The involvement of alcohol in hospital-treated self-harm and associated factors: findings from two national registries

Griffin, Eve; Arensman, Ella; Perry, Ivan J.; Bonner, Brendan; O'Hagan, Denise; Daly, Caroline; Corcoran, Paul

doi:10.1093/pubmed/fdx049

Cited by 13 publications

(12 citation statements)

References 15 publications

(29 reference statements)

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“…However, total numbers remained small (men 378, 9%; women 275, 6%). Given that alcohol ingestion associated with self-harm was common at 66% in men and 62% in women – and higher than found in broader self-harm samples 13,28,29 – and the frequency with which alcohol problems are cited as a precipitating factor, improved access to drug, alcohol and dual diagnosis services may be an important area for reducing self-harm in midlife and should be considered when creating care pathways.…”

Section: Discussionmentioning

confidence: 99%

Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

et al. 2019

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BackgroundIn England suicide rates are highest in midlife (defined as age 40–59). Despite a strong link with suicide there has been little focus on self-harm in this age group.AimTo describe characteristics and treatment needs of people in midlife who present to hospital following self-harm.MethodData from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000–2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models.ResultsA quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02–1.12, P < 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00–1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide.ConclusionSelf-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.Declaration of interestK.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.

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Section: Discussionmentioning

confidence: 99%

Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

et al. 2019

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“… Hunter et al, 2013 ; MacDonald et al, 2020 ). However, rates of self-harm are generally higher for women than men in Australia ( Carter et al, 2016 ), New Zealand ( Carter et al., 2016 ; Hatcher et al, 2009 ), England ( Geulayov et al, 2019 ) and the United States ( Finkelstein et al., 2015 ) and are rapidly increasing in a number of Western countries ( Griffin et al, 2018 ; McManus et al., 2019 ; Morgan et al, 2017 ; Perera et al, 2018 ; Westers, 2019 ). Rates of self-harm for some methods such as self-poisoning may also be higher for women compared to men.…”

Section: Discussionmentioning

confidence: 99%

“…Suicide and self-harm repetition risk increases with rising levels of alcohol misuse, particularly among women ( Ness et al, 2015 ). Given the rising prevalence of clinically significant alcohol misuse and the increased risks of further self-harm and suicide for this population, specialist alcohol treatment staff and training of acute staff in hospitals may help to prevent adverse outcomes ( Griffin et al, 2018 ; Ness et al., 2015 ). Psychosocial assessments and collaborative working between services may help to engage this vulnerable group and facilitate access to appropriate aftercare ( Ness et al, 2015 ).…”

Section: Comparisons With Existing Researchmentioning

confidence: 99%

‘Wasn’t offered one, too poorly to ask for one’ – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey

Quinlivan

Gorman

Littlewood

et al. 2021

Aust N Z J Psychiatry

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Objective: Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. Methods: Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. Results: Patients’ reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). Conclusion: Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.

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“…This may reflect the presence of underlying co-morbidities in this group, including substance-related and other psychiatric disorders. The use of alcohol in self-harm has previously been shown to be highest amongst men in Northern Ireland aged 45À54 years [20], a generation who have lived through the period of 'The Troubles' and report a high prevalence of conflict-related post-traumatic stress disorder [21].…”

Section: Discussionmentioning

confidence: 99%

Risk of repetition and subsequent self-harm following presentation to hospital with suicidal ideation: A longitudinal registry study

et al. 2020

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Background: Few studies have focused on those who present to hospital with suicidal thoughts (suicidal ideation). The aim of this study was to establish the risk of repeat presentation to hospital following suicidal ideation and to identify factors which were associated with further ideation or subsequent self-harm. Methods: Data were obtained from the Northern Ireland Registry of Self-harm. Risk of repeat presentation following hospital-presenting ideation was analysed using Kaplan Meier analyses, specifically cox proportional hazard models. Findings: During the period April 2014 to March 2019, a total of 14,695 presentations to hospital due to suicidal ideation were made in Northern Ireland. The cumulative incidence of repeat presentation to hospital was 40¢5% within five years, with an 18¢3% risk of subsequent self-harm. Previous ideation had the strongest association with repeat presentation. There was evidence of recidivism considering further ideation, with an increased risk according to number of previous presentations. In contrast, risk of subsequent self-harm was highest after the first or second presentation. Male gender and alcohol were associated with further ideation, while females and young people were more likely to re-present with self-harm. Interpretation: The findings indicate that individuals who present to hospital with suicidal ideation are at risk of repeat presentation and future self-harm, however clinical guidelines do not specifically address hospitalpresenting ideation. The transition from ideation to suicidal behaviour is important to consider and research could inform effective screening and early intervention measures. Role of Funding: The Northern Ireland Registry of Self-harm is funded by the Public Health Agency, Northern Ireland.

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The involvement of alcohol in hospital-treated self-harm and associated factors: findings from two national registries

Abstract: Background: Alcohol is often involved in hospital-treated self-harm. Therefore it is important

Cited by 13 publications

References 15 publications

Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England

‘Wasn’t offered one, too poorly to ask for one’ – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey

Risk of repetition and subsequent self-harm following presentation to hospital with suicidal ideation: A longitudinal registry study

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