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2.
Artículo en Inglés | MEDLINE | ID: mdl-33339317

RESUMEN

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.


Asunto(s)
Trastornos Mentales/prevención & control , Prevención Primaria , Adolescente , Adulto , Ansiedad/epidemiología , Ansiedad/prevención & control , Depresión/epidemiología , Depresión/prevención & control , Humanos , Trastornos Mentales/epidemiología , Pandemias , Conducta Autodestructiva/prevención & control , Ideación Suicida , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-33374665

RESUMEN

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the time of questionnaire completion, and reported preexisting or new onset depression and/or anxiety during pregnancy (n = 187). Frequency of postpartum SHI ('often/sometimes' = frequent, 'hardly ever' = sporadic, 'never') was measured via the Edinburgh Postnatal Depression Scale (EPDS) item 10, which reads "The thought of harming myself has occurred to me". Mothers reported their antidepressant use in pregnancy retrospectively. Overall, 52.9% of women took an antidepressant during pregnancy. Frequent SHI postpartum was reported by 15.2% of non-medicated women and 22.0% of women on past antidepressant treatment in pregnancy; this proportion was higher following a single trimester treatment compared to three trimesters (36.3% versus 18.0%). There was no preventative association of antidepressant treatment in pregnancy on reporting frequent SHI postpartum (weighted RR: 1.90, 95% CI: 0.79, 4.56), relative to never/hardly ever SHI. In a population of women with antenatal depression/anxiety, there was no preventative association between past antidepressant treatment in pregnancy and reporting frequent SHI in the postpartum year. This analysis is only a first step in providing evidence to inform psychiatric disorder treatment decisions for pregnant women.


Asunto(s)
Antidepresivos/uso terapéutico , Depresión Posparto , Conducta Autodestructiva/epidemiología , Ideación Suicida , Estudios Transversales , Depresión Posparto/tratamiento farmacológico , Depresión Posparto/epidemiología , Femenino , Humanos , Periodo Posparto , Embarazo , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos
4.
Anesth Analg ; 131(5): 1421-1429, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33079866

RESUMEN

BACKGROUND: Previous research suggests that, compared with regional anesthesia, general anesthesia is associated with increased odds of postoperative depressive disorders. No study has specifically evaluated the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia. This exploratory study was designed to test the hypothesis that general anesthesia for cesarean delivery is associated with increased odds of severe postpartum depression (PPD) requiring hospitalization compared with neuraxial anesthesia. METHODS: This retrospective cohort study included cesarean delivery cases performed in New York State hospitals between January 2006 and December 2013. Exclusion criteria were as follows: (1) having >1 cesarean delivery during the study period; (2) residing outside of New York State; (3) having a general anesthetic for other surgery or delivery in the previous year or in the year after the index case. The primary outcome was the occurrence of PPD, and the secondary outcomes were: (1) the composite of suicidal ideation or self-inflicted injury (ie, suicidality); (2) anxiety disorders; and (3) posttraumatic stress disorders (PTSD). Primary and secondary outcomes were identified during the delivery hospitalization and up to 1 year after delivery. Adjusted odds ratios (aORs) and 95% confidence interval (CI) of adverse psychiatric outcomes associated with general anesthesia were estimated using propensity score matching. RESULTS: Of the 428,204 cesarean delivery cases included, 34,356 had general anesthesia (8.0%). Severe PPD requiring hospitalization was recorded in 1158 women (2.7/1000; 95% CI, 2.5-2.9); of them, 60% were identified during readmission, with a median of 164 days after discharge. Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was associated with a 54% increased odds of PPD (aOR, 1.54; 95% CI, 1.21-1.95) and a 91% increased odds of suicidal ideation or self-inflicted injury (aOR, 1.91; 95% CI, 1.12-3.25). There was insufficient evidence in these data that general anesthesia was associated with anxiety disorders (aOR, 1.37; 95% CI, 0.97-1.95) or PTSD (aOR, 1.50; 95% CI, 0.50-4.47). CONCLUSIONS: General anesthesia for cesarean delivery is associated with increased odds of severe PPD requiring hospitalization, suicidal ideation, and self-inflicted injury. If confirmed, these preliminary findings underscore the need to avoid the use of general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia.


