Department of Child Psychiatry in 1996-2005 and 118 age- and sex-matched children undergoing other psychosocial treatments were included. A lack of later recorded psychiatric problems was used as an indicator of good treatment outcome. On referral, functional ability was severely impaired in almost half of the children (Children's Global Assessment Scale score psychotherapy group, while no difference was found in externalizing symptoms between the groups. In both groups, later psychiatric problems were associated with a child's low functional ability and poor parental coping with their responsibilities. Children with internalizing problems had impaired prognosis if they had psychosocial treatments other than psychotherapy. Individual psychotherapy should especially be considered for children with internalizing symptoms, but the outcome of psychiatric treatment depends not only on children's own functional abilities, but also on parental abilities.

  16. Malariotherapy at Mont Park: the earliest surviving movie of psychiatric treatment in Australia.

    Science.gov (United States)

    Kaplan, Robert M

    2013-02-01

    A movie on malariotherapy for neurosyphilis made at Mont Park and filmed by Reg Ellery in 1926 is believed to be the oldest surviving movie of psychiatric treatment in Australia. The objective is to review the movie and discuss the background and context of the film, which shows the conditions of patients in a psychiatric hospital in the 1920s. Movie film is a guide to a psychiatric past that is rapidly being forgotten. The Ellery movie is an incentive to collect surviving footage before it is too late.

  17. Screening for psychiatric distress and low self-esteem in patients presenting for excimer laser surgery for myopia.

    Science.gov (United States)

    Kidd, B; Stark, C; McGhee, C N

    1997-01-01

    Patients presenting for photorefractive keratectomy (PRK) may have unusual psychological profiles. Certain psychological variables may impact treatment outcome, making early identification crucial. We report a controlled questionnaire study of psychiatric "anxiety/distress" and self-esteem in myopic patients who presented for excimer laser treatment. Ninety consecutive myopic individuals (patients) who presented for excimer laser PRK and 50 consecutive myopic individuals who presented to an optometrist for contact lens fitting (controls) were assessed using two self-completion questionnaires-the GHQ30 and Hudson Index of Self-Esteem ISE. The questionnaires were distributed during assessment for treatment. PRK patients had a 90% response rate for both questionnaires and control patients, 98% for GHQ30 and 100% for Hudson ISE. PRK patients were significantly older (p = 0.000003), had a greater myopic spherical equivalent refraction (p = 0.012) and had better spectacle-corrected visual acuity (p = 0.0096). No significant differences were demonstrated with regard to anxiety/distress in terms of absolute scores (p = 0.07), or the proportion of patients being positive or negative (p = 0.10). Similarly, self-esteem was not significantly different between the two groups (absolute scores p = 0.69; positive/negative p = 0.29). The high response rate shows that the GHQ30 and Hudson ISE are easy to use and well tolerated by myopes in a busy clinic setting. The fact that the patients were older, with a greater refractive error, may partly reflect the onset of contact lens intolerance. The psychological findings suggest that PRK patients cannot be considered more distressed or anxious than other myopic individuals. There is no evidence that their decision to undergo surgery is driven by abnormally low self-esteem.

  18. Secondhand smoke in psychiatric units: patient and staff misperceptions.

    Science.gov (United States)

    Ballbè, Montse; Sureda, Xisca; Martínez-Sánchez, Jose M; Fu, Marcela; Saltó, Esteve; Gual, Antoni; Fernández, Esteve

    2015-10-01

    Mental health units have usually been exempted from complete smoke-free policies. The aim of this study was to compare the self-reported level of exposure to secondhand smoke (SHS) of patients and staff in psychiatric units to objective measures, and examine preference for different types of smoking bans. Cross-sectional survey about ban preferences and self-reported exposure to SHS by means of a self-administered questionnaire administered to patients and staff from 65 inpatient psychiatric units in Catalonia (95.5% of all units). We measured air concentrations of particulate matter ≤ 2.5 μm (PM2.5 in µg/m(3)) as a marker of SHS in these units. 600 patients and 575 professionals completed the questionnaire. 78.7% of them were objectively exposed to SHS (PM2.5>10 μm/m(3)) but 56.9% of patients and 33.6% of staff believed they were not exposed at all and 41.6% of patients and 28.4% of staff believed the environment was not at all unhealthy. Nurses had a higher smoking prevalence than psychiatrists (35.8% vs 17.2%; psmoke-free bans. It is particularly noteworthy that less that one-third of mental health staff supported smoke-free units, suggesting an urgent need for further education about the harmful health effects of SHS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Firearm Ownership and Acquisition Among Parents With Risk Factors for Self-Harm or Other Violence.

    Science.gov (United States)

    Ladapo, Joseph A; Elliott, Marc N; Kanouse, David E; Schwebel, David C; Toomey, Sara L; Mrug, Sylvie; Cuccaro, Paula M; Tortolero, Susan R; Schuster, Mark A

