Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study
Troya MI, Cully G, Leahy D, Cassidy E, Sadath A, Nicholson S, Ramos Costa AP, Alberdi-Páramo Í, Jeffers A, Shiely F, Arensman E. Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study. BJPsych Open. 2021 Jul 8;7(4):e125. doi: 10.1192/bjo.2021.962. PMID: 34236021.
- “Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm.”
- “ A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data.
- “Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants’ CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm.”
- “CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.”
Hospital and Community Correlates of Recommended Emergency Department Mental Health Care for Patients Presenting With Self-Harm
Cullen SW, Marcus SC, Xie M, Caterino JM, Bridge JA, Olfson M. Hospital and Community Correlates of Recommended Emergency Department Mental Health Care for Patients Presenting With Self-Harm. Psychiatr Serv. 2021 Jul 8:appips202000779. doi: 10.1176/appi.ps.202000779. Epub ahead of print. PMID: 34235948.
- “Emergency departments (EDs) are well positioned to deliver suicide prevention services. This study examined hospital and community correlates of recommended practices.”
- “This study examined results from a national survey of ED nursing directors (N=513) focusing on hospital- and community-level variation in the routine provision of four recommended practices: suicide risk screening, access to means assessment, safety planning, and follow-up referrals.”
- “Few significant differences existed between hospitals that routinely provided these practices and hospitals that did not. Routine scheduling of follow-up appointments was associated with presence of formal contractual relationships with outpatient mental health facilities (p=0.005). Routine provision of safety planning was associated with higher levels of psychiatrist or psychologist staffing (p=0.032).”
- “There were few differences in the hospital and community characteristics between EDs that routinely provided recommended care and those that did not, suggesting few structural barriers to implementation of these recommended services for high-risk ED patients.”
Assessment of suicide attempt and death in bipolar affective disorder: a combined clinical and genetic approach
Monson ET, Shabalin AA, Docherty AR, DiBlasi E, Bakian AV, Li QS, Gray D, Keeshin B, Crowell SE, Mullins N, Willour VL, Coon H. Assessment of suicide attempt and death in bipolar affective disorder: a combined clinical and genetic approach. Transl Psychiatry. 2021 Jul 7;11(1):379. doi: 10.1038/s41398-021-01500-w. PMID: 34234108.
- “Bipolar disorder (BP) suicide death rates are 10-30 times greater than the general population, likely arising from environmental and genetic risk factors. Though suicidal behavior in BP has been investigated, studies have not addressed combined clinical and genetic factors specific to suicide death.”
- “To address this gap, a large, harmonized BP cohort was assessed to identify clinical risk factors for suicide death and attempt which then directed testing of underlying polygenic risks. 5901 individuals of European ancestry were assessed: 353 individuals with BP and 2498 without BP who died from suicide (BPS and NBPS, respectively) from a population-derived sample along with a volunteer-derived sample of 799 individuals with BP and a history of suicide attempt (BPSA), 824 individuals with BP and no prior attempts (BPNSA), and 1427 individuals without several common psychiatric illnesses per self-report (C).”
- “Clinical and subsequent directed genetic analyses utilized multivariable logistic models accounting for critical covariates and multiple testing. There was overrepresentation of diagnosis of PTSD (OR = 4.9, 95%CI: 3.1-7.6) in BPS versus BPSA, driven by female subjects. PRS assessments showed elevations in BPS including PTSD (OR = 1.3, 95%CI:1.1-1.5, versus C), female-derived ADHD (OR = 1.2, 95%CI:1.1-1.4, versus C), and male insomnia (OR = 1.4, 95%CI: 1.1-1.7, versus BPSA).”
- “The results provide support from genetic and clinical standpoints for dysregulated traumatic response particularly increasing risk of suicide death among individuals with BP of Northern European ancestry. Such findings may direct more aggressive treatment and prevention of trauma sequelae within at-risk bipolar individuals.”
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