The manifestation of emotional distress: Correlations between self-compassion and self-mutilation in Brazilian women with disordered eating behavior.

BACKGROUND: The functions or motives for self-mutilation behavior (SMB) in Eating Disorders are diverse, and the relationship with self-compassion is unclear. Objectives This study aims to evaluate the relationship between SMB and Self-compassion. METHODS: 251 women aged 25.8 years (SD=5.94) and 73.54kg (SD=19.33) completed measures for Binge Eating (BE), Self-Compassion, and SMB. RESULTS: In the total evaluated, 83.27% (n=209) presented BE and 94.02% (n=236) presented at least 1 type of SMB. In comparison between groups, the BE-purging one's reached higher values for BE, and less self-compassion, while BE group presented higher self-compassion values. For the BE-purging group, the behaviors "Cut or carving skin", "Hitting self", "Pulling out one's hair", "Burning skin" and "Picking areas of the body to the point of drawing blood" showed inverse correlations with self-compassion. CONCLUSION: There is an inverse correlation between self-compassion and SMB, and SMB seems to have different functions between BE-purging group vs. BE group.

Suicidality and self-injurious behavior among adolescent social media users at psychiatric hospitalization.

BACKGROUND: The current study sought to examine the relationship between documented social media use and suicidality and self-injurious behaviors in adolescents at the time of psychiatric hospitalization. METHODS: We retrospectively identified adolescents (aged 12-17 years) hospitalized on an inpatient psychiatric unit during 1 year. Abstracted information included documented social media use, demographic variables, documented self-injurious behaviors, the Patient Health Questionnaire-9, and the Suicide Status Form-II. Logistic regression was implemented to examine the effect of social media use on the risk of self-injurious behaviors and suicidality. RESULTS: Fifty-six adolescents who used social media were identified and matched with 56 non-social media users. Those with reported social media use had significantly greater odds of self-injurious behaviors at admission (odds ratio, 2.55; 95% confidence intervals, 1.17-5.71; P = .02) vs youth without reported social media use. Adolescents with reported social media use also had greater odds of increased suicidal ideation and suicide risk than those with no reported use, but these relationships were not statistically significant. CONCLUSIONS: Social media use in adolescents with a psychiatric admission may be associated with the risk of self-injurious behaviors and could be a marker of impulsivity. Further work should guide the assessment of social media use as part of a routine adolescent psychiatric history.

Caracterização das tentativas de suicídio e automutilações por adolescentes e adultos notificadas em Santa Catarina, 2014-2018 / Caracterización de intentos de suicidio y automutilación por adolescentes y adultos notificados en Santa Catarina, Brasil, 2014-2018 / Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018

Objetivo: Caracterizar as tentativas de suicídio e automutilações por adolescentes e adultos, notificadas em Santa Catarina, Brasil, de 2014 a 2018. Métodos: Estudo transversal descritivo, com dados do Sistema de Informação de Agravos de Notificação. Compararam-se características sociodemográficas, clínicas e do tipo de violência autoprovocada, entre adolescentes e adultos. Resultados: Nas 8.859 notificações analisadas, as tentativas de suicídio predominaram em relação à automutilação; as violências autoprovocadas foram mais frequentes no sexo feminino, raça/cor da pele branca e presença de transtorno mental; e sua ocorrência foi maior na residência, para ambas as idades. Nos adolescentes, destacou-se a automutilação de repetição (83,3%); e nos adultos, as tentativas de suicídio de repetição (50,6%) e a suspeita de uso de álcool no momento da violência (18,3%). Conclusão: Identificou-se altas prevalências de tentativa de suicídio entre adolescentes e adultos; as características das violências foram semelhantes entre as faixas etárias analisadas.