    Recent policy initiatives aiming to reduce firearm morbidity focus on mental health and illness. However, few studies have simultaneously examined mental health and behavioral predictors within families, or their longitudinal association with newly acquiring a firearm. Population-based, longitudinal survey of 4251 parents of fifth-grade students in 3 US metropolitan areas; 2004 to 2011. Multivariate logistic models were used to assess associations between owning or acquiring a firearm and parent mental illness and substance use. Ninety-three percent of parents interviewed were women. Overall, 19.6% of families reported keeping a firearm in the home. After adjustment for confounders, history of depression (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04-1.77), binge drinking (aOR 1.75; 95% CI, 1.14-2.68), and illicit drug use (aOR 1.75; 95% CI, 1.12-2.76) were associated with a higher likelihood of keeping a firearm in the home. After a mean of 3.1 years, 6.1% of parents who did not keep a firearm in the home at baseline acquired one by follow-up and kept it in the home (average annual likelihood = 2.1%). No risk factors for self-harm or other violence were associated with newly acquiring a gun in the home. Families with risk factors for self-harm or other violence have a modestly greater probability of having a firearm in the home compared with families without risk factors, and similar probability of newly acquiring a firearm. Treatment interventions for many of these risk factors might reduce firearm-related morbidity. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

    Science.gov (United States)

    De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

    2017-01-01

    To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

  1. Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal

    Directory of Open Access Journals (Sweden)

    Diogo F Guerreiro

    2009-11-01

    Full Text Available Diogo F Guerreiro, Ema L Neves, Rita Navarro, Raquel Mendes, Ana Prioste, Diana Ribeiro, Tiago Lila, António Neves, Mónica Salgado, Nazaré Santos, Daniel SampaioYouth Suicide Study Group (NES, The Hospital Santa Maria, Psychiatry Department, Lisbon Faculty of Medicine, PortugalAbstract: Deliberate self-harm (DSH among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal, using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years. The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.Keywords: deliberate self-harm, suicide, adolescents, suicide risk, case control

  2. Associations between self-rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist?

    Science.gov (United States)

    Kim, Giyeon; DeCoster, Jamie; Chiriboga, David A; Jang, Yuri; Allen, Rebecca S; Parmelee, Patricia

    2011-05-01

    [corrected] This study examined racial/ethnic differences in the association between self-rated mental health (SRMH) and psychiatric disorders among community-dwelling older adults in the United States. Cross-sectional analyses of nationally representative data from the Collaborative Psychiatric Epidemiology Surveys (2001-2003). In-person household interviews. Older adults aged 60 and older (N = 1,840), including non-Hispanic Whites (N = 351), Blacks (N = 826), Hispanics (N = 406), and Asians (N = 257). SRMH was measured with a single item, "How would you rate your own mental health?" Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnoses for mood and anxiety disorders were measured with the World Health Organization's World Mental Health version of the Composite International Diagnostic Interview. Results from logistic regression analyses showed significant main effects of both SRMH and race/ethnicity on the presence of mood and anxiety disorders: people who have poor SRMH and are non-Hispanic Whites were more likely to have mood and anxiety disorders. There were also significant interaction effects between SRMH and race/ethnicity, such that the relation of SRMH with diagnoses of psychiatric disorders was strongest in non-Hispanic Whites. Racial/ethnic variations were found in the relationship between self-perception of mental health and DSM-IV psychiatric disorders. The findings suggest the need to develop race/ethnicity-specific strategies to screen psychiatric disorders in diverse elderly populations. Future studies are needed to investigate possible reasons for the racial/ethnic group differences.

  3. Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study.

    Science.gov (United States)

    Owens, Christabel; Sharkey, Siobhan; Smithson, Janet; Hewis, Elaine; Emmens, Tobit; Ford, Tamsin; Jones, Ray

    2015-02-01

    Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa. We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice. We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction. The young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators. Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities. © 2012 John Wiley & Sons Ltd.

  4. Naltrexone treatment reverses astrocyte atrophy and immune dysfunction in self-harming macaques.

    Science.gov (United States)

    Lee, Kim M; Chiu, Kevin B; Didier, Peter J; Baker, Kate C; MacLean, Andrew G

    2015-11-01

    The role of glia in the development and treatment of behavioral abnormalities is understudied. Recent reports have observed glial activation in several disorders, including depression, autism spectrum disorders and self-injurious behaviors (SIB). In the current study, we examined SIB in the physiologically and anatomically relevant nonhuman primate (NHP) model. At the Tulane National Primate Research Center (TNPRC), approximately 5% of singly housed macaques develop symptoms of SIB. We have previously demonstrated that naltrexone hydrochloride can be effective in reducing SIB. We have also demonstrated that the astrocytes of animals with SIB are distinctly atrophic and display heightened innate immune activation compared with control animals. We have added a third group of animals (five macaques identified with SIB and treated with oral naltrexone at a dose of 3.2mg/kg) to the previous cohort (six macaques with a history of SIB but not treated, and nine animals with no history of SIB) for this study. Gray and white matter astrocytes from frontal cortical tissue were examined following necropsy. Innate immune activation of astrocytes, which was increased in SIB animals, was markedly decreased in animals receiving naltrexone, as was atrophy of both grey and white matter astrocytes. This was concomitant with improved behavioral correlates. Preventing astrocyte activation in select areas of the brain to reduce injurious behavior is an innovative concept with implications for mental health studies. Differences in multiple areas of primate brain would help determine how self-injurious behavior develops. These studies suggest a stronger role for astrocytes in the cellular events associated with self-injurious behaviors. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Development and piloting of a treatment foster care program for older youth with psychiatric problems.

    Science.gov (United States)

    McMillen, J Curtis; Narendorf, Sarah Carter; Robinson, Debra; Havlicek, Judy; Fedoravicius, Nicole; Bertram, Julie; McNelly, David

    2015-01-01

    Older youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes. A team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes. Development efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles - that of psychiatric nurse and skills coaches - very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities. The intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important

  6. Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

    OpenAIRE

    Sailaxmi Gandhi; Rajitha Pavalur; Sivakumar Thanapal; Nirmala B Parathasarathy; Geetha Desai; Poornima Bhola; Mariamma Philip; Santosh K Chaturvedi

    2014-01-01

    Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to ...

