The relationship between cumulative ecological risk and health risk behaviors among Chinese adolescents.

OBJECTIVES: To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences. METHODS: A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze. RESULTS: Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 (p = 0.228), 0.67 (p < 0.001), 0.44 (p < 0.001), 0.60 (p < 0.001), 0.78 (p = 0.001), 0.83 (p = 0.001), 0.80 (p = 0.001), 0.83 (p = 0.022), 0.71 (p = 0.005), 0.75 (p = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p = 0.001). CONCLUSIONS: Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys.

Childhood Trauma and Self-harm in Youths with Bipolar Disorders.

BACKGROUND: Bipolar disorders (BD) in youth are associated with a high risk of self-harm behaviors. Childhood trauma (CT) is a relevant environmental stressor that is related to both BD diagnosis and self-harm in adulthood. It is not yet established whether CT may impact self-harm risk in youth. Therefore, the aim of this study was to investigate the distribution patterns of CT in youth BD with and without self-harm. METHODS: We assessed 273 participants (aged 13-25 years), 96 youths with BD according to DSM-5 criteria and 177 healthy controls (HC). History of CT was obtained using the Childhood Trauma Questionnaire (CTQ). The association between CT and self-harm was tested using multivariate statistical models. RESULTS: Over 45% of participants with BD reported lifetime self-harm. The BD Self-harm group reported more emotional abuse, emotional neglect, sexual abuse, and physical abuse than HC. The BD No-Self-harm group reported more emotional abuse than HC. The BD Self-harm group reported more emotional abuse and neglect than the BD No-Self-harm group. The BD Self-harm group also reported separated parents, hospitalizations, smoking, use of antiepileptics, antipsychotics and lithium. Emotional abuse was an independent predictor of self-harm in youths with BD. CONCLUSION: Findings support the importance of assessing CT, in particular emotional abuse, in youth with BD at risk for self-harm.

Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka.

OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.

The role of trauma services in intentional self-harm at a regional level 1 trauma center.

INTRODUCTION: Suicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. METHODS: We conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. RESULTS: Four hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). CONCLUSIONS: We need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.

Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study.

BACKGROUND: The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. OBJECTIVE: This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth's risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. METHODS: A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. RESULTS: The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=-0.01, P=.72). CONCLUSIONS: Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.

Comportamentos Autolesivos, Percepção de Suporte Familiar e Sintomas Ansiosos e Depressivos em Adolescentes Pernambucanos / Self-Injurious Behaviors, Family Support Perception and Anxious and Depressive Symptoms in Adolescents from Pernambuco / Comportamientos Autolesivos, Percepción de Apoyo Familiar y Síntomas Ansiosos y Depresivos en Adolescentes de Pernambuco

Comportamentos autolesivos na adolescência se tornaram um problema de saúde pública mundial. Frequentemente, esses comportamentos compõem o quadro sintomático de doenças psiquiátricas, sendo conceitualizados como estratégias disfuncionais de regulação emocional. Diante disso, este estudo investiga a relação entre comportamentos autolesivos, percepção de suporte familiar e sintomas ansiosos e depressivos em adolescentes da rede estadual de ensino do Recife, assim como estima a prevalência do fenômeno (n=501). Também buscou-se estimar a prevalência do fenômeno e sua relação com variáveis sociodemográficas. Os instrumentos utilizados foram o Protocolo Health Behaviour in School-Aged Children, a Spence Children's Anxiety Scale e o Inventário de Depressão Infantil, todos adaptados ao português brasileiro. Foram realizadas análises da consistência interna, qui quadrado, teste t, correlação e descritivas. Os resultados apontaram prevalência de 31,3% para comportamentos autolesivos. Adolescentes do sexo feminino apresentaram 2,26 vezes mais chance de engajar na prática de comportamentos autolesivos. Verificou-se diferenças significativas entre participantes que se autolesionavam e aqueles que não se autolesionavam no tangente à percepção de sintomas depressivos, sintomas ansiosos e suporte familiar. Nossos achados enfatizam a importância dos vínculos familiares no combate aos comportamentos autolesivos. Assim, esperamos contribuir para a construção de estratégias preventivas contra comportamentos de risco, ansiedade e depressão.

