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ABSTRACT: To assess the long term effect of United Kingdom legislation introduced in September 1998 to restrict pack sizes of paracetamol on deaths from paracetamol poisoning and liver unit activity.
Interrupted time series analyses to assess mean quarterly changes from October 1998 to the end of 2009 relative to projected deaths without the legislation based on pre-legislation trends.
Mortality (1993-2009) and liver unit activity (1995-2009) in England and Wales, using information from the Office for National Statistics and NHS Blood and Transplant, respectively.
Residents of England and Wales.
Suicide, deaths of undetermined intent, and accidental poisoning deaths involving single drug ingestion of paracetamol and paracetamol compounds in people aged 10 years and over, and liver unit registrations and transplantations for paracetamol induced hepatotoxicity.
Compared with the pre-legislation level, following the legislation there was an estimated average reduction of 17 (95% confidence interval -25 to -9) deaths per quarter in England and Wales involving paracetamol alone (with or without alcohol) that received suicide or undetermined verdicts. This decrease represented a 43% reduction or an estimated 765 fewer deaths over the 11¼ years after the legislation. A similar effect was found when accidental poisoning deaths were included, and when a conservative method of analysis was used. This decrease was largely unaltered after controlling for a non-significant reduction in deaths involving other methods of poisoning and also suicides by all methods. There was a 61% reduction in registrations for liver transplantation for paracetamol induced hepatotoxicity (-11 (-20 to -1) registrations per quarter). But no reduction was seen in actual transplantations (-3 (-12 to 6)), nor in registrations after a conservative method of analysis was used.
UK legislation to reduce pack sizes of paracetamol was followed by significant reductions in deaths due to paracetamol overdose, with some indication of fewer registrations for transplantation at liver units during the 11 years after the legislation. The continuing toll of deaths suggests, however, that further preventive measures should be sought.
BMJ (Clinical research ed.). 01/2013; 346:f403.
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ABSTRACT: BACKGROUND: Suicide by carbon monoxide poisoning from burning barbecue charcoal has become a common method of suicide in several Asian countries over the last 15 years. The characteristics of people using this method in Western countries have received little attention. METHOD: We reviewed the inquest reports of 12 English Coroners (11% of all Coroners) to identify charcoal-burning suicides. We compared socio-demographic and clinical characteristics of suicide by charcoal burning occurring between 2005 and 2007 with suicides using other methods in 2005. RESULTS: Eleven charcoal-burning suicides were identified; people using this method were younger (mean age 33.4 versus 44.8 years, P = 0.02), and more likely to be unemployed (70.0 versus 30.1%, P = 0.01) and unmarried (100 versus 70%, P = 0.04) than those using other methods. Charcoal-burning suicides had higher levels of contact with psychiatric services (80.0 versus 59.1%) and previous self-harm (63.6 versus 53.0%) compared with suicides using other methods, but these differences did not reach conventional levels of statistical significance. Over one-third of people dying by charcoal burning obtained information on this method from the Internet. CONCLUSIONS: Working with media, including Internet Service Providers, and close monitoring of changes in the incidence of suicide using this method might help prevent an epidemic of charcoal-burning suicides such as that seen in some Asian countries.
Journal of Public Health 11/2012; · 2.06 Impact Factor
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ABSTRACT: Suicide rates are elevated in the veterinary profession in several countries, yet little is known about possible contributory and preventive factors.
To obtain information from veterinarians with a history of suicidal ideation or behavior about the factors associated with suicidality in their profession.
We conducted a mixed-methods interview study with 21 UK veterinarians who had attempted suicide or reported recent suicidal ideation. Interview topics included work and nonwork contributory factors, coping mechanisms, and preventive factors.
Self-poisoning was the most common method used or considered by participants. Common contributory factors were workplace relationships, career concerns, patient issues, number of hours and volume of work, and responsibility, although two-thirds of participants reported co-occurring difficult life events. Around half had received a psychiatric diagnosis following their suicidal behavior. Several possible preventive measures were suggested by participants.
Several work- and non-work-related contributory factors to suicidality in the veterinary profession were identified. Future preventive measures may involve better promotion of support services, formal support for recent graduates, and improving employers' attitudes toward work-life balance.
