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1.
Actas Esp Psiquiatr ; 52(3): 289-300, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38863041

RESUMO

BACKGROUND: In recent years, the number of adolescents with depression has been increasing annually, with individuals often exhibiting non-suicidal self-injury (NSSI) behavior. The purpose of this study is to investigate the family (childhood abuse), school (peer victimization), and individual (psychological resilience) factors of adolescents with depression with or without NSSI (the Chinese version of the Functional Assessment of Self-Mutilation [C-FASM] scale), and to analyze the correlation between the above psychological and social factors and the frequency of NSSI, to provide a basis for NSSI prevention and intervention in adolescents with depression. METHODS: We recruited 355 adolescents with depressive symptoms to participate in this study and divided them into Group NSSI (N = 227) and Group no-NSSI (n-NSSI) (N = 128) based on the C-FASM scale. The Short-Form Childhood Trauma Questionnaire (CTQ-SF), Multidimensional Peer Visualization Scale (MPVS), and Resilience Scale for Chinese Adolescents (RISC) scores were compared between two groups of adolescents. Pearson correlation coefficient was used to analyze the correlation between NSSI frequency and the above scores. RESULTS: Emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ-SF score in Group NSSI were significantly higher than those in Group n-NSSI (all p < 0.001). Physical victimization, verbal victimization, social manipulation, attacks on property, and total MPVS score in Group NSSI were significantly higher than those in Group n-NSSI (p < 0.001, p < 0.001, p = 0.009, p < 0.001, p < 0.001). Goal concentration, emotion regulation, positive perception, family support, interpersonal assistance, and total RISC score in Group NSSI were significantly lower than those in Group n-NSSI (all p < 0.001). The frequency of NSSI was significantly positively correlated with emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ-SF score (r = 0.366, p < 0.001; r = 0.411, p < 0.001; r = 0.554, p < 0.001; r = 0.220, p = 0.001; r = 0.255, p < 0.001; r = 0.673, p < 0.001). The frequency of NSSI was significantly positively correlated with physical victimization, verbal victimization, social manipulation, attacks on property, and total MPVS score (r = 0.418, p < 0.001; r = 0.455, p < 0.001; r = 0.447, p < 0.001; r = 0.555, p = 0.001; r = 0.704, p < 0.001). The frequency of NSSI was significantly negatively correlated with goal concentration, emotion regulation, positive perception, family support, interpersonal assistance, and total RISC score (r = -0.393, p < 0.001; r = -0.341, p < 0.001; r = -0.465, p < 0.001; r = -0.272, p = 0.001; r = -0.160, p = 0.016; r = -0.540, p < 0.001). CONCLUSIONS: Our findings highlight the importance of family (childhood abuse), school (peer victimization), and individual (psychological resilience) factors for NSSI in depressed adolescents, and these factors are closely related to NSSI frequency. IMPLICATIONS FOR PRACTICE: Maintaining a good family environment, solving the problem of peer victimization at school, and developing corresponding measures to improve psychological resilience are of great significance for improving the mental health of depressed adolescents and reducing the risk of NSSI.


Assuntos
Maus-Tratos Infantis , Vítimas de Crime , Depressão , Resiliência Psicológica , Comportamento Autodestrutivo , Humanos , Adolescente , Comportamento Autodestrutivo/psicologia , Masculino , Feminino , Maus-Tratos Infantis/psicologia , Vítimas de Crime/psicologia , Depressão/psicologia , Grupo Associado , Criança , Bullying/psicologia , Correlação de Dados
2.
Front Public Health ; 12: 1384688, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38827623

