Crisis telephone consultation for deliberate self-harm patients: effects on repetition.

BACKGROUND: No interventions have been shown to be effective in reducing deliberate self-harm (DSH) repetition in this group of patients as a whole. AIMS: To investigate the effect on repetition of offering emergency telephone support in a group of hospital-admitted DSH patients. METHOD: A total of 827 DSH patients admitted to medical wards were randomly allocated to either control or intervention (green card) groups. In addition to treatment as usual, the intervention group was offered telephone support should any further crises occur. The main outcome measure was DSH repetition within six months of the index event. RESULTS: The intervention had no significant effect on the overall DSH repetition rate (odds ratio 1.20, 95% CI 0.82-1.75). Sub-group analysis suggested that response to the intervention differed according to the past history of DSH--subjects with a previous history repeating more often and first-timers appearing to benefit. CONCLUSIONS: No overall effect of the intervention was shown. Conclusions concerning sub-groups must be regarded as speculative, but they suggest that further assessment of the value of telephone support in first-timer DSH patients is indicated.

Suicide in Avon. Life stress, alcohol misuse and use of services.

BACKGROUND: Suicide rates among young men are rising. Further information about their contacts with services and possible associated stressful life events is necessary. METHOD: The sample consisted of all cases where the coroner in the County of Avon had given an inquest verdict of suicide over a 20-month period, together with those who were categorised as suicide by a panel of psychiatrists even though they had received open or accidental inquest verdicts. The coroner's dossiers and hospital notes were examined and the relevant general practitioners interviewed. RESULTS: Interpersonal stress in the last 72 hours was much higher in younger suicides. Young male suicide were also much less likely than others to seek help. Levels of alcohol misuse were no higher in younger than older suicide. CONCLUSIONS: Various subgroups of suicide behave differently in the way they seek and utilise help. The implications of these findings for suicide prevention and service strategy are discussed.

Suicide among psychiatric in-patients in a changing clinical scene. Suicidal ideation as a paramount index of short-term risk.

BACKGROUND: Rapid changes in styles of clinical practice mean that we should carefully monitor the way suicides occur among psychiatric patients both in hospital and in the wider community. METHOD: Patients who had died through suicide either while receiving in-patient care or within 2 months of discharge from hospital were compared with a similar series reported 10 years previously. Clinicians' perceptions of patients' behaviour were compared with concurrent controls. RESULTS: Patients in the more recent study were younger, more often male, and a greater proportion had been discharged from in-patient status. Hazards which complicated risk assessment included short-lasting misleading clinical improvements, variability in degree of distress, and a reluctance to discuss suicidal ideas. Over a range of perceived behaviours it was not possible to distinguish suicides from controls. CONCLUSIONS: In assessing suicide risk paramount importance should be attached to monitoring suicidal ideation and addressing the several hazards which might complicate this procedure.

Can a lecture influence attitudes to suicide prevention?

Attitudes held by various groups of healthcare professionals with regard to suicide prevention were assessed using an attitude inventory before and after they attended a formal lecture. The lecture presented basic facts and statistics, discussed clinical techniques and challenged negative attitudes. Evidence is presented to suggest that a reduction in the proportion of expressed attitudes which were equivocal or negative towards the feasibility of suicide prevention in clinical practice, can be achieved by a lecture of this kind.

Placental malaria and low birthweight neonates in urban Sierra Leone.

The birthweights of 768 singleton neonates were assessed in a study carried out over a 3-year period among indigenous, paturient women in Freetown, where malaria is mesoendemic. About 18.5% of placentae were found infected with malaria and the dominant species was Plasmodium falciparum. The proportion of low birthweight (LBW) babies from infected placentae (22.5%) was significantly greater than the proportion from the uninfected (P < 0.01) and, among the infected, the proportion from primiparae (38.9%) was significantly greater than that from the multiparae P < 0.05). The mean weight of babies from infected mothers was 265 g lower than that of babies from uninfected mothers (P < 0.001) and the babies of primiparae were, on average, 156 g lighter than those of the multiparae (P < 0.001). Although infection significantly lowered mean birthweight in both parity groups (P < 0.001), the reduction was larger in the primiparae (294 g) than in the multiparae (240 g). The LBW risk ratio for primiparae compared with multiparae was 2.3 for both infected and uninfected groups. The proportions of attributable risk indicated that parity accounted for about 57% of all cases of LBW in primiparae, irrespective of infection. Infection enhanced the risk of producing LBW babies in the primiparae by 11.6%. LBW frequency and relative risk were inversely related to parity of mothers and were higher for infected placentae.

How negative are we to the idea of suicide prevention?

Assessment of attitudes amongst health care professionals to suicide prevention reveals a considerable degree of doubt with regards to its feasibility and appropriateness. The various professional groups may vary considerably in the degree of negative attitudes which they exhibit. Such findings suggest that there is an urgent need to ensure that health care professionals are fully informed about the key facts concerning suicide and preventive strategies. Key elements of clinical practice and service organization with regards to suicide prevention are discussed.

Dry season malaria transmission in a forest ecosystem in Western Sierra Leone

Transmission of dry season malaria was studied in two mountain villages which are being denuded of their forest cover. A. gambiae S.I. was the principal malaria vector. Although A. funestus was found to have penetrated the forest; it did not significantly contribute to base level transmission. Salivary gland sporozoite rate in A. gambiae was 0.6 per cent. The force of malaria infection measured by the sporozoite inoculation rate of A. gambiae was greatest (0.45) in Leicester village in March. The average level of P. falciparum parasitaemia in 6 to 9 years old children living in the villages was 13.5 per cent with 1.6 per cent gametocyte rate. The proportion of malarious children was 58 per cent with a recorded attack rate of fever associated with parasitaemia for fever of 0.15 episodes per child. A population attributable fraction for fever of 0.51 points to malaria as an important cause of febrile episodes among the children. Positivity for urinary 4-aminoquinoline indicated that chloroquine was commonly used

Secondary prevention of non-fatal deliberate self-harm. The green card study.

In an attempt to address the low compliance with offers of treatment shown by patients after episodes of non-fatal deliberate self-harm (DSH), patients who had harmed themselves for the first time were offered rapid, easy access to on-call trainee psychiatrists in the event of further difficulties, and they were encouraged to seek help at an early stage should such problems arise. The follow-up data obtained after one year showed a significant reduction of actual or seriously threatened DSH in the experimental group, who also made considerably less demands on medical and psychiatric services, when compared with controls.