Case studies in adolescent deliberate self-harm

Four adolescents admitted to a general paediatric ward at a teaching hospital with deliberate self-harm were reviewed. Their initial psychosocial assessment was noted together with their subsequent course 12 months later. Despite an extensive assessment by a multidisciplinary team during the initial admission, follow-up 12 months later revealed that each subject appeared to have ongoing problems. This outcome raised doubts as to the appropriateness and effectiveness of a prolonged hospital admission in their initial assessment. The difficulties encountered with their management are highlighted.     

Assessment of adolescent varicocele

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10–20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.     

Assessment of child and adolescent overweight and obesity

Accurate appropriate assessment of overweight and obesity in children and adolescents is a critical aspect of contemporary medical care. However, physicians and other health care professionals may find this a somewhat thorny field to enter. The BMI has become the standard as a reliable indicator of overweight and obesity. The BMI is incomplete, however, without consideration of the complex behavioral factors that influence obesity. Because of limited time and resources, clinicians need to have quick, evidence-based interventions that can help patients and their families recognize the importance of reducing overweight and obesity and take action. In an era of fast food, computers, and DVDs, it is not easy to persuade patients to modify their diets and to become more physically active. Because research concerning effective assessment of childhood obesity contains many gaps, this report is intended to provide a comprehensive approach to assessment and to present the evidence available to support key aspects of assessment. The discussion and recommendations are based on >300 studies published since 1995, which examined an array of assessment tools. With this information, clinicians should find themselves better equipped to face the challenges of assessing childhood overweight and obesity accurately.     

Deliberate self-harm by Taiwanese adolescents

Aim: Prevalence rates for deliberate self‐harm (DSH) are unusually high among Taiwanese high school students. Several models have been advanced to explain the occurrence of DSH. One, the experiential avoidance model suggests that self‐mutilation helps the individual escape from unwanted emotional experiences. The purpose of this study was to examine the demographic, health and behavioral correlates of DSH in a population (Taiwanese adolescents) known to have a high rate of DSH. Method: A structured, self‐administered questionnaire survey was completed by a sample of 742 vocational high school students in Taiwan. Results: Eighty‐four students (11.3%) acknowledged DSH behavior. Results of multivariate logistic regression analysis indicated that female students were 3.47 times as likely as male students to be in the DSH group. Avoidance behaviors of running away from school [odds ratio (OR) = 3.45] and suicide attempt (OR = 13.05), a history of headache (OR = 8.96), a history of sexual abuse (OR = 4.26) and drinking (OR = 4.12) were also significantly associated with DSH. Conclusions: Gender and a history of headaches, a history of sexual abuse, drinking, running away from school, or suicidal attempts were factors associated with DSH among Taiwanese adolescents. School personnel should be aware of these to formulate appropriate and timely interventions.     

Assessment of sapheno-femoral junction continence in patients with primary adolescent varicocoele

Background Although there is much evidence supporting a relationship between primary varicocoele and venous incompetence of the saphenofemoral junction in adults, there is no evidence for such a relationship during adolescence. Because of the effect of age and future occupation (standing upright for long periods) on the aetiology, pathogenesis and frequency of varicose veins of the lower extremity and incompetence of saphenofemoral junctions in adulthood, a comparison during adolescence is appropriate.Objective On the basis of a close physiopathological and haemodynamic relationship between primary varicose veins and primary varicocoele, we decided to evaluate the competence of the saphenofemoral junctions in a selected group of adolescents affected by primary varicocoele and compare these results with age-matched healthy adolescents.Materials and methods Twenty-five adolescents with primary varicocoele and 23 age-matched healthy controls were included in the study. In all cases physical examination and colour Doppler US was used to diagnose or exclude the presence of primary varicocoele and to evaluate the continence of the saphenofemoral junction.Results On the right side, 10 of 25 varicocoele patients and on the left side 11 of 25 varicocoele patients had incompetence of the saphenofemoral junction. For the control patients the incidence was 2/23 on the right side and 4/23 on the left side. The difference is statistically significant.Conclustions We demonstrated high concurrence of varicocoele and valvular incompetence of the saphenofemoral junction in a particular adolescent group. We suggest clinical examination and US assessment of the saphenofemoral junctions of adolescents affected by varicocoele in order to detect the early diagnosis of venous insufficiency of the lower limbs among these patients.     

Assessment and disposition planning for adolescent suicide attempters treated in the emergency department

Emergency departments (EDs) are often the adolescent suicide attempter’s first point of contact with the medical system. After reviewing the characteristics of adolescent suicide attempters treated in EDs, a procedure for the evaluation of a variety of suicide-specific factors when planning the disposition of adolescents who attempt suicide is discussed. Current suicidal ideation, intent, history of suicidal behavior, reasons for the attempt, common stressful events that might trigger another suicidal act in a vulnerable adolescent, as well as reasons for future hope are assessed. Because it is difficult to predict adolescents at risk for repeat attempts, emphasis is placed on hospitalizing high risk patients and enhancing the probability that those appropriate for discharge receive psychiatric aftercare in the community.     

