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Special Issue "Hospital and Primary Care-Presenting Self-Harm: Incidence, Management and Outcomes"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 December 2020).

Special Issue Editors

Dr. Katerina Kavalidou
E-Mail Website
Guest Editor
National Suicide Research Foundation, University College Cork, Cork, Ireland
Interests: multimorbidity as a risk factor of suicidal behaviours and suicide; self-harm and suicide-related registries
Dr. Eve Griffin
E-Mail Website
Guest Editor
School of Public Health, University College Cork, Ireland & National Suicide Research Foundation, Cork, Ireland
Interests: suicidal behaviour; surveillance; epidemiology; clinical management; public health
Dr. Paul Corcoran
E-Mail Website
Guest Editor
National Suicide Research Foundation, Cork, Ireland and School of Public Health, University College Cork, Cork, Ireland
Interests: suicidal behaviour epidemiology; surveillance systems; suicide prevention strategies; statistical epidemiology; biostatistics

Special Issue Information

Dear Colleagues,

Establishing the extent of a health problem is a fundamental step in public health. High-income countries have vital statistics systems for the recording and reporting of mortality data, but morbidity data are required to provide a more complete picture. In 2014, the World Health Organization (WHO) called for suicide prevention to be a global imperative. The WHO highlighted the need to consider both fatal and nonfatal suicidal behaviour and subsequently provided resources to support the establishing and maintaining of surveillance systems for suicide attempts and self-harm. Self-harm is a strong predictor of further suicide-related outcomes. Although suicide prevention policies should be informed by “real time data” based on patients’ records, there is a lack of studies reporting on the incidence of self-harm presenting in hospital and primary care settings, the management of such cases and subsequent outcomes. This Special Issue aims to establish the extent of hospital and primary care self-harm attendances, the profile of those reaching health care services for self-harm, the incidence of self-harm and the treatment or intervention outcomes related to hospital and primary care self-harm presentations. Self-harm and suicide attempts will be used interchangeably in the current issue, as these are the most common terms used internationally.

Dr. Katerina Kavalidou
Dr. Eve Griffin
Dr. Paul Corcoran
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surveillance system
  • self-harm
  • registry
  • suicide attempts
  • hospital
  • primary care

Published Papers (6 papers)