RESUMO

Background: Self-harm is a preventable, but a leading, cause of maternal morbidity and mortality all over the world, with a significant impact on healthcare systems. Objective: To assess the magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics. Methods: An institution-based cross-sectional study was employed among postnatal mothers attending infant immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 1 October to 30 October 2023. A pretested, face-to-face interviewer-administered structured questionnaire prepared by Kobo Toolbox was used to collect the data. Both bivariable and multivariable logistic regression analyses were done. The level of significance was declared at p-value <0.05 with a 95% CI. Results: Among the 423 mothers enrolled in the study, 415 of them finally participated, at a response rate of 98.10%. The magnitude of self-harm was 12.53% (95% CI: 9.33, 15.73). Involvement of husband in maternity and child healthcare (AOR = 1.90; 95% CI: 1.12, 2.10), depression (AOR = 2.79; 95% CI: 2.14, 6.94), loneliness (AOR = 2.49; 95% CI: 1.15, 5.40), postpartum intimate partner violence (AOR = 2.15; 95% CI: 1.01, 4.54), average monthly income (AOR = 3.70; 95% CI: 2.17, 10.50), and postnatal care (AOR = 2.72; 95% CI: 1.28, 5.80) were significantly associated factors. Conclusion and recommendations: The study sought a magnitude of self-harm that was slightly higher than the previous study conducted in the northern part of Ethiopia. Therefore, healthcare providers should focus on identified factors during postnatal care to overcome them. Similarly, the concerned body should develop an effective strategy based on the identified factors to pay attention to postnatal mothers.


Assuntos
Mães , Comportamento Autodestrutivo , Humanos , Etiópia/epidemiologia , Estudos Transversais , Feminino , Adulto , Comportamento Autodestrutivo/epidemiologia , Mães/estatística & dados numéricos , Mães/psicologia , Inquéritos e Questionários , Adulto Jovem , Adolescente , Instalações de Saúde/estatística & dados numéricos , Fatores de Risco , Cuidado Pós-Natal/estatística & dados numéricos , Imunização/estatística & dados numéricos
3.
J Am Acad Psychiatry Law ; 52(2): 165-175, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38824428

RESUMO

Twenty-one states and the District of Columbia have enacted Extreme Risk Protection Order (ERPO) statutes, which allow temporary removal of firearms from individuals who pose an imminent risk of harm to themselves or others. Connecticut was the first state to enact such a law in 1999. The law's implementation and use between 1999 and 2013 were previously described, finding that ERPOs were pursued rarely for the first decade and that most orders were issued in response to concerns about suicide or self-harm rather than about interpersonal violence. The current study analyzes over 1,400 ERPOs in Connecticut between 2013 and 2020 in several domains: respondent demographics, circumstances leading to ERPO filing, type of threat (suicide, violence to others, or both), number and type of firearms removed, prevalence of mental illness and drug and alcohol use, and legal outcomes. Results are similar to the earlier study, indicating that ERPO respondents in Connecticut are primarily White, male, middle-aged residents of small towns and suburbs who pose a risk of harm to themselves (67.9%) more often than to others (42.8%). Significant gender differences between ERPO respondents are discussed, as are state-specific trends over time and differences between Connecticut and other states with published ERPO data.


Assuntos
Armas de Fogo , Humanos , Connecticut , Masculino , Feminino , Armas de Fogo/legislação & jurisprudência , Adulto , Pessoa de Meia-Idade , Violência/prevenção & controle , Violência/legislação & jurisprudência , Adulto Jovem , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Transtornos Mentais , Adolescente
4.
Psychiatry Res ; 338: 115991, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38833936

RESUMO

Emerging evidence suggests that screen-based activities are associated with self-harm and suicidal behaviors. This study aimed to examine these associations among young people through a meta-analysis. We systematically searched EBSCO pshyARTICLES, MEDLINE (via PubMed), EMBASE, and Web of Science from their inception to April 1, 2022, and updated on May 1, 2024. Longitudinal studies reporting the association between various screen-based activities and subsequent self-harm and suicidal behaviors in young people aged 10 to 24 were included. Nineteen longitudinal studies were included in the qualitative synthesis, and 13 studies comprising 43,489 young people were included in the meta-analysis, revealing that total screen use is significantly associated with the risks of self-harm and suicidal behaviors. Cyberbullying victimization was also related to these adverse outcomes. Subgroup analyses indicated that social media use and problematic screen use are significant risk factors for self-harm and suicidal behaviors. Study quality was appraised using the Newcastle-Ottawa Scale, and potential publication bias was deemed unlikely to affect the results significantly. These findings suggest that screen-based activities should be considered in the management and intervention strategies for self-harm and suicidal behaviors in young people.


