In this study, we examined the relationship between suicide attempts and low-lethal self-harm behavior in a sample of psychiatric inpatients. Using a cross-sectional approach, we surveyed 107 participants about their histories of suicide attempts, including overdoses, as well as various low-lethal self-harm behaviors. Compared with those without such histories, individuals with histories of suicide attempts, including overdoses, were significantly more likely to report a greater number of: 1) low-lethal self-harm behaviors; 2) specific symptom clusters of self-harm behavior (i.e., self-mutilation, substance abuse, medically self-defeating behaviors); and 3) specific individual self-harm behaviors (e.g., torturing oneself with self-defeating thoughts, abusing prescription medications). These data suggest that suicide attempts and low-lethal self-harm behavior are likely to co-exist in many psychiatric inpatients.
"In addition to being similar, the two types of behaviors are intertwined (Andover et al. 2012; Swahn et al., 2012), and both often co-occur within individuals (Asarnow et al 2011; Boxer, 2010; Sansone, Songer, & Sellbom 2006). In other words, while some individuals engage in SSI only, and others engage exclusively in NSSI, there exists a distinct and understudied group of people that engage in both types of behavior. "
[Show abstract][Hide abstract] ABSTRACT: Nonsuicidal self-injury (NSSI) and suicidal self-injury (SSI) co-occur in adults. The purpose of the current study was to examine differences and similarities in NSSI and SSI in adult women with respect to (1) methods used and lethality of methods, (2) intent and impulsivity of act, (3) precipitating events, and (4) consequences. The data consist of variables pertaining to 46 self-injurious acts committed by 16 Finnish female participants and recorded using Suicide Attempt Self-Injury Interviews (SASII). The data were analyzed using variables weighted by the number of acts. This study found several differences as well as similarities between the acts of SSI and those of NSSI: (a) the respective acts differ in the methods used, in the lethality of the methods, and in the expectations of resulting lethality of the acts, (b) they further differ in the functions the respective acts serve and (c) in some of the precipitating events and consequences. The acts were similar in (d) impulsivity of act and (e) some of the precipitating events and consequences. Because both types of behavior can occur within the same individual, and due to the progressing evolution between them, a thorough assessment of both NSSI and SSI needs to be completed. More emphasis needs to be placed on both the assessment of social connections and interpersonal conflict as well as how it informs the treatment. Because the behavior studied is multifunctional and changing, its treatment too needs to be customized to the multiple and changing needs of the individual patients, as opposed to diagnostic tailored treatment.
"EDTP eating disorder treatment program, SATP substance abuse treatment program, UG under-graduates, MHU mental health unit, PMC primary medical care, α Coefficient Alpha, Κ Coefficient Kappa, Φ Coefficient Phi, ICC Intra Class Correlation, MHhx mental health history, SI suicide ideation, SA suicide attempt, NR not reported, MSI-BPD McLean Screening Instrument for Borderline Personality Disorder ; YRBS Youth Risk Behaviours Survey , DIB Diagnostic Interview for Borderlines , PDQ-R Personality Diagnostic Questionnaire Revised , FASM Functional Assessment of Self-Mutilation , BPO Borderline Personality Organization Scale , a one or more DSH behaviours in past month, b one or more DSH behaviours in lifetime, c items scored 0,1 for presence in last month, d items scored 0,1 for presence in lifetime, e dichotomous variable (lifetime presence) scored 0 (no items endorsed) and 1 (at least one item endorsed), f continuous variable (lifetime presence) scored as sum of 0,1 endorsements across all items, g continuous variable (lifetime frequency) scored as sum of frequency across all items, h continuous variable (frequency for each item) in last month, †  (107, 57% females, MHU, aged 18 to 65). "
[Show abstract][Hide abstract] ABSTRACT: Background
Engagement in Deliberate Self-Harm (DSH) is commonly measured by behavioural scales comprised of specific methods of self-harm. However, there is a scarcity of information about the degree to which the methods relate to the same DSH construct although such scales are routinely used to provide a DSH total score. This study addresses the shortfall by evaluating the dimensionality of six commonly used behavioural measures of DSH.
The DSH measures were Self-Injury Questionnaire Treatment Related (SIQTR), Self-Injurious Thoughts and Behaviors Interview (SITBI), Deliberate Self-Harm Inventory (DSHI), Inventory of Statements About Self-Injury (ISAS), Self-Harm Information Form (SHIF) and Self-Harm Inventory (SHI). The behavioural scales contained in each measure were administered to 568 young Australians aged 18 to 30 years (62% university students, 21% mental health patients, and 17% community members). Scale quality was examined against the stringent standards for unidimensional measurement provided by the Rasch model.
According to the stringent post-hoc tests provided by the Rasch measurement model, there is support for the unidimensionality of the items contained within each of the scales. All six scales contained items with differential item functioning, four scales contained items with local response dependency, and one item was grossly misfitting (due to a lack of discrimination).
This study supports the use of behavioural scales to measure a DSH construct, justifies the summing of items to form a total DSH score, informs the hierarchy of DSH methods in each scale, and extends the previous evidence for reliability and external validity (as provided by test developers) to a more complete account of scale quality. Given the overall adequacy of all six scales, clinicians and researchers are recommended to select the scale that best matches their adopted definition of DSH.
"Previous research has demonstrated relationships between a history of self-harm and suicide among psychiatric inpatients (Hunt et al. 2007) and that patients with a history of suicide attempts are more likely to report engaging in other types of self-harming behaviour (Powell et al. 2000, Sansone et al. 2006). "
[Show abstract][Hide abstract] ABSTRACT: The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours.
Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission.
Retrospective case note analysis.
Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients.
One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm.
A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible.
At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention.
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