Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review.

BACKGROUND: Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults. METHODS: A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843]. RESULTS: Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm. CONCLUSION: To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

Patterns of Hospital Presenting Suicide-Related Ideation in Older Adults before and during COVID-19: Findings from a National Clinical Service in Ireland 2018-2021.

OBJECTIVE: To examine changes in trends of hospital-presenting suicide-related ideation in older adults living in Ireland, during the first 24 months of the COVID-19 pandemic and 2018-2019. METHODS: Data on presentations of patients aged 60 and older from participating hospitals of the National Clinical Programme for Self-Harm and Suicide-related Ideation were used to compare trends during the first two years of the COVID-19 pandemic (2020-2021) with the preceding period (2018-2019). Poisson regression models were used to estimate trends in the pre-pandemic and pandemic periods. RESULTS: There were 1531 presentations for suicide-related ideation to hospital emergency departments in older adults between January 1, 2018-December 31, 2021, with most presentations involving males (57.2%, n = 876). There was a 27% increase in suicide-related ideation presentations during the pandemic years (2020-2021) when compared to 2018-2019 (RR: 1.27, p = .001, 95%CI: 1.14-1.40), with females showing a 29% increase (RR: 1.29, p = .001, 95%CI: 1.11-1.51) and males a 23% increase (RR: 1.23, p = .002, 95%CI: 1.08-1.40). When examining these trends by years, there were only significant increases in 2021, and no significant increases were observed in 2020. CONCLUSIONS: The study findings show that in the second year following the start of the pandemic, significant increases were observed in suicide-related ideation hospital-presentations in older adults. While immediate changes in trends were not observed in the first year of the pandemic, it is important to consider the pandemic's medium and long-term impact on older adults' mental health, to provide adequate support and reduce suicide risk among those presenting with suicide-related ideation.

Hospital-presenting suicide-related ideation increased by 27% in the first two years of the COVID-19 pandemic, with more accentuated increases in 2021.Older men had increased suicide-related ideation presentations in 2021.In the aftermath of the COVID-19 pandemic, it is important to consider the medium and long-term effects on older adults' mental health.

Profile of people attending emergency departments with thoughts of self-harm and suicide: A descriptive study of a nurse-led programme in Ireland.

Increasing research has been conducted on individuals presenting with self-harm at emergency departments (EDs). However, less is known about individuals presenting to EDs with only self-harm ideation. We aimed to describe the characteristics of those attending Irish hospitals with self-harm ideation and investigate any differences in comparison to those presenting with suicide ideation. A prospective cohort study was conducted on Irish ED presentations due to suicidal and self-harm ideation. Data were obtained from the service improvement data set of a dedicated nurse-led National Clinical programme for the assessment of those presenting to Irish emergency departments due to Self-harm and Suicide-related Ideation (NCPSHI). A total of 10 602 anonymized presentation data were analysed from 1 January 2018 to 31 December 2019. Descriptive analysis was conducted to compare those with suicidal and self-harm ideation on sociodemographic and care interventions. Being female and aged <29 were more prevalent among the self-harm ideation presentations. Compared to the self-harm ideation group, a higher proportion of those with suicidal thoughts received an emergency care plan (63% vs 58%, p = 0.002) and General Practitioner letter sent within 24 h of presentation (75% vs 69%, p = 0.045). Little variation was found between hospitals for self-harm ideation in both years. Our study suggests that females and younger populations are more prevalent in hospital presentations due self-harm ideation, while presentations related to suicidal ideation are more often made by males and involving substance use. Attention should be given to the relationship between clinicians' attitudes towards care provision and the content of suicide-related ideation ED disclosure.

Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study.

Background: Research has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. The objectives of the study were (a) to examine the sociodemographic and clinical profile of individuals with frequent self-harm (regardless of suicidal intent) episodes and, (b) the association between physical and mental illness comorbidity, self-harm repetition, highly lethal self-harm methods, and suicide intent. Methods: The study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n = 183) and semi-structured interviews (n = 36). Multivariate logistic regression models and independent samples t-tests were used to test the association between the sociodemographic and physical and mental disorders comorbidity on highly lethal self-harm methods and suicidal intent, respectively. Thematic analysis was applied to identify themes related to physical and mental illness comorbidity and frequent self-harm repetition. Findings: The majority of individuals with frequent self-harm episodes were female (59.6%), single (56.1%), and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90% of the participants had history of a mental or behavioral disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR = 2.89) and alcohol abuse (OR = 2.64) predicted the risk of a highly lethal self-harm method. Suicide intent was significantly higher among those with a diagnosis of major depressive disorder (t = 2.43; p = 0.020). Major qualitative themes were (a) the functional meaning of self-harm (b) self-harm comorbidity (c) family psychiatric history and (d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors. Conclusion: Physical and mental illness comorbidity was high among individuals with frequent self-harm episodes. Male gender and alcohol abuse were associated with highly lethal self-harm methods. The mental and physical illness comorbidity of individuals with frequent self-harm episodes should be addressed via a biopsychosocial assessment and subsequent indicated treatment interventions.