Crisis The Journal of Crisis Intervention and Suicide Prevention 06/2012; 33(5):280-9. · 1.09 Impact Factor
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ABSTRACT: Self-help resources are an important means of supporting people bereaved by suicide. These require careful evaluation.
To evaluate the use and impact of Help is at Hand, a hardcopy and online booklet produced as part of England's suicide-prevention strategy.
Data were collected on numbers of copies distributed and online access, and on users' views about the resource through questionnaires, interviews, and a focus group.
Large numbers of copies of Help is at Hand were obtained by a range of organizations, but far fewer directly by individuals, although the resource was extensively accessed online. Evaluation of individuals' responses to the resource was challenging. However, most respondents were very positive about the overall format and content and especially sections on experiencing bereavement and practical matters relating to the death. The main complaint was delay in gaining access to Help is at Hand.
Evaluation of resources for people bereaved by suicide is difficult but worthwhile. Help is at Hand was largely well received. The main problem was with regard to individuals gaining access to it, especially at a time when they most needed it. Promotion of resources such as Help is at Hand needs to be prioritized.
Crisis The Journal of Crisis Intervention and Suicide Prevention 06/2012; 33(5):254-64. · 1.09 Impact Factor
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ABSTRACT: Background: Suicide rates are elevated in the veterinary profession in several countries, yet little is known about possible contributory and preventive factors. Aims: To obtain information from veterinarians with a history of suicidal ideation or behavior about the factors associated with suicidality in their profession. Methods: We conducted a mixed-methods interview study with 21 UK veterinarians who had attempted suicide or reported recent suicidal ideation. Interview topics included work and nonwork contributory factors, coping mechanisms, and preventive factors. Results: Self-poisoning was the most common method used or considered by participants. Common contributory factors were workplace relationships, career concerns, patient issues, number of hours and volume of work, and responsibility, although two-thirds of participants reported co-occurring difficult life events. Around half had received a psychiatric
diagnosis following their suicidal behavior. Several possible preventive measures were suggested by participants. Conclusions: Several work- and non-work-related contributory factors to suicidality in the veterinary profession were identified. Future preventive measures may involve better promotion of support services, formal support for recent graduates, and improving employers’ attitudes toward work-life balance.
Crisis The Journal of Crisis Intervention and Suicide Prevention 06/2012; 33(5):280-9. · 1.09 Impact Factor
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ABSTRACT: There is widespread concern regarding the possible influence of the Internet on suicidal behaviour. The aim of this study was to estimate the prevalence and characteristics of Internet-related suicide in England.
Cross sectional study based on detailed review of the inquest reports of suicides occurring in the areas served by 12 Coroners in England. Evidence of Internet use in relation to the suicide was sought for each death.
Altogether inquest reports for 593 suicides (all methods) in 2005 and 166 suicides using specific methods in 2006-7 were assessed. There was evidence of a direct Internet contribution in nine (1.5% 95%CI 0.7 to 2.9%) of the 593 suicides in 2005. In seven (77.8%) of the cases the individuals had used the Internet to research the methods of suicide they used. Five (55.6%) individuals had used 'unusual' high-lethality methods, whereas such methods were only used in 1.7% of all suicides (p<0.001). There was evidence of Internet involvement in 2.4% (0.7% to 6.1%) of the suicides in 2006-2007. None of the Internet-related suicides appeared to occur as part of a suicide pact.
The contribution of the Internet to suicide rates may be under-estimated in this analysis as Coroners are unlikely to comprehensively pursue the possibility of Internet involvement in all the deaths they investigate.
Easy access to information about suicide methods and pro-suicide web sites on the Internet appears to contribute to a small but significant proportion of suicides. A key impact of the Internet appears to be in relation to information concerning suicide methods.
Journal of affective disorders 05/2012; 141(2-3):480-3. · 3.76 Impact Factor
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ABSTRACT: The analgesic co-proxamol (paracetamol/dextropropoxyphene combination) has been widely involved in fatal poisoning. Concerns about its safety/effectiveness profile and widespread use for suicidal poisoning prompted its withdrawal in the UK in 2005, with partial withdrawal between 2005 and 2007, and full withdrawal in 2008. Our objective in this study was to assess the association between co-proxamol withdrawal and prescribing and deaths in England and Wales in 2005-2010 compared with 1998-2004, including estimation of possible substitution effects by other analgesics.
