1,721,361 research outputs found
Help-seeking before and after episodes of self-harm: a qualitative and quantitative study of school pupils in England
Full text linkBackground: deliberate self-harm in young people is a cause for concern in many countries. The vast majority of episodes of self-harm do not result in presentation to hospital and relatively little is known about to whom or where adolescents who harm themselves go for help.Methods: this school-based survey of 5,293 15–16 year olds in the United Kingdom investigated sources of help and barriers to help seeking before and after an episode of self-harm.Results: friends (40%) and family (11%) were the main sources of support. Far fewer adolescents had sought help from formal services or health professionals. Barriers to help seeking include perceptions of self-harm as something done on the spur of the moment and therefore not serious or important or to be dwelt upon. Many adolescents felt they should be able to, or could cope on their own and feared that seeking help would create more problems for them and hurt people they cared about or lead to them being labelled as an 'attention seeker'. The decision to seek help was in some cases hampered by not knowing whom to ask for help. Gender and exposure to self-harm in the peer group influenced perceived barriers to help-seeking.Conclusion: there are both push and pull factors' acting on young people in their understanding of what leads them to want to harm themselves and potential mechanisms for seeking help. The implications for community based prevention programmes are discussed
Adolescents' views on preventing self-harm: a large community study
No full textBackground: Deliberate self-harm (DSH) is a major problem in young people in the United Kingdom. The majority of young people who harm themselves do not seek help and therefore community based prevention strategies are important. However little is known about young peoples' views on the prevention of DSH. The aims of this study were to identify what adolescents believe can be done to prevent them from feeling like they want to harm themselves, and to investigate differences in the views held according to gender, ethnic group and previous experiences of self-harm. Method: Pupils is a representative sample of 41 secondary schools in England completed an anonymous, self-report questionnaire including the question "what do you think could be done to help prevent young people from feeling that they want to harm themselves?" Thematic analytic methods were used to categorise responses, which were then also analysed by gender, ethnicity, lifetime history of DSH and lifetime exposure to DSH among friends. Results: The written responses of 2,954 students aged 15-16 years were analysed. Eleven broad categories of responses were identified covering causes and possible ways of preventing suicidal behaviour in young people, including: the primacy of informal social networks over professional organisations, the importance of confiding stable relationships, the need for structured group activities, and the key role that schools play in young peoples lives. Mental illness was mentioned by only 3% of respondents, although concerns about stigma acted as a barrier to seeking help for some young people. Bullying and serious problems at home were highlighted as psychosocial stressors that need to be addressed. Conclusions: The adolescents in this study considered family, friends and school as the main sources of support in preventing suicidal behaviour, and more pertinent than external helping agencies. Enhancing the provision of school-based mental health programmes and increased youth-orientation in helping services are indicated
Systematic review of resource utilization in the hospital management of deliberate self-harm
Full text linkBACKGROUND: Deliberate self-harm (DSH) is a significant public health problem, representing a major burden in terms of morbidity to the individual and health-service utilization. While clinical guidelines suggest good practice for the short-term hospital management of DSH, there remains considerable variability in the way that services are provided. METHOD: A systematic review of the literature was undertaken to examine the current evidence on hospital resource use and costs involved in the short-term hospital management of adults following DSH and to elucidate the factors that influence these differences, in terms of clinical characteristics and service provision. RESULTS: Twenty-one papers reporting on 17 studies met the inclusion criteria for review. Clinical characteristics associated with an increase in resource use included overdose with tricyclic antidepressants (TCAs) compared with selective serotonin re-uptake inhibitors (SSRIs) (weighted ratio 2.6:1) and co-ingestion of alcohol with SSRIs. Variations in service provision, including medical admissions policy and provision of a specialist liaison service, affected resource utilization independently of the clinical needs of patients. CONCLUSIONS: Overdoses of TCAs incur substantially greater hospital costs than overdoses of SSRIs. Variations in the medical seriousness of DSH, and in the structure of service provision, affect the resources used in its short-term hospital management, with little evidence about the impact these differences have on clinical outcome. Research is needed to evaluate the impact of different styles of service provision on outcome, and to incorporate these factors into the trial design of future cost-effectiveness studies of interventions following DSH.<br/
Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis.
