Definitions of suicide and self-harm behavior in an Australian Aboriginal community

Farrelly T, Francis K (2009)
Definitions of suicide and self-harm behavior in an Australian Aboriginal community.
Suicide and Life-Threatening Behavior;39(2):182-189

Journal Article

Source: Australian Indigenous Health Bulletin

View abstract: PubMed
View website: PubMed

Three out of 10 students in study intentionally harm themselves

Three out of 10 students surveyed for a York University study acknowledged engaging in acts of deliberate self-harm, such as skin cutting, burning and using drugs or alcohol to excess.

The study evaluates the responses of 319 first-year university students who volunteered to answer a questionnaire that assessed their personality and personal history, and that asked whether they had ever intentionally engaged in 22 self-harm behaviours.

Of the 94 students who indicated they had, women were no more likely to self-harm than men, contrary to previous studies which suggest it is a predominantly female phenomenon.

There were, however, some clear differences in the type of self-harm acts engaged in by women and men.

Right: Cutting is one form of self-harm as seen in this photo of a person's arm

Among those who engaged in self-harm, the women surveyed (45 per cent) were more likely to report cutting the wrists, arms or other areas of the body, while men (23 per cent) were more likely to report engaging in gang activity or other forms of physical violence with the intention to harm themselves. The most frequent forms of self-harm were cutting, entering into risky situations, carving, scratching and the use of substances with the intent to self-harm.

The life circumstances of the participants are relevant to the study’s findings, says Gordon Flett, Canada Research Chair in Personality & Health at York, who co-authored the study with Abby Goldstein, (MA '00, PhD '05) now an assistant professor at the Ontario Institute for Studies in Education.

The average age of the participants was 19 years old and the majority (68 per cent) had just finished high school and were living with their parents (64 per cent). The sample was evenly split between Canadian-born students and those born outside of Canada.

“In many cases, these young people are throwing themselves into the student role as a way of overcompensating for some other emotional and relationship issue,” Flett says. “If they do well in university, that might get them over the hump, but if they don’t, they may be at risk for some more extreme behaviours.”

The latest clinical research suggests that self-harm may be a response to emotional pain that cannot be resolved in a more functional way. Goldstein hopes this information will begin to remove some of the secrecy often associated with self-harm.

“These findings suggest that a significant percentage of college students have engaged in an act of deliberate self-harm at some point in their lifetime,” Goldstein says. “Unfortunately, many people hide these acts or their intentions from others, which can often lead to isolation and greater suffering.”

By assessing the personality traits and personal history of the participants, the study was also able to identify factors which may help predict which students may be vulnerable to deliberately harming themselves.

“Some of these kids come from middle-class or affluent families but that’s no protection when the issue at hand is self-image,” Flett says.

"Personality, Child Maltreatment and Substance Use in Deliberate Self-Harm Among College Students" will be published in the Canadian Journal of Behavioural Science in October.

The study was supported by funding from the Canadian Institutes of Health Research.

Source: York files

Shelved report keeps suicide prevention reforms at bay

RUTH POLLARD INVESTIGATIONS EDITOR

August 22, 2009

A HERALD INVESTIGATION

AN EVALUATION of Australia's main suicide prevention program - which found there was little evidence the strategy had reduced rates of suicide and self harm - has been kept secret for three years, stalling much needed national reforms.

The 2006 evaluation reveals the Howard government was urged to review the National Suicide Prevention Strategy to ensure that funds were better targeted to those in greatest need. ''The current goals and objectives … are too broad to provide sufficient guidance,'' it concluded.

And while the national program floundered, suicide rates remained at historically high levels. The Herald revealed yesterday that the national suicide statistics had been undercounted, and the toll could be as high as 3000 a year, rather than the 1800 reported by the Australian Bureau of Statistics, without any corresponding increase in funding to prevent further deaths.

The Federal Health Minister, Nicola Roxon, said the Government was working with the Australian Suicide Prevention Advisory Council to develop ways to improve the data and respond to the needs of people at risk. ''I'm concerned by these reports,'' Ms Roxon said.

To make progress, access to quality mental health services must be improved and structures developed to co-ordinate a new national response, said John Mendoza, the chairman of the Federal Government's National Advisory Council on Mental Health.

''We have seen our governments … implement an assertive response to swine flu [and] now we have had 121 deaths since the outbreak and … 460 people are … in hospital from H1N1.

