Suicide: Self-harm and suicide in adolescents

Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Oxford, UK.
The Lancet (Impact Factor: 45.22). 06/2012; 379(9834):2373-82. DOI: 10.1016/S0140-6736(12)60322-5
Source: PubMed


Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.

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Available from: Kate Saunders, Aug 12, 2014
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    • "The purpose of this study was to investigate the association between AVHs and suicide attempts among patients with suicidal ideation in clinical settings. As comorbid depressive symptoms may also be risk factors for adolescent suicidal behaviors, depression was considered as a potential confounder in this study (Bridge et al., 2006; Goldston et al., 1999; Hawton et al., 2012; Spirito et al., 2003). "
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    ABSTRACT: It is important to prevent patients with suicidal ideation from actually attempting suicide. A school based cohort study suggested that auditory verbal hallucinations (AVHs) might play an important role in driving young people with mental health problems to attempt suicide. However, no clinical study to date has specifically investigated the association between AVHs and suicide attempts among young patients with suicidal ideation. We conducted a cross-sectional study of first-visit psychiatric referrals aged 10-15years at two general child and adolescent mental health hospitals in Japan. We administered self-reported questionnaires to measure suicidal ideation and suicide attempts, AVHs, and depression in the two weeks prior to the date of first-visit. Among 188 patients with suicidal ideation, the presence of AVHs was associated with increased odds of suicide attempts (OR 3.4, 95% CI 1.7-6.9; p<0.05); however, depression was not associated with a significant change of odds (OR 0.7, 95% CI 0.4-1.3; p=0.29). AVHs may increase the risk of suicide attempts made by adolescents with suicidal ideation. Clinicians should consider AVHs when adolescent patients present with suicidal ideation. Copyright © 2015. Published by Elsevier B.V.
    Schizophrenia Research 07/2015; 168(1). DOI:10.1016/j.schres.2015.07.028 · 3.92 Impact Factor
    • "No reliable data were available on other types of support (Christina et al., 2013) or therapeutic interventions our sample was receiving (Diamond et al., 2010; Goodyer et al., 2007; March et al., 2004; Rathus & Miller, 2002; Swales et al., 2012;). Finally, the cross-sectional study design supports descriptive, yet not causal interpretations and cannot fully illustrate how intent and methods change over time (Hawton et al., 2012; Kapur et al., 2013). "
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    ABSTRACT: Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them. The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice. All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors. Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category. Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.
    Journal of Mental Health 07/2015; 24(4):1-5. DOI:10.3109/09638237.2015.1022249 · 1.01 Impact Factor
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    • "esearch on adolescent suicidal behavior has focused mainly on risk factors, less on outcomes (Bridge et al., 2006; Brière et al., 2014) or prognosis, despite the clear clinical relevance and policy implications of such knowledge (Fergusson et al., 2005a). The most common cause of death among adolescent girls aged 15 to 19 years is suicide (Patton et al., 2009); however, more male adolescents die by suicide (Hawton et al., 2012). The prevalence of lifetime suicide attempt for girls (10.1%) is more than double that for boys (3.8%) in community samples of school-going adolescents (Lewinsohn et al., 1996). "
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    ABSTRACT: Adulthood psychiatric and psychosocial outcomes of early adolescence suicidal acts were studied. A representative sample of school adolescents (T1, mean age, 13.7 years; n = 2464; 50.8% female; 88.3% participation) was followed up a year later with the same questionnaire (T2). High scorers of depression were matched with low or moderate scorers and interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (mean age, 14.9 years; n = 345; 94% participation). They were reassessed after 5 years (T3, mean age, 20.0 years; n = 242; 73% participation). Those who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worser prognostic profiles than incident cases between ages 14 and 15 years. Male attempters had better psychiatric prognosis than female attempters. Attempters were more likely to have contacted child protection services but not mental health services. Clinicians need to be aware of long-term pervasive outcomes of adolescent suicidality.
    Journal of Nervous & Mental Disease 03/2015; 203(4). DOI:10.1097/NMD.0000000000000281 · 1.69 Impact Factor
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