Association Between Deliberate Self-Harm and Coping in Adolescents: A Critical Review of the Last 10 Years' Literature

Coping is commonly associated with deliberate self-harm (DSH) in adolescents. This article reviews the published literature from 2000 to 2010, aiming to highlight the current evidence supporting this association. Eighteen studies met the inclusion criteria, a total sample of 24,702 subjects was obtained and 17% were DSH cases. Emotion-focused coping style and in particular avoidant coping strategies have consistently been associated with DSH in adolescents. Problem-focused coping style seems to have a negative relation. Most studies were cross-sectional, which seriously limits our conclusions on causality. There is a clear need for more systematic studies, performed in accordance with consensual methodology.     

Cannabis Use and Deliberate Self-Harm in Adolescence: A Comparative Analysis of Associations in England and Norway

The objective of this study was to test hypotheses on causality and selection regarding associations between cannabis use and deliberate self-harm (DSH) among adolescents. School surveys were conducted among 9,800 adolescents in England and Norway applying identical measures on deliberate self-harm, suicidal thoughts, cannabis use, and various potential confounders. Cannabis use was more prevalent in England than in Norway. It was associated with DHS, suicidal thoughts and various risk factors for DSH. However, these associations were stronger in Norway than in England. The adjusted associations between cannabis use and suicidal thoughts were non-significant in both countries. The adjusted cannabis–DSH association was non-significant in England but significant in Norway. Elevated risk of DSH in adolescent cannabis users seems to be mainly due to selection mechanisms. Thus the association is not likely to be direct but due to other shared contributory factors.     

Deliberate self-harm in older adults: a review of the literature from 1995 to 2004

BACKGROUND: The prevention of suicide is a national and international policy priority. Old age is an important predictor of completed suicide. Suicide rates in old age differ markedly from country to country but there is a general trend towards increasing rates with increasing age. In 1996 Draper reviewed critically the evidence on attempted suicide in old age in the 10 years between 1985 and 1994. The review highlighted a need for prospective controlled studies in older people with more representative samples as well as studies examining the interaction of risk factors, precipitants, motivations, psychopathology and response to treatment. The aim of this paper is to update this review and to summarise the advances in our understanding of DSH in later life. METHOD: We have critically reviewed relevant studies published between 1995 and 2004 to summarise the advances in our understanding of factors associated with deliberate self-harm in later life. RESULTS: The main advances in understanding have been to clarify the effect of personality and cultural factors, service utilisation pre and post attempt, and the (lesser) impact of socio-economic status and physical illness. Methodological weaknesses continue to include inadequate sample sizes performed on highly selected populations, inconsistent age criteria and lack of informant data on studies relating to role of personality. CONCLUSIONS: Future studies should include prospective, cross-cultural research with adequate sample sizes and which are population-based. Such approaches might confirm or refute the results generated to date and improve knowledge on factors such as the biological correlates of deliberate self-harm, service utilisation, costs and barriers to health care, and the interaction of these factors. Intervention studies to elucidate the impact of modifying these factors and of specific treatment packages are also needed.     

Suicidal behaviour in HIV infection: A case-control study of deliberate self-harm in people with HIV infection

A group of 22 individuals with HIV infection who had made acts of self-harm were compared with a sex and age-matched control group of individuals without known HIV infection who had also being involved in acts of deliberate self-harm (DSH). Compared with all DSH individuals referred to the deliberate self-harm service during the same period. men were over-represented amongst HIV subjects. Compared with matched controls, HIV subjects were more likely to include gay/bisexual men, and not be employed. Individuals with HIV infection were more likely to be receiving outpatient psychiatric care at the time of DSH. and to have received it in the past A diagnosis of depression was given mom frequently to HIV subjects, while alcohol misuses was more often diagnosed in controls. Concerns about their physical health were prominent amongst HIV seropositives. Psychiatric follow-up was offered to HIV subjects more often than to controls. The results indicate that HIV disease is a potential contributing factor to deliberate self-harm. and highlight the need for efforts to identify individuals with HIV infection at risk of deliberate self-harm, ant to develop effective interventions to prevent suicidal behaviour in this group of individuals.     

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample

The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.     

Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort

BACKGROUND: Little information is available about older deliberate self-harm (DSH) patients and their outcome. METHODS: This study is a prospective investigation and follow-up of 730 consecutive patients (459 females and 271 males) aged 60 years and over who presented to a general hospital following DSH over a 20-year period, 1978-1997. Outcome has been examined in terms of repetition of DSH, and deaths by the end of 2000 identified through official death registers. RESULTS: DSH involved self-poisoning in 88.6% of cases, 49.3% of the overdoses including paracetamol (acetaminophen), 24.0% minor tranquillizers, and 15.9% antidepressants. Nearly three-quarters of episodes involved high suicidal intent. Common problems preceding DSH were physical illness (46.1%), social isolation (33.5%), relationship problems with family (29.4%) or partner (25.9%), and bereavement or loss (16.7%). Repetition of DSH occurred in 15.3% of cases, 8.2% in the first year following DSH. By the end of 2000, 432/661 (65.4%) of traced patients had died. There were 30 suicides and open verdicts, which were 49 times and 33 times more frequent respectively than expected from general population death rates. Prior DSH before initial presentation was the main risk factor for suicide, with some evidence of high suicide intent being another factor. There were also excess deaths due to several types of physical disorder. CONCLUSIONS: DSH in older people is closely related to suicide, both in terms of suicidal intent and risk of eventual suicide, especially when DSH is repeated. The range of problems experienced by older DSH patients requires extensive and multidisciplinary clinical interventions.     

