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Newell V, Townsend E, Richards C, Cassidy S. Measurement properties of tools used to assess self-harm in autistic and general population adults. Clin Psychol Rev 2024; 109:102412. [PMID: 38503029 DOI: 10.1016/j.cpr.2024.102412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Autistic people are at increased risk of experiencing self-harm compared to the general population. However, it is unclear which tools are being used to assess self-harm in autistic people, or whether existing tools need to be adapted for this group. This two-stage systematic review aimed to identify tools used to assess self-harm in autistic and general population adults, evaluate these tools on their measurement properties, and make recommendations for their appropriate use in research and clinical practice. Four databases were systematically searched (PsycINFO, Embase, MEDLINE and Web of Science). Eight frequently used self-harm assessment tools were identified and assessed for risk of bias, criteria for good measurement properties, and quality of evidence using the COSMIN checklist. Of these, two tools had sufficient evidence of internal consistency (ISAS, QNSSI), and one had been frequently used with autistic adults (NSSI-AT). These three tools may have potential for use with autistic adults but require further investigation for content validity and measurement properties in the autistic population. More research and potential adaptations to current self-harm assessment tools are recommended in order to better conceptualise and understand self-harm and its measurement in autism.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom.
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham B15 2TT, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
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Khan K, Hall CL, Babbage C, Dodzo S, Greenhalgh C, Lucassen M, Merry S, Sayal K, Sprange K, Stasiak K, Tench CR, Townsend E, Stallard P, Hollis C. Precision computerised cognitive behavioural therapy (cCBT) for adolescents with depression: a pilot and feasibility randomised controlled trial protocol for SPARX-UK. Pilot Feasibility Stud 2024; 10:53. [PMID: 38532490 DOI: 10.1186/s40814-024-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND A serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context. AIMS To conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable. METHODS Following consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11-19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8-10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention. DISCUSSION The findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK's health services if delivered en masse. TRIAL REGISTRATION ISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804 .
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Affiliation(s)
- K Khan
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK.
| | - C L Hall
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - C Babbage
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - S Dodzo
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - C Greenhalgh
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - M Lucassen
- School of Health and Psychological Sciences, University of London, London, UK
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - S Merry
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - K Sayal
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - K Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - K Stasiak
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - C R Tench
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Precision Imaging Beacon, Queen's Medical Centre, Nottingham, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - P Stallard
- Department for Health, University of Bath, Bath, UK
| | - C Hollis
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Bird K, Arcelus J, Matsagoura L, O'Shea B, Townsend E. Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon 2024; 10:e26074. [PMID: 38468947 PMCID: PMC10925986 DOI: 10.1016/j.heliyon.2024.e26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention. Methods We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales. Findings Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified. Interpretation This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
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Affiliation(s)
- K. Bird
- School of Psychology, University of Nottingham, Nottingham, UK
| | - J. Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L. Matsagoura
- School of Psychology, University of Nottingham, Nottingham, UK
| | - B.A. O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK
- Department of Psychology, Harvard University, Cambridge, MA, USA
- The Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University, Denmark
| | - E. Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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Dodsworth L, Ahearne G, Dingwall R, Easthope L, Riordan M, Townsend E. The Three Rs of Fear Messaging in a Global Pandemic: Recommendations, Ramifications and Remediation. Clin Psychol Psychother 2024; 31:e2972. [PMID: 38644697 DOI: 10.1002/cpp.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION We consider the UK Independent Scientific Pandemic Insights Group on Behaviours' (SPI-B) support for fear messaging during the global COVID-19 pandemic, evaluate the consequences and make recommendations for the future. ANALYSIS Using evidence from published documents, we show that SPI-B supported the use of fear messaging during the COVID-19 pandemic. This is inconsistent with the extant psychological literature and contrary to the disaster planning literature. The recommendations regarding fear messaging may have had harmful ramifications and impacts, especially for young people. CONCLUSION We recommend that a wider multidisciplinary expertise is employed to deal effectively, ethically and holistically with future crises. Plans for future pandemics must include meaningful engagement with the public, particularly children and young people.
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Affiliation(s)
| | - Gemma Ahearne
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK
| | - Robert Dingwall
- Dingwall Enterprises Ltd, UK
- Nottingham Trent University, Nottingham, UK
| | - Lucy Easthope
- Centre for Death and Society, University of Bath, Bath, UK
| | | | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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Bilello D, Townsend E, Broome MR, Burnett Heyes S. Friendship and self-harm: a retrospective qualitative study of young adults' experiences of supporting a friend who self-harmed during adolescence. Front Psychol 2024; 14:1221661. [PMID: 38370107 PMCID: PMC10869467 DOI: 10.3389/fpsyg.2023.1221661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Self-harm amongst young people is becoming increasingly prevalent. Understanding, responding to, and supporting young people who self-harm is vital. Friends are typically the first and sometimes the only source of support sought by adolescents who self-harm. Despite their important role as confidants, friends' perspectives and experiences remain poorly understood. Methods We conducted retrospective qualitative semi-structured interviews, prompted by an adapted version of the Card Sort Task for Self-Harm (CaTS-FF), about the experiences of nine female young adults (18-20 years old) who supported a friend who self-harmed during adolescence. Data were analyzed using thematic analysis. Results Four themes were developed: (1) "I did not realize my friend was on the road to self-harm": Friends' reactions to self-harm; (2) "That's what friends do": the role of friends; (3) The impact of supporting a friend who self-harms; and (4) "They were quite formative years": reflecting on growth through the experience. Discussion The present findings highlight the complex experiences of young people supporting a friend who self-harms. Despite being willing to take on the role of a supporter, participants experienced a range of difficult emotions and consequences. The temporal transition running through the four themes reflects the evolving nature of participants' attitudes, knowledge, and friendships. Overall, results highlight the unmet needs of adolescents supporting young people who self-harm, as well as identifying potential pathways to "support the supporters" toward resilience.
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Affiliation(s)
- Delfina Bilello
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham, United Kingdom
| | - Matthew R. Broome
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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Williams AJ, Cleare S, Borschmann R, Tench CR, Gross J, Hollis C, Chapman-Nisar A, Naeche N, Townsend E, Slovak P. Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079801. [PMID: 38195171 PMCID: PMC10806609 DOI: 10.1136/bmjopen-2023-079801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Purrble, a socially assistive robot, was codesigned with children to support in situ emotion regulation. Preliminary evidence has found that LGBTQ+ youth are receptive to Purrble and find it to be an acceptable intervention to assist with emotion dysregulation and their experiences of self-harm. The present study is designed to evaluate the impact of access to Purrble among LGBTQ+ youth who have self-harmful thoughts, when compared with waitlist controls. METHODS AND ANALYSIS The study is a single-blind, randomised control trial comparing access to the Purrble robot with waitlist control. A total of 168 LGBTQ+ youth aged 16-25 years with current self-harmful ideation will be recruited, all based within the UK. The primary outcome is emotion dysregulation (Difficulties with Emotion Regulation Scale-8) measured weekly across a 13-week period, including three pre-deployment timepoints. Secondary outcomes include self-harm (Self-Harm Questionnaire), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire-9). We will conduct analyses using linear mixed models to assess primary and secondary hypotheses. Intervention participants will have unlimited access to Purrble over the deployment period, which can be used as much or as little as they like. After all assessments, control participants will receive their Purrble, with all participants keeping the robot after the end of the study. After the study has ended, a subset of participants will be invited to participate in semistructured interviews to explore engagement and appropriation of Purrble, considering the young people's own views of Purrble as an intervention device. ETHICS AND DISSEMINATION Ethical approval was received from King's College London (RESCM-22/23-34570). Findings will be disseminated in peer review open access journals and at academic conferences. TRIAL REGISTRATION NUMBER NCT06025942.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Seonaid Cleare
- Department of Informatics, King's College London, London, UK
- University of Glasgow, Glasgow, UK
| | - Rohan Borschmann
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Oxford, Oxford, UK
| | | | - James Gross
- Stanford University, Stanford, California, USA
| | - Chris Hollis
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | | | | | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Petr Slovak
- Department of Informatics, King's College London, London, UK
- University of Oxford, Oxford, UK
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Murray A, Wadman R, Townsend E. Do young people who self-harm experience cognitions and emotions related to post-traumatic growth? J Affect Disord Rep 2024; 15:100683. [PMID: 38264626 PMCID: PMC10801152 DOI: 10.1016/j.jadr.2023.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024] Open
Abstract
Background Adolescent self-harm is a vast public health concern with self-harm rates increasing each year. Looked-after adolescents are a group at increased risk of self-harm owing to adverse life-events and attachment issues, giving rise to difficulties with problem solving and relationship difficulties (Ogundele, 2020). Whilst research into risk factors of self-harm is plentiful, fewer studies have explored what factors might facilitate self-harm recovery. This paper investigates whether looked-after adolescents with experience of self-harm can experience cognitions and emotions related to post-traumatic growth (PTG). Methods Secondary Data Analysis was conducted on a primary qualitative data set from a study including twenty-four looked-after young people aged between 14 and 21 with experience of self-harm; 20 females and 4 males. An Interpretive Phenomenological Analysis was conducted. Results Five themes were identified, four of which shared similarities to prior research into the recovery of self-harm and manifestations of PTG: 1) Self-Reflection, 2) Communication, 3) Embracing and Appreciating Support, 4) Better Management of feelings. The fifth theme suggested a potential barrier to experiencing PTG; 5) Reliance on Self-Harm. Findings revealed four relevant themes suggesting that individuals who self-harm can indeed experience cognitions and emotions relevant to PTG. Limitations This study utilised a homogeneous sample, limiting the generalisability of the findings to other populations. Perhaps future research should consider other populations of individuals who self-harm. Conclusions We suggest there is a need for interventions for self-harm to focus on protective factors to increase PTG within an individual, potentially moderating the risk of suicide.