Objetivo: Caracterizar los intentos de suicidio y automutilaciones por adolescentes y adultos, reportados en Santa Catarina, Brasil, de 2014 a 2018. Métodos: Estudio transversal descriptivo con datos del Sistema de Información de Agravamientos de Notificación. Se compararon las características sociodemográficas, clínicas y del tipo de violencia autoinfligida entre adolescentes y adultos. Resultados: Entre las 8.859 notificaciones, predominaron los intentos de suicidio en relación a la automutilación; la autolesión fue más frecuente en mujeres, de piel blanca, con trastornos mentales y ocurrieron en domicilio, en ambas edades. En los adolescentes se destacó la automutilación repetida (83,3%) y en los adultos, los intentos de suicidio repetidos (50,6%) y la sospecha de consumo de alcohol (18,3%) en el momento de la violencia. Conclusión: Se identificó una alta prevalencia de intento de suicidio entre adolescentes y adultos, las características de la violencia fueron similares entre los grupos de edad.

Objective: To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018. Methods: This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared. Results Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out. Conclusion: We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.

Comparison of Intentional and Unintentional Injuries Among Chinese Children and Adolescents.

BACKGROUND: The patterns and risk factors of intentional injuries compared to unintentional injuries among Chinese children and adolescents have not been examined in depth. This work comprehensively describes patterns of intentional injuries in China, for which little information has been previously published. METHODS: All cases involving individuals 0-17 years old registered at emergency rooms and outpatient clinics were examined using data submitted to the National Injury Surveillance System from 2006 through 2017. A logistic regression model was performed to explore the risk factors related to intentional injuries compared to unintentional injuries. RESULTS: A total of 81,459 (95.1%) unintentional injuries, 4,218 (4.9%) intentional injuries (4,013 violent attacks and 205 self-mutilation/suicide) cases were identified. Blunt injuries accounted for 59.4% of violent attacks, while cuts and poisoning accounted for 37.1% and 23.4% of injuries involving self-mutilation/suicide, respectively. For unintentional injuries, falls (50.4%) ranked first. Additional risk factors for intentional injuries included being male (odds ratio [OR] 1.6), coming from rural areas (OR 1.9), being staff or workers (OR 2.2), and being a student (OR 1.8). As the age of the patients increased, so did the risk of intentional injuries (OR 5.0 in the 15-17 age group). Intentional injuries were more likely to occur at 00:00-03:00 am (OR 2.0). CONCLUSIONS: Intentional injuries affected more males, rural and older children, school students, and staff or workers. The mechanisms and occurrence times differed according to age group. Preventive measures should be taken to reduce the dropout of rural students, strengthen the school's violence prevention plan, and reduce self-harm.

A meta-analysis of the prevalence of different functions of non-suicidal self-injury.

BACKGROUND: A broad variety of different functions can underlie acts of Non-suicidal self-injury (NSSI). Whilst research so far has identified many of the commonly reported functions, no reliable estimates of prevalence currently exist for these different NSSI functions. Understanding the prevalence of NSSI functions represents a key to better understanding the phenomenology of NSSI and addressing the differing needs of the NSSI population. We conducted a systematic review and meta-analysis of the prevalence of NSSI functions in community and clinical samples. METHOD: A literature search of electronic databases PsycINFO, Medline, and Web of Science from date of inception to March 2017 was undertaken. A pre-specified framework for categorising different functions of NSSI was used to collate data from across studies. A random-effects meta-analysis of prevalence was then undertaken on these data. RESULTS: Intrapersonal functions (66-81%), and especially those concerning emotion regulation were most commonly reported by individuals who engage in NSSI (63-78%). Interpersonal functions (e.g., expressing distress) were less common (33-56%). LIMITATIONS: The review was limited to English-language articles. Reviewed articles were inconsistent in their measurement of NSSI. Inconsistency within pooled prevalence estimates was high when moderators were not accounted for. CONCLUSIONS: Findings indicate that intrapersonal functions of NSSI are most common and are present for the majority of participants. This finding supports dominant emotion-regulation models of NSSI, and the use of interventions that work to improve emotion-regulation ability. However, interpersonal functions remain endorsed by a substantial portion of participants.