''In the same period we have had at least 10 times the number of suicides and … 20,000 hospital admissions for self-harm. This is the scale of the problem, and it's time we addressed it.''

Training GPs and other health care providers in recognising the warning signs for self harm and suicide, as well as reducing access to the means of suicide and investing in self-help services would go a long way to reducing risk, Professor Mendoza said.

The chairman of Suicide Prevention Australia, Michael Dudley, said: ''We have absolute evidence that putting barriers around jumping points makes a huge difference - people do not automatically go and try something else, and it is the same with reducing access to firearms, medications and other methods.

''Maintaining a social connection can make a difference - we should be following people … after they have had contact with health services, because we know they are very much at risk.''

Lifeline: 131 114

Source: The Sydney Morning Herald

Brisbane Times

Self-harm admissions drop by a quarter

Over 2500 people were hospitalised for more than two days after intentionally injuring themselves in 2007, with women almost twice as likely to do it as men, according to figures released today.

A report by the Ministry of Health called Intentional Self-Harm Hospitalisations 2007 (Provisional), showed that 2678 people spent more than 48 hours in hospital.

However, the results show the number decreased from 3030 in 1996.

Mental Health director Dr David Chaplow said this was consistent with the declining pattern over the past 11 years.

“Self-harm hospitalisation rates have dropped by 25.6 per cent for the total population and 40.1 percent for those aged 15 to 24 years old since 1996," he said.

For males, the highest rate was among the 35-39 year age group while women aged between 15 and 19 were the most at-risk group for females.

Maori, at 75.1 hospitalisations per 100,000 people, were more likely to self-harm than non-Maori, with rates of 61.6 per 100,000.

The Health Ministry said anti-suicide initiatives included better follow-up care, mental health awareness campaigns and addressing suicide rates among the Maori community in particular.

The data does not include those who harmed themselves but spent less than two days in hospital or readmissions less than two days after being released.

The Health Ministry said this was due to differences in the way District Health Boards recorded some of these events although this had now been addressed.

By removing the data, the ministry says it allowed them to make more accurate comparisons.

Source: NZ National Health

By Micahel Fox

Last updated 21/8/09

Self-harm in Northern Ireland

Researchers from Queen's University and the University of Ulster in Northern Ireland have been asking 941 sixteen-year-olds about self-harm. One in ten had self-harmed in the past year and another 14% had thought about it but had not done so. Girls were much more likely than boys to say that they had thought about harming themselves (18% vs 7%) or had actually done so (13% vs 5%). There were strong links between self-harm and high levels of stress, high expectations the youngsters felt they could not fulfil and experiences of bullying in school. 25% of the sample said that they had suffered from serious mental and emotional health problems in the past year for which they felt they needed professional help although only 9% had actually asked for it. Youngsters from less well-off backgrounds were significantly more likely to be affected by mental-health issues and to have self-harmed or considered self-harming.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/07/090730073921.htm

“I can actually talk to them now” – Educational intervention for nurses

Posted on June 1, 2009 by sjennings29

‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self-injure, Journal of Clinical Nursing, online early view, 2009

Margaret McAllister, Wendy Moyle, Stephen Billett and Melanie Zimmer-Gembeck

Authors: Margaret McAllister, RN, Ed D, Associate Professor, University of the Sunshine Coast, Maroochydore, Australia; Wendy Moyle, RN, PhD, Professor, Griffith University, Brisbane, Queensland, Australia; Stephen Billett, PhD, Professor, Griffith University, Brisbane, Queensland, Australia; Melanie Zimmer-Gembeck, PhD, Associate Professor, Griffith University, Brisbane, Queensland, Australia

Correspondence to Dr Margaret McAllister, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore,

ABSTRACT

Aim and objectives. This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury.

Background. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies.

Design. A mixed method pretest–posttest group design was used.

Methods. Nurses (n = 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning.

Results. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses’ capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented.

Conclusions. The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting.

Relevance to clinical practice. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Self Harm & Glucose Metabolism in Women with ED

Self-injury (such as cutting or burning oneself) is fairly common amongst people with eating disorders- approximately 25% to 45% of people with eating disorders self-injure, and approximately half of those who self-injure also have eating disorders (full article here). Many people report a sense of dissociation while self-harming, a desire to turn emotional pain into physical pain (ie, "real" pain), and also that this behavior reduces anxiety. Whether self-harm is from issues relating to impulse control, a more compulsive pattern of behavior, or something else entirely, the amount of overlap between self-injury and eating disorders is significant.