We obtained prescribing data from the NHS Health and Social Care Information Centre (England) and Prescribing Services Partneriaeth Cydwasanaethau GIG Cymru (Wales), and mortality data from the Office for National Statistics. We carried out an interrupted time-series analysis of prescribing and deaths (suicide, open verdicts, accidental poisonings) involving single analgesics. The reduction in prescribing of co-proxamol following its withdrawal in 2005 was accompanied by increases in prescribing of several other analgesics (co-codamol, paracetamol, codeine, co-dydramol, tramadol, oxycodone, and morphine) during 2005-2010 compared with 1998-2004. These changes were associated with major reductions in deaths due to poisoning with co-proxamol receiving verdicts of suicide and undetermined cause of -21 deaths (95% CI -34 to -8) per quarter, equating to approximately 500 fewer suicide deaths (-61%) over the 6 years 2005-2010, and -25 deaths (95% CI -38 to -12) per quarter, equating to 600 fewer deaths (-62%) when accidental poisoning deaths were included. There was little observed change in deaths involving other analgesics, apart from an increase in oxycodone poisonings, but numbers were small. Limitations were that the study was based on deaths involving single drugs alone and changes in deaths involving prescribed morphine could not be assessed.
During the 6 years following the withdrawal of co-proxamol in the UK, there was a major reduction in poisoning deaths involving this drug, without apparent significant increase in deaths involving other analgesics.
PLoS Medicine 05/2012; 9(5):e1001213. · 16.27 Impact Factor
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Crisis The Journal of Crisis Intervention and Suicide Prevention 01/2012; 33(3):123-6. · 1.09 Impact Factor
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ABSTRACT: Suicide risk may be elevated in 'medical' occupational groups, although results of studies are inconsistent. National data are required to examine this issue. It is also important to investigate the possible contribution of psychiatric disorder and access to specific suicide methods.
In a nested case-control design we used data from Danish national registers for 1981-2006 to examine risk of suicide in nurses, physicians, dentists, pharmacists and veterinary surgeons compared to teachers and the general population, and associations with psychiatric service contact and suicide methods.
Crude age- and gender-adjusted rate ratios for suicide compared to teachers were significantly elevated in nurses (RR 1.90, 95% CI 1.63-2.21), physicians (RR 1.87, 95% CI 1.55-2.26), dentists (RR 2.10, 95% CI 1.58-2.79) and pharmacists (RR 1.91, 95% CI 1.26-2.87), but not veterinary surgeons. Risk was also elevated in nurses, physicians and dentists compared with the rest of the general population, the relative risk increasing following adjustments for psychiatric service contact, marital status, gross income and labour market status. Results were similar in both genders. The elevated risk in nurses and dentists decreased during the study period. Elevated risks were not associated with greater psychiatric service contact. Medicinal drugs were commonly used for suicide by nurses, physicians and pharmacists.
The study was based in one country.
Risk of suicide is increased in nurses, physicians, dentists and pharmacists in Denmark. This is not reflected in excess psychiatric service contact. Ready access to medicinal drugs may influence risk in nurses, physicians and pharmacists.
Journal of affective disorders 06/2011; 134(1-3):320-6. · 3.76 Impact Factor
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ABSTRACT: In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK.
We used data on general hospital presentations for non-fatal self-harm for 2002-2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings.
There were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36).
The difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant.
BMC Public Health 06/2011; 11:460. · 2.00 Impact Factor
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ABSTRACT: Rates of suicide are elevated among veterinary surgeons in several countries, yet little is known about contributory factors. We have conducted a systematic review of studies investigating suicidal behaviour and psychosocial problems in veterinary surgeons.
A systematic search of the international research literature was performed in May 2008. Data from 52 studies of non-fatal suicidal behaviour, mental health difficulties, stress and burnout, occupational difficulties, and psychological characteristics of veterinary surgeons were extracted by two independent reviewers and analysed. Studies were rated for quality and greater emphasis placed on findings from higher quality studies.