Suicide after hospital contact for psychiatric assessment in Hong Kong: A long-term cohort study.

There are few long-term studies on suicide in psychiatric settings in China. The objective of this study was to evaluate the long term suicide risk and its associated factors after the initial psychiatric assessment. Demographic and clinical data of adult subjects receiving psychiatric assessment between 1996 and 2000 in a district hospital in Hong Kong were retrieved from the hospital computer system. Data were matched with completed suicides before June 30 2015 as recorded by the Coroner's Office. From a total of 4078 subjects identified, there were 152 (3.7%) recorded suicides; one-fifth of suicides occurred within one year, and half within 5 years. Cox regression analysis revealed that the risk of suicide after the initial psychiatric assessment was positively associated with deliberate self-harm (Hazard ratio = 2.1; 95%CI = 1.5-3.0; p < 0.001), and negatively associated with 'no psychiatric disorder' (Hazard ratio = 0.4; 95%CI = 0.2-0.6; p = 0.001). The overall suicide risk for those diagnosed to have a psychiatric disorder was 4.4%; 4.5% for men and 4.3% for women. Deliberate self-harm and having a psychiatric disorder at the time of assessment are significant risk factors of suicide. Appropriate treatment of psychiatric disorders and comprehensive management of deliberate self-harm are important for suicide prevention.

Emergency department visits for attempted suicide and self harm in the USA: 2006-2013.

AIMS: To characterise and identify nationwide trends in suicide-related emergency department (ED) visits in the USA from 2006 to 2013. METHODS: We used data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2013. E-codes were used to identify ED visits related to suicide attempts and self-inflicted injury. Visits were characterised by factors such as age, sex, US census region, calendar month, as well as injury severity and mechanism. Injury severity and mechanism were compared between age groups and sex by chi-square tests and Wilcoxon rank-sum tests. Population-based rates were computed using US Census data. RESULTS: Between 2006 and 2013, a total of 3 567 084 suicide attempt-related ED visits were reported. The total number of visits was stable between 2006 and 2013, with a population-based rate ranging from 163.1 to 173.8 per 100 000 annually. The frequency of these visits peaks during ages 15-19 and plateaus during ages 35-45, with a mean age at presentation of 33.2 years. More visits were by females (57.4%) than by males (42.6%); however, the age patterns for males and females were similar. Visits peaked in late spring (8.9% of all visits occurred in May), with a smaller peak in the fall. The most common mechanism of injury was poisoning (66.5%), followed by cutting and piercing (22.1%). Males were 1.6 times more likely than females to use violent methods to attempt suicide (OR = 1.64; 95% CI = 1.60-1.68; p < 0.001). The vast majority of patients (82.7%) had a concurrent mental disorder. Mood disorders were the most common (42.1%), followed by substance-related disorders (12.1%), alcohol-related disorders (8.9%) and anxiety disorders (6.4%). CONCLUSIONS: The annual incidence of ED visits for attempted suicide and self-inflicted injury in the NEDS is comparable with figures previously reported from other national databases. We highlighted the value of the NEDS in allowing us to look in depth at age, sex, seasonal and mechanism patterns. Furthermore, using this large national database, we confirmed results from previous smaller studies, including a higher incidence of suicide attempts among women and individuals aged 15-19 years, a large seasonal peak in suicide attempts in the spring, a predominance of poisoning as the mechanism of injury for suicide attempts and a greater use of violent mechanisms in men, suggesting possible avenues for further research into strategies for prevention.

Severe clinical events in 100 patients with schizophrenia: a retrospective clinical description using a system-specific psychopathological approach.

