Deliberate Self Harm

Question 1

What is the epidemiology of suicide?

Answer 1

Poor countries contribute over 75% to global rates
Peak incidence is mid 20s in poor countries and middle age in affluent countries
Suicide rates higher in men in most parts of the world
Rates are higher in urban areas than in rural areas

Question 2

What are suicide rates like in Scotland?

Answer 2

Scotland has highest rates in Britain

Hanging and poisoning are most common methods

Question 3

What effect does restricting access to a method of suicide have?

Answer 3

Reduces overall rates of suicide, especially for high lethality methods

Question 4

What are some protective factors of suicide?

Answer 4

Marriage and lithium are protective

Those who attend church > once a fortnight have half the rates of suicide

Question 5

What are some patterns seen in methods of suicide?

Answer 5

Most suicides in China are by pesticides

Suicide by firearms is rare in UK outside farmers, but is common in Switzerland and USA

Question 6

How common are chronic illnesses in suicides?

Answer 6

10% of suicides have longterm or chronic illness = particularly dignity limiting diseases (e.g Parkinson’s, MS)

Question 7

How common are suicide notes?

Answer 7

Not very = only a minority of suicides leave a note

Question 8

Are suicide pacts successful?

Answer 8

Not really = 2/3 go uncompleted

Question 9

What changes are seen in the brains of patients with a history of high lethality self harm?

Answer 9

Lower CSF 5-HIAA

Reduced binding to 5-HT transporter sites in the ventral prefrontal cortex

Question 10

What is the difference in brain activity between high lethality self harmers and low lethality self harmers?

Answer 10

High lethality self harmers have different prefrontal cortex activity to low lethality self harmers

Question 11

Is there a genetic influence in suicide?

Answer 11

Yes = 43% of suicides may be explained by genetics

Question 12

What effect does experiencing childhood sexual abuse have?

Answer 12

May influence epigenetic expression of glucocorticoid receptors in the hippocampus

Question 13

What are some interventions that can reduces suicide rates from bridges?

Answer 13

Preventing pedestrian access and cars stopping on the bridge

Question 14

How does brain activity change in people who are acutely suicidal?

Answer 14

There is cessation of frontal cortex function

Question 15

What is the epidemiology of deliberate self harm?

Answer 15

More common in women aged 15-19
More common in Northern Europe
Associated with lower socio-economic class

Question 16

What is the most common method of deliberate self harm?

Answer 16

Self-poisoning (e.g overdose using pills)

Question 17

How common is repeated self harm?

Answer 17

Over 50% of those who deliberately self harm are repeat self harmers

Question 18

How does the time of the year influence self harming behaviours?

Answer 18

Christmas time is protective against self harm in females, but rates increase on February the 14th

Question 19

What is the association between cholesterol and deliberate self harm?

Answer 19

Low cholesterol is associated with higher rates of self harm

Question 20

What is the link between deliberate self harm and suicide?

Answer 20

History of self harm is single strongest risk factor for suicide
1% risk of suicide in the 12 months following self harm

Question 21

What effect does deliberate self harm have on mortality?

Answer 21

Patients are at increased risk of premature mortality = suicide, RTA, cancer, ischaemic heart disease

Question 22

What is the actuarial approach towards suicide risk?

Answer 22

The closer someone comes to fitting the profile of a suicide completer, the higher their risk of suicide

Question 23

What are some protective factors against deliberate self harm?

Answer 23

Religion, children, reasons to live

Question 24

How successful is suicide risk assessment at identifying those at high risk of suicide?

Answer 24

Not very = 1/2 of suicide completers who were risk assessed previously were deemed to be at low risk for suicide

Question 25

What are the motives for deliberate self harm?

Answer 25

To die, to escape anguish or situation, to display desperation or to get help

Question 26

What is the biggest predictor for deliberate self harm?

Answer 26

Hopelessness

Question 27

What is the management of deliberate self harm?

Answer 27

Calm patient and ask stock questions (e.g how close have you come before?)
Ask about the episode of self harm
Look at immediate problems and what can be done
Bolster self esteem and problem solving