  7. 'He left me a message on Facebook': comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media.

    Science.gov (United States)

    Barrett, Jessica R; Shetty, Hitesh; Broadbent, Matthew; Cross, Sean; Hotopf, Matthew; Stewart, Robert; Lee, William

    2016-05-01

    In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper. In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors. Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving. New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers. Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm. None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

  8. Improving addictions treatment outcomes by empowering self and others.

    Science.gov (United States)

    Wood, Thomas E; Englander-Golden, Paula; Golden, David E; Pillai, Vijayan K

    2010-10-01

    The present research tested the effectiveness of adding an interpersonal, interactive, experiential training programme to addictions treatment that enhances motivation, cognitive-behavioural coping skills, social support, and group cohesiveness. The research was conducted in a co-educational, long-term residential treatment facility for addictive disorders (alcohol and other substances, sexual addiction, eating disorders, compulsive shopping, and gambling) and concomitant psychiatric diagnoses. The added training is co-created by participants. They choose challenging situations important in their lives that are played out as 'movies' in which they play and experience all the parts. Motivation for change, skills to implement positive changes, self-efficacy, empathy, positive support, and group cohesiveness are rooted in their own experiences and the feedback they receive from others, as they behave in empowering and disempowering ways. The training resulted in significant increases in empowering communication, self-esteem and quality of group life in the treatment group and in the family. Many of these results have large effect sizes and are consistent with the findings from prior studies. The results obtained in this study suggest that Say It Straight training can be an effective addition to the treatment of addictions in residential treatment. Future research is needed to determine the long-term effects of this training on relapse.

  9. The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: a moderated mediation analysis.

    Science.gov (United States)

    Chung, Man Cheung; Allen, Rachel D; Dennis, Ian

    2013-12-30

    This study investigated the incidence of posttraumatic stress disorder (PTSD) and psychiatric co-morbidity following epileptic seizure, whether alexithymia mediated the relationship between self-efficacy and psychiatric outcomes, and whether the mediational effect was moderated by the severity of PTSD from other traumas. Seventy-one (M=31, F=40) people with a diagnosis of epilepsy recruited from support groups in the United Kingdom completed the Posttraumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20 and the Generalized Self-Efficacy Scale. They were compared with 71 people (M=29, F=42) without epilepsy. For people with epilepsy, 51% and 22% met the diagnostic criteria for post-epileptic seizure PTSD and for PTSD following one other traumatic life event respectively. For the control group, 24% met the diagnostic criteria for PTSD following other traumatic life events. The epilepsy group reported significantly more anxiety and depression than the control. Partial least squares (PLS) analysis showed that self-efficacy was significantly correlated with alexithymia, post-epileptic seizure PTSD and psychiatric co-morbidity. Alexithymia was also significantly correlated with post-epileptic seizure PTSD and psychiatric co-morbidity. Mediation analyses confirmed that alexithymia mediated the path between self-efficacy and post-epileptic seizure PTSD and psychiatric co-morbidity. Moderated mediation also confirmed that self-efficacy and PTSD from one other trauma moderated the effect of alexithymia on outcomes. To conclude, people can develop posttraumatic stress disorder symptoms and psychiatric co-morbidity following epileptic seizure. These psychiatric outcomes are closely linked with their belief in personal competence to deal with stressful situations and regulate their own functioning, to process rather than defend against distressing emotions, and with the degree of PTSD from other traumas. © 2013 Elsevier

  10. The use of observation on patients who self-harm: Lessons from a learning disability service

    Directory of Open Access Journals (Sweden)

    Peter Thomas Sandy

    2016-12-01

    Conclusion: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses' daily therapeutic activities in in-patient learning disability services.

  11. Disability and treatment of psychiatric and physical disorders in South Africa.

    Science.gov (United States)

    Suliman, Sharain; Stein, Dan J; Myer, Landon; Williams, David R; Seedat, Soraya

    2010-01-01

    We aimed to compare disability rates associated with physical disorders versus psychiatric disorders and to establish treatment rates of both classes of disorder in the South African population. In a nationally representative survey of 4351 adults, treatment and prevalence rates of a range of physical and psychiatric disorders, and their associated morbidity during the previous 12 months were investigated. Physical illnesses were reported in 55.2% of the sample, 60.4% of whom received treatment for their disorder. Approximately 10% of the samples show a mental illness with 6.1% having received treatment for their disorder. The prevalence of any mental illness reported was higher than that reported individually for asthma, cancer, diabetes, and peptic ulcer. Mental disorders were consistently reported to be more disabling than physical disorders and the degree of disability increased as the number of comorbid disorders increased. Depression, in particular, was rated consistently higher across all domains than all physical disorders. Despite high rates of mental disorders and associated disability in South Africa, they are less likely to be treated than physical disorders.

  12. [Girls detained under civil and criminal law in juvenile detention centres; psychiatric disorders, trauma and psychosocial problems].