Catatonic states and numerous other severe clinical events can complicate the course of schizophrenia. Whether these severe courses are associated with particular system-specific symptom dimensions remain unclear. Aim is to assess the frequency of severe clinical events in a clinical population and to investigate the association of these events with sociodemographic data and system-specific psychopathology, combining qualitative and quantitative data. We performed a comprehensive retrospective description of a well-described and geographically stable sample of 100 patients with schizophrenia or schizoaffective disorder and linked severe clinical events with sociodemographic data at inclusion into the study (as indicators of social functioning) and symptoms at first admission, classified with the Bern Psychopathology Scale (BPS). We found 12 mentions of catatonic stupor or excitement, 45 of suicide attempts, 26 of suicidality, 18 of deliberate self-harm, 18 of self-threatening behaviour other than deliberate self-harm, 34 of violence against other persons, 18 of violence against objects and six of sexual harassment. Disinhibited language on first admission seemed to be a protective factor against suicidality and disinhibited motor behaviour seemed to predict self-threatening and violent behaviour. Catatonia and violence in particular seemed to be socially disabling. This exploratory study showed that the BPS is a promising instrument and might represent a system-specific approach in identifying patients at risk for severe sequelae of schizophrenia. This will have to be tested in future prospective studies.

Main predictors for repetition of suicidal behaviour among women referred to a single public sector tertiary care hospital in Iran.

OBJECTIVE: To assess the main predictors for repetition of suicidal behaviour among women. METHODS: This cross-sectional study was conducted at Loghman Hakim Hospital, Tehran, Iran, in 2014, and comprised women patients. The patients were divided into two groups, i.e. women repeating suicide and women without repeating suicide. Data was collected through a checklist and then analysed with SPSS 20. RESULTS: Of the 300 women, 121(40.3%) repeated suicide and 179(59.7%) did not. The overall mean age was 26.9±9.1 years (range: 14-80 years). High prevalence of psychological drug usage, alcohol use, history of self-mutilation (self-harm), psychotic disturbances, sexual relationships, as well as smoking and opium addition was revealed as major factors in repeated suicidal behaviour in women when compared with other women. The result of multivariate logistic regression model showed two factors of self-mutilation (odds ratio =2.692, p=0.002) and underlying psychotic disorders (odds ratio = 2.780, p<0.001) as main predictors of suicide in women. In this regard, demographic characteristics could not predict repeating suicidal attempts (p>0.05). CONCLUSIONS: The presence of underlying psychotic disorders and self-mutilation were main predictors for repetition of suicidal behaviour.

Suicide attempts and self-injurious behaviours in adolescent and adult patients with borderline personality disorder.

OBJECTIVE: Prevalence data on self-mutilation and suicide attempts for adolescent borderline personality disorder (BPD) are currently not available. The purpose of this paper was to determine the frequency and methods of two forms of physically self-destructive acts (i.e. self-mutilation and suicide attempts) reported by adolescent borderline inpatients in one of the largest samples to date and to compare these results with a similarly diagnosed and assessed group of adult borderline inpatients. METHODS: A total of 104 adolescent inpatients with BPD and 290 adult inpatients with BPD were interviewed about their lifetime history of physically self-destructive acts. RESULTS: The overall rates of self-mutilation (about 90%) and suicide attempts (about 75%) were similar during index admission for both adolescent and adult borderline patients. However, adolescents reported significantly higher rates of extreme levels of lifetime self-mutilation (e.g. >25 and >50 episodes) and cutting in particular, as compared with adult BPD. In contrast, borderline adults were significantly more likely to report a history of numerous (five or more) suicide attempts than adolescents with BPD. CONCLUSIONS: Self-mutilation and suicide attempts among adolescent borderline patients are prevalent and serious. Taken together, these results suggest that extreme levels of self-mutilation distinguish adolescent BPD from adults with BPD. Copyright © 2017 John Wiley & Sons, Ltd.

Male genital self-mutilation: a systematic review of psychiatric disorders and psychosocial factors.