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Affiliation(s)
- Alexandra Murray
- School of Psychology, University of Nottingham, NG7 2RD, United Kingdom
| | - Ruth Wadman
- Department of Health Sciences, The University of York, YO10 5DD, United Kingdom
| | - Ellen Townsend
- School of Psychology, University of Nottingham, NG7 2RD, United Kingdom
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Williams AJ, Townsend E, Naeche N, Chapman-Nisar A, Hollis C, Slovak P. Investigating the Feasibility, Acceptability, and Appropriation of a Socially Assistive Robot Among Minority Youth at Risk of Self-Harm: Results of 2 Mixed Methods Pilot Studies. JMIR Form Res 2023; 7:e52336. [PMID: 37991838 PMCID: PMC10701649 DOI: 10.2196/52336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Minority youth are at an increased risk of experiencing self-harmful thoughts and behaviors. However, there is limited evidence of successful interventions to support young people in the moment of their distress. Digital interventions are considered a potential solution for providing in-the-moment support for those at risk of adverse mental health and self-harm. OBJECTIVE These pilot studies aim to investigate the feasibility and acceptability of a new in situ intervention tool, Purrble, among two broad groups of minority youth: (1) lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) youth and (2) racial and ethnic minority youth. Purrble was designed to support in-situ emotion regulation (ER) support when individuals are facing emotionally challenging situations. METHODS This study consisted of 2 mixed methods pilot studies that followed the same mixed methods design, including 3 weeks of daily and weekly surveys and optional follow-up interviews. Inclusion criteria were (1) aged between 16 and 25 years, (2) part of a minority group, (3) had experiences of self-harmful thoughts or behaviors or elevated symptoms of depression or anxiety, and (4) living in the United Kingdom at the time of the study. The primary outcomes were (1) the feasibility of Purrble as an intervention among pilot samples (analyzed by consent rate, retention rate, adherence to surveys, and engagement with the device) and (2) the acceptability and appropriation of Purrble across pilot studies as a tool to support ER in situ (thematically analyzed qualitative open-ended questions and interview data). The secondary outcomes were descriptive pilot data concerning the mental health outcomes in each sample. RESULTS In total, 21 LGBTQ+ young people participated in pilot study 1, with 86% (n=18) completing the baseline and 3 weeks of daily surveys. These young people maintained engagement with Purrble across deployment, across which period there was a decrease in self-harmful thoughts and anxiety symptoms. A total of 19 ethnic and racial minority youths participated in pilot study 2, and 84% (n=16) completed the study. Although pilot study 2 participants also maintained engagement with Purrble across deployment, this was to a lesser degree than participants of pilot study 1, and perceived mental health outcomes did not indicate potential change associated with the device. The thematic analysis indicated three superordinate themes: (1) stopping the self-harm cycle, (2) adopting ER strategies, and (3) stages of change. CONCLUSIONS These were the first pilot studies of a novel intervention that aimed to provide in situ ER support for young people at risk of self-harm. Both quantitative and qualitative findings indicate that young people found Purrble to be a feasible and acceptable intervention, as they effectively incorporated the device into their ER practices. These engagements with Purrble were described as interrupting the cycle of self-harmful ideation and behavior.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, United Kingdom
| | - Ellen Townsend
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Nkem Naeche
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Amelia Chapman-Nisar
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Petr Slovak
- Department of Informatics, King's College London, London, United Kingdom
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Clements C, Farooq B, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Kelly S, Townsend E, Appleby L, Kapur N. Self-harm in university students: A comparative analysis of data from the Multicentre Study of Self-harm in England. J Affect Disord 2023; 335:67-74. [PMID: 37149057 DOI: 10.1016/j.jad.2023.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Increases in poor mental health and suicide have been identified among university students in the UK. However, little is known about self-harm in this group. AIMS To describe and identify care needs of university aged-students who self-harm via comparisons with an age-equivalent non-student group who self-harm. METHODS Observational cohort data from The Multicentre Study of Self-harm in England were used to investigate students aged 18 to 24 years who presented to emergency departments for self-harm, 2003 to 2016. Data were collected via clinician reports and medical records from five hospitals in three English regions. Characteristics, rates, repetition, and mortality outcomes were investigated. RESULTS The student sample included 3491 individuals (983, 28.2 % men; 2507, 71.8 % women; 1 unknown) compared to 7807 (3342, 42.8 % men; 4465, 57.2 % women) non-students. Self-harm increased over time in students (IRR 1.08, 95%CI 1.06-1.10, p < 0.01) but not in non-students (IRR 1.01, 95%CI 1.00-1.02, p = 0.15). There were differences in monthly distribution of self-harm with more presentations by students in October, November, and February. Characteristics were broadly similar, but students reported more problems with studying and mental health. Repetition (HR 0.78, 95%CI 0.71-0.86, p < 0.01) and mortality (HR 0.51, 95%CI 0.33-0.80, p < 0.01) were lower in students than non-students. CONCLUSIONS Self-harm in students may be directly related the student experience, such as academic pressure, relocation, and the transition to independent living. Wellbeing initiatives targeting these factors, alongside mental health awareness training for academic and non-academic staff may help to support students at risk.