    Science.gov (United States)

    Hamerlynck, S M J J; Doreleijers, Th A H; Vermeiren, R R J M; Cohen-Kettenis, P T

    2009-01-01

    As from 2008, juveniles sentenced under civil law and juveniles sentenced under criminal law can no longer be assigned to the same juvenile detention centres. The reasoning runs as follows: the centres are unlikely to provide adequate treatment for the 'civil' group, and the 'criminal' group may exert a negative influence on the 'civil' group. Hitherto, there has been no research into the question of whether the problems and treatment requirements of girls in the two categories call for detention in the same detention centres or in different ones. The aim of this study is to investigate differences between the two groups of girls with regard to offence history, sociodemographic characteristics, contact with the social services, psychiatric disorders and trauma. Investigation of a representative sample of 211 female minors in three juvenile detention centres using standard instruments. results 82% of the girls were detained under civil law, 18% under criminal law. There were strong similarities between the groups. However, the 'criminal' group more often had a violent history of delinquency and a non-Dutch background, whereas the 'civil' group more often had a background of residential placements, oppositional-defiant disorder, suicidality and self-harm. Girls detained under civil and under criminal law differed in characteristics such as criminal record, but there were striking similarities in the girls' behavioural problems and psychiatric disorders. It is argued that assignment to a particular type of detention centre should depend on treatment requirements rather than on measures imposed by civil or criminal law.

  13. Fractured Identity: A Framework for Understanding Young Asian American Women's Self-harm and Suicidal Behaviors.

    Science.gov (United States)

    Hahm, Hyeouk Chris; Gonyea, Judith G; Chiao, Christine; Koritsanszky, Luca Anna

    2014-01-01

    Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of "disempowering parenting styles" that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents' expectations as well as societal expectations and to simultaneously rebel against the image of "the perfect Asian woman." Torn by the double bind, these women developed a "fractured identity," which led to the use of "unsafe coping" strategies. Trapped in a "web of pain," the young women suffered alone and engaged in self-harm and suicidal behaviors.

  14. [Nurturance of children during inpatient psychiatric treatment of their parents].

    Science.gov (United States)

    Kölch, Michael; Schmid, Marc

    2008-01-01

    About a third of all inpatients in psychiatric hospitals are parents of children aged below 18 years. The mental illness of a parent and especially the need of inpatient treatment burdens families. This study was contributed to assess parental stress, behavioural and emotional problems of the children and the needs of psychiatric inpatients for support. Barriers and hindrances as well as positive experience with support for their children were assessed. All psychiatric hospitals in a county with about 1.5 million inhabitants in South-West Germany participated in this study. From 643 inpatients after drop-out 83 (54 female, 29 male) patients with non full aged children were questioned with inventories as the SDQ, the PSS and further assessments. Diagnoses and biographic data were assessed by the documentation of the German Association of psychiatry and psychotherapy. Parents reported about an increased level of stress by parenthood (PSS mean 41.9, SD 9.4). Psychopathology of the children influenced the stress of the mentally ill parents. 40% of the patients are dissatisfied with the care of their children during their inpatient treatment, but 51% have strong resentments against the youth welfare custodies and do not ask for support. Our results prove the high negative attitude of mentally ill parents against youth welfare service which must be reduced by active information policy and offers in collaboration with the treating psychiatrist of the parents.

  15. The application of deep brain stimulation in the treatment of psychiatric disorders

    NARCIS (Netherlands)

    Graat, Ilse; Figee, Martijn; Denys, D.

    2017-01-01

    Deep brain stimulation (DBS) is a last-resort treatment for neurological and psychiatric disorders that are refractory to standard treatment. Over the last decades, the progress of DBS in psychiatry has been slower than in neurology, in part owing to the heterogenic symptomatology and complex

  16. Randomized pilot trial of a cognitive-behavioral alcohol, self-harm, and HIV prevention program for teens in mental health treatment.

    Science.gov (United States)

    Esposito-Smythers, Christianne; Hadley, Wendy; Curby, Timothy W; Brown, Larry K

    2017-02-01

    Adolescents with mental health conditions represent a high-risk group for substance use, deliberate self-harm (DSH), and risky sexual behavior. Mental health treatment does not uniformly decrease these risks. Effective prevention efforts are needed to offset the developmental trajectory from mental health problems to these behaviors. This study tested an adjunctive cognitive-behavioral family-based alcohol, DSH, and HIV prevention program (ASH-P) for adolescents in mental healthcare. A two group randomized design was used to compare ASH-P to an assessment only control (AO-C). Participants included 81 adolescents and a parent. Assessments were completed at pre-intervention as well as 1, 6, and 12-months post-enrollment, and included measures of family-based mechanisms and high-risk behaviors. ASH-P relative to AO-C was associated with greater improvements in most family process variables (perceptions of communication and parental disapproval of alcohol use and sexual behavior) as well as less DSH and greater refusal of sex to avoid a sexually transmitted infection. It also had a moderate (but non-significant) effect on odds of binge drinking. No differences were found in suicidal ideation, alcohol use, or sexual intercourse. ASH-P showed initial promise in preventing multiple high-risk behaviors. Further testing of prevention protocols that target multiple high-risk behaviors in clinical samples is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Impact of Harmful Algal Blooms on Several Lake Erie Drinking Water Treatment Plants

    Science.gov (United States)

    Recent events in Ohio have demonstrated the challenge treatment facilities face in providing safe drinking water when encountering extreme harmful algal bloom (HAB) events. Over the last two years the impact of HAB-related microcystins on several drinking water treatment facilit...