OBJECTIVE: To identify psychiatric diagnoses and psychosocial factors associated with intentional male genital self-mutilation (GSM) of specific injury subtypes. METHODS: A search of MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science and CINAHL for cases of GSM was conducted until December 2015, based on GSM and related terms. Cases were examined for injury subtype, psychiatric diagnosis and psychosocial factors. Chi-square analyses were employed to determine differences in frequency of such factors across injury subtypes. RESULTS: Data were obtained from 173 cases: genital mutilation (n=21), penile amputation (n=62), castration (n=56) and combined amputation/castration (n=34). Common psychiatric disorders included schizophrenia spectrum (49%), substance use (18.5%), personality (15.9%) and gender dysphoric disorders (15.3%). Chi-square analyses revealed that schizophrenia spectrum disorders occurred significantly more often among auto-amputates as compared with self-castrators or mutilators. Gender dysphoria occurred significantly more often among self-castrators than auto-amputates. No significant differences emerged regarding psychosocial factors across GSM subtypes. However, associations were observed between psychosocial factors and psychiatric diagnoses. Although altogether not commonly reported, experiential factors were reported in 82% of psychotic individuals. Treatment inaccessibility was noted among 71% of gender dysphorics engaging in auto-castration. CONCLUSION: Clinicians must consider the diverse range of psychiatric disorders and psychosocial factors underlying GSM.

Clusters of suicides and suicide attempts: detection, proximity and correlates.

BACKGROUND: A suicide cluster is defined as a higher number of observed cases occurring in space and/or time than would typically be expected. Previous research has largely focused on identifying clusters of suicides, while there has been comparatively limited research on clusters of suicide attempts. We sought to identify clusters of both types of behaviour, and having done that, identify the factors that distinguish suicide attempts inside a cluster from those that were outside a cluster. METHODS: We used data from Western Australia from 2000 to 2011. We defined suicide attempts as admissions to hospital for deliberate self-harm and suicides as deaths due to deliberate self-harm. Using an analytic strategy that accounted for the repetition of attempted suicide within a cluster, we performed spatial-temporal analysis using Poisson discrete scan statistics to detect clusters of suicide attempts and clusters of suicides. Logistic regression was then used to compare clustered attempts with non-clustered attempts to identify risk factors for an attempt being in a cluster. RESULTS: We detected 350 (1%) suicide attempts occurring within seven spatial-temporal clusters and 12 (0.6%) suicides occurring within two spatial-temporal clusters. Both of the suicide clusters were located within a larger but later suicide attempt cluster. In multivariate analysis, suicide attempts by individuals who lived in areas of low socioeconomic status had higher odds of being in a cluster than those living in areas of high socioeconomic status [odds ratio (OR) = 29.1, 95% confidence interval (CI) = 6.3-135.5]. A one percentage-point increase in the proportion of people who had changed address in the last year was associated with a 60% increase in the odds of the attempt being within a cluster (OR = 1.60, 95% CI = 1.29-1.98) and a one percentage-point increase in the proportion of Indigenous people in the area was associated with a 7% increase in the suicide being within a cluster (OR = 1.07, 95% CI = 1.00-1.13). Age, sex, marital status, employment status, method of harm, remoteness, percentage of people in rented accommodation and percentage of unmarried people were not associated with the odds of being in a suicide attempt cluster. CONCLUSIONS: Early identification of and responding to suicide clusters may reduce the likelihood of subsequent clusters forming. The mechanisms, however, that underlie clusters forming is poorly understood.

Oral habits, dental trauma, and occlusal characteristics among 4- to 12-year-old institutionalized orphan children in Riyadh, Saudi Arabia.

