Epidemiology Self Harm Chris Gale Otago Registrars March 2011.
Types of events. Deliberate self harm Para suicide Suicidal ideation suicidality Suicide attempt Completed suicide.
Deliberate Self Harm During the study period, 8/754 (1.1% [95% CI 0.52.1]) 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
ED, North Shore Auckland, in one year...
Age-specific incidence per 100 000 for re-presenters. The error bars mark the 95% confidence intervals. () male, ( ) female, ( ) total.
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
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
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
Age standardized rates suicide by gender, NZ, 1948 1999 Suicide rate (per 100,000 population) 25 Males Females 20 15 10 5 0 1948 1952 1956 1960 1964 1968 1972 1976 1980 1984 1988 1992 1996
Age-specific rates of suicide, 15 to 24-year-olds, by sex, 1949 1998 Suicide rate (per 100,000 population) 45 40 Males Females 35 30 25 20 15 10 5 0 1949 1953 1957 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997
Age-specific rates of suicide, 15 24, 25 44, 45 64 and 65+ years, 1949 1998 Suicide rate (per 100,000 population) 30 25 20 15 10 1524 2544 4564 65+ 5 0 1949 1953 1957 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997
Scatter plot suicide rate and divorce rate, OECD. Divorce rate (per 100 marriages) 80 70 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 0 0 2 4 6 8 10 12 14 16 18 20 Suicide rate (per 100,000 population) 22 24 26 28 30
Occupation (NZ data)
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
Physical Conditions. WIMH data set 14 countries, 37 800 participants. CIDI 3.0 Suicidal ideation Suicidal plans. Suicide attempt. Asked if have chronic diseases: 7 named.
Occupation and method suicide
Psychosom Med. 2010 Sep;72(7):712-9.
Psychosom Med. 2010 Sep;72(7):712-
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.
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.
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. 2006 Oct;40(10):896-904 Howson MA, Yates KM, Hatcher S. Re-presentation and suicide rates in emergency department patients who self-harm. Emerg Med Australas. 2008 Aug;20(4):322-7. 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. 2010 Sep;72(7):712-9. Skegg K, Firth H, Gray A, Cox B. Suicide by occupation: does access to means increase the risk? Aust N Z J Psychiatry. 2010 May;44(5):429-34.