Self-injurious behaviors in adolescence have become a public health problem worldwide. Often these behaviors are symptoms of psychiatric diseases, conceptualized as dysfunctional strategies of emotional regulation. Therefore, this study investigates the relation between self-injurious behaviors, family support perception and anxiety and depressive symptoms within adolescents from the state education network in Recife. It also estimates the prevalence of the phenomenon (n=501). Another goal was to estimate the prevalence of the phenomenon and its relation with sociodemographic variables. The instruments used were the Health Behavior in School-Aged Children Protocol, the Spence Children's Anxiety Scale and the Children's Depression Inventory, all adapted to Brazilian Portuguese. Internal consistency, chi-square, t-test, correlation and descriptive analyzes were performed. The results showed a prevalence of 31.3% for self-injurious behaviors, with female adolescents being 2.26 times more likely to engage in self-injurious behaviors. There were significant differences between participants who engaged in self-injurious behaviors and those who did not due to their perceptions of depressive symptoms, anxious symptoms and family support. Our findings emphasize the importance of family bonds in combating self-injurious behaviors. Thus, we hope to contribute to the creation of preventive strategies against risk behaviors, anxiety and depression.

Los comportamientos autolesivos en la adolescencia se han convertido en un problema de salud pública mundial. Estos comportamientos componen el cuadro sintomático de enfermedades psiquiátricas, siendo conceptualizados como estrategias disfuncionales de regulación emocional. Este estudio investiga la relación entre las conductas autolesivas, la percepción del apoyo familiar y los síntomas de ansiedad y depresión entre adolescentes de la red estatal de educación en Recife, además de estimar la prevalencia del fenómeno (n=501). También se buscó estimar la prevalencia del fenómeno y su relación con variables sociodemográficas. Los instrumentos utilizados fueron el protocolo Health Behaviour in School-Aged Children, la Spence Children's Anxiety Scale y el Invetario de Depresión Infantil, todos adaptados al portugués brasileño. Se realizaron análisis de consistencia interna, chi cuadrado, prueba t, correlación y descriptivos. Los resultados apuntaron para la prevalencia de 31,3% para comportamientos autolesivos. Adolescentes del sexo femenino presentaron 2,26 veces más chances de involucrarse en la práctica de comportamientos autolesivos. Se verificaron diferencias significativas entre participantes que se autolesionaban y aquellos que no se autolesionaban frente a la percepción de síntomas depresivos, síntomas ansiosos y apoyo familiar. Esperamos contribuir con la construcción de estrategias preventivas contra conductas de riesgo, ansiedad y depresión.

An Ounce of Prevention is the Only Cure: Nationwide Clinical and Financial Outcomes of Self-Inflicted Firearm Injuries.

BACKGROUND: Self-inflicted gunshot wounds (SIGSWs) remain a leading, preventable cause of death in the United States. The present study evaluated patient demographics, operative characteristics, in-hospital outcomes, and resource utilization between patients with SIGSW and other GSW. METHODS: The 2016-2020 National Inpatient Sample was queried for patients ≥16 years old admitted following gunshot wounds. Patients were categorized as SIGSW if they were injured through self-harm. Multivariable logistic regression was used to evaluate the association of SIGSW on outcomes. The primary endpoint was in-hospital mortality with complications, costs, and length of stay secondarily considered. RESULTS: Of an estimated 157,795 surviving to hospital admission, 14,670 (9.30%) were SIGSW. Self-inflicted gunshot wounds were more commonly female (18.1 vs 11.3%), insured by Medicare (21.1 vs 5.0%), and white (70.8 vs 22.3%) (all P < .001) compared to non-SIGSW. Psychiatric illness was more prevalent in SIGSW (46.0 vs 6.6%, P < .001). Additionally, SIGSW more frequently underwent neurologic (10.7 vs 2.9%) and facial operations (12.5 vs 3.2%) (both P < .001). After adjustment, SIGSW was associated with greater odds of mortality (AOR: 12.4, 95% CI: 10.4-14.7). Length of stay (ß: +1.5 days, 95% CI: .8-2.1) and costs (ß: +$3.6 K, 95% CI: 1.4-5.7) were significantly greater in SIGSW. CONCLUSIONS: Self-inflicted gunshot wounds are associated with increased mortality compared to other GSW, likely due to the increased proportion of injuries in the head and neck region. This lethality, coupled with the high prevalence of psychiatric illness in this population, indicates that efforts must be made to intervene through primary prevention, including enhanced screening and weapon safety considerations for those at risk.

The impact of a cancer diagnosis on nonfatal self-injury: a matched cohort study in Ontario.