No full textOBJECTIVE: To assess whether lithium has a specific preventive effect for suicide and self harm in people with unipolar and bipolar mood disorders. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, PsycINFO, CENTRAL, web based clinical trial registries, major textbooks, authors of important papers and other experts in the discipline, and websites of pharmaceutical companies that manufacture lithium or the comparator drugs (up to January 2013). INCLUSION CRITERIA: Randomised controlled trials comparing lithium with placebo or active drugs in long term treatment for mood disorders. REVIEW METHODS: Two reviewers assessed studies for inclusion and risk of bias and extracted data. The main outcomes were the number of people who completed suicide, engaged in deliberate self harm, and died from any cause. RESULTS: 48 randomised controlled trials (6674 participants, 15 comparisons) were included. Lithium was more effective than placebo in reducing the number of suicides (odds ratio 0.13, 95% confidence interval 0.03 to 0.66) and deaths from any cause (0.38, 0.15 to 0.95). No clear benefits were observed for lithium compared with placebo in preventing deliberate self harm (0.60, 0.27 to 1.32). In unipolar depression, lithium was associated with a reduced risk of suicide (0.36, 0.13 to 0.98) and also the number of total deaths (0.13, 0.02 to 0.76) compared with placebo. When lithium was compared with each active individual treatment a statistically significant difference was found only with carbamazepine for deliberate self harm. Lithium tended to be generally better than the other active comparators, with small statistical variation between the results. CONCLUSIONS: Lithium is an effective treatment for reducing the risk of suicide in people with mood disorders. Lithium may exert its antisuicidal effects by reducing relapse of mood disorder, but additional mechanisms should also be considered because there is some evidence that lithium decreases aggression and possibly impulsivity, which might be another mechanism mediating the antisuicidal effect
Vendor-based restrictions on pesticide sales to prevent pesticide self-poisoning - a pilot study
Full text linkBackground: In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such high-risk individuals. We aimed to test the feasibility and acceptability of vendor-based restrictions on pesticide sales for such high-risk individuals. Methods: We conducted a pilot study in 14 (rural = 7, urban = 7) pesticide shops in Anuradhapura District of Sri Lanka. A two-hour training program was delivered to 28 pesticide vendors; the aim of the training was to help vendors recognize and respond to customers at high risk of pesticide self-poisoning. Knowledge and attitudes of vendors towards preventing access to pesticides for self-poisoning at baseline and in a three month follow-up was evaluated by questionnaire. Vendors were interviewed to explore the practice skills taught in the training and their assessment of the program. Results: The scores of knowledge and attitudes of the vendors significantly increased by 23% (95% CI 15%–32%, p < 0.001) and by 16% (95% CI 9%–23%, p < 0.001) respectively in the follow-up. Fifteen (60%) vendors reported refusing sell pesticides to a high-risk person (non-farmer or intoxicated person) in the follow-up compared to three (12%) at baseline. Vendors reported that they were aware from community feedback that they had prevented at least seven suicide attempts. On four identified occasions, vendors in urban shops had been unable to recognize the self-harming intention of customers who then ingested the pesticide. Only 2 (8%) vendors were dissatisfied with the training and 23 (92%) said they would recommend it to other vendors. Conclusions: Our study suggests that vendor-based sales restriction in regions with high rates of self-poisoning has the potential to reduce access to pesticides for self-poisoning. A large-scale study of the effectiveness and sustainability of this approach is needed
Interventions for mood and anxiety disorders, and self harm in young offenders
No full textThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The goal of this review is to identify which interventions should be recommended for the treatment of mood disorders, anxiety disorders and self harm behaviours in young offenders. Specifically, the objectives are:1. To determine what specific interventions for mood and anxiety disorders, and self harm behaviours are effective for young offenders, and;2. To determine whether specific interventions are effective in different types of disorder in young offenders (e.g. depression, PTSD).</p
The role of autobiographical memory specificity in deliberate self-harm: correlates and consequences
No full textBACKGROUND: Several studies have identified reduced specificity of autobiographical memory in deliberate self-harm (DSH) patients. However it is not clear which clinical variables are associated with low memory specificity in this group, or whether low specificity is particularly associated with recent DSH. METHOD: 68 individuals followed up seven years after an index episode of DSH were re-interviewed and data collected on current psychiatric disorder, repetition of DSH in the intervening period and autobiographical memory specificity. Data on history of sexual and physical abuse during childhood were available from the index assessment. RESULTS: A hierarchical regression analysis identified older age, current affective disorder and level of familial sexual abuse during childhood as independent predictors of reduced memory specificity. Sixteen participants who had a further episode of DSH in the year prior to the current assessment were classified as having 'recent' DSH. Results of logistic regression suggest that low memory specificity mediates the association between childhood sexual abuse and recent DSH and partially mediates the association between current affective disorder and recent DSH. LIMITATIONS: The results are based on a relatively small sample of patients from a mixed clinical group, limiting the statistical power of the analysis. CONCLUSIONS: The findings confirm the association between low memory specificity and DSH. They are consistent with a multi-factorial model of impaired specificity and suggest that low specificity may be one of the mechanisms through which abuse history and affective disorder increase an individual's vulnerability to deliberate self-harm.<br/
Six year follow-up of a clinical sample of self-harm patients
No full textBackground: mortality from suicide and other causes is significantly increased in patients who engage in self-harm, but their long-term morbidity and quality of life are poorly defined. As the majority of self-harm patients are under the age of 35 years, understanding their longer term health outcomes is important if we are to adequately manage their care. The aim of this study was to investigate the long-term mortality, morbidity and quality of life of such patients.Method: a representative cohort of patients who had presented to hospital following an episode of self-harm was traced after 6 years. Mortality and repetition of self-harm were primary outcome measures. Psychiatric morbidity and indices of quality of life, and social functioning were also obtained.Results: 143/150 (95.3%) patients were traced after a mean of 6.2 years. Eight (5.6%) had died during follow-up, significantly more than general population estimates (p ? 0.001), four of these (2.8%) by probable suicide. Further self-harm occurred in 58/101 (57.4%) participants; 70/97 (72.2%) fulfilled criteria for at least one psychiatric disorder, and 51.3% screened positive for harmful use of alcohol. Measures of health status (EQ-5D and SF36-II) were significantly lower (p < 0.001) than in the general population.Limitations: due to the nature of this population group the attrition rate at 6 years is high; although this is the most complete such study to date.Conclusion: despite positive outcomes in some patients, overall levels of mortality, morbidity, and harmful use of alcohol are high, whilst quality of life is reported as low. This has significant implications for the long-term management of this group.<br/
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