The majority of studies were of stress and occupational difficulties experienced by veterinary surgeons. Occupational stressors included managerial aspects of the job, long working hours, heavy workload, poor work-life balance, difficult client relations, and performing euthanasia. Few studies investigated suicidal behaviour or mental health difficulties in the profession. Some studies suggested that young and female veterinarians are at greatest risk of negative outcomes such as suicidal thoughts, mental health difficulties, and job dissatisfaction.
The review highlights the difficulties faced by veterinary surgeons that may contribute to poor mental wellbeing and suicidal behaviour. Future research might include further examination of the influence of euthanasia on attitudes towards suicide and more direct examination of the impact that occupational risk factors might have on suicidal behaviour. Suggestions about the review's implications for suicide prevention in this group are also made.
Social Psychiatry 12/2010; 47(2):223-40. · 2.05 Impact Factor
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ABSTRACT: To determine whether rates of suicide and self-harm in university students differ from those in other young people.
We obtained information on Oxford University students who died by suicide or presented to hospital following deliberate self-harm (DSH) between 1976 and 2006 from official records and a General Hospital monitoring system in Oxford. Rates of suicide and self-harm in the students and in other young people in the general population were calculated from university, local and national population figures.
Forty-eight Oxford University students (32 males and 16 females) died by suicide. Most (N = 42) were aged 18-25 years. The suicide rate did not differ from that of other people in this age group in England and Wales (SMR 105.4; 95% CI 75.2, 143.4). There was evidence of clustering of methods of suicide over time. During the same period, 602 students (383 females and 219 males) presented to the General Hospital following DSH. Most (90.7%) were aged 15-24 years, in which age group rates of DSH (per 100,000) during term-time were lower than in other young people in Oxford City (females: 206.5 vs. 285.6, z = -5.03, p < 0.001; males: 75.9 vs. 111.2, z = -4.35; p < 0.001). There was an excess of student DSH episodes in the main exam term.
Contrary to earlier findings and popular belief, suicide rates in Oxford University students do not differ from those in other young people. Rates of DSH are significantly lower than in other young people. Risk of DSH may increase around the time of examinations.
Social Psychiatry 11/2010; 47(1):43-51. · 2.05 Impact Factor
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ABSTRACT: Self-poisoning is a common method of suicide and often involves ingestion of antidepressants. Information on the relative toxicity of antidepressants is therefore extremely important.
To assess the relative toxicity of specific tricyclic antidepressants (TCAs), a serotonin and noradrenaline reuptake inhibitor (SNRI), a noradrenergic and specific serotonergic antidepressant (NaSSA), and selective serotonin reuptake inhibitors (SSRIs).
Observational study of prescriptions (UK), poisoning deaths involving single antidepressants receiving coroners' verdicts of suicide or undetermined intent (England and Wales) and non-fatal self-poisoning episodes presenting to six general hospitals (in Oxford, Manchester and Derby) between 2000 and 2006. Calculation of fatal toxicity index based on ratio of rates of deaths to prescriptions, and case fatality based on ratio of rates of deaths to non-fatal self-poisonings.
Fatal toxicity and case fatality indices provided very similar results (rho for relative ranking of indices 0.99). Case fatality rate ratios showed greater toxicity for TCAs (13.8, 95% CI 13.0-14.7) than the SNRI venlafaxine (2.5, 95% CI 2.0-3.1) and the NaSSA mirtazapine (1.9, 95% CI 1.1-2.9), both of which had greater toxicity than the SSRIs (0.5, 95% CI 0.4-0.7). Within the TCAs, compared with amitriptyline both dosulepin (relative toxicity index 2.7) and doxepin (2.6) were more toxic. Within the SSRIs, citalopram had a higher case fatality than the other SSRIs (1.1, 95% CI 0.8-1.4 v. 0.3, 95% CI 0.2-0.4).
There are wide differences in toxicity not only between classes of antidepressants, but also within classes. The findings are relevant to prescribing decisions, especially in individuals at risk, and to regulatory policy.
The British journal of psychiatry: the journal of mental science 05/2010; 196(5):354-8. · 6.62 Impact Factor
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ABSTRACT: Little is known about self-harm in the armed forces.
To investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed.
Investigation of armed forces personnel presenting to hospital between 1989 and 2003 following self-harm and case-control comparison with people in the general population who had self-harmed.
One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide.
Self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.