Asunto(s)
Anestesia General/efectos adversos , Cesárea , Depresión Posparto/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Anestesia de Conducción , Anestesia Obstétrica , Ansiedad/psicología , Estudios de Cohortes , Femenino , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Embarazo , Puntaje de Propensión , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Resultado del Tratamiento
5.
Epidemiol Psychiatr Sci ; 29: e170, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33021194

RESUMEN

AIMS: Early puberty is associated with an increased risk of self-harm in adolescent females but results for males are inconsistent. This may be due to the use of subjective measures of pubertal timing, which may be biased. There is also limited evidence for the persistence of pubertal timing effects beyond adolescence, particularly in males. The primary aim of the current study was therefore to examine the association between pubertal timing and self-harm in both sexes during adolescence and young adulthood, using an objective measure of pubertal timing (age at peak height velocity; aPHV). A secondary aim was to examine whether this association differs for self-harm with v. without suicidal intent. METHODS: The sample (n = 5369, 47% male) was drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort study. Mixed-effects growth curve models were used to calculate aPHV. Lifetime history of self-harm was self-reported at age 16 and 21 years, and associated suicidal intent was examined at age 16 years. Associations were estimated using multivariable logistic regression adjusted for a range of confounders. Missing data were imputed using Multiple Imputation by Chained Equations. RESULTS: Later aPHV was associated with a reduced risk of self-harm at 16 years in both sexes (females: adjusted per-year increase in aPHV OR 0.85; 95% CI 0.75-0.96; males: OR 0.72; 95% CI 0.59-0.88). Associations were similar for self-harm with and without suicidal intent. There was some evidence of an association by age 21 years in females (adjusted per-year increase in aPHV OR 0.91; 95% CI 0.80-1.04), although the findings did not reach conventional levels of significance. There was no evidence of an association by age 21 years in males (adjusted per-year increase in aPHV OR 0.99; 95% CI 0.74-1.31). CONCLUSIONS: Earlier developing adolescents represent a group at increased risk of self-harm. This increased risk attenuates as adolescents transition into adulthood, particularly in males. Future research is needed to identify the modifiable mechanisms underlying the association between pubertal timing and self-harm risk in order to develop interventions to reduce self-harm in adolescence.


Asunto(s)
Pubertad/psicología , Conducta Autodestructiva/epidemiología , Adolescente , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios Prospectivos , Factores de Riesgo , Autoinforme , Conducta Autodestructiva/psicología , Ideación Suicida , Encuestas y Cuestionarios , Adulto Joven
6.
PLoS One ; 15(9): e0238603, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32877433

RESUMEN

Given concerns about suicide or self-harm content on Instagram, we conducted a systematic scoping review of peer-reviewed English language primary studies published between 2010-2019. Only ten studies had been published. Looking into purposive samples of Instagram posts tagged with self-harm related hashtags, studies report finding self-harm or suicide content in between 9-66% of their studied posts. Studies assessing Instagram's efforts to tackle such content found they had not been very effective. Despite heterogeneity in study aims, use of terminology, samples, methods of analysis, and study outcomes, we aggregated and distinguished 'content studies' and 'user studies'. Most studies showed concern for self-harm risk, but only one examined the relationship between self-harm posts and actual self-harm behaviours offline. It found such content had negative emotional effects on some users and reported preliminary evidence of potential harmful effects in relation to self-harm related behaviours offline, although causal effects cannot be claimed. At the same time, some benefits for those who engage with self-harm content online have been suggested. More research directly interviewing Instagram users to understand this phenomenon from their perspective is required. Finally, some ethical issues are discussed.


Asunto(s)
Conducta Autodestructiva/psicología , Medios de Comunicación Sociales , Suicidio/psicología , Humanos , Adulto Joven
7.
ANZ J Surg ; 90(11): 2227-2231, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32894624

RESUMEN

BACKGROUND: Societal restrictions and lockdown during the coronavirus (COVID-19) pandemic have had a significant impact on the volume and nature of trauma admissions. We assessed the impact of COVID-19 related societal restrictions and lockdown on trauma admissions to single level 1 trauma centre in Westmead, Australia. We hypothesized that the number of trauma admissions would decrease and number of admissions due to self-harm and assault (specifically domestic violence) would increase. METHODS: Data was collected from the prospectively maintained Westmead Hospital Trauma Registry. The primary outcome compared was the average number of trauma admissions during March and April during years 2016 to 2020. Analysis of variance was used to analyse means. Pairwise differences among group means were evaluated with Tukey's honestly significant difference test. Secondary outcomes compared were in-hospital interventions and patient outcomes. RESULTS: There was a 23-34% decrease (P = 0.018) in the mean monthly average trauma admissions during March/April 2020 compared with previous years 2016-2019. In addition, there was a 40-52% decrease (P = 0.025) and 13-29% decrease (P = 0.020) in admissions due to road traffic collisions and falls respectively. CONCLUSION: There was a significant decrease in the overall number of trauma-related admissions during the COVID-19-related period of societal restrictions and lockdown. This was due to a decrease in minor traumas, falls and road traffic collisions. There was no difference in the number of admissions secondary to major traumas, self-harm or assault.


