Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality

Franzen, Monika; Keller, Ferdinand; Brown, Rebecca C.; Plener, Paul L.

doi:10.3389/fpsyt.2019.00979

Cited by 15 publications

(19 citation statements)

References 25 publications

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“…The above-mentioned study ( 5 ) deals with patients under 18 years who visited the emergency pediatric department who needed psychiatric evaluation, while in our case a distinct selection was made of NSSI and suicidal behavior in a child and adolescent psychiatric setting. The higher proportion of girls has also been confirmed in other studies on NSSI and suicide attempts in adolescents ( 20 , 59 , 60 ).…”

Section: Discussionsupporting

confidence: 78%

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Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

et al. 2021

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Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

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Section: Discussionsupporting

confidence: 78%

“…psychiatric setting. The higher proportion of girls has also been confirmed in other studies on NSSI and suicide attempts in adolescents (20,59,60). We also interviewed the custodians of our adolescent patients about the psychiatric history of family members.…”

Section: Discussionsupporting

confidence: 70%

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

et al. 2021

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“…Primary indication for psychiatric consultation was suicidal ideation at 39% in another survey from a pediatric emergency department in the USA (35). NSSI led to 36.6% of emergency presentations in a retrospective chart review of a clinic for child and adolescent psychiatry in Germany (33). Suicidal ideation was the most common reason for emergency presentation in our study, accounting for 54.2%.…”

Section: Discussionmentioning

confidence: 53%

“…Overall, 57.8% of the emergency presentations in our clinic were female and the average age of presentations was 15;4 years. With regard to the sex distribution and mean age during the emergency consultation a previous study in Germany (33) revealed approximately similar findings (14.5 years, 56.2% females), whereas a recent study in France (13) which captured a longer time period starting from 1981 found a younger age (13;10 years) and a slightly higher rate of male children and adolescents (aggressive behavior as a frequent reason for presentation is likely to explain the higher proportion of boys).…”

Section: Discussionmentioning

confidence: 99%

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

et al. 2021

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Background: Children and adolescents who present to child and adolescent psychiatric emergency departments show a variety of reasons for their presentations. Suicidality, in particular suicidal thoughts and suicide attempts, as well as non-suicidal self-injury (NSSI) play a large and important role. In this context, inpatient admissions frequently serve as crisis intervention.Methods: In this study, face-to-face emergency presentations to the emergency department at our Clinic of Child and Adolescent Psychiatry (CAP) were analyzed over the years 2014-2018, the 4th quarter (October-December) of each year. Data from 902 emergency presentations were evaluated, primarily with regard to suicidal thoughts, suicide attempts, and NSSI as reasons for presentation.Results: Data demonstrated that the number of emergency presentations increased in general and especially for suicidal thoughts and NSSI as reasons for presentation. In addition, suicidal thoughts, suicide attempts, and NSSI as reasons for emergency presentation were more likely to result in crisis-related inpatient admissions. Furthermore, reporting suicide attempts at emergency presentation was associated with longer inpatient stays. Finally, cases with multiple diagnoses increased independent of the general increase in emergency presentations.Conclusion: The increase of utilization of clinics with CAP outpatient emergency patients and following admissions to the inpatient units for crisis intervention poses a major challenge for the future. It is important to prepare for the assessment and treatment of suicidality, which is of extraordinary importance in the care of emergency patients.

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“…These factors can thus make them more vulnerable to behaviors that intentionally cause harm to their health, such as self-destructive behaviors, 3 which have been responsible for most of the care provided to children and adolescents in emergency services. 4 Non-suicidal self-injury (NSSI) is an action with no conscious intention of suicide, but which can generate serious injuries. This behavior is related to mechanisms of coping with emotions, it is often used to decrease tension or relieve suffering and, generally, it is related to negative interpersonal relationships.…”

Section: Introductionmentioning

confidence: 99%

Autolesão não suicida entre adolescentes: significados para profissionais da educação e da Atenção Básica à Saúde

et al. 2020

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RESUMO Objetivo conhecer as percepções dos profissionais da educação e da saúde acerca da autolesão não suicida em adolescentes. Método pesquisa qualitativa, tendo como referencial teórico o Interacionismo Simbólico. Coleta de dados realizada junto a 20 profissionais de uma escola e de uma Unidade de Saúde da Família de São Carlos-SP, por meio de grupos focais e diário de campo. A análise de dados se deu pela modalidade temática indutiva. Resultados revelou-se que a adolescência ainda é vista como período de transição, e a autolesão emerge como passageira e pela busca por atenção. Reforça-se a banalização, principalmente, pela crença do efeito contágio, em que os adolescentes reproduzem o ato realizado por pares. As relações familiares e com a Internet são sinalizadas como propagadoras do fenômeno. Frente a esses significados, o cuidado é fragilizado, baseado em ações pontuais. Conclusão e implicações para a prática os profissionais agem frente à autolesão na adolescência de acordo com os significados que são construídos por eles. É urgente a necessidade de educação permanente sobre tais questões, o delineamento de ações promotoras de saúde mental no contexto escolar e construção de protocolos para cuidado intersetorial.

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Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality

Cited by 15 publications

References 25 publications

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

Autolesão não suicida entre adolescentes: significados para profissionais da educação e da Atenção Básica à Saúde

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