The Relationship Between Suicide Attempts and Low-Lethal Self-Harm Behavior Among Psychiatric Inpatients

Sansone, Randy A.; Songer, Douglas A.; Sellbom, Martin

doi:10.1097/00131746-200605000-00003

Cited by 29 publications

(23 citation statements)

References 11 publications

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“…Safer [2] reviewed the literature relating to adolescent populations and concluded that there was no convincing overlap between suicide attempts and "deliberate self-harm." In a study of 107 psychiatric inpatients, we confirmed a relationship between a history of suicide attempts and a number of low-lethal selfharm behaviors [3], including a symptom cluster of three medically self-defeating behaviors-that is, the prevention of wounds from healing, the abuse of prescription medications, and the purposeful exercising of an injury. Collectively, these sample studies report inconsistent results regarding whether patients with high-lethal behaviors, such as suicide attempts, engage in other forms of nonsuicidal self-destructive behavior.…”

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confidence: 59%

The relationship between history of overdose and medically self-sabotaging behaviors

Sansone

Wiederman

McLean

2009

Journal of Psychosomatic Research

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confidence: 59%

The relationship between history of overdose and medically self-sabotaging behaviors

Sansone

Wiederman

McLean

2009

Journal of Psychosomatic Research

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“…2,3 Previous research has shown that NSSI is associated with numerous risk factors and correlates, including: SUDs, childhood sexual abuse, MDD, SA, and completed suicide. [4][5][6][7][8] Interestingly, several studies demonstrate an association between NSSI and suicidal behaviour. In a sample of offspring of parents with a DSM-IV mood disorder, Cox et al 5 found in multivariate models that a diagnosis of depression, greater aggression, depressive symptoms, and suicidal ideation were the strongest correlates of NSSI.…”

Section: Limitationsmentioning

confidence: 99%

“…Existing data strongly suggest that SA and suicidal ideation are common among people who engage in NSSI. 4,8,[14][15][16] Teasing apart the unique correlates and risk factors of NSSI and SA has major implications for clinical practice and public health initiatives. Bridging these gaps is important to better inform the study and treatment of self-harm behaviour.…”

Section: Limitationsmentioning

confidence: 99%

Correlates of Nonsuicidal Self-Injury and Suicide Attempts among Tertiary Care, Emergency Department Patients

et al. 2015

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Objective:In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.Methods: Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.Results: NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.Conclusions: NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles. Résultats : L'AMNS était associée de façon plus marquée avec le sexe féminin, les mauvais traitements dans l'enfance, les troubles anxieux, le trouble dépressif majeur W W W Corrélats de l'automutilation non suicidaire et des tentatives de suicide chez les patients des soins tertiaires et des services d'urgence

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“…18 NO. 64 An audit revealed that approximately 20% of inmates are assigned to an ACCT in any given year. Other work has shown that up to one-quarter of women could self-harm during their current term.…”

Section: Initial Sample Size Calculationsmentioning

confidence: 99%

“…The internal consistency was not reported in the initial development work, but it has subsequently been reported as between 0.8 and 0.9. [62][63][64] Additionally, the SHI has been shown to satisfy the requirements of Rasch scaling assumptions among a non-clinical sample. 59 For the analysis, a total score was generated where < 10% of items were missing (i.e.…”

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confidence: 99%

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

Horton

Wright²,

Dyer

et al. 2014

Health Technology Assessment

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BackgroundSelf-harm is common among prisoners, particularly female prisoners. In 2007, concerned about the rising incidence, the prison service introduced a care-planning system called Assessment, Care in Custody, and Teamwork (ACCT). To date, it does not incorporate a standardised diagnostic test to estimate the risk of future self-harm.ObjectiveTo identify potential screening instruments, or items from those instruments, to predict the risk of self-harm among prisoners.ParticipantsPrisoners who had been assigned to an ACCT during the recruitment period.DesignA multistage prospective cohort study. Following a pilot study, instruments were administered to prisoners by interview at baseline, and followed up for 6 months (or until point of release if this was sooner) to ascertain self-harm status. Instruments were assessed for unidimensionality, scalability (Mokken) and quantitative structure (Rasch). Area under the curve (AUC) analysis was used to examine the ability of instruments and/or their items to predict future self-harm. Cox proportional hazards regression models were used to examine the multivariate predictive ability of the scales and various sociodemographic and sentencing factors.SettingThree prisons (including one women’s prison) in northern England.Main outcome measuresA set of standardised questionnaires, including the Prison Screening Questionnaire (PriSnQuest), Revised Borderline Symptom List-23 (frequency-based responses) (BSL-23-F), Self-Harm Inventory (SHI), Patient Health Questionnaire (PHQ-9) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), together with sociodemographic and sentencing data.ResultsIn total, 450 prisoners consented to participate in the study, of whom 26% were female. The mean age of participants was 31.2 years. Over half of male prisoners recruited were on remand, compared with just over one-fifth (22.6%) of female prisoners. The average tariff of those sentenced was 41 months, of which 14.7 months, on average, had been served. Just over one-third of ACCTs had been initiated because of a known self-harm event, and over one-quarter (27.8%) of participants self-harmed during the follow-up period. Thus, almost half (46.7%) of those entered into the study were reported to have self-harmed, either from their index ACCT, or subsequently, or both. Cutting was the most frequent behaviour (51%). All screening instruments showed some evidence of unidimensionality, and four out of five showed scaling criteria consistent with ordinal scaling, so verifying the validity of the cut points. However, many showed gender bias and failure to fit the Rasch measurement model. While a resolution was made in most cases, both ordinal raw scores and latent interval scale estimates failed to show predictive value when applied within AUC analysis (0.491–0.566) or adjusted Cox proportional hazards models. However, good predictive values were shown for gender-specific sets of items, thus providing easily applied screening indexes.ConclusionsWhile four out of five potential screening instruments were found to have acceptable psychometric properties within this setting, their predictive validity of all instruments was poor under AUC analysis. Gender-specific item sets were put together to form two screening indexes with formative indicators which gave reasonable AUC values, particularly so for females. The indexes provide identification of low–medium–high risk of self-harm, and so may help to inform potential care pathways and decisions to sign prisoners off from the ACCT. Future work should concentrate on refining a set of predictive screening items among different offender populations and investigating the time point at which this set of items should be administered. Future work may also look at the different magnitudes of risk as indicators for care pathways.FundingThe National Institute for Health Research Health Technology Assessment programme.

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The Relationship Between Suicide Attempts and Low-Lethal Self-Harm Behavior Among Psychiatric Inpatients

Cited by 29 publications

References 11 publications

The relationship between history of overdose and medically self-sabotaging behaviors

The relationship between history of overdose and medically self-sabotaging behaviors

Correlates of Nonsuicidal Self-Injury and Suicide Attempts among Tertiary Care, Emergency Department Patients

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

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