Asunto(s)
Betacoronavirus , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/prevención & control , Servicio de Urgencia en Hospital , Pandemias/prevención & control , Neumonía Viral/prevención & control , Aislamiento Social , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito , Adulto , Australia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Estudios Transversales , Femenino , Hospitalización , Humanos , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Conducta Autodestructiva/epidemiología , Violencia
8.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32958610

RESUMEN

BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.


Asunto(s)
Factores de Edad , Disforia de Género/psicología , Disforia de Género/terapia , Trastornos Mentales/epidemiología , Transexualidad/psicología , Transexualidad/terapia , Adolescente , Antipsicóticos/uso terapéutico , Trastornos de Ansiedad/epidemiología , Niño , Estudios Transversales , Depresión/epidemiología , Trastorno Depresivo/epidemiología , Revelación , Humanos , Modelos Logísticos , Trastornos Mentales/tratamiento farmacológico , Salud Mental , Pubertad , Conducta Autodestructiva/epidemiología , Factores Sexuales , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos
9.
Rev Prat ; 70(1): 49-54, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-32877029

RESUMEN

Suicide prevention after a suicide attempt: how to stay in touch? Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes, explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor, in a context where social connection seems compromised and source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and, case management programs that rely on a "stay in contact" dimension(letters, telephone, sms, mail, etc.). A prevention algorithm was further proposed to routine care in 2015, in the northern departments of France, Nord et Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists in sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS, in order to provide information about the patient and the context of his suicide attempt. The algorithm consist in giving crisis card to all the patients; an information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department, and manage the incoming calls from the patients, plus the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed incase of an inconclusive or a failed phone call. Built on a monitoring philosophy, VigilanS has further developd a real crisis case management dimension, requiring enough time to insure an effective medical supervision, and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. We measured the evolution of the number of suicide attempts before and after implantation of VigilanS: we found an acceleration of the reduction of stay for suicide attempt in Nord et Pas-de-Calais after 2014(-16% instead of -6%), instead of the two Picardy departments the most comparable show a degradation of the phenomenon (+13%). The system is currently being deployed across France.


Asunto(s)
Conducta Autodestructiva , Intento de Suicidio , Francia , Humanos , Factores de Riesgo
10.
RECIIS (Online) ; 14(3): 633-643, jul.-set. 2020.
Artículo en Portugués | LILACS | ID: biblio-1121788

RESUMEN

O fenômeno do efeito contágio na mídia não é novo, mas muito atual. No Brasil a mídia é a terceira maior causa de suicídio em jovens de 15 a 29 anos, e um grave problema de saúde pública. Nesse ensaio desvelamos por meio de uma revisão bibliográfica as evidências que suportam o efeito epidêmico de suicídio na mídia e seus modos de operação por meio de teorias como a de Albert Bandura e sua Teoria da Aprendizagem Social. Tal relação é aqui prestigiada em função dos mais recentes sucessos como 13 Reasons Why e Euphoria, que descrevem o suicídio e comportamentos autodestrutivos de forma curiosamente descuidada. Apontamos como urgente a necessidade de normatização legal da produção e distribuição dessas mensagens nos meios de comunicação social brasileiros, que venha a contemplar os diversos gêneros audiovisuais e, sobretudo, os novos suportes de veiculação caracterizados por seu modelo assincrônico de distribuição de conteúdo.


The phenomenon of the contagion effect in the media is not new, but very current. In Brazil, the media is the third leading cause of suicide in young people aged 15 to 29, and a serious public health problem. In this text, we unveiled through a bibliographic review the evidence that supports the epidemic effect of suicide in the media and its modes of operation through theories such as that of Albert Bandura and his Theory of Social Learning. This relationship is prestigious here due to the most recent hits such as 13 Reasons Why and Euphoria, which describe suicide and self-destructive behaviors in a curiously careless way. We point out as urgent the need for legal regulation of the production and distribution of these messages in the Brazilian media, which will include the various audiovisual genres and, above all, the new media that are characterized by their asynchronous model of content distribution.