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Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Samantha Kelly
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S. A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Mol Autism 2023; 14:12. [PMID: 36922899 PMCID: PMC10018918 DOI: 10.1186/s13229-023-00544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. AIMS To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. RESULTS Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. CONCLUSIONS The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lucy Phillips
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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12
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Patel A, Ness J, Kelly S, Waters K, Townsend E, Kapur N, Clements C, Farooq B, Geulayov G, Casey D, Hawton K. The characteristics, life problems and clinical management of older adults who self-harm: Findings from the multicentre study of self-harm in England. Int J Geriatr Psychiatry 2023; 38:e5895. [PMID: 36840547 DOI: 10.1002/gps.5895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Older adults have a high risk of suicide following self-harm. Contemporary information on self-harm in this population is needed to inform care provision. OBJECTIVES To examine subgroup differences in the incidence of self-harm, sociodemographic and clinical characteristics, preceding life problems and outcomes in individuals aged 60 years and over presenting to hospital following self-harm. METHOD Data on Emergency Department (ED) presentations for self-harm from 2003 to 2016 from three centres in the Multicentre Study of Self-Harm in England were analysed. Changes in self-harm rates were examined using Poisson regression. Univariable logistic regression was used to investigate factors associated with 12-month self-harm repetition. RESULTS There were 3850 presentations for self-harm by 2684 individuals aged 60 years and over. Self-harm rates increased over time for 60-74-year-old men (Incident Rate Ratio = 1.04, 95% Confidence Interval 1.02-1.06, p < 0.0001). Problems most frequently reported to have preceded self-harm were mental health (40.5%) and physical health (38.3%) concerns. Problems with alcohol, finances, employment and relationship with partner were found more frequently in 60-74-year-olds compared with those aged over 74 years. Physical health problems were common with increasing age, as were problems with alcohol for men. One in ten (10.8%) individuals presented to hospital with self-harm within 12 months of their index presentation. CONCLUSIONS Self-harm-related ED attendances in older men have increased, particularly for men aged 60-74 years. Prevention and clinical management should involve a comprehensive psychosocial assessment to target common precipitants for the wide range of problems preceding self-harm and may include support with physical and mental wellbeing and advice on safer alcohol use.
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Affiliation(s)
- Anita Patel
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Samantha Kelly
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, University Park Nottingham, Nottingham, UK
| | - Navneet Kapur
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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13
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Rodgers J, Goodwin J, Nielsen E, Bhattarai N, Heslop P, Kharatikoopaei E, O’Connor RC, Ogundimu E, Ramsay SE, Steele K, Townsend E, Vale L, Walton E, Wilson C, Cassidy S. Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2023; 9:31. [PMID: 36855212 PMCID: PMC9972793 DOI: 10.1186/s40814-023-01264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Suicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools. METHODS This is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also "self-refer" into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio. DISCUSSION The present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments. TRIAL REGISTRATION ISRCTN70594445, Protocol v4: 8/2/22.
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Affiliation(s)
- Jacqui Rodgers
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane Goodwin
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Nielsen
- grid.4563.40000 0004 1936 8868School of Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Nawaraj Bhattarai
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Phil Heslop
- grid.42629.3b0000000121965555Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Ehsan Kharatikoopaei
- grid.8250.f0000 0000 8700 0572Department of Anthropology, Durham University, Durham, UK
| | - Rory C. O’Connor
- grid.8756.c0000 0001 2193 314XSuicidal Behaviour Research Lab, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuel Ogundimu
- grid.8250.f0000 0000 8700 0572Department of Mathematical Sciences, Durham University, Durham, UK
| | - Sheena E. Ramsay
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Katie Steele
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Ellen Townsend
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Luke Vale
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily Walton
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Colin Wilson
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
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14
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Townsend E, Ness J, Waters K, Rehman M, Kapur N, Clements C, Geulayov G, Bale E, Casey D, Hawton K. Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England. Child Adolesc Ment Health 2022; 27:352-360. [PMID: 35042280 PMCID: PMC9786245 DOI: 10.1111/camh.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm, a significant and increasing global problem in children and adolescents, is often repeated and is associated with risk of future suicide. To identify potential interventions, we need to understand the life problems faced by children and adolescents, and by sub-groups of younger people who self-harm. Our aims were to include the following: (a) investigate the type and frequency of life problems in a large sample of children and adolescents who self-harmed. (b) Examine whether problems differ between those who repeat self-harm and those who do not. METHODS We analysed data for 2000 to 2013 (follow up until 2014) from the Multicentre Study of Self-harm in England on individuals aged 11 to 18 years who presented to one of the five study hospitals following self-harm and received a psychosocial assessment including questions about problems, which precipitated self-harm. RESULTS In 5648 patients (12,261 self-harm episodes), (75.5% female, mean age 16.1 years) the most frequently reported problems at first episode of self-harm were family problems. Problems around study/employment/study and relationships with friends also featured prominently. The types of problems that precede self-harm differed between late childhood/early adolescence. Abuse, mental health problems and legal problems significantly predicted repeat self-harm for females. CONCLUSION The most common problems reported by both genders were social/interpersonal in nature, indicating the need for relevant services embedded in the community (e.g. in schools/colleges). Self-harm assessment and treatment choices for children and adolescents must take age and gender into account. To prevent future self-harm, individualised supports and services are particularly needed for abuse, mental health and legal problems.
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Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Muzamal Rehman
- Centre for Self-harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Elizabeth Bale
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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15
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Yasdiman MB, Townsend E, Blackie LER. Examining the protective influence of posttraumatic growth on interpersonal suicide risk factors in a 6-week longitudinal study. Front Psychol 2022; 13:998836. [PMID: 36337476 PMCID: PMC9630643 DOI: 10.3389/fpsyg.2022.998836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Research has found an inverse relationship between posttraumatic growth (PTG) and suicidal ideation in military and community samples that holds when controlling for other suicide risk factors. However, further research is needed into the underlying mechanisms to clarify how PTG protects against the formation of suicidal ideation. The current two-wave longitudinal study examined whether perceiving PTG from recent adverse circumstances while in a national lockdown during the COVID-19 pandemic attenuated the positive relationship of two interpersonal suicide risk factors – perceived burdensomeness (PB) and thwarted belonginess (TB)–over 6 weeks. Participants (n = 170) were recruited online from Prolific from income-deprived areas in the United Kingdom (mean age = 37.65; SD = 12.50; 53.5% female). Post-hoc power analyses indicated we had insufficient power to examine the hypothesised mediation for TB. We examined whether PTG mediated the relationship between PB at wave 1 and wave 2 while controlling for depression and anxiety in a sample of individuals at-risk for suicidal ideation. PTG did significantly and partially mediate the positive relationship between PB at wave 1 and 2. We discuss the theoretical and clinical implications that could result if future research successfully replicates these initial exploratory findings.
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Affiliation(s)
- Meryem Betul Yasdiman
- Personality, Social Psychology and Health Research Group, University of Nottingham, Nottingham, United Kingdom
- Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
- *Correspondence: Meryem Betul Yasdiman,
| | - Ellen Townsend
- Personality, Social Psychology and Health Research Group, University of Nottingham, Nottingham, United Kingdom
- Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Laura E. R. Blackie
- Personality, Social Psychology and Health Research Group, University of Nottingham, Nottingham, United Kingdom
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16
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Moore H, Sayal K, Williams AJ, Townsend E. Investigating the relationship between bullying involvement and self-harmful thoughts and behaviour in young people: A systematic review. J Affect Disord 2022; 315:234-258. [PMID: 35908603 DOI: 10.1016/j.jad.2022.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a complex and inconsistent relationship between bullying involvement and self-harmful thoughts and behaviour (SHTB) in young people. This novel systematic review aims to establish key interacting, moderating and mediating variables associated with SHTB in young people involved in bullying. METHODS The systematic review was registered with PROSPERO: CRD42020192023. A search was conducted (until February 2021) across databases: PubMed/MEDLINE, EMBASE, PsycINFO (Ovid), Cochrane Library, Scopus (Elsevier), Web of Science, ERIC and CINAHL (EBSCOhost). Observational studies containing quantitative primary or secondary data analyses were included in the review, on the basis that they examined interactions, moderators, or mediators between bullying involvement and SHTB in young people. Versions of the Newcastle-Ottawa Scale were used to assess risk of bias in the included studies. RESULTS A total of 57 studies were included. Overall, 3 studies identified interactions, 25 studies identified moderators and 21 studies identified mediators. 9 studies identified moderator-mediators. The findings were categorised as either self-harmful thoughts or self-harmful behaviours and synthesised under the following themes: socio-demographic; depression; parental; personality/psychological; and social/environmental. LIMITATIONS This review uncovered significant heterogeneity and a paucity of replicated studies in the field, therefore, tentative conclusions have been drawn. CONCLUSIONS This comprehensive review highlights the key role of depression as a mediator between traditional/cyber victimisation and SHTB in young people. The moderating effects of gender on mediation models investigating the role of depression suggest the possibility that females involved in bullying may be at increased suicide risk.
