"Near-fatal" deliberate self-harm: characteristics, prevention and implications for the prevention of suicide.
ABSTRACT There have been few studies of the most serious cases of deliberate self-harm (DSH). These cases represent an important clinical problem. They may also be suitable as a "proxy" for suicide in research studies.
We developed a definition of "near-fatal" deliberate self-harm (NFDSH) and identified all cases attending accident and emergency departments in an urban area during an 18-month period. We compared them to less severe DSH on social and clinical characteristics, and examined their initial clinical management. We compared their age and gender profile with that of completed suicides. NFDSH cases who agreed to be interviewed were asked about their experiences of seeking help and their views on prevention of suicide.
158 cases were identified, 8% of all DSH. The most common method of self-harm was self-poisoning. The most common psychiatric diagnosis was depression. Compared to less severe DSH, near-fatal cases had higher rates of several social and clinical risk factors for suicide and showed evidence of greater suicidal intent. Forty-one percent were allowed home following assessment. Most admissions lasted 2 days or less. The age and gender profile was closer to that of suicide than in DSH generally. Few subjects agreed to be interviewed; those who did described poor previous experiences of services.
We did not assess each case of DSH individually but applied a workable definition of NFDSH. Firm conclusions cannot be drawn from the qualitative part of the study because of the low rate of agreement to interview.
NFDSH is an important clinical phenomenon associated with indicators of high suicide risk. This high risk is frequently not reflected in clinical management. Further studies of NFDSH could contribute to what is known about suicide prevention but the reluctance of NFDSH subjects to be interviewed may be a difficulty for future research.
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ABSTRACT: Background Suicide attempters treated in emergency rooms were studied in order to understand the motives behind this behavior. Disparities between the etiological contributions to suicidal ideation, intention, and action were examined in order to characterize motives in these categories. Methods Suicide attempters who visited the emergency departments of seven university hospitals were analyzed. Attempts leading to mortality were excluded from the analysis. Participants were assessed using semi-structured questionnaires, the results of which were noted on their medical records. These were analyzed retrospectively. Results Attempter self-report assessment revealed that participants chose external sources of stress (75.4%) and psychiatric symptoms (19.1%) as their main reasons for attempting suicide. However, assessments by interviewers indicated that stressors contributed to suicide attempts to a lesser degree (52.8%) while psychiatric symptoms were more etiologically relevant (36.6%). Compared to those with stressors that was identified as causal in both self-report and clinician assessed evaluation, the participants—regardless of their self-report evaluation—who identified with causal psychiatric symptoms by psychiatrist had more severe and intense suicidal ideation and more determined suicidal intention. Limitations We collected samples from only university hospitals, resulting in selection bias. In addition, we did not use psychiatric scales to evaluate the participants׳ symptoms. Conclusions Stress was the greatest motive for attempting suicide, affirmed in both self-report and clinician assessed evaluation. A fair proportion of people were objectively identified as being motivated by psychiatric symptoms, yet were unaware of what they suffered from. Furthermore, suicide severity, intensity, and suicidal intention were stronger in psychiatrically driven cases.Journal of Affective Disorders. 01/2014; 168:349–356.
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ABSTRACT: Abstract The study aimed to examine the role of dissociation (persisting vs. peritraumatic) in self-injurious behavior (SIB) among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse (CSA), depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale (H-DES), Center for Epidemiologic Studies Depression Scale (CES-D), The Peritraumatic Dissociative Experiences Questionnaire (PDEQ), The Traumatic Events Questionnaire (TEQ), and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for SIB more than three-fold. Higher levels of persisting dissociation were found among those who reported CSA compared to no-CSA girls. SIB was predicted by persistent dissociation. Girls who engaged in SIB had lower potency and higher depression levels, regardless of CSA history.Journal of Child Sexual Abuse 08/2014; · 0.75 Impact Factor
- The Israel journal of psychiatry and related sciences 01/2012; 49(1):58-59. · 1.36 Impact Factor