El fenómeno del efecto contagio en los medios no es nuevo, sino muy actual. En Brasil, los medios son la tercera causa principal de suicidio en jóvenes de 15 a 29 años y un grave problema de salud pública. En este texto, revelamos a través de una revisión bibliográfica la evidencia que respalda el efecto epidémico del suicidio en los medios y sus modos de operación a través de teorías como la de Albert Bandura y su Teoría del aprendizaje social. Esta relación es prestigiosa aquí debido a los éxitos más recientes, como 13 Razones Por Qué y Euforia, que describen el suicidio y los comportamientos autodestructivos de una manera curiosamente descuidada. Señalamos como urgente la necesidad de una regulación legal de la producción y distribución de estos mensajes en los medios brasileños, que incluirán los diversos géneros audiovisuales y, sobre todo, los nuevos medios que se caracterizan por su modelo asíncrono de distribución de contenido.


Asunto(s)
Humanos , Adolescente , Recursos Audiovisuales , Suicidio , Brasil , Conducta Autodestructiva , Medios de Comunicación , Comunicación Social , Red Social , Medios de Comunicación Sociales
11.
Rev. psiquiatr. infanto-juv ; 37(3): 29-34, jul.-sept. 2020.
Artículo en Español | IBECS | ID: ibc-197400

RESUMEN

A pesar del conocimiento que tenemos en la actualidad de la amplia variedad de sintomatología y fenotipos de pacientes que engloban los Trastornos del Espectro Autista, algunos de estos fenotipos siguen sin estar claramente descritos en las clasificaciones psicopatológicas. Se propone un caso clínico de una paciente adolescente que consulta por sintomatología depresiva, descubriéndose tras la evaluación y durante la evolución un Trastorno del Espectro Autista subyacente que había pasado desapercibido


Despite current knowledge about the wide variety of symptoms and phenotypes of patients that meet criteria for Autism Spectrum Disorder, some of these phenotypes are still not clearly described in psychopathological classifications. A clinical case of a teenage patient who consults for depressive symptoms is proposed. After the evaluation, an underlying Autism Spectrum Disorder that had gone unnoticed was discovered


Asunto(s)
Humanos , Femenino , Adolescente , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/psicología , Depresión/diagnóstico , Depresión/psicología , Conducta Estereotipada , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/psicología , Conducta Social
12.
PLoS One ; 15(7): e0236344, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735559

RESUMEN

Self-harm and mental health are inter-related issues that substantially contribute to the global burden of disease. However, measurement of these issues at the population level is problematic. Statistics on suicide can be captured in national cause of death data collected as part of the coroner's review process, however, there is a significant time-lag in the availability of such data, and by definition, these sources do not include non-fatal incidents. Although survey, emergency department, and hospitalisation data present alternative information sources to measure self-harm, such data do not include the richness of information available at the point of incident. This paper describes the mental health and self-harm modules within the National Ambulance Surveillance System (NASS), a unique Australian system for monitoring and mapping mental health and self-harm. Data are sourced from paramedic electronic patient care records provided by Australian state and territory-based ambulance services. A team of specialised research assistants use a purpose-built system to manually scrutinise and code these records. Specific details of each incident are coded, including mental health symptoms and relevant risk indicators, as well as the type, intent, and method of self-harm. NASS provides almost 90 output variables related to self-harm (i.e., type of behaviour, self-injurious intent, and method) and mental health (e.g., mental health symptoms) in the 24 hours preceding each attendance, as well as demographics, temporal and geospatial characteristics, clinical outcomes, co-occurring substance use, and self-reported medical and psychiatric history. NASS provides internationally unique data on self-harm and mental health, with direct implications for translational research, public policy, and clinical practice. This methodology could be replicated in other countries with universal ambulance service provision to inform health policy and service planning.


Asunto(s)
Ambulancias/normas , Morbilidad , Conducta Autodestructiva/epidemiología , Espera Vigilante/normas , Técnicos Medios en Salud/normas , Australia/epidemiología , Codificación Clínica/estadística & datos numéricos , Auxiliares de Urgencia/normas , Servicio de Urgencia en Hospital/normas , Femenino , Conductas Relacionadas con la Salud/fisiología , Humanos , Masculino , Registros Médicos , Salud Mental , Conducta Autodestructiva/patología , Conducta Autodestructiva/prevención & control
13.
Medicine (Baltimore) ; 99(34): e21847, 2020 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-32846834

RESUMEN

RATIONALE: Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect. PATIENT CONCERNS: A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability. DIAGNOSIS: The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age. INTERVENTIONS: Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion. OUTCOMES: Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period. LESSONS: Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.


Asunto(s)
Anestesia General/efectos adversos , Hipoxantina Fosforribosiltransferasa/genética , Síndrome de Lesch-Nyhan/psicología , Propofol/administración & dosificación , Administración Intravenosa , Adolescente , Periodo de Recuperación de la Anestesia , Anestesia General/métodos , Humanos , Hiperuricemia/tratamiento farmacológico , Hiperuricemia/etiología , Discapacidad Intelectual/etiología , Cálculos Renales/cirugía , Síndrome de Lesch-Nyhan/sangre , Síndrome de Lesch-Nyhan/diagnóstico , Síndrome de Lesch-Nyhan/genética , Masculino , Nefrolitotomía Percutánea/métodos , Trastornos del Neurodesarrollo/etiología , Conducta Autodestructiva/etiología , Resultado del Tratamiento , Ácido Úrico/sangre , Vómitos/inducido químicamente
16.
PLoS Med ; 17(8): e1003235, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760068

RESUMEN

BACKGROUND: Temporal patterns in the frequency and characteristics of self-harm episodes across the Australian asylum seeker population may have implications for self-harm prevention and public health policy. The aim of this study was to examine how the distribution of self-harm episodes and method(s) of self-harm used across the Australian asylum seeker population vary according to the 24-hour cycle, day, and month, and to establish a basis for further research. METHODS AND FINDINGS: We conducted an observational study of all 949 self-harm incidents reported across the Australian asylum seeker population (representing a monthly average of 28,992 adults) between 1 August 2014 and 31 July 2015, obtained by Freedom of Information (FOI) from the Department of Immigration. Time of self-harm, day, and month of occurrence were investigated across all five Australian asylum seeker populations (i.e., community-based arrangements, community detention, onshore immigration detention, offshore immigration detention [Nauru], and offshore immigration detention [Manus Island]). Significant variations in distributions over the 24-hour cycle were observed by processing arrangements. Compared with the average distribution across all other processing arrangements, self-harm more commonly occurred among community-based asylum seekers (36.3%) between 12:00 AM and 3:59 AM (p < 0.001), in asylum seekers on Manus Island (36.4%) between 4:00 PM and 7:59 PM (p = 0.02), and among asylum seekers in onshore detention (20.4%) between 8:00 PM and 11:59 PM (p < 0.001). Compared with the average distribution across all other methods, self-poisoning (by medication) (25%) was significantly more likely to occur between 12:00 AM and 3:59 AM (p = 0.009), and self-battery (42%) between 8:00 AM and 11:59 AM (p < 0.001). The highest and lowest monthly self-harm episode rates for the whole asylum seeker population were in August (2014) (5 episodes per 1,000 asylum seekers; 95% confidence interval [CI] 1-11) and in both January and February (2015) (2.1 episodes per 1,000 asylum seekers; 95% CI 0.6-7.2), respectively; however, the overlapping CIs indicate no statistically significant differences across the months. When examining monthly trends by processing arrangements, we observed that self-harm was significantly more likely to occur in August (2014) than other months of the year among asylum seekers in onshore detention (19%) (p < 0.001), in January (2015) on Manus Island (18%) (p = 0.002), and in October (2014) on Nauru (15%) (p < 0.001). The main study limitations were that we could not investigate certain characteristics associated with self-harm (e.g., gender, country of origin), as the Department of Immigration did not routinely collect such data. There was also the potential risk of making a type 1 error, given the exploratory nature of the comparisons we undertook; we minimised this by lowering our significance threshold from 0.05 to 0.01. CONCLUSIONS: Self-harm in the Australian asylum seeker population was found to vary according to time of day and month of the year, by processing arrangements. A series of procedure-related and detention-related factors were observed to be associated with the temporal variations in self-harm. These findings should form the basis for further investigation into temporal variations in self-harm among asylum seekers, which may in turn lead to effective self-harm prevention strategies.


Asunto(s)
Ritmo Circadiano , Vigilancia de la Población , Refugiados/psicología , Estaciones del Año , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Adulto , Australia/epidemiología , Ritmo Circadiano/fisiología , Femenino , Humanos , Masculino , Vigilancia de la Población/métodos , Conducta Autodestructiva/diagnóstico , Factores de Tiempo , Adulto Joven
17.
Public Health ; 186: 44-51, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32768623

RESUMEN

BACKGROUND: Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS: The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS: Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION: Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.