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Affiliation(s)
- Hayley Moore
- Self-Harm Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Kapil Sayal
- Institute of Mental Health, School of Medicine, Jubilee Campus, University of Nottingham, Nottingham NG7 2UH, UK
| | - A Jess Williams
- Self-Harm Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, UK; Institute of Mental Health, School of Medicine, Jubilee Campus, University of Nottingham, Nottingham NG7 2UH, UK; Department of Informatics, Strand Campus, King's College London, London WC2B 4BG, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, UK
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17
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Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, Appleby L, Arafat SMY, Arensman E, Ayuso-Mateos JL, Balhara YPS, Bantjes J, Baran A, Behera C, Bertolote J, Borges G, Bray M, Brečić P, Caine E, Calati R, Carli V, Castelpietra G, Chan LF, Chang SS, Colchester D, Coss-Guzmán M, Crompton D, Ćurković M, Dandona R, De Jaegere E, De Leo D, Deisenhammer EA, Dwyer J, Erlangsen A, Faust JS, Fornaro M, Fortune S, Garrett A, Gentile G, Gerstner R, Gilissen R, Gould M, Gupta SK, Hawton K, Holz F, Kamenshchikov I, Kapur N, Kasal A, Khan M, Kirtley OJ, Knipe D, Kõlves K, Kölzer SC, Krivda H, Leske S, Madeddu F, Marshall A, Memon A, Mittendorfer-Rutz E, Nestadt P, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Papsdorf R, Partonen T, Phillips MR, Platt S, Portzky G, Psota G, Qin P, Radeloff D, Reif A, Reif-Leonhard C, Rezaeian M, Román-Vázquez N, Roskar S, Rozanov V, Sara G, Scavacini K, Schneider B, Semenova N, Sinyor M, Tambuzzi S, Townsend E, Ueda M, Wasserman D, Webb RT, Winkler P, Yip PS, Zalsman G, Zoja R, John A, Spittal MJ. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine 2022; 51:101573. [PMID: 35935344 PMCID: PMC9344880 DOI: 10.1016/j.eclinm.2022.101573] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. METHODS We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. FINDINGS We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. INTERPRETATION Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Corresponding author at: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia.
| | - David Gunnell
- National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Jose Bertolote
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Guilherme Borges
- Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Michael Bray
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Petrana Brečić
- Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, United States
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
- Department of Psychiatry, Nimes University Hospital, Nimes, France
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Maria Coss-Guzmán
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - David Crompton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Marko Ćurković
- Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeremy Dwyer
- Coroners Court of Victoria, Melbourne, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Copenhagen, Denmark
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy S. Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
| | - Michele Fornaro
- Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
| | - Sarah Fortune
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
| | - Guendalina Gentile
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rebekka Gerstner
- Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
- Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany
| | - Renske Gilissen
- 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Franziska Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Iurii Kamenshchikov
- Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alexandr Kasal
- National Institute of Mental Health, Klecany, Czechia
- Faculty of Social Sciences, Charles University, Prague, Czechia
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah C. Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hryhorii Krivda
- Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Andrew Marshall
- Brigham and Women's Hospital, Harvard Medical School, MA, United States
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Nestadt
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C. O'Connor
- Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rainer Papsdorf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, United States
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nayda Román-Vázquez
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - Saska Roskar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Vsevolod Rozanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | | | - Barbara Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
- LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Stefano Tambuzzi
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Roger T. Webb
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czechia
| | - Paul S.F. Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Gil Zalsman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Zoja
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Mughal F, Troya MI, Dikomitis L, Tierney S, Corp N, Evans N, Townsend E, Chew-Graham CA. The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis. EClinicalMedicine 2022; 48:101437. [PMID: 35783485 PMCID: PMC9249546 DOI: 10.1016/j.eclinm.2022.101437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12-25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals. FUNDING FM was supported by a NIHR School for Primary Care Research GP Career Progression Fellowship (SCPR-157 2020-20) to undertake this review and is now funded by a NIHR Doctoral Fellowship (NIHR300957). CCG is part-funded by the NIHR Applied Research Collaboration West Midlands.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele ST5 5BG, United Kingdom
- Corresponding author.
| | | | - Lisa Dikomitis
- School of Medicine, Keele University, Keele ST5 5BG, United Kingdom
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Nadia Corp
- School of Medicine, Keele University, Keele ST5 5BG, United Kingdom
| | - Nicola Evans
- School of Medicine, Keele University, Keele ST5 5BG, United Kingdom
| | - Ellen Townsend
- School of Psychology, University of Nottingham, United Kingdom
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Charles A, Hare-Duke L, Nudds H, Franklin D, Llewellyn-Beardsley J, Rennick-Egglestone S, Gust O, Ng F, Evans E, Knox E, Townsend E, Yeo C, Slade M. Typology of content warnings and trigger warnings: Systematic review. PLoS One 2022; 17:e0266722. [PMID: 35507551 PMCID: PMC9067675 DOI: 10.1371/journal.pone.0266722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/25/2022] [Indexed: 11/28/2022] Open
Abstract
Content and trigger warnings give information about the content of material prior to receiving it. Different typologies of content warnings have emerged across multiple sectors, including health, social media, education and entertainment. Benefits arising from their use are contested, with recent empirical evidence from educational sectors suggesting they may raise anxiety and reinforce the centrality of trauma experience to identity, whilst benefits relate to increased individual agency in making informed decisions about engaging with content. Research is hampered by the absence of a shared inter-sectoral typology of warnings. The aims of this systematic review are to develop a typology of content warnings and to identify the contexts in which content warnings are used. The review was pre-registered (ID: CRD42020197687, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197687) and used five sources: electronic databases covering multiple sectors (n = 19); table of contents from multi-sectoral journals (n = 5), traditional and social media websites (n = 53 spanning 36 countries); forward and backward citation tracking; and expert consultation (n = 15). In total, 6,254 documents were reviewed for eligibility and 136 documents from 32 countries were included. These were synthesised to develop the Narrative Experiences Online (NEON) content warning typology, which comprises 14 domains: Violence, Sex, Stigma, Disturbing content, Language, Risky behaviours, Mental health, Death, Parental guidance, Crime, Abuse, Socio-political, Flashing lights and Objects. Ten sectors were identified: Education, Audio-visual industries, Games and Apps, Media studies, Social sciences, Comic books, Social media, Music, Mental health, and Science and Technology. Presentation formats (n = 15) comprised: education materials, film, games, websites, television, books, social media, verbally, print media, apps, radio, music, research, DVD/video and policy document. The NEON content warning typology provides a framework for consistent warning use and specification of key contextual information (sector, presentation format, target audience) in future content warning research, allowing personalisation of content warnings and investigation of global sociopolitical trends over time.