  18. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Tine K Grimholt

    Full Text Available To assess whether systematic follow-up by general practitioners (GPs of cases of deliberate self-poisoning (DSP by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice.Randomised clinical trial with two parallel groups.General practices in Oslo and the eastern part of Akershus County.Patients aged 18-75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge.The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78 or treatment as usual (n = 98.Primary outcome measure was the Beck Scale for Suicide Ideation (SSI. Secondary outcomes were Beck Depression Inventory (BDI and Beck Hopelessness Scale (BHS, self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA. We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records.There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009. Readmissions to general hospitals were similar (13% in both groups (P = 0.963, while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103.Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in

  19. [Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?].

    Science.gov (United States)

    Bandelow, B; Lueken, U; Wolff, J; Godemann, F; Menzler, C W; Deckert, J; Ströhle, A; Beutel, M; Wiltink, J; Domschke, K; Berger, M

    2016-03-01

    The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment. A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1. According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %). Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.

  20. School Counselors' Professional Experience and Practices Working with Students Who Self-Harm: A Qualitative Study

    Science.gov (United States)

    Roberts, Ellen Adams

    2013-01-01

    The professional experiences and practices of school counselors and the interventions they employ while working with adolescent students who self-harm is an underrepresented area within current research. This generic qualitative study provides a rich description and a deeper understanding of the professional experiences and practices of school…

  1. The role of comorbid psychiatric conditions in health status in epilepsy.

    Science.gov (United States)

    Zeber, John E; Copeland, Laurel A; Amuan, Megan; Cramer, Joyce A; Pugh, Mary Jo V

    2007-06-01

    Comorbid psychiatric conditions are highly prevalent in patients with epilepsy, yet the long-term implications across multiple mental health conditions are poorly understood. We examined the association between psychiatric diagnoses and self-reported health status in veterans with epilepsy. ANCOVA models were used to derive adjusted SF-36V scores for individuals with epilepsy alone (N=7379) or with additional psychiatric conditions (N=6320): depression, schizophrenia, bipolar disorder, anxiety disorder, substance abuse, and posttraumatic stress disorder (PTSD). Compared with patients with epilepsy alone, scores of veterans with comorbid psychiatric diagnoses averaged 21% lower across all domains. Role Limitation scales exhibited the greatest decrement across domains. A PTSD diagnosis consistently corresponded to lower scores, followed by depression. Schizophrenia contributed the least detriment to perceived health status. Comorbid psychiatric conditions impart significant emotional and physical burdens, requiring timely recognition and treatment of these disorders. Patients with epilepsy are uniquely at risk for high physical-psychiatric comorbidity profiles, with concomitant losses in perceived health status.

  2. Co-producing a digital educational programme for registered children's nurses to improve care of children and young people admitted with self-harm.

    Science.gov (United States)

    Latif, Asam; Carter, Timothy; Rychwalska-Brown, Lucy; Wharrad, Heather; Manning, Joseph

    2017-06-01

    Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children's nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses' knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery.

  3. Self-esteem and psychiatric features of Turkish adolescents with psychogenic non-epileptic seizures: a comparative study with epilepsy and healthy control groups.

    Science.gov (United States)

    Say, Gokçe N; Tasdemir, Haydar A; Akbas, Seher; Yüce, Murat; Karabekiroglu, Koray

    2014-01-01

    Children and adolescents with psychogenic non-epileptic seizures (PNES) and epilepsy are known to have psychosocial problems. The aim of the present study was to compare the psychosocial difficulties, history of stressful life events/abuse, psychiatric diagnosis, and self-esteem of adolescents with PNES to the ones with epilepsy and healthy controls at a tertiary care center in Turkey. Thirty-four adolescents with PNES diagnosed by video-EEG were compared with 23 adolescents that have epilepsy and 35 healthy volunteers. Comorbid psychiatric diagnoses of participants were examined by semi-structured interviews using Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (KSADS-PL). Self-esteem of adolescents was evaluated by Rosenberg Self Esteem Scale (RSES). No differences in sociodemographic features were observed between the groups. The PNES group showed significantly higher rates of parental conflicts, difficulties in relationship with siblings/peers, school under-achievement, and history of stressful events/abuse. The rates of comorbid psychiatric disorders were 64.7% in PNES and 47.8% in epilepsy group. The most common disorders in both groups were attention deficit hyperactivity disorder (ADHD) and depressive disorder. The rate of posttraumatic stress disorder (PTSD) was significantly increased in the PNES group. Additionally, adolescents with PNES displayed significantly lower levels of self-esteem than the other groups. It could be concluded that both disorders involved a high risk for developing psychiatric disorders; additionally, adolescents with PNES have higher rates of stressors and lower levels of self-esteem. Findings from this investigation point to the importance of psychiatric interventions in pediatric PNES and also epilepsy.

  4. An epidemiological study on herbal product self-medication practice among psychotic outpatients from Serbia: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Gordana Nikolić

    2018-03-01

    Full Text Available Utilization of herbal products (HPs is a common practice in the traditional medicine of people from southeastern Serbia. In this study, we focused on the usage of HPs as a self-medication practice among patients diagnosed with a mental illness, by aiming to ascertain the usage prevalence, the identity of the main plant taxa utilized, their formulations and target symptoms. This was accomplished through a cross-sectional study of psychiatric outpatients, conducted in the Clinic for Mental Health Protection in Niš, and which included a questionnaire on HP utilization and a non-structured psychiatric interview. Typically, single, middle-aged males, with a secondary education degree, utilized Matricaria chamomilla and/or Melissa officinalis in a form of an infusion (tea for relieving anxiety and psychotic symptoms. In some cases, adverse effects were noted when HPs were used in combination with prescribed psychotropic medications. Our and previous results urge a thorough evaluation of possible benefits and/or harmful interactions of HP with standard medication in the treatment of psychiatric patients.