Assuntos
Comportamento Autodestrutivo , Ideação Suicida , Humanos , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Adolescente , Estudos Longitudinais , Adulto Jovem , Criança , Cyberbullying/psicologia , Cyberbullying/estatística & dados numéricos , Fatores de Risco , Mídias Sociais/estatística & dados numéricos , Tempo de Tela , Tentativa de Suicídio/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Masculino
5.
BMC Public Health ; 24(1): 1571, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862974

RESUMO

BACKGROUND: Rates of self-harm and suicide are rising for young people globally and many implicate social media in this problem. To address this concern and to increase the confidence of adults to communicate safely about suicide and social media with young people, the #chatsafe Guide for Parents and Carers was developed in Australia. With significant uptake of the resource among Australian adults, the aim of the current study was to update and contextualise the #chatsafe Guide for Parents and Carers for audiences in 15 countries globally. To improve the relevance of this resource for parents and carers in these countries, the present study sought to understand the concerns held by parents, carers and suicide prevention professionals around the world about these topics and to explore the extent to which a resource such as #chatsafe would be helpful within their communities. METHODS: Seven focus groups were conducted via Zoom with parents, carers and suicide prevention professionals (n = 40) from 15 countries. Transcribed data were coded and thematically analysed using both inductive and deductive processes. RESULTS: Six themes are reported: (1) Two scary 'S' words; (2) Country and culture impact who talks (or is silent) about self-harm and suicide; (3) The need for a protective social ecosystem; (4) #chatsafe is a tool that can help parents, carers and young people worldwide; (5) #chatsafe should consider local context and end users to improve its relevance for parents and carers worldwide; and (6) A range of marketing and dissemination strategies are needed to reach adults with #chatsafe information. Findings of this study informed the update and contextualisation of the #chatsafe Guide for Parents and Carers for adult audiences in 15 countries. CONCLUSIONS: The findings from this study underscore a universal need for psychoeducation initiatives that provide adults with the skills and knowledge to support the mental health of young people, both online and offline, and that resources like #chastafe can play an important role in providing reliable information about these topics to adults across a range of cultures and contexts.


Assuntos
Cuidadores , Grupos Focais , Pais , Pesquisa Qualitativa , Mídias Sociais , Humanos , Pais/psicologia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Adulto , Masculino , Feminino , Austrália , Mídias Sociais/estatística & dados numéricos , Comportamento Autodestrutivo/prevenção & controle , Prevenção do Suicídio , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Apoio Social , Suicídio/psicologia , Suicídio/estatística & dados numéricos
6.
Br Dent J ; 236(11): 876-880, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38877248

RESUMO

In the healthcare domain, diagnostic overshadowing is a concerning issue involving the erroneous attribution of physical symptoms to a patient's mental health, behavioural intricacies, or pre-existing disabilities. Individuals facing learning and communication challenges are particularly susceptible to this phenomenon, struggling to articulate or comprehend their experienced symptoms. Likewise, patients with autism spectrum disorder can have an escalated risk due to possible challenges in interpreting bodily cues. This article delves into the specialised care required for individuals with learning disabilities and/or autism, highlighting the pervasive risk of diagnostic overshadowing and the potential manifestation of pain as self-injurious behaviour in these patient groups. By underscoring the need to mitigate diagnostic overshadowing within dental practice, we advocate for reasonable adjustments in care delivery and comprehensive education of the dental team. Proficient tools for pain assessment and effective communication are emphasised to collectively improve the healthcare experience for these vulnerable patient cohorts.


Assuntos
Comportamento Autodestrutivo , Humanos , Cervicalgia/etiologia , Cervicalgia/diagnóstico , Deficiências da Aprendizagem/complicações , Deficiências da Aprendizagem/diagnóstico , Transtorno do Espectro Autista/complicações , Cefaleia/etiologia
7.
BMC Psychiatry ; 24(1): 440, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38867174

RESUMO

BACKGROUND: Clozapine is an off-label drug used in most countries to prevent suicide in individuals with schizophrenia. However, few studies have reported real-world prescription practices. This study aimed to explore the association between a history of suicidal behavior and clozapine prescribing during eight weeks of hospitalization for individuals with early-stage schizophrenia. METHODS: This observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates. RESULTS: The prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08-17.83]) or during hospitalization (4.18[1.62-10.78]). CONCLUSION: The use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.