Assessment of urinary protein excretion in the adolescent: effect of body position and exercise

We examined the effects of body position and exercise on the random urinary protein/creatinine ratio (Up/Ucr) in healthy adolescents, to provide reference data to be used in a simplified evaluation of proteinuria. Random urine samples were obtained during recumbency and after both ambulation and exercise in 116 subjects. The Up/Ucr was significantly (P less than 0.0001) higher with increasing levels of activity, and was widely variable, especially during the upright and postexercise periods. No sex-related differences in Up/Ucr were noted, except during recumbency, when values were significantly (P less than 0.001) higher in females. The urinary dipstick was found to be less sensitive as a tool to define abnormal degrees of recumbent proteinuria. We conclude that body position and exercise have significant effects on protein excretion, and suggest that the Up/Ucr in recumbent and upright urine samples will be useful in the evaluation of proteinuria.     

Assessment of health-related quality of life of adolescent cancer patients using the Minneapolis-Manchester Quality of Life Adolescent Questionnaire

BACKGROUND: Improved survival after childhood cancer has shifted the focus to health-related quality of life (HRQL)-an understudied problem, especially among adolescents. PROCEDURE: We assessed HRQL among adolescents utilizing a validated self-report tool, the Minneapolis-Manchester Quality of Life (MMQL) Adolescent Form, consisting of 46 items comprising seven domains: physical, cognitive, psychological and social functioning, body image, intimate relations, and outlook on life, and computed an overall QoL score. The MMQL Adolescent Form was administered to 226 adolescent survivors of childhood cancer a median of 7.8 years from diagnosis (off therapy-median age: 16.2 years), 136 adolescent cancer patients undergoing therapy (on therapy-median age: 16.4 years), and 134 healthy adolescents (controls-median age: 15.5 years). Primary diagnoses included leukemia (46%), lymphoma (26%), brain tumors (5%), and other solid tumors (23%). RESULTS: Compared to healthy controls, on-therapy patients were at increased risk for reporting poor overall QoL [Odds Ratio (OR) = 3.3, P = 0.002)] and poor physical functioning (OR = 11.8, P < 0.001). Off-therapy survivors did not differ significantly from healthy controls for overall QoL (OR = 1.6, P = 0.5) or any HRQL domains. Female patients, both on- and off-therapy, were more likely to report poorer overall QoL, physical, psychological and cognitive functioning as well as poorer body image when compared with male patients. CONCLUSIONS: While adolescent cancer patients undergoing active therapy report poor physical functioning, there is no evidence of long-term QoL sequelae.     

Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents

OBJECTIVE: To determine the prevalence and the associated psychological and social factors of occasional and repetitive deliberate self-harming behavior in adolescents. DESIGN: Cross-sectional self-report survey. SETTING: One hundred twenty-one schools in Germany. PARTICIPANTS: A representative sample of 5759 ninth-grade students was studied between 2004 and 2005. OUTCOME MEASURES: Deliberate self-harm (DSH) and suicidal behaviors, emotional and behavioral problems (Youth Self-Report), living standard, family composition, parental conflict and illness, school type and performance, relationship to peers, bullying, body satisfaction and dieting, media consumption, smoking, and alcohol and drug use. RESULTS: Occasional forms of DSH within the previous year were reported by 10.9% of the ninth-grade students. Four percent of the students reported repetitive forms of DSH. Suicidal behavior was strongly associated with repetitive DSH, an association that held for both subtypes of DSH. The findings also indicated that social background factors were important concomitants of occasional DSH but were not related to an increased likelihood of repetitive DSH. Symptoms of depression/anxiety and delinquent/aggressive behavior were associated with self-harming behavior in both adolescent girls and boys. CONCLUSIONS: The data suggest that there is a link between social factors and occasional DSH and, especially in repetitive DSH, that there is a strong association between DSH and suicidal behavior as well as DSH and emotional and behavioral problems. These findings indicate a different pathway in the development of DSH in adolescents. The results support a need to investigate the possible neurobiological underpinnings of DSH within a longitudinal model to enhance the knowledge of this poorly understood behavior.     

Deliberate self-harm by under-15-year-olds: characteristics, trends and outcome

Background:  Relatively little information is available about the characteristics and long-term outcome of children and adolescents aged under 15 years who present to general hospitals because of deliberate self-harm (DSH).
Method:  Information was collected on 710 consecutive under-15-year-olds presenting to a general hospital in central England with DSH over a 26-year period (1978–2003). Outcome in terms of death was investigated from national statistics in 464 cases presenting during the first 20 years of the study.
Results:  Most individuals were aged 12–14 years. In this age group the female:male ratio was 6.5:1. Nearly all (680/710, 95.8%) had taken overdoses, over half of these episodes involving paracetamol (acetaminophen). Few had a history of prior (7.7%) or current psychiatric treatment (7.7%), although a quarter (150/559, 26.8%) had a history of previous DSH. Suicidal intent was usually low. The most frequent problems were difficulties in relationships with family members (77.3%) and with friends (38.9%), and school/study problems (37.9%). The long-term risk of suicide was low, 1.1% ( N  = 5) having died by probable suicide after a mean follow-up period of 11 years 2 months.
Conclusions:  DSH in children and young adolescents is usually related to life problems, is generally of low suicidal intent, and is associated with a relatively low long-term risk of suicide.     

Editorial: Suicide and self-harm: advancing from science to preventing deaths

Globally, suicide is the second leading cause of death among youth ages 15–29-years, and self-harm is one of the strongest known predictors of death by suicide. This editorial introduces the Special Issue on suicide and self-harm, emphasizing the research and policy implications of the included articles. By illustrating advances in our science, the Special Issue both celebrates our achievements and highlights the need to use our science to inform suicide prevention policy and practice to reduce the tragedy of suicide and premature deaths.