  5. Self Injurious Behavior in Adolescents

    Directory of Open Access Journals (Sweden)

    Evrim Aktepe

    2011-04-01

    Full Text Available Self injury is a kind of behavior which begins in early adolescence and difficult to determine because remains suppressed. Most often forms are to cut and hit own. To be exposed to sexual abuse and stressfully life events are known as risk factors for self injurious behavior. High anxiety, depression and hostility levels, decrease of self esteem, suicidal attempts and thoughts are usually together with self injurious behavior and it may be mediating to emotional regulation. To explain the functions of self injurious behavior automatic and social support theories and social learning theories have suggested. The relation between suicidality and self injurious behavior is complex for adolescents. There is no enough knowledge if self injurious behavior aggravates the risk of completed suicide. Although it’s a frequent behavior there are limited randomized controlled studies which examine specific treatment approaches. Dialectic behavior treatment is the type of treatment which shown as most effective for adults. To determine the needs to stop the behavior, to manage emotional senses and urges and to learn more healthy ways for needs to youth are necessary in treatment of self injurious behavior. Treatment also includes determining suicidal risk and comorbid psychiatric disorders. In self injurious behavior medical treatment is useful for comorbid psychiatric disorders. [TAF Prev Med Bull 2011; 10(2.000: 201-210

  6. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal.

    Science.gov (United States)

    Berg, Anne T; Altalib, Hamada H; Devinsky, Orrin

    2017-07-01

    Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. The literature upon which most of the field relies contains some biases that must be carefully examined and resolved in future studies. First, in the pediatric epilepsy literature, many reports find that children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. Most of these studies rely on parent-proxy completed instruments to assess these behavioral endpoints. Parents' reports are not objective but reflect parents' reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. Second, periictal phenomena may be mischaracterized as underlying mood disorders. Third, many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy, suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and psychogenic nonepileptic seizures need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to ensure appropriate therapy and to avoid unnecessary and potentially harmful treatments and common misconceptions. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  7. Comparative study of personality disorder associated with deliberate self harm in two different age groups (15?24 years and 45?74 years)

    OpenAIRE

    Nath, Saswati; Patra, Dipak Kumar; Biswas, Srilekha; Mallick, Asim Kumar; Bandyopadhyay, Gautam Kumar; Ghosh, Srijit

    2008-01-01

    Aims: To study the presence of personality disorder in cases of deliberate self harm (DSH) in young (15?24 years) and elderly (45?74 years) and compare. Materials and Methods: Deliberate self harm cases admitted in Medical and surgical departments and cases attending psychiatry department of R.G. Kar Medical College, Kolkata were studied. For diagnosis of personality disorder ICD 10 International Personality Disorder Examination (IPDE) questionnaire was used. Results: Percentage of elderly pa...

  8. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis.

    Science.gov (United States)

    Karyotaki, Eirini; Kemmeren, Lise; Riper, Heleen; Twisk, Jos; Hoogendoorn, Adriaan; Kleiboer, Annet; Mira, Adriana; Mackinnon, Andrew; Meyer, Björn; Botella, Cristina; Littlewood, Elizabeth; Andersson, Gerhard; Christensen, Helen; Klein, Jan P; Schröder, Johanna; Bretón-López, Juana; Scheider, Justine; Griffiths, Kathy; Farrer, Louise; Huibers, Marcus J H; Phillips, Rachel; Gilbody, Simon; Moritz, Steffen; Berger, Thomas; Pop, Victor; Spek, Viola; Cuijpers, Pim

    2018-03-15

    Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

  9. Coping with information style and family burden: Possible roles of self-stigma and hope among parents of children in a psychiatric inpatient unit.

    Science.gov (United States)

    Hasson-Ohayon, I; Pijnenborg, G H M; Ben-Pazi, A; Taitel, S; Goldzweig, G

    2017-05-01

    Parents of children who are hospitalized in inpatient psychiatric units must cope with significant challenges. One of these challenges relates to the way in which they cope with illness-related information. The current study examined the relationship between two such coping styles - monitoring and blunting - and family burden among parents of children in a psychiatric inpatient unit. Moreover, the possible moderating roles played by hope and self-stigma in these associations were also examined. Questionnaires regarding coping with information style, self-stigma, hope and family burden were administered to 70 parents. A main positive effect of hope and a main negative effect of self-stigma were uncovered. An interaction between self-stigma and monitoring was also revealed, suggesting that for parents with high self-stigma, compared to those with low self-stigma, more monitoring was related to more burden. Tailoring family interventions according to coping style and self-stigma is highly recommended as a mean to reduce the family burden of parents whose child is hospitalized in a psychiatric inpatient unit. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. The relationship between trauma centrality, self-efficacy, posttraumatic stress and psychiatric co-morbidity among Syrian refugees: Is gender a moderator?