The British journal of psychiatry: the journal of mental science 04/2009; 194(3):266-72. · 6.62 Impact Factor
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ABSTRACT: Self-poisoning with pesticides is a major reason for high suicide rates in rural areas of many developing countries. Safer storage of pesticides may be one means of prevention. We have conducted a study to assess the acceptability and use of lockable boxes for storing pesticides in rural Sri Lanka.
Four hundred lockable metal storage boxes were given to farming households, 100 in each of four villages. Assessment interviews were conducted by Sumithrayo (NGO) field workers immediately after boxes were supplied (T1), 11 - 14 weeks later (T2), 30 weeks later (T3), and 18 months later (T4). Data on suicide and self-harm were collected from local police and hospitals.
At T1 only 1.8% (7/396) of households reported locking up pesticides, 72.5% (279/385) easy access to pesticides for adults and 50.4% (195/387) easy access for children. At T3 most informants in households using pesticides reported using the box all (82.3%, 298/362) or most of the time (7.2%, 26/362). Informants usually reported always locking the box (92.8%, 336/362) and most boxes were locked on inspection (93.6%, 339/362). By T4 there was some reduction in reporting that the box was kept locked all of the time (75.2%, 267/355) and the box being locked on inspection (73.8%, 262/355). Easy child access to the key was reported in relatively few households (10.7% at T4), although interviewers judged that this was possible in rather more (20.6%). Most informants regarded the box as useful (100% at T3 and 99.4% at T4), with convenience for storage, security, avoiding wastage, and protection of children being major factors. A message on the box about how to deal with bad feelings and the importance of safer storage was well received. The locks had been broken or the key lost in a few households.
Introduction of lockable boxes for storing pesticides to farming households in Sri Lanka appeared to be acceptable. Most households used the boxes responsibly, although there was some decline in the proper usage over time. A large-scale trial of lockable storage devices in farming households in rural areas as a means of prevention of suicide and accidental poisoning is now indicated.
BMC Public Health 03/2009; 9:69. · 2.00 Impact Factor
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ABSTRACT: To assess the effect of the UK Committee on Safety of Medicines' announcement in January 2005 of withdrawal of co-proxamol on analgesic prescribing and poisoning mortality.
Interrupted time series analysis for 1998-2007.
England and Wales.
Prescribing data from the prescription statistics department of the Information Centre for Health and Social Care (England) and the Prescribing Services Unit, Health Solutions Wales (Wales). Mortality data from the Office for National Statistics.
Prescriptions. Deaths from drug poisoning (suicides, open verdicts, accidental poisonings) involving single analgesics.
A steep reduction in prescribing of co-proxamol occurred in the post-intervention period 2005-7, such that number of prescriptions fell by an average of 859 (95% confidence interval 653 to 1065) thousand per quarter, equating to an overall decrease of about 59%. Prescribing of some other analgesics (co-codamol, paracetamol, co-dydramol, and codeine) increased significantly during this time. These changes were associated with a major reduction in deaths involving co-proxamol compared with the expected number of deaths (an estimated 295 fewer suicides and 349 fewer deaths including accidental poisonings), but no statistical evidence for an increase in deaths involving either other analgesics or other drugs.
Major changes in prescribing after the announcement of the withdrawal of co-proxamol have had a marked beneficial effect on poisoning mortality involving this drug, with little evidence of substitution of suicide method related to increased prescribing of other analgesics.
BMJ (Clinical research ed.). 02/2009; 338:b2270.
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ABSTRACT: Suicide by hanging and self-strangulation ('hanging') has become more common. We studied people who presented to hospital during a 28-year study period after using these methods for non-fatal self-harm. Hanging increased greatly in frequency during this time. The male:female ratio was nearly 3:1. Females were distinguished from males by far higher rates of psychiatric care, personality disorder and previous self-harm. Compared with matched individuals who presented with non-fatal self-poisoning, more of those who used hanging had high suicidal intent, fewer used alcohol in association with the act, and more subsequently died by suicide. They represent an important subgroup of those who self-harm, who require especially careful assessment and follow-up.
The British journal of psychiatry: the journal of mental science 01/2009; 193(6):503-4. · 6.62 Impact Factor
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Rachael Lilley,
David Owens,
Judith Horrocks,
Allan House,
Rachael Noble,
Helen Bergen,
Keith Hawton,
Deborah Casey, Sue Simkin,
Elizabeth Murphy,
Jayne Cooper,
Navneet Kapur
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ABSTRACT: Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.