The aim of this study was to assess the oral habit practices, dental trauma, and occlusal characteristics of 4- to 12-year-old orphans living in governmental orphanages in Riyadh. This cross-sectional study was conducted in three government orphanages and three ordinary schools. All 90 orphans, residing in the orphanage, were included. Ninety schoolchildren were selected to serve as the controls. Demographic data, oral habit history, and dental trauma history were obtained through a questionnaire. All children were examined to confirm the presence of signs of oral habits, dental trauma, and associated occlusal characteristics. Pearson chi-square was used for statistical analysis. Orphans were found to have more digit sucking and oral self-mutilation habits; however, the control children were found to have more nail biting habit. Nearly 21% of the orphans had dental trauma compared to 10% of the control group. About 70% of the dental trauma affected permanent teeth among orphans, whereas, 85% affected primary teeth in the control children. Dental trauma increased as the orphans got older; however, it decreased significantly as the control children got older. Orphans were found to have more cross-bite, increased over-jet, and open-bite. Digit sucking habit was positively associated with class II molar relation, presence of posterior cross-bite, and open-bite. Orphans had increased prevalence of digit sucking habit, self-mutilation, dental trauma, and malocclusion.

Gender and Racial Disparities in Cases of Autoenucleation.

OBJECTIVE: This review demonstrates the gender and racial disparities among patients who have committed ocular autoenucleation. DESIGN: Peer-reviewed articles were identified and reviewed on the basis of a literature search in PubMed/MEDLINE and Ovid/EMBASE databases from all available literature to date. RESULTS: We identified 60 cases of autoenucleation published in contemporary literature with nine attempted cases. The ratio of men to women who have committed autoenucleation is 8:1. Only 28 cases of autoenucleation included confirmed reports of racial makeup. 17 out of 28 cases were White, eight out of 28 cases were Hispanic or Asian, and only three cases were Black. White patients account for 61% of the cases, while Black patients make up 11% and other races constitute 28%. The common underlying psychiatric motivations among autoenucleation patients include biblical interpretations, religious delusions, and paranoia of the eye. The most common associated psychiatric disorders among patients with autoenucleation include schizophrenia, major depressive disorder, and bipolar disorder. CONCLUSION: Autoenucleation largely occurs amongst male patients with active psychiatric disorders. Our findings challenge previously published reviews where the incidence of autoenucleation is reported as equal for the two sexes. A higher incidence among the White population is also suggested. This is the first time gender and racial disparity have been demonstrated with respect to autoenucleation.

Risk factors and characteristics of suicide attempts among 381 suicidal adolescents.

AIM: This study explored the relationships between suicidal adolescents and their parents, siblings and friends. It examined how much adolescents talked to their parents before suicide attempts, the frequency of self-mutilation, the extent of suicidal ideation, previous suicide attempts and suicide attempts in the adolescent's surroundings. METHODS: We performed a cross-sectional case-control study that focused on 381 adolescents aged 10-17 years who were admitted to hospitals across Denmark after suicide attempts with acetaminophen and 296 age- and gender-matched controls recruited from schools. The study used questionnaires and medical and child psychiatric records. RESULTS: The study group were ten times more likely to report dissociated parental relationships than the control group (41.5% versus 4%), and there were significant relationships between these reports and feelings of not being heard (p < 0.0001), dissociated relationships with friends (p < 0.0001) and siblings (p < 0.0001) and self-mutilation (p = 0.009). Almost two-thirds (62.5%) of the suicidal adolescents who tried to talk to their parents about their problems felt unheard, and there was a significant relationship between this feeling and the duration of suicidal ideation (p = 0.01) and self-mutilation (p = 0.003). CONCLUSION: Early risk factors for suicide were dissociated relationships with parents, siblings and friends, feeling unheard, self-mutilation and extended suicidal ideation.

Self-harm and overcrowding among prisoners in Geneva, Switzerland.

PURPOSE: Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a "deprivation state." The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study took place at Geneva's pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014). FINDINGS: Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment. RESEARCH LIMITATIONS/IMPLICATIONS: The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio - and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential. PRACTICAL IMPLICATIONS: The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior. ORIGINALITY/VALUE: This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

A review of stab wound injuries at a tertiary trauma centre in Singapore: are self-inflicted ones less severe?