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Research

Article
Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence towards Other People—“Dual Harm”
Int. J. Environ. Res. Public Health 2020, 17(24), 9409; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249409 - 15 Dec 2020
Cited by 1 | Viewed by 662
Abstract
The etiology of “dual harm” (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and [...] Read more.
The etiology of “dual harm” (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15–35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual-harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases versus controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing five or more childhood adversities was more prevalent among individuals with dual-harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence, and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual-harm risk. These novel findings indicate potential etiologic pathways to dual harm. Full article
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Article
Development of a Self-Harm Monitoring System for Victoria
Int. J. Environ. Res. Public Health 2020, 17(24), 9385; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249385 - 15 Dec 2020
Viewed by 975
Abstract
The prevention of suicide and suicide-related behaviour are key policy priorities in Australia and internationally. The World Health Organization has recommended that member states develop self-harm surveillance systems as part of their suicide prevention efforts. This is also a priority under Australia’s Fifth [...] Read more.
The prevention of suicide and suicide-related behaviour are key policy priorities in Australia and internationally. The World Health Organization has recommended that member states develop self-harm surveillance systems as part of their suicide prevention efforts. This is also a priority under Australia’s Fifth National Mental Health and Suicide Prevention Plan. The aim of this paper is to describe the development of a state-based self-harm monitoring system in Victoria, Australia. In this system, data on all self-harm presentations are collected from eight hospital emergency departments in Victoria. A natural language processing classifier that uses machine learning to identify episodes of self-harm is currently being developed. This uses the free-text triage case notes, together with certain structured data fields, contained within the metadata of the incoming records. Post-processing is undertaken to identify primary mechanism of injury, substances consumed (including alcohol, illicit drugs and pharmaceutical preparations) and presence of psychiatric disorders. This system will ultimately leverage routinely collected data in combination with advanced artificial intelligence methods to support robust community-wide monitoring of self-harm. Once fully operational, this system will provide accurate and timely information on all presentations to participating emergency departments for self-harm, thereby providing a useful indicator for Australia’s suicide prevention efforts. Full article
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Article
Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People—A National Registry Study
Int. J. Environ. Res. Public Health 2020, 17(17), 6159; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176159 - 25 Aug 2020
Cited by 1 | Viewed by 835
Abstract
Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their [...] Read more.
Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs. Full article
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Article
Suicidal Presentations to Emergency Departments in a Large Australian Public Health Service over 10 Years
Int. J. Environ. Res. Public Health 2020, 17(16), 5920; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165920 - 14 Aug 2020
Cited by 6 | Viewed by 988
Abstract
This paper presents trends and characteristics for 32,094 suicidal presentations to two Emergency Departments (EDs) in a large health service in Australia across a 10-year period (2009–2018). Prevalence of annual suicidal presentations and for selected groups of consumers (by sex, age groups, and [...] Read more.
This paper presents trends and characteristics for 32,094 suicidal presentations to two Emergency Departments (EDs) in a large health service in Australia across a 10-year period (2009–2018). Prevalence of annual suicidal presentations and for selected groups of consumers (by sex, age groups, and ethnicity) was determined from a machine learning diagnostic algorithm developed for this purpose and a Bayesian estimation approach. A linear increase in the number of suicidal presentations over 10 years was observed, which was 2.8-times higher than the increase noted in all ED presentations and 6.1-times higher than the increase in the population size. Females had higher presentation rates than males, particularly among younger age groups. The highest rates of presentations were by persons aged 15–24. Overseas-born persons had around half the rates of suicidal presentations than Australian-born persons, and Indigenous persons had 2.9-times higher rates than non-Indigenous persons. Of all presenters, 70.6% presented once, but 5.7% had five or more presentations. Seasonal distribution of presentations showed a peak at the end of spring and a decline in winter months. These findings can inform the allocation of health resources and guide the development of suicide prevention strategies for people presenting to hospitals in suicidal crisis. Full article
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Article
Online Resources for People Who Self-Harm and Those Involved in Their Informal and Formal Care: Observational Study with Content Analysis
Int. J. Environ. Res. Public Health 2020, 17(10), 3532; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103532 - 18 May 2020
Viewed by 1410
Abstract
Despite recent fears about online influences on self-harm, the internet has potential to be a useful resource, and people who self-harm commonly use it to seek advice and support. Our aim was to identify and describe UK-generated internet resources for people who self-harm, [...] Read more.
Despite recent fears about online influences on self-harm, the internet has potential to be a useful resource, and people who self-harm commonly use it to seek advice and support. Our aim was to identify and describe UK-generated internet resources for people who self-harm, their friends or families, in an observational study of information available to people who search the internet for help and guidance. The different types of advice from different websites were grouped according to thematic analysis. We found a large amount of advice and guidance regarding the management of self-harm. The most detailed and practical advice, however, was limited to a small number of non-statutory sites. A lay person or health professional who searches the web may have to search through many different websites to find practical help. Our findings therefore provide a useful starting point for clinicians who wish to provide some guidance for their patients about internet use. Websites change over time and the internet is in constant flux, so the websites that we identified would need to be reviewed before making any recommendations to patients or their families or friends. Full article
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Article
Effectiveness of a Flexible and Continuous Case Management Program for Suicide Attempters
Int. J. Environ. Res. Public Health 2020, 17(7), 2599; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072599 - 10 Apr 2020
Cited by 1 | Viewed by 1118
Abstract
The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency [...] Read more.
The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 ± 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13–0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09–0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts. Full article
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