Presentations of self-harm and suicide-related ideation among the Irish Traveller indigenous population to hospital emergency departments: evidence from the National Clinical Programme for self-harm.

PURPOSE: Previous research has examined the suicide risk of the Irish Traveller population, but less is known about self-harm and suicidal ideation among this ethnic minority group, which are established risk factors for suicide. The aim of the current study was to compare the presentation-based self-harm and suicide-related ideation of Traveller to non-Traveller patients and describe any ethnic disparities in the aftercare of their presentation. METHODS: Data were obtained from the service improvement database of an Irish dedicated national programme for the assessment of those presenting to emergency departments (EDs) due to self-harm and suicide-related ideation. Presentation data from 24 EDs were analysed and Poisson regression was used to assess the age-sex-adjusted relative risk of hospital-presenting self-harm and suicide-related ideation. RESULTS: 24,473 presentations were recorded with 3% of the presentations made by Irish Travellers. Female Traveller patients had 3·04 (95% CI 2·51-3·68) higher risk for suicide-related ideation and 3·85 (95% CI 3·37-4·41) for self-harm, compared to white Irish female patients. Male Traveller patients had 4·46 (95% CI 3·86-5·16) higher risk for suicide-related ideation and 5·43 (95% CI 4·75-6·21) higher rates for self-harm. The highest rate ratios for self-harm were observed among older Traveller patients [male: 9·23 (95% CI 5·93-14·39); female: 6·79 (95% CI 4·37-10·57)]. A higher proportion of Traveller patients requested no next of kin involvement, compared to other ethnicities. CONCLUSIONS: Given that Irish Travellers are at higher risk of self-harm and suicide-related ideation presentations compared to other ethnic groups, EDs should be viewed as an important suicide intervention point.

Associations between humiliation, shame, self-harm and suicidal behaviours among adolescents and young adults: A systematic review protocol.

BACKGROUND: Suicide is the second leading cause of death among young people worldwide and remains a major public health concern. Research indicates that negative social contexts involving familial and peer relationships, have far-reaching influences on levels of suicidal behaviours in later life. Previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent self-harm or suicidality. However, the association between adolescent experiences of humiliation and shame, and subsequent self-harm or suicidal behaviour among children and young adults has not been well examined. As such, this systematic review is conducted to examine the prevalence and association between humiliation and shame and self-harm, suicidal ideation, and death by suicide among adolescents and young adults. METHODS: A systematic literature search in extant electronic databases including; MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase will be conducted to identify potential studies. Google Scholar, and the reference list of the retrieved articles and/or previous systematic reviews in this area, will also be scanned to identify further potential studies. ProQuest will be searched to identify relevant studies available within grey literature. There are no restrictions on the date of publications. Based on our initial review, the following terms were identified: Population: Adolescent (MESH), young adult (MESH), teen, teenage. Exposure: Humiliation, degradation, shame (MESH) or embarrassment (MESH), harassment victimisation, abasement. Outcome: Self-injurious behaviour (MESH), suicide (MESH), suicide attempted (MESH), suicide completed (MESH), self-harm, intentional self-injury, deliberate self-harm, overdose, deliberate self-poisoning, non-suicidal self-injury, self-mutilation, suicidal thought, suicidal ideation, suicidal intent, suicide. At least one term from each category will be used for conducting the literature search. All original quantitative studies published in the English language which examined the prevalence or association between humiliation or shame and self-harm and/or suicidal ideation and/or completed suicide will be included. The studies will be assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Narrative synthesis will be performed for all of the studies. If the studies are sufficiently homogenous, the results will be pooled for a meta-analysis. This systematic review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843]. DISCUSSION: This is the first review to synthesise evidence on the prevalence of, and associations between the experiences of humiliation and shame and subsequent self-harm and/or suicidal behaviours among adolescents and young adults. As there is growing evidence on increased self-harm among this age group, it is important to identify population-specific risk factors for self-harm and suicidality which will have significance in formulating tailored and effective treatment and therapeutic services for adolescents and young adults.

Hospital-presenting self-harm and ideation: Comparison of incidence, profile and risk of repetition.

OBJECTIVE: The aim of this study was to describe presentations to hospital as a result of self-harm or suicidal ideation and to examine patterns of repetition. METHOD: Presentations made to hospital emergency departments in Northern Ireland following self-harm and ideation between April 2012 and March 2017 were recorded by the Northern Ireland Registry of Self-harm. Person-based rates per 100,000 were calculated using national population estimates. Risk of repeat attendance to hospital was examined using Kaplan-Meier analyses. RESULTS: A total of 62,213 presentations to emergency departments following self-harm or with ideation were recorded. The rate of self-harm was more than twice the rate of hospital-presenting ideation. Rates of ideation were higher among men, and both self-harm and ideation rates peaked for girls aged 15-19 and men aged 20-24 years. The cumulative probability of repeat attendance to hospital was higher following ideation (52% after 12 months), primarily because 12% of ideation presentations were followed by a subsequent self-harm presentation, whereas 4% of self-harm presentations were followed by ideation. CONCLUSIONS: Our findings indicate that hospital presenters with ideation are at high risk of future self-harm. The transition from ideation to suicidal behaviour is important to consider and research could inform effective and early intervention measures.