Assuntos
Antipsicóticos , Clozapina , Esquizofrenia , Tentativa de Suicídio , Humanos , Clozapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Masculino , Feminino , Adulto , Antipsicóticos/uso terapêutico , China/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Estudos de Coortes , Comportamento Autodestrutivo/epidemiologia , Ideação Suicida , Hospitalização/estatística & dados numéricos , Adulto Jovem , Pessoa de Meia-Idade
9.
BMC Psychiatry ; 24(1): 447, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877441

RESUMO

BACKGROUND: Self-harm and suicidal ideation are prevalent among adolescents, cause physical and psychosocial disability, and have potentially life-threatening consequences. Dialectical behavioral therapy for Adolescents (DBT-A) is an evidence-based intervention for reducing self-harm. However, few studies have investigated the effectiveness of DBT-A when delivered in routine clinical practice. METHODS: A follow-up cohort study, based on data from a quality assessment register of DBT-A in child and adolescent mental health services including seven outpatient clinics. Inclusion criteria were ongoing or a history of self-harming behavior the last 6 months; current suicidal behavior; at least 3 criteria of DSM-IV Borderline personality disorder (BPD), or at least the self-destruction criterion of DSM-IV BPD, in addition to minimum 2 subthreshold criteria; and fluency in Norwegian. Participants received 20 weeks of DBT-A consisting of multifamily skills training groups and individual therapy sessions. Outcomes from 41 participants included frequency of self-harm, suicide attempts and hospitalizations caused by self-harm or suicide attempts, assessed pre-, during, and post-treatment by self-report and reviews of the patient's medical records. Suicidal ideation, urge to self-harm and perceived feelings of happiness and sadness were assessed by the patients' diary cards at week 1, 5, 10, 15 and 20 of the treatment program. RESULTS: Participants attended an average of 17.9 (SD = 4.7) individual sessions, 14.7 (SD = 3.4) group-based skills training sessions and 4.6 (SD = 4.1) brief intersession telephone consultations. Moderate to large within-group effect sizes (ES) were found in self-harm from pre-treatment to 1-5 weeks (d = 0.64), 6-10 weeks (d = 0.84), 11-15 weeks (d = 0.99), 16-20 weeks (d = 1.26) and post-treatment (d = 1.68). Nine participants were admitted to hospitalization during DBT-A, whereas five had attempted suicide, but no suicides were completed. No statistically significant changes were found in suicidal ideation, urge to self-harm or perceived feelings of happiness or sadness from pre to post treatment. CONCLUSION: The findings of the current study are promising as the participants reported considerably reduced self-harm behavior after DBT-A treatment in a child and adolescent mental health outpatient setting.


Assuntos
Transtorno da Personalidade Borderline , Terapia do Comportamento Dialético , Comportamento Autodestrutivo , Ideação Suicida , Tentativa de Suicídio , Humanos , Adolescente , Feminino , Terapia do Comportamento Dialético/métodos , Masculino , Comportamento Autodestrutivo/terapia , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Transtorno da Personalidade Borderline/terapia , Transtorno da Personalidade Borderline/psicologia , Resultado do Tratamento , Seguimentos , Criança
10.
JAMA Netw Open ; 7(6): e2415436, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38874927

RESUMO

Importance: Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts. The prevalence of NSSI has been increasing among female adolescents in North America and Europe, but less is known about trends in other geographical regions. Objective: To examine sex differences in the prevalence of NSSI among adolescents within and between geographical regions. Data Sources: MEDLINE and PsycINFO were searched using the keywords adolescents, self-injury, sex factors, and synonyms for articles published in English between January 1, 2000, and May 10, 2022. Study Selection: Studies were included if they presented original data (any study design), included adolescents aged 10 to 19 years, reported results stratified by sex, and explicitly defined self-injury as behaviors occurring without suicidal intent. Data Extraction and Synthesis: This meta-analysis was registered with PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were assessed for quality by 2 independent coders (F.M. and J.A.). A random-effects model was used to calculate prevalence. Data were analyzed from July 2022 to April 2023. Main Outcomes and Measures: The prevalence of NSSI in male and female adolescents within and between regions was the main outcome. Odds ratios (OR) with 95% CIs were calculated for community samples. Results: Eight hundred and two studies were screened, and 38 were included (266 491 participants). Across 17 countries, the pooled prevalence of NSSI was 17.7% (female:male OR, 1.60; 95% CI, 1.29-1.98). NSSI was twice as prevalent among female adolescents compared with male adolescents in North America (OR, 2.49; 95% CI, 2.16-2.86) and Europe (OR, 2.08; 95% CI, 1.69-2.58), but not in Asia (OR, 1.00; 95% CI, 0.71-1.41). Conclusions and Relevance: In this meta-analysis of sex differences in global prevalence of NSSI, the female predominance of NSSI observed among adolescents in North America and Europe aligned with rising rates of suicide in these populations. The comparable prevalence of NSSI among male and female adolescents in Asia also aligned with the lower male-to-female suicide ratio compared with other countries. More research is needed to characterize regional (and potentially cultural) sex differences among adolescents with NSSI to prevent and treat the behavior and to understand the possible interplay with corresponding regional trends in suicide.