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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Nudds
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- Narrative Experience Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Onni Gust
- Department of History, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Elizabeth Evans
- School of Cultures, Languages, and Area Studies, University of Nottingham, Nottingham, United Kingdom
| | - Emily Knox
- School of Information Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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Kapatais A, Williams AJ, Townsend E. The Mediating Role of Emotion Regulation on Self-harm among Gender Identity and Sexual Orientation Minority (LGBTQ+) Individuals. Arch Suicide Res 2022; 27:165-178. [PMID: 35446245 DOI: 10.1080/13811118.2022.2064254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The present study was conducted to (1) investigate the role of emotion regulation difficulties among self-harming Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning (LGBTQ+) individuals and (2) to test for a mediating role of emotion regulation difficulties in self-harm among LGBTQ + individuals. METHOD This study investigated the relationship between LGBTQ + status, self-reported levels of emotion regulation difficulties, and self-harm in a community sample (N = 484, aged 16-63), using an online cross-sectional survey. RESULTS LGBTQ + individuals reported more emotion regulation difficulties and were almost seven times more likely to self-harm than non-LGBTQ + participants. Being an LGBTQ + participant was associated with greater self-harm frequency when controlling for age, income, and difficulties in emotion regulation. Emotion regulation difficulties mediated the association between LGBTQ + status and both self-harm status and frequency. CONCLUSIONS The present findings suggest that treating emotion regulation difficulties might reduce both the prevalence and lifetime frequency of self-harm episodes among gender identity and sexual orientation minority individuals. Targeting emotion regulation might be used as an early prevention strategy among LGBTQ + individuals who are at risk for self-harm. Further, enhancing emotion regulation skills among self-harming LGBTQ + individuals might replace maladaptive emotion regulation strategies with healthy alternatives, and can, therefore, foster resilience. HIGHLIGHTSLGBTQ + individuals are at high risk for self-harm.ER-mediated the association between LGBTQ + status and self-harm.Targeting emotion regulation in LGBTQ + people may help reduce self-harm.
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Clements C, Farooq B, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Patel A, Townsend E, Appleby L, Kapur N. Self-harm in people experiencing homelessness: investigation of incidence, characteristics and outcomes using data from the Multicentre Study of Self-Harm in England. BJPsych Open 2022; 8:e74. [PMID: 35317881 PMCID: PMC9059614 DOI: 10.1192/bjo.2022.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND People who experience homelessness are thought to be at high risk of suicide, but little is known about self-harm in this population. AIMS To examine characteristics and outcomes in people experiencing homelessness who presented to hospital following self-harm. METHOD Data were collected via specialist assessments and/or hospital patient records from emergency departments in Manchester, Oxford and Derby, UK. Data were collected from 1 January 2000 to 31 December 2016, with mortality follow-up via data linkage with NHS Digital to 31 December 2019. Trend tests estimated change in self-harm over time; descriptive statistics described characteristics associated with self-harm. Twelve-month repetition and long-term mortality were analysed using Cox proportional hazards models and controlled for age and gender. RESULTS There were 4841 self-harm presentations by 3270 people identified as homeless during the study period. Presentations increased after 2010 (IRR = 1.09, 95% CI 1.04-1.14, P < 0.001). People who experienced homelessness were more often men, White, aged under 54 years, with a history of previous self-harm and contact with psychiatric services. Risk of repetition was higher than in domiciled people (HR = 2.05, 95% CI 1.94-2.17, P < 0.001), as were all-cause mortality (HR = 1.45, 95% CI 1.32-1.59. P < 0.001) and mortality due to accidental causes (HR = 2.93, 95% CI 2.41-3.57, P < 0.001). CONCLUSIONS People who self-harm and experience homelessness have more complex needs and worse outcomes than those who are domiciled. Emergency department contact presents an opportunity to engage people experiencing homelessness with mental health, drug and alcohol, medical and housing services, as well as other sources of support.
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Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK; and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; and National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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22
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Yasdiman MB, Townsend E, Blackie LER. Examining the protective function of perceptions of post-traumatic growth against entrapment and suicidal ideation. J Affect Disord 2022; 300:474-480. [PMID: 34979187 DOI: 10.1016/j.jad.2021.12.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/30/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent evidence has found that reporting post-traumatic growth (PTG) from a past stressful life event is associated with lower reports of suicidal ideation. Perceptions of PTG measure the extent to which an individual reports positive changes in their identity, relationships, and worldviews after a stressful event. However, little is known about how perceptions of PTG interact with feelings of defeat and entrapment to influence suicidal ideation. The current study examined this question through the Integrated Motivational-Volitional (IMV) Model of Suicidal Behavior. METHODS 521 adult participants (315 females with age range of 18-82, M = 30.4 years, SD = 13.6) completed an online cross-sectional questionnaire with defeat, entrapment, suicidal ideation, PTG, depression and anxiety measures. Hypotheses and data analysis plans were pre-registered prior to data collection. RESULTS PTG negatively correlated with defeat, entrapment and suicidal ideation. PTG predicted lower suicidal ideation when controlling for entrapment, depression and anxiety. PTG did not moderate the relationship between defeat on entrapment or the relationship between entrapment on suicidal ideation. LIMITATIONS The findings were based on cross-sectional data where participants recalled experiences of defeat, entrapment and suicidal ideation from the past year. The sample was a large community (non-clinical) sample, and most of the participants identified as white (85%). CONCLUSION Although PTG did not function as a moderator within the IMV model of suicidality, it predicted lower suicidal ideation while controlling for other known predictors of suicidal ideation. Future research could explore the function of PTG in appraisal-based models of suicidality.
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Affiliation(s)
- Meryem Betul Yasdiman
- Personality, Social Psychology and Health Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom; Self-harm Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom.
| | - Ellen Townsend
- Personality, Social Psychology and Health Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom; Self-harm Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Laura E R Blackie
- Personality, Social Psychology and Health Research Group, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom
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Williams AJ, Arcelus J, Townsend E, Michail M. Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours. Front Psychiatry 2022; 13:916164. [PMID: 36061288 PMCID: PMC9428709 DOI: 10.3389/fpsyt.2022.916164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16-25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
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Affiliation(s)
- A J Williams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, London, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Geulayov G, Casey D, Bale L, Brand F, Townsend E, Ness J, Rehman M, Waters K, Clements C, Farooq B, Kapur N, Hawton K. Self-harm in children 12 years and younger: characteristics and outcomes based on the Multicentre Study of Self-harm in England. Soc Psychiatry Psychiatr Epidemiol 2022; 57:139-148. [PMID: 34282487 PMCID: PMC8761160 DOI: 10.1007/s00127-021-02133-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very little is known about self-harm in children. We describe the characteristics and outcomes of children under 13 years who presented following self-harm to five hospitals in England. METHODS We included children under 13 years who presented after self-harm to hospitals in the Multicentre Study of Self-harm in England. Information on patients' characteristics and method of self-harm was available through monitoring of self-harm in the hospitals. Area level of socioeconomic deprivation was based on the English Index of Multiple Deprivation (IMD). RESULTS 387 children aged 5-12 years presented to the study hospitals in 2000-2016, 39% of whom were 5-11 years. Boys outnumbered girls 2:1 at 5-10 years. The numbers of boys and girls were similar at age 11, while at 12 years there were 3.8 girls to every boy. The proportion of study children living in neighbourhoods ranked most deprived (43.4%) was twice the national average. 61.5% of children self-poisoned, 50.6% of them by ingesting analgesics. Of children who self-injured, 45.0% self-cut/stabbed, while 28.9% used hanging/asphyxiation. 32% of the children had a repeat hospital presentation for self-harm, 13.5% re-presented within a year. CONCLUSIONS Gender patterns of self-harm until age 11 years are different to those of adolescents, with a male preponderance, especially in 5-10 years, and hanging/suffocation being more common. The frequent use of self-poisoning in this age group highlights the need for public health messages to encourage safer household storage of medicines. Self-harm in children is strongly associated with socioeconomic deprivation; understanding the mechanisms involved could be important in effective prevention.
