Article

"Near-fatal" deliberate self-harm: Characteristics, prevention and implications for the prevention of suicide

Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, UK.
Journal of Affective Disorders (Impact Factor: 3.38). 05/2004; 79(1-3):263-8. DOI: 10.1016/S0165-0327(02)00391-9
Source: PubMed

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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    • "Similarly, most of the patients claimed that they " wanted to die " (item 9). Brown et al. (2004) also reported that the expectation to die was high for all three levels of lethality examined (see also Douglas et al., 2004). The second suicide-attempt profile is characterized by communication difficulties of the subject, with limited selfdisclosure ability and poor social relationships, poor social support, and loneliness. "

    Full-text · Article · Jan 2012 · The Israel journal of psychiatry and related sciences
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    • "Similarly, most of the patients claimed that they " wanted to die " (item 9). Brown et al. (2004) also reported that the expectation to die was high for all three levels of lethality examined (see also Douglas et al., 2004). The second suicide-attempt profile is characterized by communication difficulties of the subject, with limited selfdisclosure ability and poor social relationships, poor social support, and loneliness. "
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    ABSTRACT: The study of near-fatal suicide attempts may provide insight into the minds of suicidal subjects. The aim of the study was to investigate the relationship of intent and lethality in medically serious and medically non-serious suicide attempts and to examine relationship of specific psychological and clinical variables with the subjective and objective components of suicide intent. The study group included 102 participants, 35 consecutive subjects hospitalized for a medically serious suicide attempt and 67 subjects who presented to the same tertiary medical center after a medically non-serious suicide attempt. All were interviewed with the SCID-I and completed the Suicide Intent Scale (SIS), the Lethality Rating Scale, and instruments measuring mental pain and communication difficulties. Patients who made medically serious suicide attempts had higher total SIS score and higher objective and subjective subscale scores. The objective component of the SIS was highly correlated with the lethality of the suicide attempt and communication difficulties; the subjective component was associated with mental pain variables. The interaction of mental pain and communication difficulties was predictive of the severity of the objective suicide intent. Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. Suicidal individuals with depression and hopelessness who cannot signal their pain to others are at high risk of committing a medically serious suicide attempts.
    Full-text · Article · Dec 2011 · Journal of Affective Disorders
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    • "Also, although self-harm and attempted suicide have previously been used as proxies for suicide (Marzano, Rivlin, Fazel, & Hawton, 2009), there is evidence that physically dangerous and medically severe self-harm acts provide a better approximation of actual suicide than other forms of self-harming behaviour or suicide attempts more generally. Medically serious suicide attempters are epidemiologically very similar to individuals who die by suicide (Douglas et al., 2004; Moscicki, 1995), and twice as likely as other suicide attempters to kill themselves (Rosen, 1976). As means to self-harm are restricted in prison and therefore fatal and near-fatal injuries are more likely to result from behaviour that had not been motivated by suicidal intentions, individuals who have been involved in a 'near-lethal' act (based on severity of method and/or injuries) provide a useful focus for analysis (Marzano, Rivlin et al., 2009). "
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    ABSTRACT: We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in women's prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations.
    Full-text · Article · Feb 2011 · Social Science [?] Medicine
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