• A comparison of homicide-suicide and domestic homicide in the region of basle, Switzerland

      Vollm, Birgit A. (2011)
      Background Homicide-suicide and domestic homicide without consecutive suicide might be regarded as an extreme form of domestic violence. According to the national crime-register, however, there might be some relevant differences between the perpetrators of the two. Method The files of all cases of homicide-suicide (n=24) and of all cases of domestic homicide without suicide (n=21), which had been examined at the Institute of forensic medicine in Basle between 1987 und 2006, were compared. Results Perpetrators of domestic homicide without suicide were significantly younger, had a poorer educational background and were rather foreigners. About two thirds of the perpetrators of homicide-suicide used a gun compared with only one third of those committing domestic homicide. Discussion Measures as they are known from suicide prevention programmes like limiting the access to lethal instruments like guns might be useful in the case of homicide-suicide, measures for the prevention of domestic homicide should aim at better integration and education of the perpetrators and their family. © Georg Thieme Verlag KG Stuttgart New York.
    • A descriptive study of feelings of arrested escape (entrapment) and arrested anger in people presenting to an emergency department following an episode of self-harm

      Clarke, Martin (2016)
      Background and objectives: To explore the role of elevated feelings of anger and desires to escape (fight/flight), which are experienced as inhibited, blocked, and arrested (i.e., arrested anger and arrested flight/escape leading to feelings of entrapment). This descriptive study developed measures of arrested anger and arrested flight and explored these in the context of a recent self-harm event in people presenting to a Hospital's Emergency Department (ED). Methods: Fifty-eight individuals presenting to an ED following an act of self-harm were recruited. Participants completed newly developed measures of arrested flight, arrested anger and anger with self in regard to self-harm, and suicide intent and depression. Results: Ninety-three percent of participants presented after self-poisoning. The majority (95%) reported having experienced high escape motivation that felt blocked (arrested flight) with 69% reporting feeling angry with someone but unable to express it (arrested anger). For many participants (53.7%), strong desires to escape from current situations and/or to express anger did not diminish immediately after the act. Limitations: As with many studies, a select group of participants agreed to take part and we did not keep records of how many refused. There are no other validated measures of arrested escape and arrested anger and so for this study, our short item-focused measures rely on face validity. Conclusion: Arrested defenses of fight and flight, and self-criticism are common in those who have self-harmed and may continue after acts of self-harm. Many participants revealed that talking about their experiences of escape motivation and blocked anger (using our measures) was helpful to them. Practice points: • Feelings of entrapment and arrested anger are common in people who self-harm • Clinicians could benefit from increased awareness and measures of arrested flight and arrested anger • Discussing these concepts and experiences appears to be useful to people who have self-harmed • Further research is needed on how best to help people with such experiences. © 2016 Clarke, McEwan, Ness, Waters, Basran and Gilbert.
    • An evaluation of the staff training within the trauma and self injury (TASI) programme in the National High Secure Healthcare Service for Women (NHSHSW)

      Elcock, Sue; Milburn, Christine; Annesley, Phyllis; Jones, Jane; Vollm, Birgit A. (2013)
      Purpose - Patients in the National High Secure Healthcare Service for Women have a high prevalence of trauma and self injury This highlights the need for specialised training of staff dealing with such women. The aim of this study was to evaluate the trauma and self injury (TASI) training programme on staff knowledge and skills. Design/methodology/approach - A total of 135 nurses and nursing assistants participated in the TASI two-day training course. Questionnaires allowing for quantitative and qualitative data collection were completed before and after the training. Training and confidence levels in dealing with women who self-harm prior to the training were identified and the impact of the programme was assessed. Findings - The majority of staff had not received any previous training on trauma and self injury There was an increased level of confidence in working with trauma and self injury following training and staff reported an increased ability to ask for support. Self-perceived competence improved to a greater extent in those who had not received previous training compared to those who had. Research limitations/implications - The authors' data is limited to self-report. Future research should use objective measures to evaluate the impact of staff training. Practical implications A relatively short training programme focusing on trauma and self injury appears to improve staff confidence, understanding and competence in working with women patients in a high secure setting. Similar training programmes might also be beneficial in different patient groups with complex backgrounds and behaviours. Originality/value - This is the first report on a training programme focussing on women in high secure care who self-harm and have experienced trauma.
    • An interpretative phenomenological analysis of the experience of self-harm repetition and recovery in young adults