Assuntos
Saúde Global , Comportamento Autodestrutivo , Humanos , Adolescente , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Feminino , Masculino , Prevalência , Saúde Global/estatística & dados numéricos , Fatores Sexuais , Criança , América do Norte/epidemiologia , Europa (Continente)/epidemiologia , Adulto Jovem
11.
Medicine (Baltimore) ; 103(18): e37896, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701288

RESUMO

RATIONALE: Low-velocity penetrating head injury (PHI) is rare, comprising 0.2% to 0.4% of head traumas, but can be devastating and is associated with significant morbidity and mortality. No previous case of very-low-velocity PHI due to self-inflicted stabbing with a gimlet has been reported. PATIENT CONCERNS: A 62-year-old man was admitted to the hospital with bleeding head and abdominal wounds after stabbing his abdomen with a gimlet, and then hammering the same gimlet into his forehead and removing the gimlet himself. DIAGNOSES: Upon examination at admission, stab wounds were present on the forehead and the right upper quadrant. Computed tomography (CT) of the head revealed a bone defect in the left frontal bone and showed the intracranial path of the gimlet surrounded by mild hemorrhage and pneumocephalus. Magnetic resonance imaging (MRI) confirmed a small amount of hemorrhage with pneumocephalus but no vascular injury. INTERVENTIONS: Conservative treatment without surgery. OUTCOMES: Follow-up MRI on hospital day 58 showed no abscess or traumatic intracranial aneurysm. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 69. LESSONS: Very-low-velocity PHI might be successfully treated with conservative treatment.


Assuntos
Traumatismos Cranianos Penetrantes , Ferimentos Perfurantes , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/psicologia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Comportamento Autodestrutivo/psicologia , Imageamento por Ressonância Magnética , Tratamento Conservador/métodos
12.
BMC Psychiatry ; 24(1): 332, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693475

RESUMO

BACKGROUND: Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients. METHODS: This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs. RESULTS: ​​​The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years. CONCLUSION: Among forensic patients in Ontario, psychopathy mediates​ ​the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.


Assuntos
Experiências Adversas da Infância , Comportamento Autodestrutivo , Humanos , Masculino , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/epidemiologia , Feminino , Ontário/epidemiologia , Adulto , Estudos Retrospectivos , Experiências Adversas da Infância/psicologia , Experiências Adversas da Infância/estatística & dados numéricos , Pessoa de Meia-Idade , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Personalidade Antissocial/epidemiologia , Psiquiatria Legal , Criança
13.
Int J Qual Stud Health Well-being ; 19(1): 2353460, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38739443

RESUMO

PURPOSE: Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives' experiences of BA. Relatives' perspectives may contribute to an increased understanding of the effects of BA given the relatives' role as support and informal caregivers as well as being co-sufferers. METHODS: Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis. RESULTS: We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable). CONCLUSIONS: BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users' ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.