An interesting new paper from the journal Psychoneuroendocrinology looked at the relationship between self-injury and glucose metabolism in women with eating disorders, and what they found was significant. Women engaging in self-harm behaviors were given an oral glucose tolerance test, in which they were asked to drink a sweet solution to measure how the body handles sugar. The self-harming women who also had an eating disorder had higher levels of blood glucose after the test, but also higher levels of a hormone called glucagon.

Glucagon is essentially insulin's opposite: when the blood sugar is low, the pancreas secretes glucagon to prod cells into breaking down long chains of carbohydrates called glycogen into small sugars that can be released into the bloodstream and readily used by the body. When blood sugar rises after a meal, the pancreas secretes insulin, which stimulates cells to pull excess sugars out of the bloodstream and store them as glycogen for a rainy day*.

Besides low blood sugar, several other factors can stimulate the release of glucagon, including epinephrine (aka adrenaline), which is involved in the fight or flight response. Though I was unable to find any specific studies linking high levels of epinephrine and self-injury, it's certainly plausible to think that people who self-harm would have higher levels of epinephrine, especially right after an incident where such behavior occurs. Alternately, if high levels of glucagon also stem from high levels of epinephrine, the sufferer may be caught in a cycle of self-harm during episodes of low blood sugar.

For instance, a common pattern in those who binge and purge is binge-purge-self harm, where the self-harm typically occurs after the completion of the binge/purge cycle. After a binge, blood sugar goes up and glucagon levels go down. After a purge, blood sugar goes down, and glucagon and epinephrine levels go up.

No one knows at this point where the relationship between self-harm and glucose metabolism lies on the cause/effect scale. Certainly there is a feedback cycle between all of these systems. But one good point to keep in mind is the importance of helping sufferers regulate blood sugar levels by frequent meals and snacks that involve complex carbohydrates, proteins, AND fats. Food is medicine for the eating disorder, but it also might be true for self-injury.

*Aren't you glad I paid attention in my 8am biochem lecture 10 years ago?

Crosspost from ED Bites

New Risk Factors For Teen Self Harm

Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry
Article Date: 19 May 2009 - 8:00 PDT

A lack of emotional intelligence leads to poor coping strategies and seriously increases the likelihood of self-harm in teenagers, claims a study published yesterday, in the British Journal of Clinical Psychology.

The study, carried out by Moira Mikolajczak from the Universite Catholique de Louvain, Belgium, K. V. Petrides from the London Psychometric Laboratory at University College London and Jane Hurry from the Institute of Education examined the levels of self harm, emotional intelligence and coping strategies of 490 British secondary school pupils.

Dr Petrides said: "People who turn to self harm claim to do so to regulate their emotions, which indicates that they cannot manage their feelings in a healthy way. We wanted to better understand the underlying psychological issues that lead adolescents to harm themselves."

Of the 490 students who took part, 132 (27 per cent) reported having deliberately self harmed, either hitting or cutting themselves or taking an overdose of recreational drugs. 65 per cent of self harmers were found to have mild to severe symptoms of depression.

"We found that teenagers who self harmed had both significantly lower scores on a measure of emotional intelligence and were more likely to use maladaptive coping strategies such as self criticism or self blame. This suggests that self harm is a desperate attempt to reduce the negative feelings that are worsened by their poor and ineffective emotional coping strategies."

"However efficient self harm may be at reducing negative emotions in the short term, this is at the cost of serious physical injury and longer term psychological problems. These findings will help us develop coaching programmes for the treatment of self harm patients that focus on developing both better methods of coping and boosting emotional intelligence."

Source
British Psychological Society

Intentional self-harm NSW Department Of Health

Data table

View data table

Note

Includes suicide (attempted) and purposedly self-inflicted poisoning or injury. Hospital separations were classified using ICD-9-CM up to 1997-98 and ICD-10-AM from 1998-99 onwards. Rates were age-adjusted using the Australian population as at 30 June 2001. Numbers for 2006-07 include an estimate of the small number of interstate hospitalisations, data for which were unavailable at the time of production.

Source

NSW Admitted Patient Data Collection and ABS population estimates (HOIST). Centre for Epidemiology and Research, NSW Department of Health.