      Armstrong, Marie; Majumder, Pallab (2016)
      Six young adults (aged 19-21 years) with repeat self-harm for over 5 years were interviewed about their self-harm, why they continued and what factors might help them to stop. Interpretative phenomenological analysis identified six themes: keeping self-harm private and hidden; self-harm as self-punishment; self-harm provides relief and comfort; habituation and escalation of self-harm; emotional gains and practical costs of cutting, and not believing they will stop completely. Young adults presented self-harm as an ingrained and purposeful behaviour which they could not stop, despite the costs and risks in early adulthood. Support strategies focused on coping skills, not just eradicating self-harm, are required.; © The Author(s) 2016.
    • Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database

      Morriss, Richard K. (2015)
      OBJECTIVE: To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression.
    • Assessing risk of suicide or self harm in adults

      Morriss, Richard K. (2013)
      This review discusses how general practitioners and non-psychiatric specialists can assess suicide risk and self harm. A middle aged man presents to his general practitioner having just lost his job. He seems to be low in mood and asks for something to help him to "pick myself up." He is reluctant to talk. Meanwhile, a teenage girl presents to the local emergency department having made a third drug overdose in the past two months. In both situations the attending doctor wants to know what factors would suggest that the person was more likely or less likely to be at risk of suicide or repeat self harm. The clinical problem: Suicide is one of the top three causes of death in people aged 10-44 years throughout the world. In the UK, suicide rates fell from a peak in the 1980s in men and women, but they have started to rise again in the past few years (11.8 per 100 000 in 2011) (www.ons.gov.uk/ons/dcp171778_295718.pdf), with the highest rates in men aged 30-59 years. Self harm is defined here as any act of self poisoning or self injury irrespective of motivation1 but generally excludes habitual behaviours such as hair pulling and the consequences of excessive consumption of alcohol or drugs. Self harm is one of the five leading causes of hospital admission2 and is associated with a significantly increased risk of subsequent death, much of it by suicide.3 Methods: Data on the assessment of suicide risk and self harm have been compiled primarily from recent systematic reviews of risk factors for guidelines developed by the National Institute for Health and Care Excellence (NICE),4 a review of 15 years of findings from the UK National Confidential Inquiry into Suicide,5 a systematic review of risk factors for suicide in people with depression,6 and a Medline search on risk factors for suicide in non-depressed groups and for repetition of self harm (updating the NICE review). These data have limitations - for example, many of the risk factors in the general population are common in clinical patients (such as unemployment, living alone, alcohol misuse). This article will concentrate on the general clinical assessment of suicide7 and self harm. [PUBLICATION]
    • Association of risk of suicide attempts with methylphenidate treatment

      Hollis, Chris P.; Liddle, Elizabeth B.; Sayal, Kapil (2017)
      Importance: Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear. Objective: To investigate the association between methylphenidate and the risk of suicide attempts. Design, Setting, and Participants: A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients. Main Outcomes and Measures: Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods. Results: Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35). Conclusions and Relevance: The incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.
    • CAMHS self-harm teams and crisis/liaison teams; What CAMH nurses bring to the acute moments in young people's lives

      Armstrong, Marie (2019)
      This chapter focuses on one of the places where young people who self-harm are in contact with services, the general hospital. This includes their experience in the Emergency Department and on hospital wards-usually paediatric wards where young people under the age of 16 are admitted overnight, as recommended by NICE guidelines (NICE 2004).
    • Childhood determinants of suicidality: comparing males in military and civilian employed populations

