Epidemiology Self Harm

Transcription

1 Epidemiology Self Harm Chris Gale Otago Registrars March 2011.

2 Types of events. Deliberate self harm Para suicide Suicidal ideation suicidality Suicide attempt Completed suicide.

3 Deliberate Self Harm During the study period, 8/754 (1.1% [95% CI ]) went on to commit suicide within 1 year after their index presentation with DSH. Of the eight, three killed themselves with an overdose of drugs, two by carbon monoxide poisoning, one by stabbing, one in a vehicle incident and one by hanging. Four of the suicides were by men and four were by women, with seven of them occurring between the ages of 35 and 65 years and one at age of 1525 years. The index presentation of DSH for these eight people involved an overdose of drugs in six cases and self-injury in the other two cases. Four of the people killed themselves within 1 month of their index presentation and two within the next 4 months. The last two people committed suicide at 7 and 11 months after the index presentation, respectively. Hawson Med Emerg Australasia Aug 2008

4 ED, North Shore Auckland, in one year...

5 Age-specific incidence per for re-presenters. The error bars mark the 95% confidence intervals. () male, ( ) female, ( ) total.

6 Comments DSH. DSH is not uncommon. About one in six (122/762) will represent. Most in the first month. Mid aged women at highest risk. About one in a hundred will kill selves in next year. Male == Female. Variety methods. Not necessarily same method first attempt

7 NZ Mental Health Survey Lifetime prevalences were 15.7% for suicidal ideation, 5.5% for suicide plan 4.5% for suicide attempt. Twelve-month prevalences were 3.2% for ideation, 1.0% for plan 0.4% for attempt

8 Risk factors NZMHS Risk of ideation in the past 12 months was higher in: females younger people, people with lower educational qualifications, people with low household income. Risk of making a plan or attempt was higher in: younger people people with low household income

9 Age standardized rates suicide by gender, NZ, Suicide rate (per 100,000 population) 25 Males Females

10 Age-specific rates of suicide, 15 to 24-year-olds, by sex, Suicide rate (per 100,000 population) Males Females

11 Age-specific rates of suicide, 15 24, 25 44, and 65+ years, Suicide rate (per 100,000 population)

12 Scatter plot suicide rate and divorce rate, OECD. Divorce rate (per 100 marriages) Belgium Sweden 60 Finland Czechoslovakia US UK 50 Canada Netherlands 40 Australia Germany Iceland Luxembourg 30 Denmark J apan Portugal 20 France Austria Switzerland New Zealand Greece Poland Korea Spain 10 Italy Suicide rate (per 100,000 population)

13 Occupation (NZ data)

14 Comments suicide NZ had an epidemic of male youth suicides in the 1990s. This corrected itself during the 2000s somewhat. There seems to be a correlation with social distress and suicidality (see below). Occupational group seems to lead to methods of use. But doctors and dentists have a lower than average suicide rate on official statistics

15 Physical Conditions. WIMH data set 14 countries, participants. CIDI 3.0 Suicidal ideation Suicidal plans. Suicide attempt. Asked if have chronic diseases: 7 named.

16 Occupation and method suicide

17 Psychosom Med Sep;72(7):712-9.

18 Psychosom Med Sep;72(7):712-

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20 Conclusions. Both type of disorder (pain, cardiovascular) AND total number of disabilities associated with increase in sucidal ideation all types. There is not a huge difference when one controls for mental disorder.

21 Summary Risk groups. Young men. Socail deprivation. People with multiple physical disabilities. Multiple attempts. Risk repetition DSH higher in first month. But ability to predict death is very low. THUS suicidality is not sufficient for admission need information in formulation that state admission needed.

22 References Beautrais AL, Wells JE, McGee MA, Oakley Browne MA; New Zealand Mental Health Survey Research Team. Suicidal behaviour in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psychiatry Oct;40(10): Howson MA, Yates KM, Hatcher S. Re-presentation and suicide rates in emergency department patients who self-harm. Emerg Med Australas Aug;20(4): Scott KM, Hwang I, Chiu WT, Kessler RC, Sampson NA, Angermeyer M, Beautrais A, Borges G, Bruffaerts R, de Graaf R, Florescu S, Fukao A, Haro JM, Hu C, Kovess V, Levinson D, Posada-Villa J, Scocco P, Nock MK. Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med Sep;72(7): Skegg K, Firth H, Gray A, Cox B. Suicide by occupation: does access to means increase the risk? Aust N Z J Psychiatry May;44(5):