Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit

Abstract

Background Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions. Methods A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children’s unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge. Results A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children’s self-harm/suicidality. Conclusions Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.

Staff responses to self‐harm by children and young people in mental health inpatient settings: Experiences and views of children and young people, parents and staff

“…The first theme related to how and when staff should intervene when incidents of self‐harm occur. Participants' accounts suggest that self‐harm by CYP is a common occurrence in mental health inpatient settings, which is consistent with existing research (Kipoulas et al, 2021; Monto et al, 2018). Also consistent with research in this area is the finding that parents and staff find incidents of self‐harm by CYP distressing (Ferrey et al, 2016; Ribeiro Coimbra & Noakes, 2021).…”

“…This has been described as a major public health concern (Glenn and Klonsky, 2013). There is evidence that adolescents from non-clinical populations are at high risk of self-harm (Monto et al, 2018), and that these risks increase further for CYP admitted to mental health inpatient settings (Kipoulas et al, 2021). A recent retrospective review of medical records for 105 children admitted to a mental health inpatient unit found that 66% had reported thoughts of self-harm, and 61% had engaged in self-harm behaviours (Kipoulas et al, 2021).…”

“…There is evidence that adolescents from non-clinical populations are at high risk of self-harm (Monto et al, 2018), and that these risks increase further for CYP admitted to mental health inpatient settings (Kipoulas et al, 2021). A recent retrospective review of medical records for 105 children admitted to a mental health inpatient unit found that 66% had reported thoughts of self-harm, and 61% had engaged in self-harm behaviours (Kipoulas et al, 2021). This is concerning in itself and because repeated selfharm is associated with an increased risk of suicide (Hawton et al, 2015;Morgan et al, 2017).…”

Daily prediction of nonsuicidal self-injury among inpatients: The roles of suicidal thoughts, interpersonal difficulties, hopelessness, and affect.

“…Reviews of the literature suggest a wide range from 1% to 21% of patients may self-injure while in inpatient care, influenced greatly by the clinical profile of patients within a setting (James et al, 2012). More recent research has identified rates of self-harm upward of 60% among young people during inpatient admissions (Kipoulas et al, 2021). While a high-risk population, inpatient settings allow for immediate support from nursing and other clinical staff to intervene and prevent incidents when possible.…”

Adolescent Inpatient Mental Health Admissions: An Exploration of Interpersonal Polyvictimization, Family Dysfunction, Self-Harm and Suicidal Behaviours

“…Self-harm and suicidality are among one of the most common reasons for mental health inpatient admissions [8,13,67]. Children admitted to acute mental health services for self-harm and suicidal behaviours are believed to have greater mental health issues when compared to peers admitted for other reasons [68]. These adolescents also possess more risk factors heightening their vulnerability including low self-esteem, maltreatment and dysfunctional families [8].…”