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  • Suicide and Self-Harm by Drowning: A Review of the Literature.

    3 July 2018

    The objectives of this study were to carry out a comprehensive review of the worldwide literature on suicidal behaviour by drowning. Systematic electronic searches of databases using various search terms were carried out. Recent trends in suicide and undetermined deaths due to drowning in England and Wales are described. The characteristics of patients presenting to the general hospital in Oxford, UK following attempted drowning are compared with self-poisoning patients. A total of 20 studies containing empirical data about suicide by drowning were identified, mainly concerning Western countries. Drowning suicides have declined in most countries in recent years. The proportion of undetermined deaths remains high. Drowning suicides and self-harm patients tend to be older, with only a small excess of males compared to those using other methods. This is an under-researched area that deserves good quality studies focusing upon prevention.

  • Self-harm and life problems: findings from the Multicentre Study of Self-harm in England.

    3 July 2018

    PURPOSE: Self-harm is a major clinical problem and is strongly linked to suicide. It is important to understand the problems faced by those who self-harm to design effective clinical services and suicide prevention strategies. We investigated the life problems experienced by patients presenting to general hospitals for self-harm. METHODS: Data for 2000-2010 from the Multicentre Study of Self-harm in England were used to investigate life problems associated with self-harm and their relationship to patient and clinical characteristics, including age, gender, repeat self-harm and employment status. RESULTS: Of 24,598 patients (36,431 assessed episodes), 57% were female and with a mean age of 33.1 years (SD 14.0 years), 92.6% were identified as having at least one contributing life problem. The most frequently reported problems at first episode of self-harm within the study period were relationship difficulties (especially with partners). Mental health issues and problems with alcohol were also very common (especially in those aged 35-54 years, and those who repeated self-harm). Those who repeated self-harm were more likely to report problems with housing, mental health and dealing with the consequences of abuse. CONCLUSIONS: Self-harm usually occurs in the context of multiple life problems. Clinical services for self-harm patients should have access to appropriate care for provision of help for relationship difficulties and problems concerning alcohol and mental health issues. Individualised clinical support (e.g. psychological therapy, interventions for alcohol problems and relationship counselling) for self-harm patients facing these life problems may play a crucial role in suicide prevention.

  • Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England.

    3 July 2018

    BACKGROUND: Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. AIMS: To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. METHOD: Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. RESULTS: Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients. LIMITATIONS: We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. CONCLUSIONS: Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. DECLARATION OF INTEREST: None.

  • Introduction

    3 July 2018

  • The International Handbook of Suicide and Attempted Suicide

    3 July 2018

    © 2000 John Wiley & Sons Ltd. All rights reserved. Recent research in the area of suicidology has provided significant new insights in the epidemiological,psychopathological,and biological characteristics of suicidal behaviour. The International Handbook of Suicide and Attempted Suicide is the first book to bring together this expertise and translate it into practical guidelines for those responsible for policy issues and for those involved in the treatment and prevention of suicidal behaviour. Leading international authorities provide a truly comprehensive and research-based reference to understanding,treating,and preventing suicidal behaviour.They explore concepts and theories which best guide work within this field and detail key research which has supported conceptual developments,preventive interventions and clinical treatment. "No self-respecting worker in deliberate self-harm and suicide prevention, either clinical or research, can afford to be without access to this comprehensive handbook - possession and regular use, may well become a marker of serious involvement in the subject! ...This is the most comprehensive, up-to-date, informative and well-written source of information on sucide and suicidal behaviour...an invaluable work of reference which will be essential for clinicians and researchers for many years to come."

  • Suicidal behavior and self-harm

    3 July 2018

    © 2015 by JohnWiley & Sons, Ltd. All rights reserved. In this chapter we first address the issue of operational definitions of suicidal and self-harm phenomena in research and clinical practice, followed by consideration of the variety of motives and intentions associated with acts of self-harm in young people and a conceptual model of self-harm and suicide. The rates of suicidal behaviors are presented, in conjunction with a summary of research on risk and protective factors. Clinical assessment issues and possible outcomes following an episode of self-harm are described. Treatment options, including psychological interventions and medication, are reviewed, with particular consideration of the issue of engagement in treatment with young people and their families. Finally, we consider factors that influence help-seeking and describe prevention initiatives.

  • Police and Suicide Prevention.

    7 August 2018

    Police officers are frequently the first responders to individuals in crisis, but generally receive little training for this role. We developed and evaluated training in suicide awareness and prevention for frontline rail police in the UK.To investigate the impact of training on officers' suicide prevention attitudes, confidence, and knowledge.Fifty-three participants completed a brief questionnaire before and after undertaking training. In addition, two focus groups were conducted with 10 officers to explore in greater depth their views and experiences of the training program and the perceived impact on practice.Baseline levels of suicide prevention attitudes, confidence, and knowledge were mixed but mostly positive and improved significantly after training. Such improvements were seemingly maintained over time, but there was insufficient power to test this statistically. Feedback on the course was generally excellent, notwithstanding some criticisms and suggestions for improvement.Training in suicide prevention appears to have been well received and to have had a beneficial impact on officers' attitudes, confidence, and knowledge. Further research is needed to assess its longer-term effects on police attitudes, skills, and interactions with suicidal individuals, and to establish its relative effectiveness in the context of multilevel interventions.

  • Why Do Adolescents Self-Harm?

    3 July 2018

    BACKGROUND: Given the high rates of self-harm among adolescents, recent research has focused on a better understanding of the motives for the behavior. AIMS: The present study had three aims: to investigate (a) which motives are most frequently endorsed by adolescents who report self-harm; (b) whether motives reported at baseline predict repetition of self-harm over a 6-month period; and (c) whether self-harm motives differ between boys and girls. METHOD: In all, 987 school pupils aged 14-16 years completed a lifestyle and coping questionnaire at two time points 6 months apart that recorded self-harm and the associated motives. RESULTS: The motive "to get relief from a terrible state of mind" was the most commonly endorsed reason for self-harm (in boys and girls). Interpersonal reasons (e.g., "to frighten someone") were least commonly endorsed. Regression analyses showed that adolescents who endorsed wanting to get relief from a terrible state of mind at baseline were significantly more likely to repeat self-harm at follow-up than those adolescents who did not cite this motive. CONCLUSION: The results highlight the complex nature of self-harm. They have implications for mental health provision in educational settings, especially in relation to encouraging regulation of emotions and help-seeking.

  • Psychiatric assessment and management of deliberate self-poisoning patients

    2 August 2018

    © 2015 Elsevier Ltd. All rights reserved. Deliberate self-poisoning is one of the most common reasons for general hospital presentation. The majority of the individuals involved are young, but it occurs across the life cycle. Females outnumber males. Self-poisoning occurs in people from a variety of social backgrounds, but is associated with socioeconomic deprivation and social fragmentation. Common precipitants include relationship problems, often in the context of depression and alcohol abuse. The risks of repetition of self-harm and of suicide following self-poisoning are substantial. Psychosocial assessment of patients should include investigation of the events and problems preceding the act, suicidal intent and other motives for the act, psychiatric disorder, personality traits and disorder, family and personal history, psychiatric history, including of self-harm, risk of further self-harm and suicide, and coping resources and support. Aftercare should focus on the patient's needs and reducing their risk.