Child sexual abuse in women who take overdoses: I. A study of prevalence and severity

There is now considerable evidence that people reporting a history of child abuse have an increased prevalence of deliberate self-harm, a term that includes deliberate self-poisoning (overdose) and deliberate self-injury, but little information is available on the prevalence of abuse experiences in those who have harmed themselves. Modified versions of standardised self-report questionnaires of sexual, physical, and psychological abuse were administered to a sample of 257 female patients consecutively admitted over a one year period to a general hospital in England after taking an overdose. This study suggests that sexual abuse is very prevalent in the female overdose population. Seventy-two percent reported some form of sexual abuse, and 51% reported sexual abuse involving attempted or actual penetration. Grand repeaters (five overdoses or more) had been more severely abused for all three types of abuse. They were also more likely to have been sexually abused at a younger age (before age 13), for longer periods, and for the sexual abuse to have occurred again in adulthood. Our results support the view that childhood sexual abuse may place adults at special risk of subsequent overdoses or other deliberate self-injury. Therefore, clinicians should ask about abuse experiences during the routine psychiatric assessment following an overdose, and especially in those who harm themselves repeatedly.     

Caring Contacts to Reduce Psychiatric Morbidity Following Hospitalization During the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

ObjectivesCaring Contacts are an emerging intervention that aims to reduce distress and suicide risk after acute psychiatric care. This trial aimed to determine whether, during a pandemic, there was any evidence that the mental health benefits and reduction in suicidal ideation (SI) associated with delivering Caring Contacts to recently discharged psychiatric patients were greater than a control communication. The secondary objective was to identify whether the predicted benefits were greater among people living alone or those diagnosed with depression.MethodA single-site pilot randomized clinical trial (n = 100), with patients recruited from the adult Inpatient Psychiatry Unit at Sunnybrook Health Sciences Centre, Toronto, Canada between August 2020 and May 2021. Participants were randomized (1:1) to the Caring Contact or control group. Participants received three Caring Contact or control communications via email or mail (on days 4, 21, and 56 post-discharge). Mental health symptoms were assessed using the self-report Hopkins Symptom Checklist-25 (HSCL-25) scores at discharge (baseline) and when participants received each communication. Analysis of variance was used for the primary comparisons and exploratory analyses for subgroups.ResultsBoth groups experienced a significant worsening of mental health symptoms at all time points post-discharge relative to baseline. There were no significant differences between groups at any time point, however, on day 4 there was a 24.2% and 72.6% attenuated worsening in the Caring Contact group compared to the control group for total symptom severity and SI, respectively. There was no significant interaction effect for the depression subgroup or those living alone.ConclusionsWhile this pilot study was not powered to identify significant differences between groups, results are indicative of feasibility and acceptability of the intervention and provide some indication that Caring Contacts may have benefited patients in the days following discharge, supporting the need for larger-scale trials. The study was registered with clinicaltrials.gov (study ID {"type":"clinical-trial","attrs":{"text":"NCT04456062","term_id":"NCT04456062"}}NCT04456062).     

Group Therapy for Repeated Deliberate Self-Harm in Adolescents: Failure of Replication of a Randomized Trial

ObjectiveTo replicate a study, which found group therapy superior to routine care in preventing the recurrence of self-harming behavior in adolescents who had deliberately harmed themselves on at least two occasions.MethodSingle blind study with parallel randomized groups undertaken in three sites in Australia. The primary outcome measure was repetition of self-harm, assessed on average after 6 and 12 months. Secondary outcome measures included suicidal ideation, psychiatric disorder, and service use.ResultsSeventy-two adolescents aged 12 to 16 years (91% female subjects) were randomized to group therapy or routine care. Primary outcome data were available for 68 of the 72 randomized participants. More adolescents randomized to group therapy than those randomized to routine care had self-harmed by 6 months (30/34 versus 23/34, χ² = 4.19, p = .04), and there was a statistically nonsignificant trend for this pattern to be repeated in the interval of 6 to 12 months (30/34 versus 24/34, χ² = 3.24, p = .07). There were few differences between the treatment groups on secondary outcome measures, other than a trend for greater improvement over time on global symptom ratings among the experimental group compared with the control group.ConclusionsOur findings contradict those of the original study. Some differences in participant characteristics between the studies, along with less experience at the Australian sites in delivering the intervention, may have accounted for the different outcome. The benefit of group therapy for deliberate self-harm is unproven outside the environment in which it was originally developed. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):662–670.     

Mirror Illusion for Sensori-Motor Training in Stroke: A Randomized Controlled Trial

Background

Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects.