Hopelessness is frequently observed in people who harm themselves and is an established risk factor for nonfatal self-harm repetition and suicide. Little is known about how the presence of hopelessness in addition to other risk factors... more
Hopelessness is frequently observed in people who harm themselves and is an established risk factor for nonfatal self-harm repetition and suicide. Little is known about how the presence of hopelessness in addition to other risk factors affects subsequent risk. Prospective cohort of 19,479 individuals presenting with self-harm to one of three English Emergency Departments between 1st January 2000 and 31st December 2010. Repeat self-harm and suicide deaths within twelve months of the first assessed episode were identified. Cox Proportional Hazards models were used to estimate Hazard Ratios (HRs) for risk factors with and without hopelessness. A clinical impression of hopelessness was associated with increased risk of further self-harm (HR 1.35, 95% CI 1.16-1.58) and suicide (HR 2.56, CI 1.10-5.96) in the year following an index episode. For individuals who were living alone or homeless, unemployed, reported problems with housing, had received psychiatric treatment in the past, were cu...
Research Interests: Emergency Medicine, Psychiatry, Epidemiology, Hope, Adolescent, and 15 moreMedicine, Prospective studies, Humans, Affective Disorders, Female, Male, Hopelessness, Aged, Middle Aged, Adult, Risk Factors, C, Proportional Hazards Models, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Research Interests: Psychology, Psychiatry, Bipolar Disorder, Medicine, Impulsivity, and 15 moreProspective studies, Humans, Affective Disorders, Female, Male, Recurrence, Aged, Great Britain, Middle Aged, Adult, Risk Factors, Case Control Studies, Prospective Cohort Study, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Rates of self-harm appear high in South Asian young women in the United Kingdom (UK) although previous studies were mostly small. Data on treatment and outcomes for South Asians are lacking. This study compared rates of self-harm,... more
Rates of self-harm appear high in South Asian young women in the United Kingdom (UK) although previous studies were mostly small. Data on treatment and outcomes for South Asians are lacking. This study compared rates of self-harm, socio-demographic and clinical characteristics, provision of services and risk of repetition by ethnicity. A prospective cohort of adult self-harm attendees (n = 7185), aged 15 and over presenting to four emergency departments in the cities of Manchester and Salford, UK over a 4-year period. The study included 299 South Asians. South Asian women aged 16-24 years were more likely to self-harm than Whites of the same age group (1010.9 vs. 754 per 100,000). Across all age groups the rates of self-harm were lower in South Asian men compared to White men and to South Asian women. South Asian women were significantly more likely to report relationship problems within the family than White women (32% vs. 19%, P = <0.001). South Asians were less likely than Whites to report depressive symptoms and to be offered specialist mental health services (Rate ratio = 0.75), and more likely to be referred back to the GP (Rate ratio = 1.83). South Asians were less likely to attend with a repeat episode (Rate ratio = 0.56). Young South Asian women are at high risk of self-harm, but their clinical risk appears to be lower in terms of the accepted contextual factors contributing to risk. Potentially useful service provision may include an interpersonal problem solving approach although to be effective, interventions would need to be acceptable to South Asian women and culturally appropriate.
Research Interests: Cognitive Science, Demography, Epidemiology, Health Services Research, Adolescent, and 15 moreEthnicity, England, Humans, Female, Asia, Deliberate Self Harm, Clinical Sciences, Adult, Harm, European Continental Ancestry Group, Asian Continental Ancestry Group, Depressive Symptoms, Emergency Department, Age Groups, and High risk
BackgroundOfficial suicide statistics for England are based on deaths given suicide verdicts and most cases given an open verdict following a coroner's inquest. Previous research indicates that some deaths given accidental verdicts... more
BackgroundOfficial suicide statistics for England are based on deaths given suicide verdicts and most cases given an open verdict following a coroner's inquest. Previous research indicates that some deaths given accidental verdicts are considered to be suicides by clinicians. Changes in coroners' use of different verdicts may bias suicide trend estimates. We investigated whether suicide trends may be over- or underestimated when they are based on deaths given suicide and open verdicts.MethodPossible suicides assessed by 12 English coroners in 1990/91, 1998 and 2005 and assigned open, accident/misadventure or narrative verdicts were rated by three experienced suicide researchers according to the likelihood that they were suicides. Details of all suicide verdicts given by these coroners were also recorded.ResultsIn 1990/91, 72.0% of researcher-defined suicides received a suicide verdict from the coroner, this decreased to 65.4% in 2005 (ptrend < 0.01); equivalent figures fo...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Self-harm (intentional self-poisoning and self-injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors associated with these outcomes. We used data... more
Self-harm (intentional self-poisoning and self-injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors associated with these outcomes. We used data collected in the Multicentre Study of Self-harm in England on all self-harm hospital presentations by individuals aged 10-18 years between 2000 and 2007, and national death information on these individuals to the end of 2010. Cox hazard proportional models were used to identify independent and multivariable predictors of repetition of self-harm and of suicide. Repetition of self-harm occurred in 27.3% of individuals (N = 3920) who presented between 2000 and 2005 and were followed up until 2007. Multivariate analysis showed that repetition was associated with age, self-cutting, and previous self-harm and psychiatric treatment. Of 51 deaths in individuals who presented between 2000 and 2007 and were followed up to 2010 (N = 5133) half (49.0%) were suicides. The method used was usually different to that used for self-harm. Multivariate analysis showed that suicide was associated with male gender [Hazard ratio (HR) = 2.4, 95% CI 1.2-4.8], self-cutting (HR = 2.1, 95% CI 1.1-3.7) and prior psychiatric treatment at initial presentation (HR = 4.2, 95% CI 1.7-10.5). It was also associated with self-cutting and history of psychiatric treatment at the last episode before death, and history of previous self harm. Self-cutting as a method of self-harm in children and adolescents conveys greater risk of suicide (and repetition) than self-poisoning although different methods are usually used for suicide. The findings underline the need for psychosocial assessment in all cases.
Research Interests: Psychology, Cognitive Science, Psychiatry, Injury Prevention, Adolescent, and 15 moreMedicine, England, Prospective studies, Humans, Child, Female, Male, Incidence, Clinical Sciences, Longitudinal Studies, Poison Control, Proportional Hazards Models, Attempted Suicide, hazard ratio, and Age distribution
Research Interests:
Little information is available to inform clinical assessments on risk of self-harm repetition in ethnic minority groups. In a prospective cohort study, using data collected from six hospitals in England for self-harm presentations... more
Little information is available to inform clinical assessments on risk of self-harm repetition in ethnic minority groups. In a prospective cohort study, using data collected from six hospitals in England for self-harm presentations occurring between 2000 and 2007, we investigated risk factors for repeat self-harm in South Asian and Black people in comparison to Whites. During the study period, 751 South Asian, 468 Black and 15,705 White people presented with self-harm in the study centres. Repeat self-harm occurred in 4379 individuals, which included 229 suicides (with eight of these fatalities being in the ethnic minority groups). The risk ratios for repetition in the South Asian and Black groups compared to the White group were 0.6, 95% CI 0.5-0.7 and 0.7, 95% CI 0.5-0.8, respectively. Risk factors for repetition were similar across all three groups, although excess risk versus Whites was seen in Black people presenting with mental health symptoms, and South Asian people reporting alcohol use and not having a partner. Additional modelling of repeat self-harm count data showed that alcohol misuse was especially strongly linked with multiple repetitions in both BME groups. Ethnicity was not recorded in a third of cases which may introduce selection bias. Differences may exist due to cultural diversity within the broad ethnic groups. Known social and psychological features that infer risk were present in South Asian and Black people who repeated self-harm. Clinical assessment in these ethnic groups should ensure recognition and treatment of mental illness and alcohol misuse.
