A Study of Deliberate Self-Harm and Its Repetition Among Patients Presenting to an Emergency Department
Abstract
Background: Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH). Aims: To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong. Methods: A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford. Results: The majority of patients in Hong Kong were female (male:female ratio of 1:2.4), young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck’s Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford. Conclusions: The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.
References
1974). Development of suicidal intent scales. In , The prediction of suicide (pp. 45–56). New York: Charles Press.
(2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563–570. doi: 10.1001/jama.294.5.563
(2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine, 33, 395–405.
(2006). 2006 population by-census. Retrieved from www.bycensus2006.gov.hk/en/data/data3/statistical_tables/index.htm#A2
. (2005). Research findings into suicide and its prevention – Final report 2005. Hong Kong SAR: The University of Hong Kong.
. (2009). Cherishing Life. Nourishing Hope. CSRP Newsletter, February, 11.
. (1996). Attempted suicide by Chinese elderly in Hong Kong. General Hospital Psychiatry, 18, 444–447.
(1989). Attempted suicide in Hong Kong. Acta Psychiatrica Scandinavica, 79, 425–430.
(2001). Randomized controlled trial of brief psychological intervention after deliberate self poisoning. British Medical Journal, 323(7305), 135–138.
(2005). Alcohol dependence, excessive drinking and deliberate self-harm: trends and patterns in Oxford, 1989–2002. Social Psychiatry and Psychiatric Epidemiology, 40, 964–971. doi: 10.1007/s00127-005-0981-3
(2009). Problem drug use, drug misuse and deliberate self-harm: trends and patient characteristics, with a focus on young people, Oxford, 1993–2006. Social Psychiatry and Psychiatric Epidemiology, 46(2), 85–93. doi: 10.1007/s00127-009-0170-x
(2009). Deliberate self-harm in Oxford 2007. Oxford: Centre for Suicide Research, University of Oxford.
(1997). Trends in deliberate self-harm in Oxford, 1985–1995. Implications for clinical services and the prevention of suicide. British Journal of Psychiatry, 171, 556–560.
(2003). Deliberate self-harm in Oxford, 1990–2000: A time of change in patient characteristics. Psychological Medicine, 33, 987–995.
(2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542.
(2006). Socio-economic and psychological correlates of suicidality among Hong Kong working-age adults: Results from a population-based survey. Psychological Medicine, 36, 1759–1767. doi: 10.1017/S0033291706009032
S. F. (1989). A comparison between male and female parasuicides in Hong Kong. Social Psychiatry and Psychiatric Epidemiology, 24, 253–257.
(2002). Risk factors for suicide in China: A national case-control psychological autopsy study. Lancet, 360, 1728–1736.
(1988). Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: A tale of two cities. Psychological Medicine, 18, 405–418.
(2000). Repetition of suicidal behavior. In , The international handbook of suicide and attempted suicide (pp. 385–404). Chichester: Wiley.
(2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine, 31, 979–988.
(1995). The management of non-compliance with referral to out-patient after-care among attempted suicide patients: A controlled intervention study. Psychological Medicine, 25, 963–970.
(2007). Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents. Suicide and Life-Threatening Behavior, 37, 453–466. doi: 10.1521/suli.2007.37.4.453
(2004). Suicide after discharge from psychiatric inpatient care: A case-control study in Hong Kong. Australian and New Zealand Journal of Psychiatry, 38(1–2), 65–72.
(2000). Urban/rural and gender differentials in suicide rates: East and west. Journal of Affective Disorders, 57(1–3), 99–106.
(2004). Suicidality among high school students in Hong Kong, SAR. Suicide and Life-Threatening Behavior, 34, 284–297. doi: 10.1521/suli.34.3.284.42772
(2008). Suicide in Asia – causes and prevention. Hong Kong: Hong Kong University Press.
(2004). Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11,583 patients. British Journal of Psychiatry, 185, 70–75.
(2010). Characteristics of young rural Chinese suicides: A psychological autopsy study. Psychological Medicine, 40, 581–589. doi: 10.1017/S0033291709990808
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