    Science.gov (United States)

    Chung, Man Cheung; AlQarni, Nowf; Al Muhairi, Shamsa; Mitchell, Britt

    2017-11-01

    This study examined the inter-relationship between trauma centrality, self-efficacy, posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among a group of Syrian refugees living in Turkey, and whether gender would moderate the mediational effect of self-efficacy on the impact of trauma centrality on distress. Seven hundred and ninety-two Syrian refugees completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale and Generalized Self-Efficacy Scale. The results showed that 52% met the cutoff for PTSD. Trauma centrality was positively correlated with PTSD, psychiatric co-morbidity and self-efficacy. Self-efficacy was negatively correlated with PTSD only. Gender did not moderate the mediational effect of self-efficacy on the path between trauma centrality and distress outcomes. To conclude, following exposure to traumatic events, more than half reported PTSD. Perception of the future and identity construction was affected. Signs of psychological distress were evident, alongside resilience, regardless of gender. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. The benefits and harms of screening for cancer with a focus on breast screening

    DEFF Research Database (Denmark)

    Brodersen, John; Juhl Jørgensen, Karsten; Gøtzsche, Peter C.

    2010-01-01

    . The effects of routine clinical breast examination are unknown, but considering the results of the breast self-examination trials, it is likely that it is harmful. The effects of screening for breast cancer with thermography, ultrasound or magnetic resonance imaging are unknown. It is not clear whether......The balance between benefits and harms is delicate for cancer screening programs. By attending screening with mammography some women will avoid dying from breast cancer or receive less aggressive treatment. But many more women will be overdiagnosed, receive needless treatment, have a false...... and will be treated unnecessarily. Furthermore, more than 200 women will experience substantial psychosocial distress for months because of false-positive findings. Regular breast self-examination does not reduce breast cancer mortality, but doubles the number of biopsies, and it therefore cannot be recommended...

  12. An orthomolecular approach to the prevention and treatment of psychiatric disorders.

    Science.gov (United States)

    Zell, Mark; Grundmann, Oliver

    2012-01-01

    Orthomolecular medicine is based on the use of endogenous and naturally occurring substances to supplement deficiencies in vitamins, minerals, and other essential substances in the human body. Although the medical community has long regarded it as a nonscientific approach to healing, scientific and clinical evidence is emerging for the supplemental use of orthomolecular medicine in the treatment of schizophrenia, depression, bipolar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder. Psychiatrists currently treat these common psychiatric disorders using a wide range of pharmacological approaches that often have significant side effects, resulting in patients' noncompliance. With newly gained knowledge about the neurophysiology and neuropathophysiology of psychiatric disorders, researchers now can link potential mechanisms for both pharmacological and orthomolecular treatments to physiological processes. In many cases, the use of orthomolecular supplements may provide a feasible addition to conventional drug therapy.

  13. System dynamics in complex psychiatric treatment organizations.

    Science.gov (United States)

    Rosenheck, R

    1988-05-01

    One of the major challenges facing contemporary psychiatry is the coordination of diverse services through organizational integration. With increasing frequency, psychiatric treatment takes place in complex treatment systems composed of multiple inpatient and outpatient programs. Particularly in public health care systems serving the chronically ill, contemporary practice demands a broad spectrum of programs, often geographically dispersed, that include crisis intervention teams, day treatment programs, substance abuse units, social rehabilitation programs and halfway houses (Bachrach 1983; Turner and TenHoor 1978). Individualized treatment planning often requires that a particular patient participate in two or more specialized programs either simultaneously or in a specified sequence. As a consequence of this specialization, treatment fragmentation has emerged as a significant clinical problem, and continuity of care has been highlighted as a valuable but elusive ingredient of optimal treatment. This paper will describe the dynamic interactions that result when several such programs are united under a common organizational roof. Using a large VA Psychiatry Service as an example, I will outline the hierarchical structure characteristic of such an organization, as well as the persistent pulls toward both integration and fragmentation that influence its operation.

  14. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem.

    Science.gov (United States)

    Picco, Louisa; Pang, Shirlene; Lau, Ying Wen; Jeyagurunathan, Anitha; Satghare, Pratika; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Lim, Susan; Poh, Chee Lien; Chong, Siow Ann; Subramaniam, Mythily

    2016-12-30

    This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Childhood Predictors of Deliberate Self-Harm Behavior and Suicide Ideation in Korean Adolescents: A Prospective Population-Based Follow-Up Study

    Science.gov (United States)

    Shin, Yun Mi; Chung, Young Ki; Lim, Ki Young; Lee, Young Moon; Oh, Eun Young

    2009-01-01

    The aim of this study was to investigate predictors of adolescence suicidality in a longitudinal study. Additionally, the prevalence of deliberate self-harm behavior and suicide ideation at age 7 and during middle school were examined. Initial assessment data was obtained from 1998 to 2000, and a follow-up assessment was performed in 2006 when the original subjects became middle school students. The addresses and names of 1,857 subjects were located from the original data; they were 910 boys and 947 girls. The subjects were evaluated with the Korean version of the Child Behavior Checklist (K-CBCL), which was administered by the parents of the children, and by various demographic and psychosocial factors. They were reassessed using self reports on the Korea Youth Self Report (K-YSR); in particular, replies to items related to self-harm behavior and suicide ideation were recorded. A logistic regression analysis showed that the factors of gender, economic status, the overall amount of behavior problems, the tendency to internalizing and externalizing problems, somatic problems, thought problems, delinquent behavior, and aggressive behavior were independent predictors of adolescent suicide ideation and self-harm behavior. The importance of total behavior problems suggested that adolescent difficulty is a consequence of an accumulation of various risk factors. Accordingly, clinicians must consider a range of internalizing and externalizing issues, especially overall adaptation, for suicide intervention. PMID:19399261