INTRODUCTION: In Singapore, as strict laws are a strong deterrent against armed violence, little is known about the epidemiology of penetrating stab wound injuries. Our study aimed to investigate the epidemiology of stab wound injuries at a major trauma centre in Singapore and determine if there was a difference in severity between self-inflicted stab wound (SI) injuries and those inflicted by others (IO). METHODS: We retrospectively reviewed all penetrating injuries at Tan Tock Seng Hospital, and identified and categorised all stab wound injuries as SI or IO. Basic demographic information, injury severity characteristics and outcome data were compared between these two groups. A review of all mortalities was performed, including recording the causes of death. RESULTS: Between 2005 and 2010, there were a total of 149 stab wound injuries, of which 24 (16.1%) were SI and 125 (83.9%) were IO injuries. Patients tended to be young (mean age 34.1 ± 14.2 years). The mean Injury Severity Score was significantly different between the SI and IO groups (8.8 ± 6.5 vs. 12.3 ± 8.1; p = 0.03). In both groups, the majority underwent an operative procedure (83.3% vs. 85.6%) and had an average hospital stay of four days. CONCLUSION: The study confirms our hypothesis that SI injuries tend to be less severe than IO injuries and are more likely to occur at home rather than at a public area. This finding may be useful in the triage of patients with stab wound injuries.

[The phenomenon of covert self-mutilation in the surgical routine]. / Das Phänomen der heimlichen Automutilation im chirurgischen Alltag.

Factitious disorders are conditions which are unknown to many physicians but have a prevalence of 1-5 % in outpatient departments and hospitals. In order to avoid prolonged and complicated (false) treatment in surgery this article gives a review of the definition, epidemiology and pathogenesis of factitious disorders as well as clinical symptoms and therapy options. A focus is placed on the identification of patients, treatment strategies and the prevention of malpractice. Additionally, clinical features of the disorder are illustrated with the description of some characteristic cases.

Does the Hospital Predict Readmission? A Multi-level Survival Analysis Approach.

Time to psychiatric rehospitalization was predicted for a sample of 1473 Medicaid-insured youth in Illinois in 2005 and 2006. A multi-level model statistical strategy was employed to account for the fact that youth days to rehospitalization were nested within hospital and to test the hypothesis that hospitals would vary significantly in return rates, controlling for individual-level (e.g., symptom, demographic) variables. Hospitals did not vary significantly in days to rehospitalization. At the individual-level, level of externalizing behavior and residential treatment placement predicted a faster return to the hospital. These results support the perspective that hospital outcomes are best operationalized using variables tied more directly to the inpatient episode (e.g., LOS, reductions in acuity).

Prevalence and functions of non-suicidal self-injury in Spanish adolescents.

BACKGROUND: This study examined the prevalence, characteristics and functions of Non-suicidal Self-injury (NSSI) among Spanish adolescents. METHOD: The sample consisted of 1,864 adolescents aged between 12 and 19 years (Mean Age = 15.32, SD = 1.97, 51.45% girls). The participants completed a modified version of the self-report scale Functional Assessment of Self-Mutilation (FASM; Lloyd, Kelley, & Hope, 1997) to assess rates and methods of NSSI used during the last 12 months. They also indicated the functions of NSSI. RESULTS: NSSI behaviors are common among Spanish adolescents. More than half of the sample showed such behavior in the past year, and 32.2% had carried out severe NSSI behaviors. The functions of NSSI were examined by using confirmatory factor analyses. Results supported a hierarchical model consisting of two second-order factors: automatic reinforcement, which explained both positive and negative automatic reinforcement, and social reinforcement, which explained both positive and negative social reinforcement. CONCLUSIONS: These dimensions are critical to understand the factors that maintain NSSI behavior and have implications for treatments.