Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study.

Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18-35 years during the period 2008-2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention.

Deliberate self-harm and associated risk factors in young adults: the importance of education attainment and sick leave.

PURPOSE: The prevalence of deliberate self-harm (DSH) is high in young adults. However, few studies have examined risk in this specific age group. We, therefore, examined the relative influence and interactive nature of a wide range of potential sociodemographic and sick leave related risk factors in young adults, aged 18-35 years, using Norwegian register data. METHODS: All subjects with at least one episode of hospital presentation for DSH registered in the Norwegian Patient Register during the period 2008-2013 were compared with age, gender and date matched population controls using a nested case-control design. The relative influence of factors and their interactions were assessed using conditional logistic regression and recursive partitioning models. RESULTS: 9 873 study cases were compared to 186 092 controls. Socioeconomic status, marital status, sick leave and several demographic factors influenced risk for DSH. Specifically, low education (OR 7.44, 95% CI 6.82-8.12), current sick leave due to psychiatric disorders (OR 18.25, 95% CI 14.97-22.25) and being previously married (OR 3.83, 95% CI 3.37-4.36) showed the highest effect sizes. Importantly, there was an interaction between education and sick leave, where those with either low education and no sick leave (OR 13.33, 95% CI 11.66-15.23) or high education and sick leave (OR 18. 87, 95% CI 17.41-24.21) were the subgroups at highest risk. CONCLUSION: DSH in young adults is associated with multiple sociodemographic and health disadvantages. Importantly, the two high-risk subgroups imply different pathways of risk and a need for differentiated preventative efforts.

The short-term rate of non-fatal and fatal repetition of deliberate self-harm: A systematic review and meta-analysis of longitudinal studies.

BACKGROUND: Deliberate self-harm (DSH) is often recurrent, but the reported rate of short-term repetition of DSH has varied greatly. This systematic review and meta-analysis aim to synthesize findings through providing pooled rate estimates and to explore their differences by age, gender, and other factors. METHODS: A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted to include longitudinal studies from 1999 to 2018. Random effects model was applied to pool rates of non-fatal and fatal repetition at 0.5, 1, 2, and 3 years intervals. RESULTS: Of 9201 potentially eligible articles 76 studies were included for this systematic review and meta-analysis. The pooled rates of non-fatal repetition were 15.01%, 17.03%, 20.82%, and 24.20% during the 0.5-year, 1-year, 2-year, and 3-year follow-up, respectively. The corresponding rates of fatal repetition were 0.77%, 1.34%, 1.49% and 2.46%, respectively. When focusing on the 1-year follow-up, the pooled rate of fatal, not non-fatal, repetition was significantly higher in males than females. The rate of non-fatal DSH repetition was highest in middle-aged adults, while the rate of fatal repetition was highest among the elderly. Geographically, Europe had higher rate of non-fatal repetition whilst Asia had higher rate of repetition leading to death. LIMITATION: Search was limited to English language and publication bias was observed. CONCLUSIONS: Both non-fatal and fatal repetitions are common among people with DSH, but the rates differ considerably by gender, age and geographical location. These insights may guide provision of follow-up care and effort of suicide prevention for this high-risk population.

Incarcerated Violent Offenders' Ability to Avoid Revealing Their Potential for Violence on the Rorschach and the MMPI-2.

Recently, Hartmann and Hartmann (2014) found that psychiatric outpatients, both with and without access to Internet-based information about the Rorschach Inkblot Method (RIM; Weiner, 2003 ) and the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989 ), were unable to imitate healthy test performance on these tests. We replicated the study by administering the RIM and the MMPI-2 to 63 incarcerated violent offenders using similar testing conditions. As in the previous study, comparisons were made not only among the 3 subgroups of incarcerated offenders, but also between these offender groups and the group of nonpatients examined in the previous study. On the RIM, Internet-coached and uncoached "faking good" offenders produced records with significantly higher F% and X-% and significantly lower M, m, SumC, X+%, P, AG, and COP than nonoffenders under standard instructions (effect sizes between d = 0.24 and d = 2.39). For AgC, AgPot, AgPast, and TCI% there were no significant differences between the faking offenders and the nonoffenders under standard instructions. On the MMPI-2 clinical scales, there were no significant differences between the faking good groups and the nonoffenders under standard instructions, except on Hs, Pd, and Sc. Both faking groups were identifiable by their high L scale scores. Although both faking groups managed to avoid giving responses with aggressive and generally psychopathological content on the RIM, they were unable to produce test profiles demonstrating healthy test performance on any of the tests; nevertheless, Internet-based test information might weaken test validity.