BACKGROUND: Psychological distress following a cancer diagnosis potentially increases the risk of intentional, nonfatal self-injury. The purpose of this work is to evaluate and compare rates of nonfatal self-injury among individuals in Ontario diagnosed with cancer against matched controls with no history of cancer. METHODS: Adults in Ontario diagnosed with cancer from 2007 to 2019 were matched to 2 controls with no history of cancer, based on age and sex. We calculated the absolute and relative difference in rates of nonfatal self-injury in the 5 years before and after the index date (date of cancer diagnosis and dummy date for controls). We used crude difference-in-differences methods and adjusted Poisson regression-based analyses to examine whether the change in rates of nonfatal self-injury before and after index differed between cancer patients and controls. RESULTS: The cohort included 803 740 people with cancer and 1 607 480 matched controls. In the first year after diagnosis, individuals with cancer had a 1.17-fold increase in rates of nonfatal self-injury (95% confidence interval [CI] 1.03-1.33) compared with matched controls, after accounting for pre-existing differences in rates of nonfatal self-injury and other clinical characteristics between the groups. Rates of nonfatal self-injury remained elevated in the cancer group by 1.07-fold for up to 5 years after diagnosis (95% CI 0.95-1.21). INTERPRETATION: In this study, incidence of nonfatal self-injury was higher among individuals diagnosed with cancer, with the greatest impact observed in the first year after diagnosis. This work highlights the need for robust and accessible psychosocial oncology programs to support mental health along the cancer journey.

Patient or Prisoner?: Acute Burn Injuries in Prisoners-The Birmingham Burns Centre Experience.

Increased risk of violence and self-harm means prisoners are a vulnerable population with complex health needs. They account for a small proportion of patients with burn injuries; however, present a unique set of challenges. This study investigates the incidence, pattern and outcomes of burn injuries in prison population. Prisoners referred from 2010 to 2021 were identified using the International Burn Injury Database (iBID). Patient demographics, burn injury characteristics and outcomes were collected. Patients were then stratified based on mechanism of injury, treatment modality (surgery/conservative), hospital admission (inpatient/outpatient), and compliance with outpatient follow-up, for subgroup analyses. Sixty-eight prisoners sustained burns during the study period, with a median age of 28.5 years and TBSA of 3%. The majority were male (98.5%) and required hospital admission (75%). Scalds were the most common injury type (77.9%) and assault the most frequent cause of burns (63.2%). Eighteen patients (26.5%) underwent a surgical procedure and there were two mortalities. Of patients for whom follow-up was planned, 22% attended no appointments, with a further 49% of prisoners missing at least one appointment. Relative to patients managed nonoperatively, prisoners undergoing surgery had a longer stay and all attended outpatient follow-up appointments. Prisoners represent a unique population with exceptional challenges. Attention should be given to protecting vulnerable patients at risk of assault, education of prison staff around burn prevention and first aid, and ensuring that prisoners are able to access burns follow-up to minimize long-term sequelae. Opportunities exist to aid this such as the adoption of telemedicine.

Educational level and the risk of mental disorders, substance use disorders and self-harm in different age-groups: A cohort study covering 1,6 million subjects in the Stockholm region.

OBJECTIVE: To investigate the associations between low education and risk of mental disorders, substance use disorders and self-harm in different age-groups. METHODS: All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed-up for these disorders in health care registers 2001-2016. Subjects were stratified into four age-groups: 10-18, 19-27, 28-50, and 51-70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models. RESULTS: Low education increased the risk of substance use disorders and self-harm in all age-groups. Males aged 10-18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19-27 years had increased risks of anxiety and depression, and those aged 28-50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0-1.3) for bipolar disorder to 5.4 (95% CIs 5.1-5.7) for drug use disorder. Females aged 51-70 years had increased risks of schizophrenia and autism. CONCLUSION: Low education is associated with risk of most mental disorders, substance use disorders and self-harm in all age-groups, but especially among those aged 28-50 years.

Incidence of self-harm after bariatric surgery: A nationwide registry-based matched cohort study.

The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18-70 years at time of surgery, body mass index (BMI) > 30 kg/m2 , who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36-3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78-0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11-4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.

Longitudinal associations between pandemic post-traumatic stress symptoms and subsequent non-suicidal self-injury in adolescents: A multiple mediation model.