Commentary

Completed suicide is only one outcome of intentionally self-harming behaviours.

One other outcome of these behaviours is hospitalisation. It is not accurate to regard hospitalised self-harm as equivalent to 'attempted suicide' for comparison with 'completed suicide'. There is some overlap between hospitalised self-harm and suicide, as some suicide deaths occur after admission to a hospital, however, hospitalised self-harm is more frequent than completed suicide. (Steenkamp et al, 2000).

Most people who contact health services after an episode of intentional self harm are seen by emergency departments. They may or may not be admitted as hospital inpatients, and the injury may or may not be recorded as intentional. In recent years, there have been more than 10,000 hospital separations per year following an episode of intentional self harm.

Hospitalisation rates for intentional self-harm are consistently higher in females than in males, while the death rates from suicide are about 3 - 4 times greater in males than in females. This is thought to be mostly due to males using more lethal methods than females. The numbers of young females aged 15-24 hospitalised for self harm has begun to decrease after a peak in 2004-05 (483.0 per 100,000 in 2004-05), however the numbers remain significantly higher than among any other age group (435.6 per 100,000 population compared to 185.3 per 100,000 for females of all ages in 2006-07).

[back to top]

For more information

NSW Department of Health. Suicide prevention in NSW. Sydney: NSW Department of Health, 2003. Available at www.health.nsw.gov.au/pubs/s/pdf/well_suicide.pdf.

NSW Government New South Wales Interagency Action Plan for Better Mental Health Sydney: Available at http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0015/11490/interagency.pdf

NSW Department of Health. Policy guidelines for the management of patients with possible suicidal behaviour for NSW Health staff and staff in private health facilities. Sydney: NSW Department of Health Circular 92/31, 1998.

Pirkis J, Burgess P, Dunt D. Suicidal ideation and suicide attempts among Australian adults. Crisis 2000; 21: 16-25.

Steenkamp M, Harrison J. Suicide and hospitalised self-harm in Australia. Injury Research and Statistics Series. AIHW Catalogue no. INJCAT 30. Adelaide: Australian Institute of Health and Welfare, 2000.

Steenkamp M, Harrison J. Suicide and hospitalised self-harm in Australia. Injury Research and Statistics Series. AIHW Catalogue no. INJCAT 30. Adelaide: Australian Institute of Health and Welfare, 2000.

Australian Government of Health and Aged Care's suicide prevention information available at Suicide prevention, national suicide prevention strategy www.health.gov.au/internet/wcms/publishing.nsf/Content/mental-suicide and at Healthinsite www.healthinsite.gov.au/topics/Suicide_Prevention.

Print version with data

Although this page can be printed directly from your Web browser, a higher quality version of this entire page (graph, table and text) is available as an Acrobat PDF file which can be printed or viewed on screen using free software.

Downloadable files

The data contained in the table on this page are available for download as a CSV file which can be imported into many software packages. The graph is available for download as an EPS (Encapsulated PostScript) file and as an EMF (Enhanced Metafile Format) file. Files in these formats can be imported into most word processing, presentation and graphics software packages.

Copyright notice

This work is copyright NSW Department of Health, 2006. It may be reproduced in whole or in part, subject to the inclusion of an acknowledgement of the source. Commercial usage or sale is prohibited.

Suggested citation

Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/publichealth/chorep/. Accessed (insert date of access).

Produced by

Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.

Last updated on 15 December 2008

The Internet and Self-Injury: What Psychotherapists Should Know

Abstract

The Internet affords information gathering and sharing previously impossible. For individuals who practice self-injury, this capacity allows rapid identification of others with shared history, experience, and practices. For many of those who self-injure, the ability to find others like themselves reduces the isolation and loneliness which so often characterizes the behavior.

For others, however, active participation in on-line communities may effectively substitute for the real work required to develop positive coping and healthy relationships. Our experience suggests that regular assessment of self-injury Internet use is uncommon in therapeutic settings. Proliferation of self-injury message boards, informational websites, blogs, and YouTube posts is a clinical challenge. In this article, we review the research on self-injury and Internet use and then make a series of recommendations for clinicians.

Read entire report here

Who are the kids who self-harm?