      Syed Sheriff, Rebecca (2018)
      BackgroundTo better understand the associations of childhood trauma and childhood disorder with past-year suicidality (thoughts, plans or attempts), we compared male military and civilian populations aged 18–60 years old.MethodsData derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics Australian National Survey of Mental Health and Wellbeing were compared using logistic regression and Generalized Structural Equation Modelling (GSEM).ResultsA greater proportion of the ADF experienced suicidality than civilians. Those who experienced childhood trauma that was not interpersonal in nature were not at increased odds of suicidality, in either population. A higher proportion of the ADF experienced three or more types of trauma in childhood and first experienced three or more types of trauma in adulthood. Both were associated with suicidality in the ADF and civilians. Childhood anxiety had a strong and independent association with suicidality in the ADF (controlling for demographics and childhood trauma, adult trauma and adult onset disorder). Childhood anxiety fully mediated the relationship between childhood trauma and suicidality in the ADF, but not in civilians.ConclusionsThese data highlight the need to take a whole life approach to understanding suicidality, and the importance of categorizing the nature of childhood trauma exposure. Importantly, childhood anxiety was not only associated with suicidality, it fully mediated the relationship between childhood trauma and suicidality in the more trauma exposed (military) population only. These findings have the potential to inform the development of strategies for suicide prevention.
    • Childhood trauma, dissociation and self-harming behaviour: A pilot study

      Low, Gail; Jones, David; Duggan, Conor (2000)
      OBJECTIVE: Childhood trauma is known to be an important antecedent in those who engage in deliberate self-harm (DSH). We aimed to explore the mediating mechanisms between childhood trauma and subsequent DSH in a sample of women detained in a high secure setting.
    • Completed suicide, ideation and attempt in attention deficit hyperactivity disorder

      Impey, Matthew (2012)
      Objective: Attention deficit hyperactivity disorder (ADHD) and suicidal behaviour are common conditions with significant social and emotional morbidity. Although completed suicide in ADHD has been assessed in a previous meta-analysis, other domains of suicidal behaviour such as attempts and ideation have been documented only in individual studies. This review provides a comprehensive summary of the relationship between attention-deficit and suicidality.; Method: Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around suicidality, attention-deficit and hyperactivity.; Results: Twenty five papers were identified describing a relationship between ADHD and suicide. ADHD occurred more frequently in suicidal groups than controls, with most differences being statistically significant. The direction of results was consistent, with only one sample showing equivocal findings and one showing a reverse pattern. Attempts and ideation were more common in prediagnosed ADHD samples than controls. Three studies showed significant results only for men. Comorbidity had a large influence including delinquency and substance misuse.; Conclusion: There is a positive relationship between ADHD and risk to self. More focussed research needs to take place on younger populations and those without comorbidity. This review highlights the importance of thorough risk assessment in the attention-deficit population.; © 2011 John Wiley & Sons A/S.
    • Could a brief assessment of negative emotions and self-esteem identify adolescents at current and future risk of self-harm in the community? A prospective cohort analysis

      Sayal, Kapil (2013)
      Background: Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings. Methods. Data were collected as part of a clinical trial from young people in school years 8-11 (aged 12-16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children's Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months. Results: Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77). Conclusions: A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in community settings. Further research should assess the psychometric properties of the items identified and test this approach in more diverse community contexts. © 2013 Phillips et al.; licensee BioMed Central Ltd.
    • Deaths from psychiatric causes

      Oates, Margaret R. (2011)
    • Decisional support for young people who self-harm: Protocol for a feasibility trial

      Slade, Mike (2016)
      INTRODUCTION: Self-harm is common in adolescents, and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DAs) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention and the ability to recruit and follow-up participants within a school setting. METHODS AND ANALYSIS: In this parallel arm, single-blind feasibility trial, 60 participants aged 12-18 years who have self-harmed in the past 12 months, will be randomised to either (1) a group receiving the online DA or (2) a control group receiving general information about feelings and emotions. Both groups will complete measures assessing decision-making and help-seeking behaviour. The school counsellor will be notified of any participants who have been randomised to ensure safeguarding for the young person. Participants in both groups will be followed up at 4 weeks, and the measures will be repeated. Qualitative interviews will be conducted with a subset of participants to explore their views and experiences of the DA and of participation in the study. ETHICS AND DISSEMINATION: Ethical approval was granted by King's College London (KCL) College Research Ethics Committee. Results of this study will help to clarify if we can recruit and administer an online decisional support intervention within a school setting for young people who self-harm. The study will inform the design and implementation of a larger randomised controlled trial to test the effectiveness of the DA. Dissemination of the study findings will target publication in peer-reviewed journals of general and special interest. The funder will be sent a report outlining the major findings of the study. TRIAL REGISTRATION NUMBER: ISRCTN11230559.
    • Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