BACKGROUNDS: PTSD is one of the most common conditions after people have experienced trauma. While previous studies have found a link between PTSD and non-suicidal self-injury, (NSSI), few studies have longitudinally explored this relationship and the underlying mechanisms. AIMS: This study explored adolescent NSSI frequency after COVID-19 lockdown experiences, the relationship with early PTSD symptoms, and the mediating role of depression and sleep problems. METHODS: A cohort of 1609 adolescents completed two surveys during and after the national lockdown in China; one month into the lockdown and six months later; which assessed demographic and pandemic-related exposure variables; PTSD, depression, sleep, and NSSI. Mediation analyses and hierarchical regression were employed to examine the relationships and the paths between these variables. RESULTS: The NSSI rate was found to be 31.9 % after the three-month lockdown, with 20.6 % of adolescent participants reporting sleeping disorders, and 33.9 % indicating probable depression. Adolescents who had earlier PTSD symptoms, often smoked and/or drank, and had current depression and sleep disorders reported greater NSSI. Early PTSD symptoms were found to predict later NSSI and were mediated by sleep problems and depressive symptoms. Specifically, PTSD avoidance and numbing symptoms were significantly associated with NSSI above and beyond the depressive symptoms, sleeping problems, and the other covariables. CONCLUSION: It is necessary to be vigilant about the increased risk of NSSI in adolescents who have experienced extended pandemic lockdowns. Preventing early adolescent PTSD symptoms, especially avoidance and numbness, and helping teenagers quit smoking and drinking could reduce the risk of sleep disorders, depression, and NSSI.

Positive outcomes for operatively managed self-harm burns.

Within healthcare generally, patients who self-harm can experience stigma and inequitable medical care. Previous studies have suggested that patients with small self-harm burn injuries may not be treated equally in comparison to non-intentional injuries. Furthermore, there is an absence of literature related to surgical outcomes for self-harm burn injuries. A retrospective cohort study of an adult burns service's outpatient attendances over a four-year period was completed. Self-harm burn injuries were identified and hospital medical records were used to extract demographic, burn injury, treatment and outcome information. 94 self-harm burn injuries in 58 patients presented over the study period. Of those who presented with self-harm burn injuries, 29 % (n = 17) of patients presented on more than one occasion, 54 % (n = 50) of wounds were managed surgically and 80 % (n = 36) of full thickness injuries were managed surgically. The post-operative course and healing time was similar to what would be expected after non-intentional burn injuries. In 93 % (n = 54) of all patients presenting with self-harm burn injuries, there was no reported tampering or non-compliance. There was no tampering or non-compliance in 94 % (n = 47) of those with self-harm burn injuries when wounds were treated surgically. The findings support the view that self-harm burn injuries should be treated in the same way as non-intentional burn injuries and that similar outcomes from treatment can be expected. However, further research is needed to explore this systematically.

Violência autoprovocada em adultos no Espírito Santo entre 2011-2018: análises em relação aos casos notificados / Self-harm violence in adults in Espírito Santo between 2011-2018: Analyses in relation to reported cases / Violencia autoinflingida de adultos en Espírito Santo entre 2011-2018: análisis en relación a casos informados

Objetivo: identificar a proporção de violência autoprovocada em adultos em relação aos casos notificados no Espírito Santo no período de 2011-2018 e sua associação com características individuais e do evento. Métodos: estudo transversal, realizado com dados dos casos notificados de violência do Sistema de Informação de Agravos de Notificação (SINAN) do Espírito Santo, entre 2011 e 2018. A população de interesse foi de indivíduos na faixa etária de 20 a 59 anos. O desfecho foi violência autoprovocada. Características individuais e do evento foram as variáveis independentes. Realizou-se análise bivariada e multivariada apresentadas em razão de prevalência bruta e ajustada. Resultados: a proporção de violência autoprovocada notificada foi de 29,6% no período estudado. Considerando o montante de casos de violência notificados, foram verificadas associações de violência autoprovocada com sexo feminino, ter idade 20 a 29 anos, apresentar maior escolaridade, deficiência ou transtorno mental, residência como local de ocorrência, suspeita de uso de álcool e ausência de história de ocorrência anterior. Conclusão: as variáveis relacionadas ao indivíduo e ao ambiente da ocorrência estão associadas a violência autoprovocada, indicando um perfil específico para estes casos de violência em relação ao conjunto das notificações.