An Australian self-report school survey

Authors: Diego De Leo and Travis S Heller

[Australian Medical Journal]

MJA 2004; 181 (3): 140-144

Introduction —
Methods —
Sampling —
Survey instrument —
Procedure —
Data treatment —
Results —
Sample —
Prevalence of DSH —
Factors associated with DSH —
Time to engage in DSH —
Help-seeking behaviours —
Discussion —
Conclusion —
Acknowledgements —
Competing interests —
References —
Author details

Research

Published 18 November 2008, doi:10.1136/bmj.a2278

Cite this as: BMJ 2008;337:a2278

Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study

Abstract

Abstract
Introduction
Methods
Results
Discussion
References

Objective To determine the risk of non-fatal self harm in the 12 months after discharge from psychiatric inpatient care.

Design Cohort study based on national hospital episode statistics.

Setting England.

Population Patients aged 16-64 years discharged from psychiatric inpatient care between 1 April 2004 and 31 March 2005 and followed up for one year.

Results 75 401 people were discharged from psychiatric inpatient care over the study period, 4935 (6.5%) of whom were admitted at least once for self harm in the following 12 months. Risk of self harm was greatest in the four weeks after discharge; one third (32%, n=1578) of admissions for self harm occurred in this period. The strongest risk factor for self harm after discharge was admission for self harm in the previous 12 months (hazard ratio 4.9, 95% confidence interval 4.6 to 5.2). The risk of self harm was also higher in females, younger people, those with diagnoses of depression, personality disorders, and substance misuse, and those with short lengths of stay.

Conclusion More than 6% of patients discharged from psychiatric inpatient care are readmitted for an episode of self harm within 12 months, with one third of these episodes occurring in the month after discharge. Self harm after discharge from hospital shares many of the features of suicide after discharge. Interventions should be developed to reduce risk in this period.

Entire Findings Here; BMJ Medical Publication

2.9 Explanations of Self-harming Behaviour

The models presented here provide a theoretical overview of the possible reasons that individuals engage in self-harming behaviours (Suyemoto, 1998). The following table is adapted from Suyemoto and MacDonald’s (1995) Model Summaries and Suyemoto’s (1998) Functional Models of Self-Mutilation.

Current Models Used To Explain Self-Harming Behaviour
Environmental Model Grounded in behavioural & systemic theory, particularly Bandura’s (1977) social learning theory, this model concentrates on the interaction between an individual who self-harms & their environment.
Environmental	Self-harming behaviour is learnt through modelling or vicarious reinforcement. Adolescents typically learn that injury & care are associated via their parents’ models, & attempt to use self-harm as a mechanism for self-caring. Self-harming is subsequently maintained by external reinforcement (i.e. attention, social status) or self-reinforced (i.e. relief from emotional tension, ending dissociation).
Drive Models Based on psychoanalytic theory, these two models conceptualise self-harm as repression or an expression of life, death & sexual drives.
Antisuicide	Self-harm is seen as conceptually distinct from suicide in intent, lethality & desired outcome. Destructive impulses are directed into self-harming behaviours to avoid the total destruction of the self. As such, self-harm is conceptualised as an active coping mechanism, not a suicide attempt.
Sexual	Self-harm is a form of punishment for or an attempt to avoid sexual feelings or acts; an attempt to control sexuality or sexual maturation; or a means of attaining sexual gratification. Support for this model is derived from the high correlation between sexual abuse & self-harm, the absence of self-harm before puberty, & the greater incidence of sexual dysfunction exhibited by self-harmers.
Affect Regulation Models Predominantly situated within ego and self-psychology, although also associated with object relations theory, the following two models view self-harm as a means of regulating affect.
Affect Regulation	Self-harm is a means of communicating to the self or others, the intolerable emotional pain experienced by the individual. It is also a mechanism for maintaining control over these intense emotions & feelings.
Dissociation	Self-harm is utilised to terminate or induce dissociation to create or maintain a sense of self when presented with intolerable emotional pain.
Interpersonal Model Fundamentally grounded in object relations but also conceptualised in self-psychology, this model focuses on the need to emphasise the boundaries of the self.
Boundaries	Self-harm is used an attempt to overcome the intense feelings & emotions that threaten to engulf the individual. The skin - the most obvious physical boundary between the self & others – is attacked to reiterate a sense of self & the blood reassures the self-harmer that they are alive.

* Taken from the 2004 Project Report
Adolescent Self-Harm: An Exploration of the Nature and Prevalence in Banyule/Nillumbik
[the report is a word document but can be veiwed in html .... abz