Assuntos
Intervenção em Crise , Família , Grupos Focais , Pesquisa Qualitativa , Comportamento Autodestrutivo , Ideação Suicida , Humanos , Masculino , Feminino , Adulto , Suécia , Comportamento Autodestrutivo/terapia , Comportamento Autodestrutivo/psicologia , Pessoa de Meia-Idade , Família/psicologia , Idoso , Encaminhamento e Consulta , Cuidadores/psicologia , Adulto Jovem
14.
J Clin Psychiatry ; 85(2)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38696137

RESUMO

Objective: To examine rates of clozapine use among people with psychotic disorders who experience specific indications for clozapine.Methods: Records data from 11 integrated health systems identified patients aged 18 years or older with recorded International Classification of Diseases, Tenth Revision, Clinical Modification, diagnoses of schizophrenia, schizoaffective disorder, or other psychotic disorder who experienced any of the 3 events between January 1, 2019, and December 31, 2019, suggesting indications for clozapine: a diagnosis of self-harm injury or poisoning, suicidal ideation diagnosed or in response to standardized assessments, and hospitalization or emergency department (ED) care for psychotic disorder despite treatment with 2 or more antipsychotic medications. Prescription dispensing data identified all clozapine use prior to or in the 12 months following each indication event. Analyses were conducted with aggregate data from each health system; no individual data were shared.Results: A total of 7,648 patients with psychotic disorder diagnoses experienced at least 1 indication event. Among 1,097 experiencing a self-harm event, 32 (2.9%) had any prior clozapine use, and 10 (0.9%) initiated clozapine during the following 12 months. Among 6,396 with significant suicidal ideation, 238 (3.7%) had any prior clozapine use, and 70 (1.1%) initiated clozapine over 12 months. Among 881 with hospitalization or ED visit despite pharmacotherapy, 77 (8.7%) had any prior clozapine treatment, and 41 (4.7%) initiated clozapine over 12 months. Among those with significant suicidal ideation, rates of both prior clozapine treatment and subsequent initiation varied significantly by race and ethnicity, with rates among Hispanic and non-Hispanic Black patients lower than among non Hispanic White patients.Conclusions: Initiating clozapine treatment is uncommon among people with psychotic disorders who experience events suggesting clozapine is indicated, with even lower rates among Black and Hispanic patients.


Assuntos
Antipsicóticos , Clozapina , Transtornos Psicóticos , Humanos , Clozapina/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Masculino , Feminino , Adulto , Antipsicóticos/uso terapêutico , Pessoa de Meia-Idade , Comportamento Autodestrutivo/epidemiologia , Ideação Suicida , Hospitalização/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto Jovem , Estados Unidos , Adolescente
15.
CNS Neurosci Ther ; 30(5): e14684, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38739217

RESUMO

AIMS: Limited understanding exists regarding the neurobiological mechanisms underlying non-suicidal self-injury (NSSI) and suicide attempts (SA) in depressed adolescents. The maturation of brain network is crucial during adolescence, yet the abnormal alternations in depressed adolescents with NSSI or NSSI+SA remain poorly understood. METHODS: Resting-state functional magnetic resonance imaging data were collected from 114 depressed adolescents, classified into three groups: clinical control (non-self-harm), NSSI only, and NSSI+SA based on self-harm history. The alternations of resting-state functional connectivity (RSFC) were identified through support vector machine-based classification. RESULTS: Convergent alterations in NSSI and NSSI+SA predominantly centered on the inter-network RSFC between the Limbic network and the three core neurocognitive networks (SalVAttn, Control, and Default networks). Divergent alterations in the NSSI+SA group primarily focused on the Visual, Limbic, and Subcortical networks. Additionally, the severity of depressive symptoms only showed a significant correlation with altered RSFCs between Limbic and DorsAttn or Visual networks, strengthening the fact that increased depression severity alone does not fully explain observed FC alternations in the NSSI+SA group. CONCLUSION: Convergent alterations suggest a shared neurobiological mechanism along the self-destructiveness continuum. Divergent alterations may indicate biomarkers differentiating risk for SA, informing neurobiologically guided interventions.


Assuntos
Encéfalo , Imageamento por Ressonância Magnética , Comportamento Autodestrutivo , Tentativa de Suicídio , Humanos , Comportamento Autodestrutivo/psicologia , Adolescente , Masculino , Feminino , Tentativa de Suicídio/psicologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Depressão/psicologia , Depressão/fisiopatologia , Depressão/diagnóstico por imagem , Vias Neurais/fisiopatologia , Vias Neurais/diagnóstico por imagem , Criança
17.
Clin Psychol Psychother ; 31(3): e2976, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38757462

RESUMO

BACKGROUND: Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). METHODS: A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. RESULTS: The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. CONCLUSIONS: The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.