Objective: identify the proportion of self-inflicted violence in adults in relation to reported cases in Espírito Santo in the period 2011-2018 and its association with individual and event characteristics. Methods: cross-sectional study, conducted with data from reported cases of violence from the Brazilian Information System for Notifiable Diseases (SINAN) of Espírito Santo, between 2011 and 2018. The population of interest was individuals in the aged between 20 and 59 years. The outcome variable was self-inflicted violence. The individual and event characteristics were the independent variables. Bivariate and multivariate analysis were performed and presented in relation to the crude and adjusted prevalence ratio. Results: the proportion of self-inflicted violence reported was 29.6% in the period studied. Considering the number of reported cases of violence, associations of self-inflicted violence were verified with the female gender, age range of 20 to 29 years, higher education, disability or mental disorder, residence as place of occurrence, suspected alcohol use, and no history of previous event occurrence. Conclusion: the variables related to the individual and the environment of the occurrence are associated with self-inflicted violence, indicating a specific profile for these cases of violence in relation to the set of notifications

Objetivo: identificar la proporción de violencia autoinflingida de adultos en relación a casos informados en Espírito Santo en período 2011-2018 y su asociación con características individuales y del evento. Métodos: estudio transversal, realizado sobre datos de los casos informados de violencia del Sistema de Información de Enfermedades de Notificación Obligatoria (SINAN, acorde sigla en portugués) de Espírito Santo, entre 2011 y 2018. La población de interés corresponde a individuos en faja etaria de 20 a 59 años. El desenlace refiere a violencia autoinflingida. Las características individuales y del evento fueron las variables independientes. Se realizó análisis bivariado y multivariado, expresados en razón de prevalencia bruta y ajustada. Resultados: la proporción de violencia autoinflingida informada fue del 29,6% en el período estudiado. Considerando la cantidad de casos de violencia notificados, fueron verificadas asociaciones de violencia autoinflingida con sexo femenino, edad de 20 a 29 años, tener mayor escolarización, deficiencia o trastorno mental, domicilio como lugar de ocurrencia, sospecha de abuso de alcohol y ausencia de historial de ocurrencia previa. Conclusión: las variables relacionadas al individuo y al ámbito de ocurrencia están asociadas a violencia autoinflingida, indicando un perfil específico para estos casos de violencia en relación al conjunto de notificaciones.

Childhood Adversity Phenotypes and Risky Health Behaviors among Chinese Adolescents: Extending the Concept of Adversity.

Objective: To present an approach to phenotyping ACEs and explore the association between ACEs and adolescent health risky behaviors based on the social context of China. Methods: Totally, 5,726 adolescents aged 12-18 years were investigated about their ACEs in the family, peer, school, and personal domains and the occurrence of six types of risky health behaviors (i.e., smoking, drinking, sexual intercourse, self-harm, and suicidal ideation and attempts). Latent class analysis (LCA) was used to explore the ACE patterns. Results: Six latent classes of ACEs were identified, including low adversity, school adversity, school adversity and peer victimization, peer victimization, maltreatment and peer victimization, and high adversity, and associated with risky health behaviors in adolescents. Being physically punished by a teacher, experiencing sexual abuse, and experiencing family trauma most strongly differentiated from the six ACE classes and were correlated with an increased risk for risky adolescent health behaviors. Conclusion: This study supports a positive association between ACEs and risky adolescent health behaviors. Peer victimization, school adversity and associated contexts need to be considered in future ACE studies.

Predictors of repeated adolescent self-harm: The display of multiple variables and mediators in a 2-year study.

BACKGROUND: Data on self-harm (SH) repetition in non-Western adolescents are limited; this study is to survey the predictors. METHODS: A total of 5879 adolescents (mean age 16.02 years) in Northern Taiwan were recruited. The participants filled in online questionnaires about their sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use at baseline (T1) and at the 1 year follow-up (T2). We used logistic regression analysis to examine the predictors of SH continuation. Generalized structural equation modeling (GSEM) was then estimated to analyze the treatable variables for both years and to investigate their relationships and mediating effects. RESULTS: A total of 125 students were identified as being in the SH continuation group; while 470 students were identified as being in the SH stop group. The SH continuation rate was 21%; no significant gender difference was found. Logistic regression analysis showed that the predictors of SH continuation were low school ranking, poor quality of listening from relatives, use of the cutting method for SH, and a suicide plan in the past year at T1, and more depressed mood, use of the cutting method for SH, more suicide ideation and plans at T2. Similar predictors were found by GSEM; self-esteem at T1 and depressed mood at T2 were found to be mediators in the pathways. CONCLUSION: The continuation rate of SH was similar to that reported in Western countries. These predictors should be included in the treatment plan to prevent SH continuation.

The Association of Physical and Mental Illness and Self-Harm Resulting in Hospitalization: A Population-Based Study of Older Adults in South Korea.

