Deliberate Self Harm and Suicide

1
Deliberate Self Harm and Suicide

• Carolyn Sullivan Dr Ella Arensman National
  Suicide Research Foundation2nd September 2004

2
Attitudes towards suicidal behaviour

• There is a risk of evoking suicidal thoughts in
  a persons mind if you ask about it
• Agree Undecided Disagree

3
Attitudes towards suicidal behaviour

• People who make suicidal threats/attempts
• seldom complete suicide
• Agree Undecided Disagree

4
Attitudes towards suicidal behaviour

• Once a person has suicidal thoughts, he/she will
  always have them
• Agree Undecided Disagree

5
Suicide in Europe by age
Based on most recent WHO/Euro suicide data
available between 1993 and 1997
National Suicide Research Foundation
6
Irish male and female rate of suicide, 1960-2002
National Suicide Research Foundation
7
Irish suicide rate by age, 1998-2002
National Suicide Research Foundation
8
Definition of parasuicide / deliberate self-harm
(DSH)

• Basic features
• Non-fatal outcome
• Deliberately initiated behaviour
• Self-injury or overdose
• Realise changes through the actual or expected
• physical consequences

9
Registry Coverage
North Western North Eastern Western Eastern
Region Northern Area Eastern Region East Coast
Area Eastern Region South Western
Area Midland Mid-Western South Eastern Southern
10 Health Board Regions 38/41 hospitals with AE
depts 12 registry officers (8.4 FTEs)
10
Incidence by age
11
Method of DSH
Men
Women
Alcohol was involved in 46 and 39 of male and
female episodes, respectively
12
Motives associated with DSH

• Escape from an unbearable situation
• Wish to die
• Cry for help
• Making it easier for others
• Self-punishment
• Revenge

13
Factors associated with increased vulnerability

• Biological
• For example, genetically determined receptor
  deficits of the serotonergic system, familial
  psychopathology
• Psychiatric
• For example, early onset psychiatric
  disorder,
• developmental and personality disorder

14
Factors associated with increased vulnerability

• Psychological
• For example, loss of parent or caregiver,
• history of sexual abuse and/or physical
  maltreatment and or emotional neglect
• Socio demographic
• For example, females of young age,
• being single or divorced, or unemployed

15
Factors increasing the risk of DSH and
stressful/traumatic events associated with DSH

• Psychiatric
• For example, mood disorders, anxiety
  disorders,
• substance abuse, in particular alcohol
• Co-morbidity, in particular depression in
  combination with other types of psychopathology
• Stressful or traumatic life events
• For example, cumulation of stressful or
  traumatic life events,
• conflicts or loss, history of suicidal
  behaviour (imitation)

16
Community-based intervention programme for
depression and suicidal behaviourcommunity
intervention study by NSRF 2004-2005

• General public will be addressed by posters,
  information leaflets, public events and internet
  homepage
• Information will be provided to General
  Practitioners, based on specific requests, and
  information will be provided that can be handed
  out to patients
• Other professionals, such as teachers, priests,
  police, and social workers will be informed and
  workshops will be organised
• Persons who engaged in DSH, will receive an
  emergency card guaranteeing direct access to
  professional help in a suicidal crisis.

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Young peoples perspective Based on a self
report survey in Irish schools

• Carolyn Sullivan,1 Paul Corcoran,1 Ella Arensman1
  
• Ivan J Perry 1,2
• 1National Suicide Research Foundation (NSRF)
• 2Depart. of Epidemiology and Public Health

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Background

• There is limited accurate information on the
  extent of deliberate self harm within Ireland.
• National Parasuicide Registry illustrates that
  adolescent girls have the highest rate of
  hospital-treated parasuicide in Ireland (NSRF,
  2003).
• The extent to which Irish adolescents engage in
  self harm that does not result in medical
  attention is not known.

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Objectives

• To describe the lifestyle, coping behaviour,
  psychological profile, attitudes and life
  experiences of Irish adolescents.
• To determine the prevalence of deliberate
  self-harm (DSH) in adolescents aged 15 to 17
  years and the social, behavioural and
  psychological risk and protective factors
  associated with DSH.

20
Methodology
Selection of students from schools in the
Southern Health Board Area
Schools invited to participate (n54)
Representative sample of 39 schools
4, 583 students invited to take part
Response rate85
3,881 students surveyed
702 students not surveyed (opt-out65, absent637)
21
Methodology cont..

• Ethical approval was given by the UCC Clinical
  Research Ethics Committee of the Cork Teaching
  Hospitals
• A self report anonymous questionnaire was
  administered to transition year and 5th year
  students in the class room setting
• The questionnaire included items on personal
  information, lifestyle, coping, problems, alcohol
  and drug use, deliberate self-harm (DSH),
  depression, anxiety, impulsivity and self-esteem.
• Unique quality of the questionnaire was to ask
  respondents to describe the act of DSH. This
  participants description was then coded to the
  studys standard definition of DSH.

22
Young peoples emotional health and wellbeing

• Do young Irish people have good emotional health
  and wellbeing?

23
Young people are emotionally healthy

• Overall, the young people reported a healthy
  lifestyle with generally good emotional health
  and wellbeing.
• 62 ate healthy food often
• 56 take exercise often
• 80 were happy with making and keeping friends
• 62 feel cheerful most of the time
• 75 look forward to things with enjoyment
• 82 are happy with who they are
• 93 said they have a pleasant personality

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Prevalence of deliberate
self-harm

• 333 (9.1, 95CI ) young people reported a
  lifetime history of deliberate self-harm.
• Females (n 253,13.9) were more likely to DSH
  than Males (n 79, 4.4) (Relative Risk 3.2,
  95CI 2.5-4.1).
• Of the 333 who self-harmed
• 20 did so less than a month ago
• 44 did so between a month and a year ago

25
Prevelance of life events and problems in the
previous year
26
Helpseeking

• Who do young people turn to for support?

27
Help seeking behaviour

• of self-harmers whom sought help or talked to
  someone before and after the event
• Only 11.1 (n 36) of young people have been to
  hospital as a result of an overdose or because
  they have harmed themselves.

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What young people say about preventing self-harm

• 6 main themes raised by participants of survey

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Theme 1
Offering young people support
Have a student body set up.
Counsellors and psychologists need to be more
available to everyone.
Just to get someone who is approachable set
up in schools
30
Theme 2
More information needed on topics such as
suicide, depression, drugs, sex etc
Raising awareness
Make the subject of suicide easier to talk
about.
By informing young people that help is out
there.
31
Theme 3
People should be less judgmental towards
young people.
Feeling valued respected
Respect yourself at all Times only you
can feel good about yourself
32
Themes 4 and 5
Pay more attention to teenagers being bullied
at school.
Minimize pressure
Make them feel more at ease and not under
constant pressure.
Reduce bullying
33
Theme 6
There should be places for young people to hang
around. They call the police for simple noise
We have as much right to socialise as they have
to silence
Safe places to go
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Points to consider when working with young people

• A significant minority of young people are
  harming themselves
• Few young people are seeking help from medical
  services after they have harmed themselves
• Young people want more information about positive
  mental health and suicidal behaviour including
  services that are available to help them.
• Young people want to feel valued by their
  community
• Young people are looking for creative and fun
  things to do and somewhere that they can hang out
  
• Young people should be involved in the
  development of programmes and activities that are
  being developed for them.

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• All artwork was done by young people. The artwork
  and photos were sourced from the Reach Out! Rural
  and Regional Tour www.rorrt.reachout.com.au.