Asunto(s)
Conducta Autodestructiva/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Censos , Niño , Bases de Datos Factuales , Femenino , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Conducta Autodestructiva/epidemiología , Factores Sexuales , Factores de Tiempo , Adulto Joven
18.
Artículo en Inglés | MEDLINE | ID: mdl-32854234

RESUMEN

BACKGROUND: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. METHODS: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10-24 years during 2009-2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. RESULTS: During 2009-2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03-1.24), aged 10-17 years (HR = 1.29, 95% CI: 1.18-1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07-1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40-1.98) or antidepressants (HR = 1.36, 95% CI: 1.18-1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2-2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09-1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19-2.25). CONCLUSION: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.


Asunto(s)
Sobredosis de Droga/epidemiología , Conducta Autodestructiva/epidemiología , Suicidio/estadística & datos numéricos , Adolescente , Niño , Sobredosis de Droga/psicología , Femenino , Humanos , Irlanda/epidemiología , Masculino , Modelos de Riesgos Proporcionales , Recurrencia , Sistema de Registros , Factores de Riesgo , Conducta Autodestructiva/psicología , Distribución por Sexo , Factores Sexuales , Adulto Joven
19.
Crim Behav Ment Health ; 30(5): 240-255, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32715530

RESUMEN

Most studies of prisoners, the nature of their offending and any related characteristics have been conducted in rich Western countries. In Nigeria, prison conditions differ in many important respects, key among them that prisoners share large communal spaces much of the time-up to 50 men sleeping in the same space as well as spending the day together. Our aim was to compare levels of impulsivity, aggression and suicide-related behaviours between prisoners in one prison in Nigeria who had committed a homicide and those who had not, allowing for socio-demographic factors. A case-control study design was employed with 102 homicide and an equal number of non-homicide offenders. Each participant was interviewed using the Abbreviated Barratt Impulsiveness Scale for impulsivity, the Modified Overt Aggression Scale for aggression, the MINI International Neuropsychiatric Interview (Module C) for suicide-related behaviours, and a questionnaire for ascertaining socio-demographic characteristics. On bivariate analysis, motor impulsivity was higher among homicide offenders (p = .014) while non-planning was higher among non-homicide offenders (p = .006), but this relationship was affected by demographic variables. Physical aggression levels did not distinguish the two groups, but homicide offenders were less likely to record property-directed and auto-aggressive behaviours (p < .05). By contrast, on average, scores for suicide-related behaviours were lower among the homicide offenders (p = .001), with non-homicide offenders showing a mean score in the high-risk category (13.25; SD, 1.25). As motor impulsivity significantly differentiated the groups, this may be an important measure to add to any risk assessment battery when there are concerns about homicidal behaviours. In this sample, history of interpersonal aggression did not distinguish the groups. People with indications of self-harm or suicide-related behaviours may be at less risk of violence to others, but care should be taken in interpreting this finding as it is not entirely consistent with other findings.


Asunto(s)
Agresión/psicología , Criminales/psicología , Conducta Impulsiva , Prisioneros/psicología , Conducta Autodestructiva/psicología , Suicidio/psicología , Adulto , Estudios de Casos y Controles , Homicidio , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Violencia/psicología
20.
Br J Psychiatry ; 217(4): 543-546, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32654678

RESUMEN

This study explored patterns of abuse, self-harm and thoughts of suicide/self-harm in the UK during the first month of the COVID-19 pandemic using data from the COVID-19 Social Study (n=44 775), a non-probability sample weighted to population proportions. The reported frequency of abuse, self-harm and thoughts of suicide/self-harm was higher among women, Black, Asian and minority ethnic (BAME) groups and people experiencing socioeconomic disadvantage, unemployment, disability, chronic physical illnesses, mental disorders and COVID-19 diagnosis. Psychiatric medications were the most common type of support being used, but fewer than half of those affected were accessing formal or informal support.


Asunto(s)
Infecciones por Coronavirus , Violencia Doméstica , Trastornos Mentales , Pandemias , Neumonía Viral , Conducta Autodestructiva , Suicidio , Adulto , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Violencia Doméstica/prevención & control , Violencia Doméstica/psicología , Violencia Doméstica/estadística & datos numéricos , Femenino , Humanos , Estudios Longitudinales , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/virología , Servicios de Salud Mental , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Prevalencia , Sistemas de Apoyo Psicosocial , Medición de Riesgo , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/prevención & control , Conducta Autodestructiva/psicología , Aislamiento Social/psicología , Ideación Suicida , Suicidio/prevención & control , Suicidio/psicología , Suicidio/estadística & datos numéricos , Reino Unido/epidemiología
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