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Affiliation(s)
- Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
| | - Debbie Casey
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Liz Bale
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK ,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Muzamal Rehman
- Centre for Self-Harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Caroline Clements
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Bushra Farooq
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK ,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK ,Oxford Health NHS Foundation Trust, Oxford, UK
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Lockwood J, Babbage C, Bird K, Thynne I, Barsky A, Clarke DD, Townsend E. A comparison of temporal pathways to self-harm in young people compared to adults: A pilot test of the Card Sort Task for Self-harm online using Indicator Wave Analysis. Front Psychiatry 2022; 13:938003. [PMID: 36713895 PMCID: PMC9878399 DOI: 10.3389/fpsyt.2022.938003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Self-harm is complex, multifaceted, and dynamic, typically starts in adolescence, and is prevalent in young people. A novel research tool (the Card Sort Task for Self-harm; CaTS) offers a systematic approach to understanding this complexity by charting the dynamic interplay between multidimensional factors in the build-up to self-harm. Sequential analysis of CaTS has revealed differences in key factors between the first and the most recent episode of self-harm in adolescence. Rates of self-harm typically decline post-adolescence, but self-harm can continue into adulthood. A comparison between factors linked to self-harm in young people vs. adults will inform an understanding of how risk unfolds over time and clarify age-specific points for intervention. A pilot online adaptation (CaTS-online) and a new method (Indicator Wave Analysis; IWA) were used to assess key factors in the build-up to self-harm. METHODS Community-based young people (n = 66; 18-25 years, M = 21.4; SD = 1.8) and adults (n = 43; 26-57 years, M = 35; SD = 8.8) completed CaTS-online, documenting thoughts, feelings, events, and behaviours over a 6-month timeline for the first ever and most recent self-harm. A notable interdependence between factors and time points was identified using IWA. RESULTS Positive emotion at and immediately after self-harm exceeded the threshold for both groups for both episodes. Feeling better following self-harm was more pronounced for the first-ever episodes. Impulsivity was an important immediate antecedent to self-harm for both groups at both episodes but most markedly for young people. Acquired capability was notable for adults' most recent episodes, suggesting this develops over time. Burdensomeness was only more notable for adults and occurred 1 week prior to a recent episode. Both groups revealed patterns of accessing support that were helpful and unhelpful. CONCLUSION Commonalities and differences in the temporal organisation of factors leading to and following self-harm were identified in young people and adult pathways which shed light on age-specific factors and possible points of intervention. This has implications for clinical support and services around approaches to positive feelings after self-harm (especially for first-ever self-harm), feeling of burdensomeness, impulsivity, and acquired capability leading up to self-harm. Support is provided for card-sort approaches that enable the investigation of the complex and dynamic nature of pathways to self-harm.
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Affiliation(s)
- Joanna Lockwood
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Camilla Babbage
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katherine Bird
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Imogen Thynne
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Andrey Barsky
- School of Computational Biology, University of Birmingham, Birmingham, United Kingdom
| | - David D Clarke
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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Williams AJ, Arcelus J, Townsend E, Michail M. Understanding the processes underlying self-harm ideation and behaviors within LGBTQ+ young people: A qualitative study. Arch Suicide Res 2021; 27:380-396. [PMID: 34806945 DOI: 10.1080/13811118.2021.2003273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to understand the processes underlying self-harmful thoughts and behaviors, with and without suicidal intent, among LGBTQ+ young people. METHOD Nineteen semi-structured interviews took place between October 2019 and May 2020. Participants were aged between 16 and 25 years, had experiences of self-harm ideation and behaviors, and were part of the LGBTQ+ umbrella. A range of sexualities and gender identities were represented: eleven participants were cisgender, six were transgender and two were non-binary. Interviews were transcribed verbatim and anonymised. Thematic analysis and reflective member-checking were used to develop a thematic framework. RESULTS Three themes were developed from the interviews and evaluated by four participants who engaged with reflective member-checking. Findings indicated that internal processes and external responses to being LGBTQ+ resulted in self-harmful thoughts and behaviors. Alongside these, additional stressors related to being a young person were led to difficulties with self-harm. CONCLUSIONS Findings from this study indicate that young people often struggle with accepting their LGBTQ+ identity for a number of reasons, whether this is due to access to a resource or their own feelings about their identity. These negative self-perceptions can be enhanced by poor responses from others and additional life stressors which impact their self-esteem or self-perception.HIGHLIGHTSUnderstanding and accepting that one is LGBTQ+ is not always a simple process, struggling with these thoughts can influence self-harm.Lack of LGBTQ+ terminology hinders self-acceptance and caused young people to engage with self-harm.Peers and family members responses to a young people's LGBTQ+ identity is highly significant and can directly led to self-harmful thoughts and experiences.
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Farooq B, Clements C, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Patel A, Kelly S, Townsend E, Appleby L, Kapur N. Self-harm in children and adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England. Lancet Child Adolesc Health 2021; 5:782-791. [PMID: 34555352 PMCID: PMC9766885 DOI: 10.1016/s2352-4642(21)00239-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes. METHODS In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10-19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10-19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models. FINDINGS Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03-1·11]), South Asian groups (1·05 [1·01-1·09]), and other non-White groups (1·11 [1·06-1·16]) than in White groups (1·02 [1·00-1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small. INTERPRETATION Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured. FUNDING UK Department of Health and Social Care.
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Affiliation(s)
- Bushra Farooq
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Caroline Clements
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Samantha Kelly
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Rojas L, Ergun A, Accorsi A, Sartain C, Raman A, Lieberman R, Valentine E, Wertz M, Townsend E, Wilson G, Plioudakis D, Wallace O, Silver S, Moxham C. APPLICATION OF NEXT GENERATION TECHNOLOGIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pirkis J, John A, Shin S, DelPozo-Banos M, Arya V, Analuisa-Aguilar P, Appleby L, Arensman E, Bantjes J, Baran A, Bertolote JM, Borges G, Brečić P, Caine E, Castelpietra G, Chang SS, Colchester D, Crompton D, Curkovic M, Deisenhammer EA, Du C, Dwyer J, Erlangsen A, Faust JS, Fortune S, Garrett A, George D, Gerstner R, Gilissen R, Gould M, Hawton K, Kanter J, Kapur N, Khan M, Kirtley OJ, Knipe D, Kolves K, Leske S, Marahatta K, Mittendorfer-Rutz E, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Pearson M, Phillips MR, Platt S, Plener PL, Psota G, Qin P, Radeloff D, Rados C, Reif A, Reif-Leonhard C, Rozanov V, Schlang C, Schneider B, Semenova N, Sinyor M, Townsend E, Ueda M, Vijayakumar L, Webb RT, Weerasinghe M, Zalsman G, Gunnell D, Spittal MJ. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 2021; 8:579-588. [PMID: 33862016 PMCID: PMC9188435 DOI: 10.1016/s2215-0366(21)00091-2] [Citation(s) in RCA: 358] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. METHODS We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). FINDINGS We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72-0·91]); Alberta, Canada (0·80 [0·68-0·93]); British Columbia, Canada (0·76 [0·66-0·87]); Chile (0·85 [0·78-0·94]); Leipzig, Germany (0·49 [0·32-0·74]); Japan (0·94 [0·91-0·96]); New Zealand (0·79 [0·68-0·91]); South Korea (0·94 [0·92-0·97]); California, USA (0·90 [0·85-0·95]); Illinois (Cook County), USA (0·79 [0·67-0·93]); Texas (four counties), USA (0·82 [0·68-0·98]); and Ecuador (0·74 [0·67-0·82]). INTERPRETATION This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Ann John
- Swansea University Medical School, Swansea, UK
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, UK
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Warsaw, Poland; Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Jose M Bertolote
- Botucatu Medical School, Universidade Estadual Paulista, São Paulo, Brazil
| | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Petrana Brečić
- Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Psychiatry, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, USA
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy; Department of Medicine, University of Udine, Trieste, Italy
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - David Crompton
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Marko Curkovic
- Department for Medical Ethics, University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eberhard A Deisenhammer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Chengan Du
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy Dwyer
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Coroners Court of Victoria, Melbourne, VIC, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jeremy S Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Boston, MA, USA
| | - Sarah Fortune
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Magistrates Court of Tasmania (Coronial Division), Hobart, TAS, Australia
| | - Devin George
- Bureau of Vital Records and Statistics, Louisiana Office of Public Health, Baton Rouge, LA, USA
| | - Rebekka Gerstner
- Ministry of Public Health, Undersecretary of Health Services, Quito, Ecuador
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Joseph Kanter
- Louisiana Department of Health, Baton Rouge, LA, USA
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Kedar Marahatta
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | | | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C O'Connor
- Suicidal Behaviour Research Lab, University of Glasgow, Glasgow, UK
| | - Melissa Pearson
- Preventing Deaths from Poisoning Research Group, University of Edinburgh, Edinburgh, UK
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Christa Rados
- Department of Psychiatry and Psychotherapeutic Medicine, Landeskrankenhaus Villach, Villach, Austria
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vsevolod Rozanov
- Department of Borderline Disorders and Psychotherapy, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Christiane Schlang
- Department of Psychiatry, Health Authority Frankfurt am Main, Frankfurt, Germany