We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.
Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10,498 consecutive episodes of self-harm at six English teaching hospitals.
Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.
Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.
The British Journal of Psychiatry 06/2008; 192(6):440-5. · 6.62 Impact Factor
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Navneet Kapur,
Elizabeth Murphy,
Jayne Cooper,
Helen Bergen,
Keith Hawton, Sue Simkin,
Deborah Casey,
Judith Horrocks,
Rachael Lilley,
Rachael Noble,
David Owens
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ABSTRACT: Psychosocial assessment is central to the management of self-harm, but not all individuals receive an assessment following presentation to hospital. Research exploring the factors associated with assessment and non-assessment is sparse. It is unclear how assessment relates to subsequent outcome.
We identified episodes of self-harm presenting to six hospitals in the UK cities of Oxford, Leeds, and Manchester over an 18-month period (1st March 2000 to 31st August 2001). We used established monitoring systems to investigate: the proportion of episodes resulting in a specialist assessment in each hospital; the factors associated with assessment and non-assessment; the relationship between assessment and repetition of self-harm.
A total of 7344 individuals presented with 10,498 episodes of self-harm during the study period. Overall, 60% of episodes resulted in a specialist psychosocial assessment. Factors associated with an increased likelihood of assessment included age over 55 years, current psychiatric treatment, admission to a medical ward, and ingestion of antidepressants. Factors associated with a decreased likelihood of assessment included unemployment, self-cutting, attending outside normal working hours, and self-discharge. We found no overall association between assessment and self-harm repetition, but there were differences between hospitals--assessments were protective in one hospital but associated with an increased risk of repetition in another.
Some data may have been more likely to be recorded if episodes resulted in a specialist assessment. This was a non-experimental study and so the findings relating specialist assessment to repetition should be interpreted cautiously.
Many people who harm themselves, including potentially vulnerable individuals, do not receive an adequate assessment while at hospital. Staff should be aware of the organizational and clinical factors associated with non-assessment. Identifying the active components of psychosocial assessment may help to inform future interventions for self-harm.
Journal of Affective Disorders 04/2008; 106(3):285-93. · 3.52 Impact Factor
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Keith Hawton,
Helen Bergen,
Deborah Casey, Sue Simkin,
Ben Palmer,
Jayne Cooper,
Nav Kapur,
Judith Horrocks,
Allan House,
Rachael Lilley,
Rachael Noble,
David Owens
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ABSTRACT: Self-harm is a major healthcare problem in the United Kingdom, but monitoring of hospital presentations has largely been done separately in single centres. Multicentre monitoring of self-harm has been established as a result of the National Suicide Prevention Strategy for England.
Data on self-harm presentations to general hospitals in Oxford (one hospital), Manchester (three hospitals) and Leeds (two hospitals), collected through monitoring systems in each centre, were analysed for the 18-month period March 2000 to August 2001.
The findings were based on 7344 persons who presented following 10,498 episodes of self-harm. Gender and age patterns were similar in the three centres, 57.0% of patients being female and two-thirds (62.9%) under 35 years of age. The largest numbers by age groups were 15-19 year-old females and 20-24 year-old males. The female to male ratio decreased with age. Rates of self-harm were higher in Manchester than Oxford or Leeds, in keeping with local suicide rates. The proportion of patients receiving a specialist psychosocial assessment varied between centres and was strongly associated with admission to the general hospital. Approximately 80% of self-harm involved self-poisoning. Overdoses of paracetamol, the most frequent method, were more common in younger age groups, antidepressants in middle age groups, and benzodiazepines and sedatives in older age groups. Alcohol was involved in more than half (54.9%) of assessed episodes. The most common time of presentation to hospital was between 10 pm and 2 am.
Multicentre monitoring of self-harm in England has demonstrated similar overall patterns of self-harm in Oxford, Manchester and Leeds, with some differences reflecting local suicide rates. Diurnal variation in time of presentation to hospital and the need for assessment of non-admitted patients have implications for service provision.
Social Psychiatry and Psychiatric Epidemiology 08/2007; 42(7):513-21. · 2.70 Impact Factor