      Sarkar, Jaydip; Beeley, Chris (2011)
      There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive self-harm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity. © 2011 Copyright Taylor and Francis Group, LLC.
    • "Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security": Corrigendum

      Sarkar, Jaydip; Beeley, Chris (2012)
      Reports an error in "Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security" by Jaydip Sarkar and Chris Beeley (Journal of Forensic Psychiatry & Psychology, 2011[Dec], Vol 22[6], 845-862). In the original article, Table 1 was reproduced incorrectly. The table is given in the erratum. (The following abstract of the original article appeared in record 2011-28873-006). There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive self-harm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Dialectical behaviour therapy as a treatment for deliberate self-harm: Case studies from a high security psychiatric hospital population

      Low, Gail; Duggan, Conor (2001)
      Deliberate self-harm has recently assumed increasing importance in outpatient clinics, accident and emergency units, and psychiatric settings. One approach that has been shown to be effective in randomly controlled clinical trials is Dialectical Behaviour Therapy (DBT; Linehan, 1993). DBT is a cognitive-behavioural approach developed for Borderline Personality Disorder, the criteria of which include suicidal attempts, threats and gestures, as well as impulsive behaviour, including deliberate self-harm. We assessed the efficacy of DBT in a high security psychiatric setting, where deliberate self-harm is particularly common among the women patients. From the group of patients who participated in the therapy (N = 15), three cases were identified which illustrate the application of DBT, and which highlight specific strategies and their uses in different situations. Specific strategies which were most useful involved the skills training of Distress Tolerance, and Emotion Regulation. DBT is an holistic approach, addressing problematic thoughts as well as behaviour, and the package of skills taught can be considered particularly useful in regulating emotions and alleviating some of the distress experienced by individuals who engage in this behaviour. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Economic crisis and mental health-findings from Greece

      Christodoulou, Nikos G. (2017)
      Background: The direct and indirect effects of the economic crisis in Greece have resulted in inequalities, poverty and unemployment. Public health services, social care and welfare have been both severely curtailed and overstretched by increased demand due to higher private care costs and the refugee crisis. For society's most vulnerable this is beyond an economic crisis, it is a humanitarian crisis. Method: In this narrative review we report a continued rise in suicides, persistent mental health problems in the population, and continued systemic problems despite some successful reforms and slowing of the economic deterioration. Synergistic effects are identified between pre-existing systemic weaknesses, the effects of the crisis, and the effects of austerity. Outlook: Psychiatrists should promote evidence-based interventions, for example preventing mental illness by supporting vulnerable groups and by reducing inequalities. Evidence-based heurism is advocated for, in the interest of outcome. Psychiatrists also have a political role in tackling stigma towards mental illness, refugees and other vulnerable groups, and in promoting resilience and solidarity.
    • An electronic clinical decision support system for the assessment and management of suicidality in primary care: Protocol for a mixed-methods study

      Horrocks, Matthew; Aubeeluck, Aimee; Wright, Nicola; Morriss, Richard K. (2018)
      Background: Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management is an area that many General Practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalise and assess suicide risk which subsequently has an impact on clinical decision making. Clinical Decision Support systems (CDSS) have been widely implemented across different healthcare settings, including primary care to support practitioners in clinical decision making. CDSS may reduce inconsistencies in the identification, assessment and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialised mental health services. Objective: To co-develop and test with end users (e.g. GPs, primary care attendees, mental health professionals) an e-CDSS to support GPs in the identification, assessment and management of suicidality in primary care. Methods: An ongoing embedded mixed methods study with four phases: 1) Qualitative interviews with GPs to explore their views on the content, format and use of the e-CDSS; consultation with two service user advisory groups (people aged ≤ 25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; 2) Participatory co-production workshops with GPs, service users and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity (CVI) and identify pathways to implementation, using the Consolidated Framework for Implementation Research; 3) Building the e-CDSS so that it guides the GP through a consultation and 4) Usability testing of the e-CDSS with GPs and service users in one primary care practice involving a non-live and a live stage. Results: This is an ongoing study. The findings will enable us to evaluate the feasibility, acceptability and usability of a suicide specific electronic guided decision support system in primary care. Conclusions: This study will be the first to explore the feasibility, acceptability and usability of electronic guided decision support system for use in primary care consultations for the improved assessment and management of suicidality.