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Köln, Cologne, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Frankfurt am Main, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russia
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | | | - Roger T Webb
- Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gil Zalsman
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University and Geha Mental Health Center, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, USA
| | - David Gunnell
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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31
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Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Williams AJ, Jones C, Arcelus J, Townsend E, Lazaridou A, Michail M. A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PLoS One 2021; 16:e0245268. [PMID: 33481862 PMCID: PMC7822285 DOI: 10.1371/journal.pone.0245268] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. OBJECTIVES The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. DATA SOURCES MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). STUDY ELIGIBILITY CRITERIA Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years). SYNTHESIS METHODS 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. RESULTS Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. CONCLUSIONS Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A. Jess Williams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Christopher Jones
- School of Psychology, Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Jon Arcelus
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Townsend
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Aikaterini Lazaridou
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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33
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Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of pharmacological agents and/or natural products in the treatment of SH is lacking, especially when compared with the evidence for psychosocial interventions. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of pharmacological interventions for SH in adults. OBJECTIVES To assess the effects of pharmacological agents or natural products for SH compared to comparison types of treatment (e.g. placebo or alternative pharmacological treatment) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE. Ovid Embase and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing pharmacological agents or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment acceptability, treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CI. The overall certainty of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from seven trials with a total of 574 participants. Participants in these trials were predominately female (63.5%) with a mean age of 35.3 years (standard deviation (SD) 3.1 years). It is uncertain if newer generation antidepressants reduce repetition of SH compared to placebo (OR 0.59, 95% CI 0.29 to 1.19; N = 129; k = 2; very low-certainty evidence). There may be a lower rate of SH repetition for antipsychotics (21%) as compared to placebo (75%) (OR 0.09, 95% CI 0.02 to 0.50; N = 30; k = 1; low-certainty evidence). However, there was no evidence of a difference between antipsychotics compared to another comparator drug/dose for repetition of SH (OR 1.51, 95% CI 0.50 to 4.58; N = 53; k = 1; low-certainty evidence). There was also no evidence of a difference for mood stabilisers compared to placebo for repetition of SH (OR 0.99, 95% CI 0.33 to 2.95; N = 167; k = 1; very low-certainty evidence), or for natural products compared to placebo for repetition of SH (OR 1.33, 95% CI 0.38 to 4.62; N = 49; k = 1; lo- certainty) evidence. AUTHORS' CONCLUSIONS Given the low or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding pharmacological interventions in patients who engage in SH. More and larger trials of pharmacotherapy are required, preferably using newer agents. These might include evaluation of newer atypical antipsychotics. Further work should also include evaluation of adverse effects of pharmacological agents. Other research could include evaluation of combined pharmacotherapy and psychological treatment.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Cassidy SA, Gould K, Townsend E, Pelton M, Robertson AE, Rodgers J. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord 2020; 50:3638-3648. [PMID: 31820344 PMCID: PMC7502035 DOI: 10.1007/s10803-019-04323-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.
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Affiliation(s)
- S A Cassidy
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK. .,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - K Gould
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - M Pelton
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - A E Robertson
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - J Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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35
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Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK.
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36
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Abstract
The COVID-19 pandemic lockdown response has had a disproportionate and damaging effect on the lives, mental health and well-being of young people globally. They have been neglected in policy-making and their needs have been subjugated to those of adults which contravenes the UN Convention on the Rights of the Child. Here, I argue that the needs and rights of young people must come first to protect their health, mental health and futures. If we do not do this, we will let down a generation of children who will bear the brunt of the fallout of the economic burden of the global COVID-19 crisis.
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Affiliation(s)
- Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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37
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Robertson L, Aboaja A, Walker DM, Vostanis P, Witt KG, Chakrabarti I, Perry AE, Townsend E. Interventions for mood, anxiety disorders or self-harm in young offenders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation Trust; Middlesbrough UK
| | | | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour; University of Leicester; Leicester UK
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | | | - Amanda E Perry
- Department of Health Sciences; University of York; York UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
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38
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Hanna ES, Dingwall R, McCartney M, West R, Townsend E, Cassell J, Martin G. Sociocultural reflections on face coverings must not ignore the negative consequences. BMJ 2020; 371:m3782. [PMID: 33004352 DOI: 10.1136/bmj.m3782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | | | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | | | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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39
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Cassidy SA, Robertson A, Townsend E, O'Connor RC, Rodgers J. Advancing Our Understanding of Self-harm, Suicidal Thoughts and Behaviours in Autism. J Autism Dev Disord 2020; 50:3445-3449. [PMID: 32880789 DOI: 10.1007/s10803-020-04643-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah A Cassidy
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Ashley Robertson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.,School of Psychology, University of Glasgow, Glasgow, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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40
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Schofield C, Evans K, Young H, Paguinto SG, Carroll K, Townsend E, Kiefer M, McGuire M, Sodhi J, Bray P, Bayley K, Vorster NM, Downs J. The development of a consensus statement for the prescription of powered wheelchair standing devices in Duchenne muscular dystrophy. Disabil Rehabil 2020; 44:1889-1897. [DOI: 10.1080/09638288.2020.1810786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Schofield
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - H. Young
- The Children’s Hospital at Westmead, Westmead, Australia
| | | | - K. Carroll
- The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - E. Townsend
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. Kiefer
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. McGuire
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - J. Sodhi
- Institute of Genetic Medicine, International Centre for Life, John Walton Muscular Dystrophy Research Centre, Newcastle Upon Tyne, UK
| | - P. Bray
- The Children’s Hospital at Westmead, Westmead, Australia
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - K. Bayley
- Centre for Community-Driven Research, Perth, Australia
| | - N. M. Vorster
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - J. Downs
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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41
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Holland J, Sayal K, Berry A, Sawyer C, Majumder P, Vostanis P, Armstrong M, Harroe C, Clarke D, Townsend E. What do young people who self-harm find helpful? A comparative study of young people with and without experience of being looked after in care. Child Adolesc Ment Health 2020; 25:157-164. [PMID: 32542877 DOI: 10.1111/camh.12384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm amongst young people is an increasing problem, with looked-after young people at higher risk. Despite this, little research exists on what young people who self-harm find helpful. METHOD One hundred and twenty-six 11-21 year olds (53 who had experience of the care system and 73 who did not) were recruited from the community and NHS. All participants had self-harmed in the past 6 months. Participants completed an Audio Computer-Assisted Self-interview (ACASI) regarding their views about the support they had received, how helpful it was, and what further help they felt they needed. RESULTS Looked-after young people reported the three most helpful sources of support were Child and Adolescent Mental Health Services (CAMHS), friends and pets and the least helpful were CAMHS, Accident and Emergency (A&E) and Social services. For non-looked-after young people, CAMHS, counselling and Harmless (user-led support service for self-harm) were most helpful and CAMHS, cognitive behavioural therapy (CBT) and general practitioner (GP) were the least. Compared with the other group, more looked-after young people had received help from A&E and CAMHS, whereas more non-looked-after young people had accessed GPs, parents, psychological therapies, self-help books and websites. More looked-after young people found support groups helpful, and more non-looked-after young people reported that distraction techniques, medication and their siblings were helpful. CONCLUSION Young people who self-harm have mixed views about CAMHS. Differences in the pattern of access and preferences for support between looked-after and non-looked-after young people should be reflected in service availability and commissioning. KEY PRACTITIONER MESSAGE Little is known about what young people who self-harm find helpful, particularly for looked-after young people. CAMHS was named amongst the most helpful and the least helpful services by both looked-after and non-looked-after young people. Social services and A&E were frequently cited amongst the least helpful sources of support. Young people report finding informal support helpful, including family and friends. There appears to be a need for explorations of the reasons behind the apparent negative perception of statutory services in young people, and what is required to shift that.