Assuntos
Terapia Cognitivo-Comportamental , Comportamento Autodestrutivo , Humanos , Adolescente , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/terapia , Masculino , Feminino , Terapia Cognitivo-Comportamental/métodos , Estudos de Viabilidade , Resultado do Tratamento , Psicoterapia Breve/métodos
18.
Fam Community Health ; 47(3): 202-208, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38758023

RESUMO

BACKGROUND AND OBJECTIVES: The purpose of this research is to investigate associations between police contact, non-suicidal self-injury (NSSI), and suicidal ideation (SI) among a national sample of Canadian adolescents and young adults (ages 16-30). METHODS: Data used in this study were obtained from the Canadian Study of Adolescent Health Behaviors (N = 940), a national survey of Canadians ages 16-30. RESULTS: Police contact was associated with higher odds of NSSI (OR = 1.98, 95% CI = 1.37, 2.86). Those who reported police contact with intrusion (OR = 2.39, 95% CI = 1.49, 3.38) and police contact with harassment (OR = 3.98, 95% CI = 2.30, 6.88) had higher odds of NSSI relative to respondents with no contact. Finally, any police contact was associated with higher odds of SI (OR = 1.56, 95% CI = 1.04, 2.34) and respondents experiencing police stops with harassment had higher odds of SI compared to those who had never been stopped (OR = 2.48, 95% CI = 1.45, 4.24). CONCLUSIONS: Distressing police contact heightens the risk of NSSI and SI among young people. Rigorous evaluation of trauma-informed, developmentally appropriate strategies for identifying and intervening on NSSI and SI following adverse police encounters should be prioritized.


Assuntos
Polícia , Comportamento Autodestrutivo , Ideação Suicida , Humanos , Adolescente , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Canadá/epidemiologia , Feminino , Masculino , Adulto Jovem , Polícia/psicologia , Polícia/estatística & dados numéricos , Adulto , Fatores de Risco
19.
BMC Psychiatry ; 24(1): 370, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38755597

RESUMO

BACKGROUND: Borderline personality traits play a significant role in nonsuicidal self-injury (NSSI), particularly in depressed youths. NSSI is also highly correlated with negative life events. This research aimed to explore the connections between negative life events, borderline personality traits, and NSSI. METHODS: The study included 338 depressed youth aged 13 to 25 years. Self-reported measures and clinical interviews were utilized to evaluate the depressive symptoms, borderline personality traits, negative life events, and NSSI behaviours of these participants. Identifying variables linked to NSSI was the aim of our analysis, and we also conducted a mediation analysis to look into the influence of borderline traits on the connection between negative life events and NSSI. RESULTS: Of the 338 depressed youth, approximately 59.47% (201/338) displayed NSSI, which was associated with greater clinical severity. Borderline traits had an independent influence on NSSI and it partially explained the connection between negative life events and NSSI, even when accounting for depression symptoms. Depressed youth who were more vulnerable to NSSI behaviours often experienced negative life events such as interpersonal relationships, academic pressure, being punished, and loss. CONCLUSIONS: Our research suggests that depressed youth who experience more negative life events are more likely to experience NSSI, and negative life events indirectly influence nonsuicidal self-injury through borderline personality traits. Implementing interventions focused on mitigating borderline symptoms could be a promising therapeutic approach for addressing NSSI in young people.


Assuntos
Transtorno da Personalidade Borderline , Comportamento Autodestrutivo , Humanos , Comportamento Autodestrutivo/psicologia , Adolescente , Transtorno da Personalidade Borderline/psicologia , Feminino , Masculino , Adulto Jovem , Adulto , Depressão/psicologia , Acontecimentos que Mudam a Vida
20.
BMC Public Health ; 24(1): 1263, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720265

RESUMO

BACKGROUND: Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally. METHODS: A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome). RESULTS: The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt. CONCLUSION: Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.


Assuntos
Comportamento Autodestrutivo , Ideação Suicida , Tentativa de Suicídio , Humanos , Masculino , Tentativa de Suicídio/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adulto , Irlanda/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Estudos Transversais , Prevalência , Fatores de Risco , Pessoa de Meia-Idade , Adulto Jovem , Indústria da Construção , Adolescente
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