Self-harm injury among older adults is a pressing problem that demands social attention in South Korea. This study sought to identify the association between physical and mental illness and hospitalization following self-harm injuries, compared to non-self-harm injuries, among older adults living in Korea. We analyzed individuals aged 65 and older who were admitted to hospitals either for self-harm or non-self-harm from a population-based survey of the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS). A logistic regression analysis was performed. Compared with non-self-harm-related hospitalization, self-harm hospitalization was associated with higher odds of depression, other disorders of the nervous system, malignancies, alcohol misuse and dependence, and drug-related dependence. Dementia, anxiety disorder, diabetes, arthritis, cerebral palsy, and other paralytic syndromes had a lower likelihood of leading to self-harm than non-self-harm hospitalization. The findings of this study can inform medical professionals to identify older adults with a heightened risk of self-harming behavior leading to hospitalization.

Autolesiones deliberadas y consumo de sustancias psicoactivas en adolescentes escolarizados de Colombia 2016 / Deliberate self-harm and psychoactive substance use in colombian school adolescents

BACKGROUND: Deliberate self-harm and the consumption of psy- choactive substances are important public health problems among adolescents. AIM: To determine the association of deliberate self-harm with the consumption of psychoactive substances, in school adolescents in Colombia. MATERIAL AND METHODS: A survey about deliberate self harm and psychoactive substance use during the last 12 months was answered by 80 018 adolescents aged between 12 and 18 years. RESULTS: The prevalence of deliberate self-harm in the last 12 months was 14.1%. The use of psychoactive drugs was associated with deliberate self-harm. The greatest association was observed with the use of non-prescription tranquilizers (Odds ratio 4.05 95% confidence intervals 3.42-4.81). CONCLUSIONS: We observed an association between deliberate self-harm and the consumption of different psychoactive substances.

[Non-suicidal self-injurious Behaviour: Insights into a littleknown Patient Population in Plastic Surgery]. / Nicht-suizidales selbstverletzendes Verhalten ­ Einblicke in ein wenig bekanntes plastisch-chirurgisches Patient*innenkollektiv.

BACKGROUND: Despite its high prevalence in adolescents and young adults, non-suicidal self-injury (NSSI) is poorly known and understood in areas other than psychiatry. Due to this lack of knowledge, affected patients often face a lack of understanding as well as rejection and discrimination when seeking help from medical professionals. This not only hampers a lasting improvement of NSSI and the development of a trustful physician-patient relationship but may also lead to traumatisation of affected patients. Based on our patients' data, this article aims to inform interested plastic surgeons about NSSI and thus to support the treatment of affected patients. PATIENTS AND METHODS: 600 patients with scars from NSSI presenting to our outpatient clinic for the first time during the past five years were enrolled in this study. Extensive data collected during the first contact was analysed and compared with the current literature. RESULTS: 95 % of the patients were female; 5 % were male. On average, patients presented 8.4 years after the last NSSI event and with a mean age of 26 years. NSSI scars were most often located on the left forearm (48 %), followed by both forearms (40 %), the left upper arm (20 %), both upper arms (15 %) and both thighs (14 %). In 57 % of patients, scars were only present on one side. A mean of 380 cm2 of the body surface was affected by NSSI scars. 47 % of patients reported having at least one additional diagnosis, with thyroid dysfunction and depression being the most common. 21 % of patients had ongoing psychiatric or psychological therapy at the time of their first consultation in our clinic. CONCLUSION: Our data provides first insight into a large population of NSSI patients seeking treatment options for their NSSI-associated scars in a plastic surgery outpatient clinic. Most patients were female with scars located on their forearms. A mean of more than 8 years had passed between their last NSSI and their first presentation to our clinic. Our findings offer a data-based approach to a group of patients with a disease pattern that is largely misunderstood in surgical disciplines and needs more attention, especially in the light of its high prevalence and life-long consequences.

Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers.

Cancer is a life-altering event causing considerable psychological distress. However, information on the total burden of psychiatric disorders across all common adult cancers and therapy exposures has remained scarce. Here, we estimated the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer and the risk of unnatural deaths after self-harm in 459,542 individuals. Depression was the most common psychiatric disorder in patients with cancer. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders, whereas those treated with kinase inhibitors had the lowest burden. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (hazard ratio (HR), 6.8; 95% confidence interval (CI), 4.3-10.7). The risk of unnatural death after 12 months was markedly lower (HR, 2.0; 95% CI, 1.5-2.7). We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritizing patients who are most at risk.