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Affiliation(s)
- Josephine Holland
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Alexandra Berry
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Chelsea Sawyer
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Pallab Majumder
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Marie Armstrong
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - David Clarke
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
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Lockwood J, Townsend E, Daley D, Sayal K. Impulsivity as a predictor of self-harm onset and maintenance in young adolescents: a longitudinal prospective study. J Affect Disord 2020; 274:583-592. [PMID: 32663991 DOI: 10.1016/j.jad.2020.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/30/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rates of self-harm in young adolescents are increasing and self-harm typically emerges at this developmental stage. Greater specificity of impulsivity as a multifaceted construct is enabling investigation of links between individual impulsivity facets and self-harm outcomes. However, studies have yet to adequately explore these associations in young adolescents, and prospective relationships between multidimensional impulsivity and self-harm in younger adolescents remain untested. This study investigates unidimensional facets of impulsivity as risk-factors for the emergence and maintenance of self-harm, specifically within young community-based adolescents. METHODS A school-based sample of 594 adolescents (aged 13-15 years) provided data at two time points, 12 weeks apart. Logistic regression analyses determined associations between impulsivity-related facets (as delineated by the UPPS-P scale) and self-harm outcomes over time. RESULTS Overall, 23.6% of young people reported lifetime self-harm. A higher tendency towards Sensation Seeking was associated with self-harm onset over the study-period (OR 1.19, 95% CI 1.017-1.401). Deficits in Premeditation predicted maintained (versus remitted) self-harm behaviour during this time (OR 1.16, 95% CI 1.013-1.328). Negative Urgency was a significant cross-sectional correlate, but did not offer prospective predictive utility. LIMITATIONS The study relied on self-report. Interpretations are cautious given low incidence of self-harm outcomes over the course of the study. CONCLUSIONS Separate pathways to impulsive behaviour describe the psychological context in which self-harm starts and develops in young people. Findings support differential treatment targets and developmentally-focused early intervention. The predictive utility of impulsivity was inconsistent between cross-sectional and longitudinal analyses, underlining the role for temporality in the establishment of risk of self-harm.
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Affiliation(s)
- Joanna Lockwood
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK.
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
| | - David Daley
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
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Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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Wadman R, Nielsen E, O'Raw L, Brown K, Williams AJ, Sayal K, Townsend E. "These Things Don't Work." Young People's Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach. Arch Suicide Res 2020; 24:384-401. [PMID: 31322056 DOI: 10.1080/13811118.2019.1624669] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although UK clinical guidelines make tentative recommendations for "harm minimization" strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people's views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N = 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N = 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.
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Clements C, Hawton K, Geulayov G, Waters K, Ness J, Rehman M, Townsend E, Appleby L, Kapur N. Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England - ADDENDUM. Br J Psychiatry 2020; 216:286. [PMID: 31771667 DOI: 10.1192/bjp.2019.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hawton K, Bale L, Brand F, Townsend E, Ness J, Waters K, Clements C, Kapur N, Geulayov G. Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study. Lancet Child Adolesc Health 2020; 4:111-120. [PMID: 31926769 DOI: 10.1016/s2352-4642(19)30373-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Self-harm and suicide in children and adolescents are growing problems, and self-harm is associated with a significant risk of subsequent death, particularly suicide. Long-term follow-up studies are necessary to examine the extent and nature of this association. METHODS For this prospective observational cohort study, we used data from the Multicentre Study of Self-harm in England for all individuals aged 10-18 years who presented to the emergency department of five study hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Deaths were identified through the Office for National Statistics via linkage with data from NHS Digital up until Dec 31, 2015. The key outcomes were mortality after presentation to hospital for self-harm, categorised into suicide, accidental deaths, and death by other causes. We calculated incidence of suicide since first hospital presentation for self-harm and used Cox proportional hazard models to estimate the associations between risk factors (sex, age, previous self-harm) and suicide. FINDINGS Between Jan 1, 2000, and Dec 31, 2013, 9303 individuals aged 10-18 years presented to the study hospitals. 130 individuals were excluded because they could not be traced on the national mortality register or had missing data on sex or age, thus the resulting study sample consisted of 9173 individuals who had 13 175 presentations for self-harm. By the end of the follow-up on Dec 31, 2015, 124 (1%) of 9173 individuals had died. 55 (44%) of 124 deaths were suicides, 27 (22%) accidental, and 42 (34%) due to other causes. Of the 9173 individuals who presented for self-harm, 55 (0·6%) died by suicide. Most suicide deaths involved self-injury (45 [82%] of 55 deaths). Switching of method between self-harm and suicide was common, especially from self-poisoning to hanging or asphyxiation. The 12-month incidence of suicide in this cohort was more than 30 times higher than the expected rate in the general population of individuals aged 10-18 years in England (standardised mortality ratio 31·0, 95% CI 15·5-61·9). 42 (76%) of 55 suicides occurred after age 18 years and the annual incidence remained similar during more than 10 years of follow-up. Increased suicide risk was associated with male sex (adjusted hazard ratio 2·50, 95% CI 1·46-4·26), being an older adolescent at presentation to hospital for self-harm (1·82, 0·93-3·54), use of self-injury for self-harm (2·11, 1·17-3·81; especially hanging or asphyxiation [4·90, 1·47-16·39]), and repeated self-harm (1·87, 1·10-3·20). Accidental poisoning deaths were especially frequent among males compared with females (odds ratio 6·81, 95% CI 2·09-22·15). INTERPRETATION Children and adolescents who self-harm have a considerable risk of future suicide, especially males, older adolescents, and those who repeated self-harm. Risk might persist over several years. Switching of method from self-harm to suicide was common, usually from self-poisoning to self-injury (especially hanging or asphyxiation). Self-harm is also associated with risk of death from accidental poisoning, particularly involving drugs of abuse, especially in young males. FUNDING UK Department of Health and Social Care.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Liz Bale
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ellen Townsend
- School of Psychology, Faculty of Science, Nottingham University, Nottingham, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Caroline Clements
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Witt K, Townsend E, Arensman E, Gunnell D, Hazell P, Taylor Salisbury T, Van Heeringen K, Hawton K. Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness. Arch Suicide Res 2020; 24:S32-S93. [PMID: 30955501 DOI: 10.1080/13811118.2019.1592043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.
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Abstract
INTRODUCTION Young people who identify as Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQ+) are at increased risk for self-harm, suicide ideation and behaviours. However, there has yet to be a comprehensive understanding of what risk factors influence these behaviours within LGBTQ+ young people as a whole. The purpose of this systematic review is to examine risk factors associated with self-harm, suicidal ideation and behaviour in LGBTQ+) young people. METHODS AND ANALYSIS A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (MEDLINE, Scopus, EMBASE, PsycINFO and Web of Science) will be systematically searched for cross-sectional, prospective, longitudinal, cohort and case-control designs which examine risk factors for self-harm and/or suicidal ideation and behaviour in LGBTQ+ young people (aged 12-25 years). Only studies published in English will be included. No date restrictions will be applied. Study quality assessment will be conducted using the original and modified Newcastle-Ottawa Scales. Meta-analysis or narrative synthesis will be used, dependent on findings. ETHICS AND DISSEMINATION This is a systematic review of published literature and thereby ethical approval was not sought. The review will be submitted to a peer-reviewed journal, be publicly disseminated at conferences focusing on mental health, self-harm and suicide prevention. The findings will also be shared through public engagement and involvement, particularly those related to young LGBTQ+ individuals. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A Jess Williams
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Self-Harm Research Group, University of Nottingham, Nottingham, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Townsend
- Self-Harm Research Group, University of Nottingham, Nottingham, UK
| | - Maria Michail
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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