  16. Do resettlement variables predict psychiatric treatment outcomes in a sample of asylum-seeking survivors of torture?

    Science.gov (United States)

    Whitsett, David; Sherman, Martin F

    2017-12-01

    Mental health clinicians who work with asylum seekers provide services to patients who face stressful everyday living conditions. However, little is known about how these problems potentially impact psychiatric treatment within these populations. The purpose of this study was thus to examine whether resettlement factors predict outcomes of a mental health intervention for a sample of asylum-seeking survivors of torture. The study included data from a US outpatient clinic that specialized in treating asylum-seeking survivors of torture. Patients (primarily from Iraq, Afghanistan and African Countries) were evaluated on demographic factors at intake and psychiatric symptoms throughout the course of treatment. Patients experienced significant reductions in depression, anxiety and trauma symptoms, although symptoms still remained near or above clinical thresholds. Stable, uncrowded housing conditions significantly predicted lower depression, anxiety and trauma symptoms at follow-up. These findings support the hypotheses that individuals seeking asylum within the United States who have survived torture can benefit from psychiatric treatment and emphasize the importance of stable living conditions in improving treatment effectiveness. This suggests the need for further research on social predictors of treatment outcomes, as well as the need for clinicians and policymakers to target improved housing as a potentially important tool to reduce psychiatric problems related to torture and forced migration.

  17. How Often Does Deliberate Self-Harm Occur Relative to Each Suicide? A Study of Variations by Gender and Age

    Science.gov (United States)

    Hawton, Keith; Harriss, Louise

    2008-01-01

    Deliberate self-harm (DSH; i.e., nonfatal self-poisoning or self-injury) occurs much more frequently than suicide, yet there has been little detailed investigation of the comparative rates of DSH and suicide. We conducted a study of how rates of DSH relate to suicide rates across the life cycle by gender and by method of estimation of DSH rates,…

  18. [Alcohol consumption in patients with psychiatric disorders: assessment and treatment].

    Science.gov (United States)

    Lang, J-P; Bonnewitz, M-L; Kusterer, M; Lalanne-Tongio, L

    2014-09-01

    Alcohol consumption in France exceeds the European average (12.7L of pure alcohol/habitant/year in 2009 for an average of 12.5 L). This consumption has a major professional, social and health impact on the individuals and their families. The cost of such, estimated in Europe to be of 155.8 billion Euros in 2010, is the highest among the central nervous system diseases in Europe, far higher than that of depression or dementia. Patients suffering from psychiatric disorders are more frequently affected by problems related to alcohol use than the general population. They are also more vulnerable to the immediate and subsequent consequences of their consumption. The alcohol related disorders that are often accompanied by risk taking and other addictive behaviour require a global assessment of the addiction, with and without substance, and of the complications. These have a strong impact on risk taking, compliance with care, and the morbidity of somatic and psychiatric disorders, as well as access to optimal care and the life span of patients suffering from psychiatric disorders. The development of addictology care, with integrative treatment programs, is recommended in response to these public health issues. Nevertheless, specific addictology practices and partners with addictology care structures are still scarcely developed in psychiatry. Firstly, it would be necessary to set up such integrated treatments through the systematisation of an "addictology" checkup on admission, a global assessment of addictive behaviour and cognitive disorders, using pragmatic tools that are user-friendly for the care teams, maintain the reduction in risk taking, and apply prescriptions for addiction to psychotropic treatments, in liaison with the referring general practitioner. As early as possible, accompanied by specific training in addictology for the psychiatrists and the mental health nursing teams, such care could be enhanced by the development of liaison and advanced psychiatric

  19. Benefit and harm of pregabalin in acute pain treatment

    DEFF Research Database (Denmark)

    Fabritius, M L; Strøm, C; Koyuncu, S

    2017-01-01

    Pregabalin has demonstrated anti-hyperalgesic properties and was introduced into acute pain treatment in 2001. Our aim was to evaluate the beneficial and harmful effects of pregabalin in postoperative pain management. We included randomized clinical trials investigating perioperative pregabalin......, Peto's odds ratio was 2.9 (1.2, 6.8; TSA adjusted confidence interval: 0.1, 97.1). Based on trials with low risk of bias, pregabalin may have a minimal opioid-sparing effect, but the risk of SAEs seems increased. However, the GRADE-rated evaluations showed only moderate to very low quality of evidence....... Consequently, a routine use of pregabalin for postoperative pain treatment cannot be recommended....

  20. Conceptions of mobile emergency service health professionals concerning psychiatric emergency

    Directory of Open Access Journals (Sweden)

    Diego Bonfada

    2012-06-01

    Full Text Available Under the Brazilian Psychiatric Reformation, assistance to psychological seizures represents a challenge for the emergency services. Therefore, the objective of this paper is the analysis of the conceptions of health professionals who work at the Mobile Emergency Service in Natal on psychiatric emergency care. This paper is, then, a qualitative study that used interviews as tools for collecting information. By using thematic analysis, the speeches were grouped into three categories: the stigma on patients and the professionals' fear of services interventions in psychiatric emergencies; having psychiatric emergencies regarded as harmful to patients and others' security; psychiatric emergencies being taken as patients' aggressiveness or severe depression. The data collected indicate that the interviewed professionals' ideas are supported by elements associated with the ideology that insanity implies social segregation and dangerousness. Thus, the survey prompted reflection on relevant issues to the process of psychiatric reformation implementation.