Research Interests: Demography, Medicine, England, Prospective studies, Humans, and 15 moreAffective Disorders, Minority Groups, Female, Male, Repetition, Mental Disorders, Ethnic Minority, Cohort, Harm, Ethnic Group, European Continental Ancestry Group, Asian Continental Ancestry Group, Risk Factors, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Qualitative Research, Risk assessment, Medicine, Attendance, and 15 moreHumans, Needs Assessment, Affective Disorders, Female, Male, Young Adult, Psychosocial, Middle Aged, Adult, Risk Assessment, L, V, attitude to health, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
BackgroundStudies of self-harm in Black and minority ethnic (BME) groups have been restricted to single geographical areas, with few studies of Black people.AimsTo calculate age- and gender-specific rates of self-harm by ethnic group in... more
BackgroundStudies of self-harm in Black and minority ethnic (BME) groups have been restricted to single geographical areas, with few studies of Black people.AimsTo calculate age- and gender-specific rates of self-harm by ethnic group in three cities and compare characteristics and outcomes.MethodA population-based self-harm cohort presenting to five emergency departments in three English cities during 2001 to 2006.ResultsA total of 20 574 individuals (16–64 years) presented with self-harm; ethnicity data were available for 75%. Rates of self-harm were highest in young Black females (16–34 years) in all three cities. Risk of self-harm in young South Asian people varied between cities. Black and minority ethnic groups were less likely to receive a psychiatric assessment and to re-present with self-harm.ConclusionsDespite the increased risk of self-harm in young Black females fewer receive psychiatric care. Our findings have implications for assessment and appropriate management for so...
Research Interests: Demography, Adolescent, England, Humans, Age, and 15 moreBME, Female, Cohort Study, Cohort, Hospital Services, Adult, Harm, Ethnic Group, European Continental Ancestry Group, Asian Continental Ancestry Group, Clinical management, Attempted Suicide, attitude to health, healthcare disparities, and Age distribution
BackgroundSelf-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health... more
BackgroundSelf-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres.AimsTo investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide.MethodData on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007.ResultsRates of self-harm declined significantly over 8 years for males in three centres (Oxford: −14%; Manchester: −25%; Derby: −18%) and females in two centres (Oxford: −2% (not significant); Manchester: −13%; Derby: −17%), in keeping with national trends...
Research Interests:
BackgroundSelf-poisoning is a common method of suicide and often involves ingestion of antidepressants. Information on the relative toxicity of antidepressants is therefore extremely important.AimsTo assess the relative toxicity of... more
BackgroundSelf-poisoning is a common method of suicide and often involves ingestion of antidepressants. Information on the relative toxicity of antidepressants is therefore extremely important.AimsTo 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).MethodObservational 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.ResultsFatal toxicity and case fatality indices provided very...
Research Interests: Mental Health, Suicide, Public Health, Adolescent, Medicine, and 15 moreEngland, Papers, Humans, Child, Social Environment, Aged, Middle Aged, Adult, Poison Control, Psychology and Cognitive Sciences, Medical and Health Sciences, Antidepressive agents, Drug prescriptions, Medical prescription, and DOXEPIN
SummaryStudies of therapeutic contact following self-harm have had mixed results. We carried out a pilot randomised controlled trial comparing an intervention (information leaflet listing sources of help, two telephone calls soon after... more
SummaryStudies of therapeutic contact following self-harm have had mixed results. We carried out a pilot randomised controlled trial comparing an intervention (information leaflet listing sources of help, two telephone calls soon after presentation and a series of letters over 12 months) to usual treatment alone in 66 adults presenting with self-harm to two hospitals. We found that our methodology was feasible, recruitment was challenging and repeat self-harm was more common in those who received the intervention (12-month repetition rate 34.4% v. 12.5%).
Research Interests:
Research Interests:
Research Interests:
Background Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that... more
Background Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring. Methods We carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002–2004) and 194 controls were interviewed by clinicians using a detailed schedule. Results Many of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personalit...
Research Interests: Clinical Psychology, Health Sciences, Epidemiology, Bipolar Disorder, Humans, and 15 moreHungary, Female, Depressive Disorder, Educational Attainment, Clinical Sciences, Adult, Case Control Study, Living Standards, Affective Disorder, Life Change Events, LIFE EVENT, Case Control Studies, BMC, Cause of death, and Antidepressive agents
Research Interests:
Background: Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than... more
Background: Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists. Aims: To compare psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm: comparing assessments carried out by trainee psychiatrists, allocated to the task alongside other duties on a roster, or by mental health nurses with a designated role in self-harm services. Methods: Arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city were compared, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses. Results: Compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help – such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2). Conclusions: Despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.