Suicide Mortality Patterns in Greek Work Force before and during the Economic Crisis.

Background: The global recession of 2007 has attracted research attention in regard to a possible increase of deaths by suicide among employed populations. The aim of the current study was to update the first Greek study on suicide mortality among broad occupational groups during 2000⁻2009, with the last available data covering the first period of economic crisis and recession in Greece. Methods: Data on suicide deaths for the age groups of 15⁻39, 40⁻49 and 50⁻59, between 2000⁻2013 were retrieved from the national statististical authority of Greece, ELSTAT. The coding of suicide used was X60⁻X84 (intentional self-harm), based on the 10th International Classification of Diseases (ICD-10). Comparative mortality ratio (CMR) and exact 95% confidence intervals (CI) are presented. Results: Males and females in the occupational group of clerks exhibited high and increased CMRs during the crisis period (2010⁻2013). Although high ratios for males in elementary, agricultural and fishery and armed forces occupational groups were monitored during the whole period, a decrease was evident during the crisis period. Increased trends in CMRs during the crisis were monitored for both males and females in the broad occupational group of members including managers, executives and directors. In addition, females especially in the 50⁻59 age group showed increased ratios and trends in several occupational groups during the crisis, especially in technologists and associate professionals, plant and machine operators and assemblers, professionals, and craft and related trade workers. Conclusions: Austerity-related stress should alert key stakeholders and provide mental health and suicide prevention interventions for employed occupations.

The role of physical and mental health multimorbidity in suicidal ideation.

BACKGROUND: Previous research has focused on the separate roles of mental illness and physical health conditions in suicide risk, with relatively few studies investigating the importance of physical and psychiatric disorder co-occurrence. We aimed to investigate whether suicidal ideation might be influenced by physical and mental ill-health multimorbidity. METHODS: Data from the Adult Psychiatric Morbidity Survey of England were analysed. Participants who responded to the suicidal thoughts question were grouped into four distinct categories based on their health conditions (Common mental disorders (CMD) only, physical health conditions only, CMD/physical health multimorbidity and a control group with neither physical nor mental health conditions). Multinomial logistic regression analyses were conducted and odds ratios (OR) and 95% CIs are presented. RESULTS: In the fully adjusted model, both the multimorbidity and CMD-only groups were associated with higher levels of suicidal ideation relative to the control group. LIMITATIONS: Secondary analyses of cross-sectional data. CONCLUSIONS: Although multimorbidity was associated with suicidal thoughts, it does not appear to elevate risk beyond the independent effects of common mental disorders or physical health problems. Primary care and mental health clinicians should consider assessment of suicidal ideation among patients with multimorbid physical/mental health conditions.

Suicide Mortality Across Broad Occupational Groups in Greece: A Descriptive Study.

BACKGROUND: Several studies have investigated the relationship between specific occupations and suicide mortality, as suicide rates differ by profession. The aim of this study was to investigate suicide mortality ratios across broad occupational groups in Greece for both sexes in the period 2000-2009. METHODS: Data of suicide deaths were retrieved from the Hellenic Statistical Authority and comparative mortality ratios were calculated. Occupational classification was based on the International Classification of Occupations (ISCO-88) and the coding for Intentional self-harm (X60-X84) was based on the international classification of diseases (ICD-10). RESULTS: Male dominant occupations, mainly armed forces, skilled farmers and elementary workers, and female high-skilled occupations were seen as high risk groups for suicide in a period of 10 years. The age-productive group of 30-39 years in Greek male elementary workers and the 50-59 age-productive group of Greek professional women proved to have the most elevated number of suicide deaths. CONCLUSION: Further research is needed into the work-related stressors of occupations with high suicide mortality risk and focused suicide prevention strategies should be applied within vulnerable working age populations.

Farmers' contact with health care services prior to suicide: evidence for the role of general practitioners as an intervention point.

Suicide in Australian rural communities has received significant attention from researchers, health practitioners and policymakers. Farmers and agricultural workers have been a focus of particular interest, especially in relation to levels of help seeking for mental health concerns. A less explored area, however, is the level of contact that Australian farming and agriculture workers who die by suicide have had with health providers for physical, rather than mental, health conditions. It is often assumed that farmers and agricultural workers have lower levels of contact with health care services than other rural residents, although this assumption has not been well tested. Using data from the Queensland Suicide Register, this paper describes levels of contact with health care providers in the 3 months before death by suicide among men in farming and agriculture occupations and other occupations in rural Queensland. No significant differences were found in farming and agricultural workers' levels of contact with a general practitioner when compared with other rural men in Queensland. The current findings lend weight to the view that rural general practitioners represent an important intervention point for farming and agriculture workers at risk of suicide (whether or not those individuals exhibit accompanying psychiatric illness).