Deliberate Self-Harm in the Emergency Department

Shahid, Muhammad; Khan, Mohammed M.; Khan, Muhammad Saleem; Jamal, Yasir S.; Badshah, Aaref; Rehmani, Rifat

doi:10.1027/0227-5910.30.2.85

Cited by 19 publications

(16 citation statements)

References 15 publications

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“…This is similar to findings from other recent Sri Lankan and Asian studies [13-16,39] and is in accordance with internationally established patterns of higher rates of attempted suicide and self-harm among females [6,17,40]. This finding is unlikely to be a reflection of the distribution of males and females in the population, given that the 2001 population census for Sri Lanka reports a male:female gender ratio of 0.99:1.…”

Section: Discussionsupporting

confidence: 93%

“…Similar patterns of change have been reported in other countries in the Asian regions such as Pakistan and Vietnam [15,16]. With increasing urbanization, patterns of non-fatal self-poisoning in Sri Lanka and other South Asian countries may be changing to resemble that of developed countries, accompanied by an increasing proportion of attempted suicides among females [13-16]. …”

Section: Introductionsupporting

confidence: 58%

“…However, this gender pattern now appears to be changing in Sri Lanka, with more women being admitted to hospital as a result of the ingestions of medicines and other substances [13,14]. Similar patterns of change have been reported in other countries in the Asian regions such as Pakistan and Vietnam [15,16]. With increasing urbanization, patterns of non-fatal self-poisoning in Sri Lanka and other South Asian countries may be changing to resemble that of developed countries, accompanied by an increasing proportion of attempted suicides among females [13-16].…”

Section: Introductionmentioning

confidence: 78%

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A comparison of non-fatal self-poisoning among males and females, in Sri Lanka

et al. 2014

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BackgroundIn the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity.MethodsPersons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years.ResultsMales were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders.ConclusionsPatterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 78%

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A comparison of non-fatal self-poisoning among males and females, in Sri Lanka

et al. 2014

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“…This appears to signify a trend that has been emerging in the last decade, of an increasing ratio of non-fatal self-poisoning among females compared to males in urban areas, paralleled by an increase of pharmaceutical drug overdoses rather than pesticide self-poisoning in these areas. Other developing countries too have shown similar gender differences of non-fatal self-poisoning in rural compared to urban areas [45,53]. For example, a study undertaken in Hanoi, Vietnam [45] reported a higher female-to-male ratio of non-fatal self-poisoning in urban areas where medicinal overdose is more common, compared to rural areas where pesticides ingestion is more common.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of non-fatal self-poisoning in Sri Lanka: a systematic review

2013

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BackgroundThe rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the published literature for the characteristics and factors associated with non-fatal self-poisoning in Sri Lanka.MethodsElectronic searches were conducted in Psychinfo, Proquest, Medline and Cochrane databases from inception to October 2011.Results26 publications (representing 23 studies) were eligible to be included in the review. A majority of studies reported non-fatal self-poisoning to be more common among males, with a peak age range of 10–30 years. Pesticide ingestion was the most commonly used method of non-fatal self-poisoning. However three studies conducted within the last ten years, in urban areas of the country, reported non-fatal self-poisoning by medicinal overdose to be more common, and also reported non-fatal self-poisoning to be more common among females. Interpersonal conflict was the most commonly reported short-term stressor associated with self-poisoning. Alcohol misuse was reported among males who self-poisoned, and data regarding other psychiatric morbidity was limited.ConclusionsThe findings indicate that pesticide ingestion is the commonest method of non-fatal self-poisoning in Sri Lanka, and it is more common among young males, similar to other Asian countries. However there appears to be an emerging pattern of increasing medicinal overdoses, paralleled by a gender shift towards increased female non-fatal self-poisoning in urban areas.Many non-fatal self-poisoning attempts appear to occur in the context of acute interpersonal stress, with short premeditation, and associated with alcohol misuse in males. Similar to other Asian countries, strategies to reduce non-fatal self-poisoning in Sri Lanka require integrated intervention programs with several key aspects, including culturally appropriate interventions to develop interpersonal skills in young people, community based programs to reduce alcohol misuse, and screening for and specific management of those at high risk of repetition following an attempt of self-poisoning.

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“…Additionally, intentional poisonings are a medicolegal cases, and socially unacceptable in Pakistan. As such, individuals tend to avoid presenting to a hospital for fear of reporting and the social stigma [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project

et al. 2015

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BackgroundAcute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments.MethodsThe data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. Information about patient demographics, type of poisoning agent, reason for poisoning and outcomes were collected using a standard questionnaire.ResultsAcute poisoning contributed to 1.2% (n = 233) of patients with intentional and unintentional injuries presenting to EDs of participating centers. Of these, 68% were male, 54% were aged 19 to 44 and 19% were children and adolescents (<18 years). Types of poisoning included chemical/gas (43.8%), drug/medicine (27%), alcohol (16.7%) and food/plant (6%). In half of all patients the poisoning was intentional. A total of 11.6% of the patients were admitted and 6.6% died.ConclusionPoisoning causes more morbidity and mortality in young adults in Pakistan compared to other age groups, half of which is intentional. Improving mental health, regulatory control for hazardous chemicals and better access to care through poison information centers and emergency departments will potentially help control the problem.

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Deliberate Self-Harm in the Emergency Department

Abstract: Patients who left the ED without psychosocial assessment are at increased risk for repetition of DSH as well as suicide.

Cited by 19 publications

References 15 publications

A comparison of non-fatal self-poisoning among males and females, in Sri Lanka

A comparison of non-fatal self-poisoning among males and females, in Sri Lanka

Characteristics of non-fatal self-poisoning in Sri Lanka: a systematic review

Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project

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